Inholland University of Applied Sciences

Objective This randomised controlled trial evaluated the efficacy of the Tailored Injury Prevention in Adapted Sports (TIPAS) intervention on sports-related health problems in athletes participating in adaptive sports with physical impairments. Methods We randomly assigned 60 athletes participating in adaptive sports with physical impairments to an intervention group and 47 to a control group. The intervention group received direct, automated, predetermined preventive and management measures tailored to their weekly reported health problems, physical impairments and sports. The primary outcome was injury and illness prevalence over 40 weeks. Secondary outcomes were incidence, weekly cumulative severity score, weekly time loss, and total burden. A multinomial mixed methods analysis was performed to identify an intervention effect over time. Results The athletes (53 women, 54 men; age±45 years) reported 449 health problems (162 illnesses, 287 injuries) during the study period. The overall prevalence of health problems was 44% in the intervention group and 46% in the control group. Over time, no significant main intervention effect was found (illnesses OR: 1.02; 95% CI: 0.52 to 1.99; and injuries OR: 1.01; 95% CI: 0.55 to 1.86). However, a significant positive time×group interaction effect (p<0.001) indicated a reduction in injury prevalence in the intervention group over time, though not for illnesses. The rates versus severity analysis showed a significantly lower illness severity in the intervention group relative to the control group. Conclusion The TIPAS intervention provides a non-significant decrease in the overall prevalence of sport-related injuries and illnesses and may reduce the severity of sport-related illnesses throughout a Dutch sports season. This tailored online preventive strategy provides an accessible programme to consider in adapted sports suited to athletes’ physical impairments, sports participation and current health status. Trial registration number : ICTRP register: NL-OMON24078

Background Huntington's disease has a disruptive effect on entire families. While previous reviews have examined lived experiences of individuals with Huntington's Disease, their informal caregivers, or their offspring, none have provided a comprehensive overview that integrates these three perspectives. Design A scoping review. Aims Providing an integrated view and a holistic understanding of the multifaceted challenges faced by families affected by Huntington's disease. Methods We operationalised the lived experiences using the keywords: “barriers”, “facilitators” and “needs”. We extracted and thematically analysed data from 35 articles searched from 1993 to 2023. Results Twelve themes were identified, organised into three dimensions: (1) Having the Disease: encompassing the symptoms and progression of the disease; (2) Family Dynamics: reflecting the challenges of living in a household affected by Huntington's disease; and (3) Outside World: describing relationships and interactions with relatives, friends, health services and wider social structures. Conclusions The dimensions and related experiences of all three perspectives are intertwined. These experiences are mutually reinforcing, with fluid shifts in perspective occurring between family members. While the needs of family members overlap, they also diverge, highlighting the need for a systemic, family‐centred approach to address the evolving challenges faced by all family members. Patient or Public Contribution No Patient or Public Contribution.

Background Recently, a cluster-randomised controlled trial was conducted within Dutch ambulatory mental healthcare to assess the effectiveness of a one-year smoking cessation intervention consisting of group sessions, peer support and pharmacological treatment (KISMET). This article presents its process evaluation, exploring the perceptions of patients and mental healthcare professionals (MHPs) regarding the implementation of KISMET. Methods We conducted a mixed methods study, including 26 semi-structured interviews (10 MHPs and 16 patients) following the RE-AIM framework. Qualitative data was thematically analysed with MAXQDA software. We collected additional data on inclusion, drop-out and assessed treatment adherence during on-site observations. Results Recruitment and subsequent retention of patients in the RCT was found to be challenging (58% drop-out at one-year follow-up). MHPs suggested more motivational enhancement techniques to aid recruitment and reduce study attrition. The intervention components were generally assessed positively. Patients experienced the group and peer support sessions as supportive and beneficial. Inconsistent group attendance was demotivating and disrupted implementation. Pharmacological treatment was found to be helpful, although MHPs mentioned the treating psychiatrist or clinical nurse specialist need to facilitate better to ensure medication supply. The handbook offered MHPs excellent guidance and significantly contributed to treatment fidelity. Surprisingly, the carbon monoxide monitoring (originally included in the study protocol for research purposes) was appraised as a motivational tool. Finally, shortage of staff, limited collaboration and high turnover were barriers for the delivery of the intervention. Implementation heavily depends on the quality of the collaboration between MHPs and patients, as well as the infrastructure created by the organisation. Conclusion This study demonstrates the benefits, unique demands and challenges of a smoking cessation intervention for people with SMI. Results could guide and improve the implementation of smoking cessation interventions in mental healthcare settings. Fostering a culture of connectivity through team development, along with the provision of supportive and communicative supervision is critical for the effective recruitment and retention in smoking cessation studies in psychiatric care.

