Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “NETHERLANDS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,441 records · Page 80Linked to original sources
PubMed2005

The disciplinary code for nurses and its contribution to the quality of nursing care in the Netherlands.

AIM: To obtain insight into the contribution of the disciplinary code for nurses to monitoring the quality of nursing care in the Netherlands. METHODS: Complaints dealt with in the period 1998-2001 were studied. Questionnaires were sent to 3200 nurses (71%), all 388 members of the disciplinary boards (89%) and 43 lawyers (65%). RESULTS: There was an increase in the number of nurses who were accused (20 in 1998, 12 in 1999, 54 in 2000, and 56 in 2001) and also in the annual percentages of sanctions imposed (0% in 1998, 8% in 1999, 13% in 2000 and 16% in 2001). The disciplinary code appears to be an important corrective instrument for serious professional misconduct.

Attitude of Health Personnel↗
PubMed2006

The prevalence and incidence of pressure ulcers in hospitalised patients in the Netherlands: a prospective inception cohort study.

BACKGROUND: Pressure ulcers frequently occur in hospitalised patients. The prevalence of pressure ulcers grade 2 or worse varies from 3% to 12% in hospitalised patients. Incidence figures are not frequently reported. While incidence and prevalence are both measures of disease frequency, they provide different perspectives on pressure ulcers. OBJECTIVES: To describe the incidence rate and prevalence of pressure ulcers in hospitalised patients. DESIGN: Prospective inception cohort study. SETTING: Two large hospitals, one general (530-beds) and one teaching (1042-beds), in The Netherlands. PARTICIPANTS: A non-selected, though not strictly random, sample of 1536 patients was eligible for inclusion in the study. One thousand four hundred and thirty one patients (93.2%) consented to participate. Eventually, 1229 patients (80%) had a complete follow-up. The sample consisted of patients admitted to the surgical, internal, neurological and geriatric wards for more than 5 days between January 1999 and June 2000. METHODS: Follow-up once a week until pressure ulcer occurrence, discharge or length of stay over 12 weeks. MAIN OUTCOME MEASURES: Occurrence of a pressure ulcer grade 2 or worse during admission to hospital, according to the classification of the European Pressure Ulcer Advisory Panel. RESULTS: One hundred and thirty four patients developed 172 pressure ulcers during follow-up. The overall weekly incidence rate was 0.06 per week (95% confidence interval 0.05-0.07 per week). Highest rates were observed for surgical patients and lowest for geriatric and neurologic patients (0.08 and 0.02, respectively). The week specific prevalence varied between 12.8% and 20.3%. CONCLUSIONS: Among patients hospitalised for more than 5 days overall one may expect 6% per week to develop pressure ulcers. It would appear that any preventive measures can only be effective if taken timely. Accordingly, preventive measures should be considered early, because pressure ulcers were observed already within the first week of admission.

Cohort Studies↗
PubMed2004

Determinants of persistence of major depressive episodes in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).

BACKGROUND: Data on determinants of persistence of major depressive episodes (MDE) are inconsistent due to methodological shortcomings of the studies involved. AIMS: To examine determinants of persistence of MDE in subjects from the general population (N=250) with new episodes of DSM-III-R major depression. METHOD: The Netherlands Mental Health Survey and Incidence Study is a prospective epidemiologic survey in the adult population (N=7076), using the Composite International Diagnostic Interview (CIDI). A broad range of potential determinants was assessed. RESULTS: Determinants of persistence were severity of the index episode, longer duration of previous episodes, (chronic) physical illness and lack of social support. A recurrent episode predicted shorter duration. LIMITATIONS: Follow-up was only 2 years and duration of episode was retrospectively assessed. CONCLUSIONS: Just as in clinical populations, illness-related factors seem to be the strongest predictors of persistence of MDE. A thorough assessment of each depressed patient on the predictors of persistence is advisable.

Adolescent↗
PubMed2006

Indications for antidepressant drug prescribing in general practice in the Netherlands.

