The relationship between personality, supportive transactions and support satisfaction, and mental health of patients with early rheumatoid arthritis. Results from the Dutch part of the Euridiss study:results from the Dutch part of the Euridiss study

The relationships between two personality characteristics (neuroticism, extraversion), three types of supportive transactions (emotional support, social companionship, instrumental support) and satisfaction with these transactions, and two aspects of mental health (feelings of anxiety and depressive mood) were studied among 280 patients with early rheumatoid arthritis. Structural equation modeling of the relevant variables showed that people with a more neurotic personality profile showed more anxiety and depressed feelings. Extraversion had no direct effect on depression or anxiety. Companionship, both transactions and satisfaction, had an independent positive effect on depression but not on anxiety. The effect of emotional support ran via social companionship: more emotional support (both transactions and satisfaction) was expressed in companionship leading to a less depressed mood. Finally, more depressed people received more instrumental supportive transactions while more satisfaction with this type of supportive transactions was related to less anxiety. Apart from the disturbing effect of a neurotic personality profile on mental health, the results once more underscore the importance of social companionship as a multifunctional activity for people's mental health. Maintaining this type of relationships despite a disabling condition gives people the opportunity to derive rewards that otherwise could not or only with more difficulty be achieved

Health systems research in Lao PDR: capacity development for getting research into policy and practice

<p>Abstract</p> <p>Background</p> <p>Lao PDR is a low-income country with an urgent need for evidence-informed policymaking in the healthcare sector. During the last decade a number of Health Systems Research (HSR) projects have been conducted in order to meet this need. However, although knowledge about research is increasing among policymakers, the use of research in policymaking is still limited.</p> <p>Methods</p> <p>This article investigates the relationship between research and policymaking from the perspective of those participating in HSR projects. The study is based on 28 interviews, two group discussions and the responses from 56 questionnaires.</p> <p>Results</p> <p>The interviewees and questionnaire respondents were aware of the barriers to getting research into policy and practice. But while some were optimistic, claiming that there had been a change of attitudes among policymakers in the last two years, others were more pessimistic and did not expect any real changes until years from now. The major barriers to feeding research results into policy and practice included an inability to influence the policy process and to get policymakers and practitioners interested in research results. Another barrier was the lack of continuous capacity development and high-quality research, both of which are related to funding and international support. Many of the interviewees and questionnaire respondents also pointed out that communication between those conducting research and policymakers must be improved.</p> <p>Conclusion</p> <p>The results show that in the case of Lao PDR, research capacity development is at a crucial stage for implementing research into policy and practice. If research is going to make a consistent impact on policymaking in the Lao health care sector, the attitude towards research will need to be changed in order to get research prioritised, both among those conducting research, and among policymakers and practitioners. Our findings indicate that there is awareness about the barriers in this process.</p

The utilisation of health research in policy-making: Concepts, examples and methods of assessment

The importance of health research utilisation in policy-making, and of understanding the mechanisms involved, is increasingly recognised. Recent reports calling for more resources to improve health in developing countries, and global pressures for accountability, draw greater attention to research-informed policy-making. Key utilisation issues have been described for at least twenty years, but the growing focus on health research systems creates additional dimensions. The utilisation of health research in policy-making should contribute to policies that may eventually lead to desired outcomes, including health gains. In this article, exploration of these issues is combined with a review of various forms of policy-making. When this is linked to analysis of different types of health research, it assists in building a comprehensive account of the diverse meanings of research utilisation. Previous studies report methods and conceptual frameworks that have been applied, if with varying degrees of success, to record utilisation in policy-making. These studies reveal various examples of research impact within a general picture of underutilisation. Factors potentially enhancing utilisation can be identified by exploration of: priority setting; activities of the health research system at the interface between research and policy-making; and the role of the recipients, or 'receptors', of health research. An interfaces and receptors model provides a framework for analysis. Recommendations about possible methods for assessing health research utilisation follow identification of the purposes of such assessments. Our conclusion is that research utilisation can be better understood, and enhanced, by developing assessment methods informed by conceptual analysis and review of previous studies

Non-functioning pituitary tumours - mortality, morbidity and tumour progression

Non-functioning pituitary tumours, i.e. non-functioning pituitary adenomas (NFPA) and craniopharyngiomas (CP), are histologically benign brain tumours. They are, however, associated with hypopituitarism, diabetes insipidus and other local symptoms caused by the tumour itself or its treatment. Previous studies have shown an excess mortality in patient populations with hypopituitarism, caused by various aetiologies. The mortality rates and factors predicting the mortality in NFPA and CP patients are largely unknown. Modern replacement therapy for patients with hypopituitarism includes treatment with growth hormone (GH) replacement therapy (GHRT). GH has known mitogenic effects, and is considered to possibly increase the risk of tumour progression in patients with a history of pituitary tumours. This thesis is based on four studies aimed to investigate whether GHRT influences the risk of tumour progression and to study mortality and morbidity in patients with NFPA or CP. In two case-control studies the frequency of tumour progression was investigated in patients with NFPA or CP treated with and without GHRT. The 10-year tumour progression free survival rate in NFPA patients with and without GHRT was 74% and 70%, respectively. The corresponding figures for CP patients were 88% and 57%. In a population-based registry-study of 2795 NFPA patients an excess mortality was demonstrated in women and in patients diagnosed at or before 40 years of age. In another population-based registry-study of 307 CP patients, mortality and morbidity were highly increased, especially in patients with a childhood-onset of the disease. The incidences of type 2 diabetes mellitus, cerebral infarction and severe infection were 5-fold elevated compared to the general population. In conclusion, GHRT does not affect the frequency of tumour progression in patients with NFPA or CP. Furthermore, there is an increased mortality in women and young patients with NFPA and an excess mortality in CP patients, especially in patients with childhoodonset of CP