Based on theory and practice it takes the student through the key issues focusing on the hospitality industry, particularly the hotel sector. It analyses environmental, economic and social value in the industry, and what can be done to maximise the good for all the stakeholders in the long term.

Background There is a substantial body of literature addressing the prevention, acute management, and follow-up care of radiation induced dermatitis (RID). The quality and application of this evidence, however, is inconsistent and its interpretation varies widely. While several national guidelines have been developed to standardise practices locally, many of these resources are not publicly available. On behalf of the European Society for Radiotherapy and Oncology (ESTRO) Radiation Therapist (RTT) Committee, an international writing group consisting of 12 experts from radiotherapy and two patient representatives composed a recommendation document for the management of RID. Main body The consensus for these recommendations was generated based on available international guidelines, and supplemented with evidence-based review articles on the topic. These recommendations focus on the prevention and practical management of early stage RID by avoiding skin trauma and maintaining hygiene. Addressing pain and inflammation in higher grades is also covered. The current literature refutes some of the traditional recommendations, especially restricting washing as well as the use of deodorant or the potential dose build-up of lotions which has been included and rectified in recent guidelines. In addition, the importance of grading the severity, including a baseline assessment is presented. The benefit of clear, and non-contradictory communication within the multidisciplinary team as well as patient involvement (e.g. PROMs or similar) is highlighted. Furthermore, the importance of recognising different skin types and skin tones, and the impact on how RID changes these in their appearance is stressed. Conclusion This document provides practical, actionable recommendations for the clinical management of RID, referencing the supporting literature. These recommendations have, however, identified a lack of high-level evidence, especially for agent-specific recommendations.

Purpose Current evidence on the use of eHealth in geriatric rehabilitation is limited. This aim of this study was to achieve international consensus on three key eHealth-related topics in geriatric rehabilitation: the use, domains, and scientific evaluation of eHealth. Additionally, we developed a model that provides insight into the use of eHealth in geriatric rehabilitation. Methods An international, two-round Delphi study was conducted. Two models served as a framework for the initial statement draft, with a total of 28 statements based on our systematic review results, an international survey, and expert opinion. Eligible healthcare professionals working in geriatric rehabilitation facilities were recruited across 10 countries. Results Eighty healthcare professionals participated in round one and 47 in round two. In the first round, consensus was obtained for 20 of the 28 statements (71%). Prior to round two, four statements were revised, two statements were combined, and one statement was removed. In round two, consensus was obtained on six statements, bringing the total to 26: three related to the use of eHealth, five to the domains of eHealth, and 18 related to the scientific evaluation of eHealth. Conclusion International consensus has been reached on the use, domains, and scientific evaluation of eHealth in geriatric rehabilitation. This first step in generating reliable knowledge and understandable information will help promote a consistent approach to the development, implementation, and scientific evaluation of eHealth in geriatric rehabilitation.