BACKGROUND: The intensity of the use of antidepressants in large populations can nowadays relatively easily be estimated using databases encompassing prescription data. There are shortcomings when using prescription databases as they contain no clinical data on patient illness. Antidepressants are prescribed for different illnesses, thus information on the indications could help when interpreting results from database studies on antidepressant drug use. The aim of this study is to investigate for which indications antidepressants are being prescribed in general practice in the Netherlands. METHODS: Data were obtained from the Second Dutch National Survey of General Practice, carried out by NIVEL (N=385,461). Patients, 18 years and older, who received an antidepressant prescription from a general practitioner in 2001 were selected (N=13,835). Indications for antidepressant drug prescribing were identified using time windows of different lengths. RESULTS: Antidepressants are most often being prescribed for depression (45.5%) and anxiety/panic disorders (17.2%). For these indications lengthening the time window around prescription date from 0 to 180 days resulted in an increase of 20-40% in antidepressant drug users identified with these indications. LIMITATION: None of our selected indications could be identified in the physician-patient contact file for about a third of the antidepressant drug users. The study was performed in a general practice setting and did not include antidepressant users who consult psychiatrists. CONCLUSION: GPs prescribe antidepressants predominantly for treating depression. However, using antidepressant drug as a proxy for identifying depressed patients in a prescription database should be done with caution and when possible in combination with clinical data.

Adolescent↗
PubMedDate not supplied

Information exchange between general practitioner and nursing home physician in The Netherlands.

BACKGROUND: In response to the specific characteristics of nursing home residents, the Netherlands has become the only country to develop the specialty of nursing home medicine. The "nursing home physician" has attained independent status. This development has, however, created a division between medical care in the community and medical care in nursing homes, which challenges the quality of the transitional processes taking place when a patient is admitted to or discharged from nursing home care. OBJECTIVES: To give insight into the type of medical information exchanged between general practitioners (GPs) and nursing home physicians (NHPs) at the time of admission, while a patient is under care of the NHP, and at the time of discharge. METHODS: Questionnaires were sent to a sample of 780 GPs, who were selected using a 2-phase sample strategy. Three hypothetical patient vignettes, involving the admission of a patient to a nursing home, to day care, and to an outreaching nursing home care project, were constructed and presented in the questionnaire. GPs were asked to answer questions about the information exchanged during the care of a patient illustrated in each vignette only if they were really familiar with a patient such as presented. The advantage of hypothetical patient vignettes is that each physician reacts to a standardized situation. RESULTS: In the case of admitting a patient to or discharging a patient from the nursing home, results indicate that the continuity of care at those moments will be better ensured if GPs have more frequent personal contacts with NHPs. In the case of day care patients, the study also reveals that GPs who have frequent personal contact with NHPs will share relevant patient information significantly more often at the start of the day care program, both during day care and also when intercurrent medical problems occur. Similar findings can be expected in patients receiving outreaching nursing home care. CONCLUSIONS: The findings indicate the advantages of personal contacts between different medical professionals in exchanging specific patient information. It can be expected that this will lead to more tailor-made medical care for the patient. Adequate exchange of relevant information is an important aspect of mutual collaboration between professionals. Recommendations as to how to achieve more personal contact and a better collaboration among medical professionals are proposed.

Aged↗
PubMed2005

Survey of acyclovir-resistant herpes simplex virus in the Netherlands: prevalence and characterization.

