Interpretatie en behandeling van psychosociale klachten in de huisartspraktijk : een onderzoek naar verschillen tussen huisartsen

The factors that influence the interpretation and treatment of psycho-soei al complaints by general practitioners are discussed in this dissertation. The assessment of complaints differs considerably from one GP to another, in the sense that the one GP will attach significanee to psychological and sociological factors in very many more cases than another GP. The frequency with which GPs prescribe psychopharmaca, refer patients to the mental health care authorities, or even enter into therapeutic discussions appears to vary from one doctor to another. For this reason the following broadly based question is put in the first chapter: In what way is the interpretation and treatment of complaints related to - the norms, views and methods of the GP the expectation of the GP and the patient in respect of one another - the communication between GP and patient during the consultation.In dit proefschrift wordt de vraag aan de orde gesteld welke factoren van invloed zijn op de interpretatie en behandeling van psychosociale klachten door huisartsen

Symptoms in long-term breast cancer survivors:A cross-sectional study in primary care

Purpose: Various long-term symptoms can manifest after breast cancer treatment, but we wanted to clarify whether these are more frequent among long-term breast cancer survivors than matched controls and if they are associated with certain diagnoses. Methods: This was a cross-sectional, population-based study of 350 breast cancer survivors treated with chemo- and/or radiotherapy >= 5 years (median 10) after diagnosis and 350 women without cancer matched by age and primary care physician. All women completed a questionnaire enquiring about symptoms, underwent echocardiography to assess the left ventricle ejection fraction, and completed the Hospital Anxiety and Depression Scale. Cardiovascular diseases were diagnosed from primary care records. In a multivariable logistic regression analysis, symptoms were adjusted for the long-term effects and compared between cohorts and within the survivor group. Results: Concentration difficulties, forgetfulness, dizziness, and nocturia were more frequent among breast cancer survivors compared with controls, but differences could not be explained by cardiac dysfunction, cardiovascular diseases, depression, or anxiety. Intermittent claudication and appetite loss were more frequent among breast cancer survivors than controls and associated with cardiac dysfunction, depression, and anxiety. Breast cancer survivors treated with chemotherapy with/without radiotherapy were at significantly higher odds of forgetfulness and nocturia, but significantly lower odds of dizziness, compared with breast cancer survivors treated with radiotherapy alone. Conclusions: Intermittent claudication and appetite loss are common among breast cancer survivors and are associated with cardiac dysfunction and mood disorders. Other symptoms varied by whether the patient underwent chemotherapy with/without radiotherapy (forgetfulness and nocturia) radiotherapy alone (dizziness). (C) 2020 The Author(s). Published by Elsevier Ltd

Formação continuada para físicos educadores : potencializando a integração das TDIC no processo de ensinoaprendizagem de física

Este trabalho aproxima duas demandas relacionadas ao processo de ensino-aprendizagem de Física: às mudanças sociais provocadas pelas Tecnologias Digitais de Informação e Comunicação (TDIC) e a falta de profissionais habilitados para o ensino desta disciplina. Seu objetivo principal foi investigar a integração das TDIC nas práticas dos educadores participantes de um curso de formação continuada. A investigação configura uma abordagem qualitativa desenvolvida a partir da análise das atividades planejadas e desenvolvidas pelos educadores em suas práticas e dos questionários aplicados antes e depois da participação no curso em questão. Entre os resultados destacamos que as TDIC utilizadas contribuíram para que os educadores saíssem do isolamento, potencializando as interações com outros professores e contribuindo com o compartilhamento de conhecimentos e práticas

Functionele klachten: de kleren van de keizer?

De aandacht voor functionele klachten en de oplossingen die daarvoor in he

Geestelijke gezondheidszorg in de huisartspraktijk: psychiatriseren of normaliseren?

In 2004 Ormel, Bartel and Nolen (2004) formulated the ‘depression paradox’: although evidence based interventions for depression have been developed the past 20 years, the prevalence of depression is not decreasing, it is even increasing for certain subgroups. Different explanations for this paradoxical development have been put forward. Patients do not look for help. However, part of them do not experience a need for help. Patients who get help are not treated adequately. However, the more severe the disorder, the larger the odds to get adequate help. Moreover, those not treated according to guidelines have comparable remission rates as those treated adequately. Patients who receive adequate treatment are not compliant. However, patients are offered treatment that is not their first choice. To explain the depression paradox, we propose a new conceptualizing in primary mental health care. A clearer distinction is needed between the larger category of psychological problems, expressions of distress etc., that deserves professional attention and guidance and the smaller category of psychiatric disorder, linked to pathophysiological disturbance and in need for evidence based medicine. DSM-IV criteria are not sufficient to make this distinction. My research program for the following five years will be aimed at a further clarification of this distinction. Main lines of research are the need for psychological help as the patient perceives it, psychological treatments that avoid treatment within a ‘psychiatric’ paradigm, unless needed and cooperation between family medicine and specialized mental health care to realize a proper task division between general psychological care and psychiatric care. (aut.ref.

Somatic disease and psychological disorder.

The association between physical and psychological disorders has been demonstrated repeatedly. There are a number of explanations for this association, each of them pointing to specific diseases and operationalizions of mental distress. In this article, the relationship between various somatic diseases and a number of indices for psychological distress was investigated. Within one study population, patients with different somatic diseases were identified, and their experience with mental distress, their requests for help from their GP during consultations, and their GPs' diagnoses were registered and compared with the total study populations. It appears that relationships could be demonstrated between experience of distress and presentations of psychological symptoms during consultations, on the one hand, and common physical disorders, on the other. Patients with neurological diseases (Parkinson's, epilepsy, multiple sclerosis) and gastric ulcers showed the same relationships, but were also more frequently diagnosed by the GP as having psychological disorders. Patients with a number of other serious somatic diseases, such as diabetes, cancer, and arthritis, did not distinguish themselves in a positive way on one of indices for psychological distress