Objective To examine determinants of the prevalence and frequency of criminal victimization (i.e. both personal and property crime victimization) in outpatients with severe mental illness. Methods Data was collected using a multisite epidemiological survey including a random sample of 956 adult outpatients with SMI. Data were collected between 2010 and 2012. Data on 12-month victimization prevalence and frequency were obtained using the victimization scale of the Dutch Crime and Victimization Survey. Demographic characteristics, clinical determinants, e.g., clinical diagnosis, psychosocial functioning, drug use and alcohol abuse over the past 12 months, co-morbid PTSD diagnosis, and victimological determinants e.g. physical abuse, physical neglect and sexual abuse in childhood, perpetration of violence over the past 12-months, and anger disposition were assessed as determinants. Univariable and multivariable hurdle regression analyses were conducted to test associations of the potential determinants with victimization prevalence and frequency. Results Twelve-month prevalence rates of personal and property crime were 19% and 28%, respectively. Clinical characteristics were more pronounced regarding personal crime victimization. In the multivariable model, presence of psychotic disorder, drug use, childhood physical and sexual abuse, and recent violent perpetration were associated with the 12-month prevalence or frequency rate of personal crime victimization. Native Dutch and divorced patients were more at risk as well. Next to this being employed, poor social functioning, having perpetrated a violent crime, as well as alcohol abuse and recent drug use were all significantly related to property crime prevalence or frequency rate in the multivariable model. In absolute terms, the effect sizes observed tended to be moderate to small. The multivariate models, however, explained the outcome variance moderately well (Nagelkerke’s pseudo R² = 25.0 - 27.9%. Conclusions Clinicians should be aware of the high risk of victimization among their patients with severe mental illness. Particular attention should be devoted to people with substance use histories and perpetrators of violence, since they are also at an increased risk of being victims as well.

Background The association between the sex of family caregivers and their perceived care burden has been examined thoroughly. The role of sex- and gender-related characteristics of these caregivers in this association remains unknown. We therefore explored the extent to which various gender-related characteristics of caregivers and the sex of people with dementia explain or affect the association between sex of caregivers and their perceived care burden. Methods Data were derived from a large-scale survey among Dutch family caregivers of people with dementia in 2022 (N = 3067). Both linear and logistic regression analyses were performed to assess mediation of gender-related caregiver characteristics in the association between the sex of the caregiver and the perceived care burden. These characteristics included: hours per week spent on caregiving, being the primary caregiver, relationship with the person with dementia and perceived difficulty in combining daily activities with caregiving. Linear regression analyses were used to assess moderation of the sex of the person with dementia in the association between the sex of the caregiver and the perceived care burden. Results Female caregivers perceived a greater care burden than male caregivers. This association was partly explained by female caregivers more often perceiving difficulty of combining daily activities with caregiving than male caregivers. Male caregivers perceived a slightly greater care burden when caring for a female than when caring for a male. The perceived care burden of female caregivers was not related to the sex of the person with dementia. Discussion This study highlights how gender-related aspects of family caregiving can contribute to sex differences in perceived care burden. The findings imply that it is important to take gender-related aspects of caregiving into account when developing or offering caregiver support, as support needs differ between male and female caregivers.

Introduction Therapeutic decision‐making often involves weighing several treatment options on the basis of, among other things, the disease profile, patient characteristics but also prescriber‐specific factors. This study investigated the factors influencing therapeutic decision‐making among prescribers and explores how these factors differ between healthcare professionals. Methods This Q‐methodology study involved 37 participants from different medical backgrounds, including physicians, dentists, midwives, physician assistants and advanced nurse practitioners from various intra‐ and extramural settings in the Netherlands. Participants ranked 55 factors on their importance for medication prescribing, and factor analysis was used to identify distinct prescriber profiles. These profiles were subsequently enriched using qualitative data derived from post‐sorting interviews. Results Four prescriber profiles were identified that explained 59% of the study variance: pragmatic contextual, guideline oriented, experience driven and vulnerability focused. Several factors were ranked differently in each profile. The pragmatic contextual profile emphasized patient context and risk prevention, the guideline‐oriented profile adhered to clinical guidelines, the experience‐driven profile relied on clinical experience and patient‐centred communication, and the vulnerability‐focused profile prioritized personalized care for specific patient groups. Conclusion This study sheds light on the diverse factors influencing prescriber decision‐making in medical practice. By identifying four prescriber profiles, it reveals the complexity and diversity in how prescribers balance guidelines, clinical experience and patient‐specific considerations in their practice. These findings offer direction for developing educational and policy initiatives to enhance the quality of prescribing, ultimately improving patient outcomes.