BACKGROUND: Widespread and frequent use of acyclovir (ACV) for treatment, suppressive therapy and prophylaxis of herpes simplex virus (HSV) infections and its over the counter availability may be associated with emergence of HSV resistance. OBJECTIVES: To determine the prevalence of ACV-resistant HSV isolates in different patient groups between 1999 and 2002 in the Netherlands. STUDY DESIGN: A total of 542 isolates, 410 HSV-1 and 132 HSV-2, from 496 patients were screened for reduced susceptibility to ACV. A newly developed ELVIRA HSV screening assay was used that allowed a high throughput screening. The genotypic analysis of the HSV thymidine kinase gene was performed to identify resistance-associated mutations. RESULTS: Thirteen isolates, 8 HSV-1 and 5 HSV-2, from 10 patients (2%) were found resistant to ACV. A single ACV-resistant strain was identified among isolates from 368 immunocompetent patients (0.27%; 95% confidence interval [CI], 0.007%-1.5%), whereas in nine isolates from 128 immunocompromised patients resistant HSV was identified (7%; 95% CI, 3.26%-12.93%). The highest frequency of ACV-resistant HSV was associated with bone marrow transplantation: four patients out of 28 (14.3%) shed resistant virus. In addition, resistant virus was obtained from two HIV-positive patients, one patient with a hematological malignancy and two patients on immunosuppressive drugs. Further testing showed that none of the isolates was resistant to foscarnet. Several new mutations were identified in the thymidine kinase gene of these resistant isolates, and their effect on ACV-resistance is discussed. CONCLUSIONS: Our study shows that the prevalence of ACV resistance is low in immunocompetent patients (0.27%), whereas ACV-resistant HSV infections occur relatively frequently in immunocompromised patients (7%; P < 0.0001). This emphasizes the need for drug susceptibility monitoring of HSV infections in immunocompromised patients with persisting infections despite antiviral therapy.

Acyclovir↗
PubMed2006

Evaluating farm performance using agri-environmental indicators: recent experiences for nitrogen management in The Netherlands.

Intensive agriculture, characterized by high inputs, has serious implications on the environment. Monitoring and evaluation of projects aiming at designing, testing and applying more sustainable practices require instruments to asses agronomic as well as environmental performance. Guidelines for Good Agricultural Practice (GAP) or Good Farming Practice (GFP) define sustainable practices but give limited insight into their environmental performance. Agri-environmental indicators (AEIs) provide information on environmental as well as agronomic performance, which allows them to serve as analytical instruments in research and provide thresholds for legislation purposes. Effective AEIs are quantifiable and scientifically sound, relevant, acceptable to target groups, easy to interpret and cost-effective. This paper discusses application of four AEIs for nitrogen (N) management in three Dutch research projects: 'De Marke', 'Cows and Opportunities' and 'Farming with a future'. 'De Marke' applied Nitrogen Surplus and Groundwater Nitrate Concentration in the design and testing of environmentally sound dairy systems. 'Cows and Opportunities', testing and disseminating dairy systems designed at 'De Marke', mainly applied Nitrogen Surplus, while 'Farming with a future' used Nitrogen Surplus, Groundwater Nitrate Concentration and Residual Mineral Soil Nitrogen to support arable farmers in complying with Dutch legislation (MINAS). Nitrogen Surplus is quantifiable, appealing and easy to interpret, but lacks scientific soundness or a good relationship with groundwater quality. Nitrogen Use Efficiency is sensitive to changes in management, while Residual Mineral Soil Nitrogen is appealing and cheap, but has difficulties in scaling. Groundwater Nitrate Concentration lacks clear rules for sampling, is labor consuming, expensive and mainly used in combination with other indicators. AEIs enhanced improvements in N management by facilitating (i) definition of project goals, (ii) design of desired systems, (iii) evaluation of applied systems and (iv) improving effective communication. AEI applications in other countries show a similar pattern as found in The Netherlands. Limitations to AEI application relate to inconsistencies between different indicators, heterogeneity of soil characteristics and linkages of N, carbon and water management. AEIs should be applied in an integrated evaluation, at a scale that reflects the farm's spatial variability. Simple AEIs like Nitrogen Surplus should be supported by other indicators and/or model calculations. The paper concludes that AEIs proved their value in design, implementation and testing of farming systems, but they should be used with care, always keeping in mind that indicators are simplifications of complex and variable processes.

Agriculture↗
PubMed2006

Risk-maps informing land-use planning processes A survey on the Netherlands and the United Kingdom recent developments.

