Security is something that people tend to care about. But is it also something that they should care about? To explore this question, this dissertation first develops a new conceptual framework of... Show moreSecurity is something that people tend to care about. But is it also something that they should care about? To explore this question, this dissertation first develops a new conceptual framework of security. Next, it analyses how security relates to some key values for liberal democratic societies. The first of these is well-being. It is argued that there are important ways in which security can contribute to somebody’s well-being – but there are also ways in which security may hamper a person’s flourishing. The second value is freedom. It is shown that in public decision-making freedom and security may come at each other’s cost – yet there are also ways in which the two can work to each other’s benefit. The third value is equality. It is demonstrated that in order for a society to meet the demands of equality it must provide its members with a particular set of securities – while at the same time the pursuit of equality puts another set of securities out of reach. Ultimately, this dissertation finds no reason for considering security to be good for its own sake, but it argues that security can be good for the sake of well-being, freedom, and equality. Show less
Debets, M.P.M.; Tummers, F.H.M.P.; Silkens, M.E.W.M.; Huizinga, C.R.H.; Lombarts, K.M.J.M.H.; Bogt, K.E.A. van der 2023
BackgroundWhile night shifts are crucial for patient care, they threaten doctors' well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate... Show moreBackgroundWhile night shifts are crucial for patient care, they threaten doctors' well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate the adverse effects of night shifts. This study aimed to obtain more precise insight into doctors' feelings surrounding night shift by: identifying profiles based on doctors' alertness, contentedness and calmness scores before and after night shifts (research question (RQ) 1); assessing how doctors' pre- and post-shift profiles change (RQ2); and determining associations of doctors' demographics and shift circumstances with alertness, contentedness and calmness change (RQ3).MethodsLatent Profile Analysis using doctors' pre- and post-shift self-rated alertness, contentedness and calmness scores was employed to identify pre- and post-shift profiles (RQ1). A cross-tabulation revealed pre- and post-shift profile changes (RQ2). Multiple regressions determined associations of demographics (i.e. age, sex, specialty) and night shift circumstances (i.e. hours worked pre-call, hours awake pre-call, shift duration, number of consecutive shifts, total hours of sleep) with alertness, contentedness and calmness change (RQ3).ResultsIn total, 211 doctors participated with a mean age of 39.8 & PLUSMN; 10 years; 47.4% was male. The participants included consultants (46.4%) and trainees (53.6%) of the specialties surgery (64.5%) and obstetrics/gynaecology (35.5%). Three pre-shift (Indifferent, Ready, Engaged) and four post-shift profiles (Lethargic, Tired but satisfied, Excited, Mindful) were found. Most doctors changed from Ready to Tired but satisfied, with alertness reducing most. Age, specialty, sleep, shift duration and the number of consecutive shifts associated with alertness, contentedness and calmness changes.ConclusionsThe results provided nuanced insight into doctors' feelings before and after night shifts. Future research may assess whether specific subgroups benefit from tailored interventions. Show less
Dijxhoorn, A.F.; Raijmakers, N.; Linden, Y. van der; Leget, C.; Brom, L. 2022
Objectives. Many aspects of palliative care, such as managing (complicated) symptoms, conductinggoals-of-care conversations, and repeated exposure to loss, can be stressful to clinicians.Previous... Show moreObjectives. Many aspects of palliative care, such as managing (complicated) symptoms, conductinggoals-of-care conversations, and repeated exposure to loss, can be stressful to clinicians.Previous research on the emotional impact of providing palliative care was mainlydone in specialist settings. However, the majority of palliative care is provided by clinicianswho are not specialized in palliative care, and can be supported by palliative care specialistsonly when needed. Therefore, this study aimed to gain insight into the emotional impactof providing palliative care on clinicians, both palliative care generalists and specialists.Methods. A qualitative interview study among 21 clinicians (11 doctors and 10 nurses) workingin hospitals, home care, or nursing homes in the Netherlands was conducted. BetweenFebruary and June 2019, 13 palliative care generalists and 8 specialists were interviewed.Interviews were thematically analyzed by two researchers.Results. All clinicians considered the emotional impact of providing palliative care to be substantialand experienced both positive and negative aspects of providing palliative care. Severalaspects of providing palliative care can support or undermine emotional stability. These socalledfacilitators and barriers, such as practicing self-care and complexity of palliative care,were found at three different levels: individual, team, and organization.Significance of results. Although clinicians experience providing palliative care as meaningfuland valuable, the emotional impact is considerable. Negative and positive aspects often coexist.Further insight into the dynamics and magnitude of the emotional impact of providingpalliative care is needed in order to create a healthy working environment and develop adequateinterventions. Show less
Objective: To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus ... Show moreObjective: To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus (T2DM). Method: A longitudinal prospective study was conducted with measurements at baseline and 20-week follow-up among 603 people with T2DM participating in a group-based walking intervention. Patient activation and risk factors were assessed using online questionnaires. Health outcomes were assessed in participants' general practices. Results: No association was found between risk factors for activation and change in patient activation. Patient activation significantly increased (t(602) = 2.53, p = 0.012) and was associated with an increase in emotional well-being (beta = 0.22), exercise behavior (beta = 0.17), general diet behavior (beta = 0.20), and a reduction in BMI (beta = -0.28), weight (beta = -0.29), and HbA1c (beta = -0.27). Conclusion: Favorable changes in patient activation, self-management, well-being, and health outcomes occurred during a walking intervention, despite highly prevalent risk factors for low activation and less engagement in self-management. Practice implications: Group-based walking interventions might empower people with T2DM to begin taking a larger role in their self-care and improve (mental) health outcomes. Vulnerable groups of patients (with multiple risk factors for low activation) can change and presumably need this kind of interventions to be able to change. Show less