Purpose Recovery is a key objective in mental health services for people with severe mental illness (SMI). In addition to clinical and functional recovery, personal recovery has gained increasing attention. The CHIME Framework identifies five personal recovery processes—Connectedness, Hope, Identity, Meaning, Empowerment—and is the theoretical foundation for the Brief INSPIRE, a validated Patient-Rated Experience Measure (PREM) to evaluate recovery support. Brief INSPIRE was modified to a five-item Patient-Rated Outcome Measure (PROM) assessing recovery, called Brief INSPIRE-Outcome (Brief INSPIRE-O). Subject of this study are the psychometric properties of the Brief INSPIRE-O. Methods Data on validity and reliability gathered through annual routine outcome monitoring were collected for 861 individuals with SMI of Flexible Assertive Community Treatment teams and a follow-up measurement was available for 232 of these individuals. Test–retest reliability was evaluated in a separate subset of 30 individuals with SMI. Results The Brief INSPIRE-O shows good internal consistency (Cronbach’s alpha 0.77), test–retest reliability, construct validity, sensitivity to change and no floor or ceiling effects. Furthermore, change in Brief INSPIRE-O was positively related to changes in quality of life and negatively to problems in clinical functioning and unmet care need. Conclusion Brief INSPIRE-O can be used for research and monitoring to better understand and improve processes of personal recovery in individuals with SMI.

Creating truly equitable education is a challenge. Equity, diversity, and inclusion endeavours are often characterized by a depreciative deficit-thinking and a problem-based view on diversity. In this article, we present the MIXED model (Multi-perspective Inclusive eXchanges for Equity and Diversity), which can support lecturers in establishing an inclusive learning environment by building on different perspectives and talents in the (college) classroom. The model offers both inspiration and practical guidance as it describes a vision, strategies, and examples of learning activities for various classroom settings (online/offline, larger/smaller). We also describe the theoretical framework and the process of development and implementation. The MIXED model, developed at the Vrije Universiteit Amsterdam, unpacks three phases in classroom dynamics. Feedback from lecturers indicates utilizing the model can lead to a more equitable learning environment. This approach aims to educate future academics and professionals who are capable of building on the different perspectives in diverse settings when resolving complex societal problems.

We conducted a genome-wide association study on income among individuals of European descent (N = 668,288) to investigate the relationship between socio-economic status and health disparities. We identified 162 genomic loci associated with a common genetic factor underlying various income measures, all with small effect sizes (the Income Factor). Our polygenic index captures 1–5% of income variance, with only one fourth due to direct genetic effects. A phenome-wide association study using this index showed reduced risks for diseases including hypertension, obesity, type 2 diabetes, depression, asthma and back pain. The Income Factor had a substantial genetic correlation (0.92, s.e. = 0.006) with educational attainment. Accounting for the genetic overlap of educational attainment with income revealed that the remaining genetic signal was linked to better mental health but reduced physical health and increased risky behaviours such as drinking and smoking. These findings highlight the complex genetic influences on income and health.

Aim The aim of this study was to provide insights into how, through exploring goal‐setting interventions, a nursing team in geriatric rehabilitation might refine their patient‐centred strategies. Design The study design was participatory action research (PAR). Method Team members and nursing students, under the guidance of a facilitator, performed two PAR cycles. In the first cycle, the action phase consisted of preparing a multidisciplinary team meeting (MTM) with a patient. In the second cycle, based on the evaluation of the first, the participants worked with goals on a whiteboard in the patient's room. The data were collected in The Netherlands between February 2020 and June 2022. The data collection methods included the facilitator's logbook, observations, (group) interviews, charting activities and short surveys. Data analysis was conducted in weekly team sessions. The Guidelines for Best Practices in the Reporting of Participatory Action Research were followed. Results In the first PAR cycle, the team learned that preparing an MTM with a patient did not enhance the patient's engagement in achieving their rehabilitation goals, but it was beneficial for the nurses' intermediate role between the patient and the multidisciplinary team. Clarity about responsibilities in the multidisciplinary team was a prerequisite for nurses to take on this role adequately. In the second PAR cycle, it became clear that working with a whiteboard in the patient's room had a positive effect on the patient's engagement in the rehabilitation process, and the nurses gained knowledge about a broader variety of professional rehabilitation domains. Conclusion Through PAR, the nursing team learned two lessons: cooperating with patients through MTM preparation and working with whiteboards enhanced their patient‐centredness, but patients needed tangible goals to become engaged in their rehabilitation planning. Implications for the Profession and Patient Care Prepare the multidisciplinary team meeting with the patient, as discussing rehabilitation goals can indirectly boost motivation by making older patients feel seen and heard, even if they seem unable to fully participate in the conversation. Clarify responsibilities in the multidisciplinary geriatric rehabilitation team. This is a prerequisite for nurses to take on an advocacy role for patients in multidisciplinary team meetings. To enhance patient‐centred care, consider working with tangible goals on a whiteboard in the patient's room. Patient and Public Contribution No public and patient involvement.