The definition of safety distances as required by Art 12 of the Seveso II Directive on dangerous substances (96/82/EC) is necessary to minimize the consequences of potential major accidents. As they affect the land-use destinations of involved areas, safety distances can be considered as risk tolerability criteria with a territorial reflection. Recent studies explored the suitability of using Geographical Information System technologies to support their elaboration and visual rendering. In particular, the elaboration of GIS "risk-maps" has been recognized as functional to two objectives: connecting spatial planners and safety experts during decision making processes and communicating risk to non-experts audiences. In order to elaborate on these findings and to verify their reflection on European practices, the article presents the result of a comparative study between the United Kingdom and the Netherlands recent developments. Their land-use planning practices for areas falling under Seveso II requirements are explored. The role of GIS risk-maps within decisional processes is analyzed and the reflection on the transparency and accessibility of risk-information is commented. Recommendations for further developments are given.

Accidents, Occupational↗
PubMed2004

Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of search and destroy and restrictive antibiotic use.

In the Netherlands, less than 1% of clinical isolates of Staphylococcus aureus are methicillin-resistant (MRSA). A national search and destroy policy prevents MRSA from becoming endemic. Some MRSA outbreaks cannot be related to patients at risk for MRSA carriage. This study was designed to measure the prevalence of MRSA among patients without risk factors for MRSA carriage at the time of admission to the hospital. In four Dutch hospitals, patients admitted to non-surgical departments in the period 1999-2000 were screened for MRSA nasal carriage. Nasal swabs were streaked on 5% sheep blood agar (BA), submerged in a selective broth, and incubated for two to three days at 35 degrees C. Colonies suspected of being S. aureus were identified with an agglutination test. Susceptibility testing was performed by an automated system and additional oxacillin disk diffusion. Methicillin resistance was confirmed by a DNA hybridization test and mecA PCR. MRSA strains were genotyped by pulsed-field gel electrophoresis (PFGE). Twenty-four percent (2332/9859) of the patients were S. aureus nasal carriers. Only three (0.03%) patients were MRSA carriers. These patients were not repatriated, nor known to be MRSA carriers before screening. Genotyping revealed that the strains were not clonally related and were not related to MRSA outbreaks in the hospital where the patients were admitted. We conclude that at routine admission to a Dutch hospital (excluding high-risk foreign admissions) the MRSA prevalence is low (0.03%), due to the Dutch search and destroy policy and restrictive antibiotic prescribing.

Carrier State↗
PubMed2004

Palliative care consultation in The Netherlands: a nationwide evaluation study.

Palliative care in The Netherlands is mainly provided by generalist professionals who are part of the regular health care system. In order to provide good quality palliative care, they need options for training and consultation. Therefore, Palliative Care Consultation (PCC) teams were established, which inform, support, and advise professional caregivers involved with patients in palliative care without taking over responsibility. This study is the first nationwide study on PCC teams. Investigated was the nature and effect of consultations by registration and evaluation of consultations given by 19 PCC teams during a one-year period. Sixty-one percent of the requesting caregivers were primary care professionals and the problems discussed covered the entire field of palliative care, although physical problems played a dominant role. Although the patient was often not seen by the consultant, the consultant appeared to be able to identify more problems than initially discussed by the requesting professional. The types of problems discussed were hardly related to patient characteristics but more related to the discipline of the professional caregiver. According to the requesting professionals, consultation was helpful and contributed to improving the quality of palliative care.

Adolescent↗
PubMed2005

A comparison between telephone and bedside consultations given by palliative care consultation teams in the Netherlands: results from a two-year nationwide registration.

Palliative Care Consultation (PCC) teams in The Netherlands give support to professional caregivers in palliative care. In contrast to many other countries, consultants only give advice. They do not give prescriptions. Most consultations are given by phone; in some, the consultant also visits the patient. For two years, the PCC teams registered all consultations prospectively on a standard registration form in a nationwide database. The aim of this study was to obtain more insight into the possible differences between telephone and bedsides consultations with regard to characteristics of consultants, requesting caregivers, and the patients, as well as the number and kind of problems discussed. The data demonstrate that bedside consultations show more variety in requesting caregivers and are conducted more often for patients. Bedside consultations also addressed a higher number of problems and a wider range of domains (e.g., psychological, spiritual, daily functioning, and support for informal caregivers). These results suggest that bedside consultations have a surplus value compared to telephone consultations. More rigorous study is needed to compare the relative merits of different methods of consultations in palliative care.

Adolescent↗
PubMed2006

Endovascular management of traumatic ruptures of the thoracic aorta: a retrospective multicenter analysis of 28 cases in The Netherlands.

BACKGROUND: Minimally invasive endovascular treatment of a traumatic rupture of the thoracic aorta is a new strategy in the care of multitrauma patients. We report the experience in The Netherlands with endovascular management of patients with acute traumatic ruptures of the thoracic aorta. METHODS: We reviewed 28 patients with a traumatic thoracic aortic rupture treated with a thoracic aortic endograft between June 2000 and April 2004. All patients underwent treatment at one of the four participating level 1 trauma centers. Data collected included age, sex, injury severity score, type of endovascular graft, endovascular operation time, length of stay, length of stay in the intensive care unit, and mortality. Follow-up data consisted of computed tomographic angiography and plain chest radiographs at regular intervals. RESULTS: All patients (mean age, 40.9 years; SD, 18.5 years) experienced severe traumatic injury, and the mean injury severity score was 37.1 (SD, 7.8). All endovascular procedures were technically successful, and the median operating time for the endovascular procedure was 58 minutes (interquartile range, 47-88 minutes). The overall hospital mortality was 14.3% (n = 4), and all deaths were unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during a median follow-up of 26.5 months (interquartile range, 10-34.6 months). Postoperative data showed no severe endovascular graft- or procedure-related morbidity, except for one patient with an asymptomatic collapse of the endovascular graft during regular follow-up. This was corrected by placing a second graft. CONCLUSIONS: This study shows that the results of immediate endovascular repair of a traumatic aortic rupture are at least equal to those of conventional open surgical repair. Especially in these multitrauma patients with traumatic ruptures of the thoracic aorta, endovascular therapy seems to be preferable to conventional open surgical repair.

Aorta, Thoracic↗
PubMed2005

Use of hormones in the menopausal transition period in the Netherlands between 1993 and 1997.

OBJECTIVES: To describe the patterns and to assess the indicators of hormone use during the menopausal transition period in a Dutch population. METHODS: Between 1993 and 1997, 17,357 women aged 49-70 years participated in the Prospect-EPIC (European Prospective Investigation into Cancer and Nutrition) cohort and filled out an extensive questionnaire, which included information about hormone use during menopausal transition and other medical and lifestyle characteristics. Patterns of hormone use were described and various characteristics were evaluated as indicators of current hormone use by logistic regression. RESULTS: Overall, 13% of women were current hormone users, which was highest in the 49-54 age group (19%). Hysterectomized women and older non-hysterectomized women mainly used unopposed estrogen therapy (ET), whereas younger non-hysterectomized women mainly used oral contraceptives or combined estrogen+progestogen therapy. Of all ever users, 61% used hormones for more than 1 year and 28% for more than 5 years. The most important indicators of hormone use for women without a surgical menopause were age, alcohol use, smoking, parity, ever use of oral contraceptives and family history of breast cancer. For women with a surgical menopause age, parity, ever use of oral contraceptives, diastolic blood pressure and the number of removed ovaries were the most relevant indicators. CONCLUSIONS: The frequency of hormone use during menopausal transition in the Netherlands is low compared to other western countries, but the duration of use is quite long. Hormone use seems to be largely determined by factors that are known to affect endogenous estrogen levels.

Aged↗
PubMed2006

A comparison of labour and birth experiences of women delivering in a birthing centre and at home in the Netherlands.