In mental healthcare, therapists' empathy and mentalizing are associated with better opportunities to establish positive working relations with patients. The present study aimed to explore mental health nurses' level of empathy and mentalizing (compared with reference groups studying or working in different contexts), the association between mental health nurses' level of empathy and mentalizing and sociodemographic characteristics of these nurses, and the association between mental health nurses' level of empathy and mentalizing. A cross‐sectional design was used in adherence with the Strengthening the Reporting of Observational Studies in Epidemiology statement. The 28‐item Empathy Quotient was used to investigate empathy, and the 28‐item Mentalisation Scale was used to assess mentalizing. One hundred and seven mental health nurses working in different work‐intensity settings (intensive and intermittent‐intensive) participated in the study. Our analyses showed that mental health nurses had statistically significantly higher levels of empathy and mentalizing than the matched reference groups. They also showed that most mental health nurses' demographic characteristics were not statistically significantly associated with their level of empathy and mentalizing: not with age, years of work experience, or educational level. Only two aspects were statistically significantly associated: female gender (for higher levels of empathy and mentalizing) and practicing in an intermittent‐intensive work setting (for higher scores on the subscale ‘Motivation’ of the Mentalisation Scale). Furthermore, empathy and mentalizing of mental health nurses were strongly associated and also emerged as two partly overlapping concepts. We conclude that mental health educational institutions and supervisors could pay extra attention to the aspects of gender and work situation concerning mental health nurses' mentalizing and empathy in patient relations.

Background The quality of registry based studies depends largely on the data accuracy of the registries. The Dutch Perinatal Registry (Perined) is a nationwide database comprising perinatal data digitally provided by different healthcare providers. Perined data are used for comparing outcomes across regions and healthcare institutions as well as for quality analyses and research purposes. However, little is known about the data quality of the Perined database. Therefore, this research protocol depicts our proposed study assessing the quality of Perined data compared to hospital records and case report forms (CRFs) that were part of the IUGR Risk Selection (IRIS) study. Methods In the planned comparison study data from Perined and the IRIS Study will be used. The IRIS study was a large cluster-randomized trial investigating the effectiveness of routine third trimester ultrasonography in reducing severe adverse perinatal outcomes among Dutch low-risk pregnant women. A subsample of the IRIS study of neonates being at risk of severe adverse perinatal outcomes and their mothers will be used. Baseline demographic data were collected by midwives from participating women at inclusion (around 22 weeks’ gestation) using CRFs, and in-depth neonatal and maternal clinical data were retrieved from hospital records by trained research assistants. These latter IRIS study data were linked and compared to Perined data. Completeness of Perined data will be calculated for every variable. The reliability will be assessed as the percent of agreement between Perined and hospital record data or the CRF-based data. Additionally, intra-class correlation coefficients will be calculated for continuous variables, and Kappa and ‘Prevalence-and-Bias-Adjusted Kappa’ will be calculated for categorical variables. Discussion The results of the planned comparison study will provide users of Perined data insight in its data quality. This will serve as an example of the accuracy of registry based data used in maternal and neonatal care research.

Objectives Only studying effectiveness of lifestyle interventions for people with severe mental illness (SMI) is insufficient for policy making. As budgets for healthcare are limited, policy makers face the problem of allocating scarce healthcare resources. Cost-effectiveness studies are needed, but currently cost-effectiveness studies of lifestyle interventions for people with SMI delivered in ambulatory care are limited. The aim of this current study was to evaluate the cost-effectiveness of a lifestyle intervention for people with SMI living in the Dutch community in comparison with usual care. Methods and findings An economic evaluation was performed using a societal perspective alongside the Severe Mental Illness Lifestyle Evaluation (SMILE) pragmatic cluster randomized controlled trial. The SMILE lifestyle intervention is a one-year, group-based intervention delivered by trained mental healthcare workers. Costs, body weight change and quality of life were assessed at baseline, 6 and 12 months. Mixed models were used to estimate incremental costs and effects between the treatment group and the usual care group. Overall, the SMILE intervention resulted in lower total costs compared to the usual care group (-€719, 95% CI -7133; 3897). The effect difference between the intervention and usual care groups was -3.76 (95% CI -6.30; -1.23) kilograms for body weight and -0.037 (95% CI -0.083; 0.010) for QALYs. Conclusions Overall, the SMILE intervention resulted in lower total costs compared to the usual care group and was cost-effective for body weight change. However, the SMILE intervention does not seem cost-effective with regards to QALYs. More cost-effectiveness studies in other countries and other settings are needed to gain further insight into the cost-effectiveness of lifestyle interventions for people with SMI.

Background Retrieval practice is a highly effective learning strategy that enhances long-term retention by encouraging the active recall of information. However, the optimal question format for maximizing knowledge retention remains uncertain. In this study, we compared the effect of very short answer (VSAQ) versus multiple-choice question (MCQ) practice tests on students’ knowledge retention. By analyzing these two formats, we aim to identify the most effective approach to retrieval practice, thereby helping to optimize its implementation and improve learning outcomes. Methods In this randomized within-subjects study, students (n = 45) practiced with both VSAQs and MCQs in an extracurricular lifestyle course, without receiving feedback. The final retention test consisted of identical questions in both formats. A 2 × 2 repeated measures ANOVA was used to determine the effect of question format in practice testing and final test on final test score. Additionally, digital questionnaires were used to explore students’ test-taking experiences. Results The VSAQs were answered incorrectly more frequently on the practice tests and final test. There was no main effect of practice question format on final test performance, and no interaction effect between question format on the practice and final test. Regardless of question format, most students thought the practice tests were beneficial for learning. Conclusions We found no evidence indicating that either MCQ or VSAQ is more effective for knowledge retention during retrieval practice. The lower initial retrieval success in the VSAQs, indicated by the higher degree of incorrect answers on the practice tests, might have limited their effectiveness during retrieval practice. To optimize the use of VSAQs in retrieval practice, it seems important to improve initial retrieval success to maximize learning outcomes. Clinical trial number Not applicable.

Intensified slash-and-burn cultivation and forest clearing have caused severe land degradation in the Khasi Hills (Meghalaya plateau, NE India). Despite very high annual rainfall, the region faces severe water scarcity during the dry season. Local initiatives aim to restore forests through assisted natural regeneration (ANR) in this hydrologically poorly known area. As a first step towards assessing the potential hydrological impact of forest regrowth and ANR, we measured infiltrability at sites representing Imperata-dominated grassland (n = 2, degraded baseline); < 20-year-old fallows with ANR (n = 3); semi-mature to old-growth forests (n = 4, near-natural baseline); and a bench-terraced Cryptomeria plantation. Group-median infiltrability was highest in forests (425 mm h −1), followed by young fallows with ANR, and grasslands (145 and 68 mm h −1 , respectively), and the terraced plantation (50 mm h −1). Infiltrability increased with regrowth age at an average rate of 3.0 mm h −1 y −1. Dye infiltration experiments were used to identify dominant percolation pathways per main land-cover type. Infiltration in the least-disturbed forest was dominated by flow along roots, stones and other preferential pathways, while matrix flow dominated in the grassland; the ANR site showed intermediate behaviour (macropore flow with high matrix interaction). Comparing median infiltrabilities with (maximum) hourly rainfall intensities suggested infiltration-excess overland flow may occur occasionally in the grasslands. Despite improved infiltrability during regrowth (with or without ANR), the extreme monsoon rainfall and often shallow and stony soils pose serious limitations to rebuilding soil water storage capacity and favour frequent saturation-excess overland flow.