OBJECTIVE: to compare the labour and birth experiences of women who delivered at home without complications with the experiences of women who delivered in a birth centre without complications. DESIGN: a descriptive study using postal questionnaires at 1-6 months after birth of a consecutive sample of postpartum women. SETTING: women were recruited from one birth centre and three midwifery practices in an urban area of the Netherlands between September and December 2003. PARTICIPANTS: 193 women; 129 delivered at home and 64 delivered in the birth centre. FINDINGS: the home-birth group perceived less pain (mean score home birth 6.291, birth-centre birth 6.977), desired less pain-relieving medication (home birth 7.9%, birth-centre birth 21.9%), believed they knew their midwife better (home birth 36%, birth-centre birth 10% 'knew her well'), and rated their birth setting 'higher' than the birth-centre group (mean score home birth 4.70, birth-centre birth 4.01). Furthermore, the birth-centre group emphasised safety, having medical help available, and convenience, whereas the home-birth group placed more importance on the home being trustworthy and dependable, having their own place and belongings, and feeling comfortable and relaxed. KEY CONCLUSIONS: having an understanding of a woman's labour and delivery experience allows health-care providers to continue to improve the quality of maternity care. The environment can have a positive effect on a woman's birth experience; recommendations have been proposed that can be applied to all pregnant and labouring women. IMPLICATIONS FOR PRACTICE: identification and understanding of the factors in the environment that make the labour and birth experience more positive should be incorporated into the education and preparation for an upcoming birth.

Adult↗
PubMed2006

A retrospective study of the success, safety and effectiveness of external cephalic version without tocolysis in a specialised midwifery centre in the Netherlands.

BACKGROUND: to evaluate the effectiveness of external cephalic version (ECV) without tocolysis or epidural analgesia, the complications associated with the procedure and the association between the number of ECV attempts and cephalic presentation at birth and caesarean section. METHODS: retrospective cohort study of all (n=924) ECVs carried out between 1996 and 2000 in a specialised midwifery centre in the Netherlands. After bivariate analysis, those variables with a p value under 0.05 were considered statistically significant and were tested in a logistic regression model using backward stepwise selection. Analyses were carried out separately for first ECV attempts and second ECV attempts. FINDINGS: in total, 958 ECVs were analysed, 889 first attempts and 69 repeat attempts. Seventy per cent of all first ECVs were carried out before 37 weeks, but half of those were carried out between 36 and 37 weeks. The success rate for first ECV was 41% and for the second ECV 29%. Bivariate analysis showed that the success of the first ECV was positively influenced by parity, non-Dutch origin, higher birth weight, higher age and longer duration of pregnancy. After logistic regression, parity (odds ratio [OR] 2.8, 95% CI 2.1 to 3.7), non-Dutch origin (OR 1.8, 95% CI 1.2 to 2.8) and birth weight (OR 1.7, 95% CI 1.4 to 2.0) remained factors that independently influenced the success of ECV. The odds ratio for duration of pregnancy at first ECV was borderline significant: OR 1.2 (1.0 to 1.4). After an unsuccessful first ECV, only 13% of the women received a second ECV. The prevalence of cephalic presentation at birth increased with 3% after a second ECV. Three cases of complications were reported during or very shortly after the first ECV, and these did not result in serious complications. No complications were reported after a second ECV. CONCLUSION: ECV without tocolysis is a safe procedure for pregnant women and their babies. Repeat ECV increases the number of cephalic presentations at birth and should be considered after an unsuccessful ECV.

Adult↗
PubMed2005

The impact of an intervention in intercultural communication on doctor-patient interaction in The Netherlands.

OBJECTIVE: Findings of scarcely available studies indicate that there are substantial gaps in intercultural doctor-patient communication. In order to improve intercultural communication in medical practice in The Netherlands, an educational intervention was developed. The aim of the present study was to examine the effects of this intervention on doctor-patient communication. METHODS: Participants (general practitioners: n=38; patients: n=124) were assigned at random to an intervention or a control group. GPs in the intervention group received 2.5 days training on intercultural communication. Patients in the intervention group were exposed to a videotaped instruction in the waiting room, right before the consultation. Data were collected through videotapes of visits of ethnic minority patients to their GP and home interviews with the patients after their medical visit. Communication behaviour was assessed using the Roter interaction analysis system (RIAS). Interview length was assessed as well. RESULTS: The length of the medical encounter increased significantly after having received the intervention. Total number of GP utterances increased significantly too. When comparing relative frequencies on affective and instrumental verbal behaviour of both patients and doctors, no significant changes could be detected. CONCLUSION: It is concluded that there seems to be some change in doctor-patient interaction, but RIAS may not be suitable to detect subtle changes in the medical communication process. It is recommended to use other analysis methods to assess cultural differences in medical communication. PRACTICE IMPLICATIONS: Knowledge about possible antecedents of gaps in intercultural medical communication should be increased in order to be able to design effective interventions for intercultural doctor-patient communication.

Communication↗
PubMed2005

Does stimulating self-care increase self-care behaviour for minor illnesses of Dutch and Turkish inhabitants of a deprived area in The Netherlands?

OBJECTIVE: The aim of the present study was to examine whether self-care behaviour increases after a self-care stimulating intervention that proved to be successful in reducing care-seeking behaviour for minor illnesses of Turkish and Dutch inhabitants of a deprived area in the Netherlands, and to see whether there are cultural differences. METHOD: This longitudinal study was based on a "pre-test/post-test one group" design. Data were collected during three structured face-to-face interviews: before the intervention, and 6 months and 1 year after the intervention, in which GPs personally handed out booklets to their patients containing guidelines on the management of 12 minor illnesses. RESULTS: The number of self-reported self-care actions did not increase. In contrast to the Dutch, the Turkish participants reported a decrease in the number of self-care actions, their attitude towards self-care became more negative, and they perceived less control. CONCLUSION: Apparently, a reduction in formal health care utilisation is not engendered by an increase in self-care behaviour. In order to make sure that interventions like these will have the intended effect, more research is needed, particularly among non-western populations. PRACTICE IMPLICATIONS: In developing future healthcare-reducing interventions, one should be aware of possible unwanted side effects in non-western populations.

Cross-Cultural Comparison↗
PubMed2006

Worries are the mother of many diseases: general practitioners and refugees in the Netherlands on stress, being ill and prejudice.

OBJECTIVE: To confront the views of refugee patients and general practitioners in the Netherlands, focusing on medically unexplained physical symptoms (MUPS). METHODS: The study is based on in depth interviews with refugees from Afghanistan (n = 36) and Somalia (n = 30). Additionally, semi-structured interviews were conducted with 24 general practitioners. Text fragments concerning the relationship between mental worries and health or physical ailments were subject of a secondary analysis, the results of which are presented. RESULTS: Medically unexplained physical symptoms were a key issue for both refugees and GPs. The GPs saw MUPS as a significant part of the illness presentation by refugee patients. Refugees felt GPs were often prejudiced, too readily using their difficult background as an explanation for physical symptoms. A 'general narrative' circulating in the refugee communities undermines trust. The GPs applied different strategies in dealing with MUPS presented by their refugee patients. A 'human interest strategy' is distinguished from a 'technical strategy'. The results are discussed in the wider context of the literature on MUPS and patient satisfaction. CONCLUSION: No fundamental difference in paradigms was found between refugees and GPs as to the negative influence worries and bad experiences can have on health. For a fruitful cooperation to develop, based on trust, GPs need to invest in the relationship with individual refugees, and avoid actions based on prejudice. PRACTICE IMPLICATIONS: The importance of (a lack of) trust is underestimated in medical practice. Phenomena undermining trust are often out of sight for practitioners. Critical reflection is needed on the strategies practitioners employ to deal with MUPS.

Adaptation, Psychological↗