Vitamin D is a hormone produced in the skin via a non-enzymatic process involving ultraviolet light.It is well known that the physiology of aging makes older people particularly susceptible to... Show moreVitamin D is a hormone produced in the skin via a non-enzymatic process involving ultraviolet light.It is well known that the physiology of aging makes older people particularly susceptible to vitamin D deficiency and that, if untreated, it can have serious health consequences. This thesis deliberates on the topics of vitamin D supplementation in older people in light of the current guidelines and on the possible additional effects of ultraviolet light beyond vitamin D synthesis on nursing home residents. We present a cross-sectional study in nursing home residents aged 70 years and over designed to evaluate the efficacy of vitamin D supplementation in achieving vitamin D sufficiency. We also discuss the different supplementation strategies for nursing home residents and community dwelling persons aged 70 years and over based on a survey administered to general practitioners and elderly care physicians in the Netherlands.In the second part we concentrate on additional effects of ultraviolet light beyond vitamin D synthesis. We describe our systematic review of literature on the effect of ultraviolet light, when applied to the skin or eyes, on mood, depression and well-being. We present also our randomized controlled trial on the effect of ultraviolet radiation compared with oral vitamin D supplementation on the well-being of nursing home residents with dementia. Further we use the data of the RCT to carry out a post-hoc analysis to compare the effect of vitamin D alone compared with ultraviolet radiation on the blood pressure of old people with dementia. Show less
Dalmaijer, E.; Leeuwen, M. van; Putte, E. van de 2021
The aim of this article is to show what a linguistic-stylistic approach can offer for the study of correlations between language use and well-being, in which quantitative and qualitative analysis... Show moreThe aim of this article is to show what a linguistic-stylistic approach can offer for the study of correlations between language use and well-being, in which quantitative and qualitative analysis go hand in hand. As a case study, we investigate whether there are differences in the language used by recovered and non-recovered adolescents who followed the online FitNet treatment for chronic fatique syndrome (CFS). More specifically, we analyzed whether there are differences between both groups in their use of five linguistic means that hide agency. Our results indicate that this is the case indeed: non-recovered patients used these linguistic means more often than recovered patients. In addition, both patient groups show a different development during the therapy: while non-recovered patients increased their use of these stylistic phenomena during the treatment, recovered patients decreased their use of these same phenomena. As such, our study shows that there is indeed a correlation between the use of certain formulations in the language used by patients with CFS and (a change in) their well-being. It is argued that the linguistic means that we investigated, could not have been analysed with a purely computational approach, and that a linguistic-stylistic approach is thus of added value for studying correlations between language use and recovery. Show less
The average person spends more than one-third of their life working. Considering that work plays a central role in our lives, many of us are concerned about choosing career paths that are... Show moreThe average person spends more than one-third of their life working. Considering that work plays a central role in our lives, many of us are concerned about choosing career paths that are sustainable. However, as much as we want to, we cannot craft sustainable careers by simply making the right career decisions. Our careers are continuously affected by less controllable aspects in our lives, such as societal changes and the organization we work for. To understand what makes careers sustainable, we need to investigate how the person together with other contextual stakeholders can influence sustainable careers. This dissertation consists of four empirical chapters that study the consequences of a number of contemporary career choices made by the individual, such as working from home and becoming self-employed, and the influence of supervisors and society on sustainable careers. Additionally, this thesis sheds light on the challenges that certain minority group members face in building a sustainable career. The findings demonstrate that contemporary work forms, such as working from home, have the potential to promote sustainable careers but only if supervisors support individuals’ decisions. Moreover, this dissertation shows that women and non-parents may face greater challenges in crafting a sustainable career. Show less
Patients treated for DTC represent a unique clinical population to investigate aspects of thyroid hormone metabolism, thyroid function and related clinical endpoints. Thyroidectomized patients... Show morePatients treated for DTC represent a unique clinical population to investigate aspects of thyroid hormone metabolism, thyroid function and related clinical endpoints. Thyroidectomized patients have no intrinsic T3 production and are completely dependent on peripheral deiodination of exogenous T4. Furthermore, during long-term follow-up thyroid hormone serum levels are frequently measured and the majority of patients have a normal life-span related to high cure rates. Mostly, no autoimmune origin of hypothyroidism is present to take account of, which may have effects on thyroid hormone metabolism itself. It is therefore favorable to investigate the influence of e.g. genetic factors and certain drugs on thyroid metabolism and other endpoints in an athyreotic population.In this thesis several aspects being encountered in the diagnostic process, therapeutic process and follow-up of a thyroid carcinoma are addressed: - Bone morphogenetic protein 7 (BMP7) and downstream proteins as a tool to differentiate between different thyroid pathologies - Thyroid function following hemithyroidectomy - Thyroid dysfunction following treatment with tyrosine kinase inhibitors - Clinical effects of genetic variation in deiodinases - Factors affecting quality of life in patients treated for DTC Show less
Purpose - The purpose of this paper is to evaluate the effects of the Dutch "Skills for Life" programme on students' health behaviours, bullying behaviour and suicidal ideation.Design/methodology... Show morePurpose - The purpose of this paper is to evaluate the effects of the Dutch "Skills for Life" programme on students' health behaviours, bullying behaviour and suicidal ideation.Design/methodology/approach - The effectiveness of the "Skills for Life" programme on health behaviour outcomes was evaluated at three points in time in using a cluster randomized controlled study design with a follow-up of 20 months. In total, 27 schools and 1,394 students were included.Findings - The programme was judged to be well implemented in just under half of cases. The outcome results for the experimental group (EG) compared with controls present a complex picture at the three different time points used for evaluation. There was a clearly positive effect on levels of alcohol consumption and a clearly negative effect on smoking across time. There was a mixed picture over time for suicide ideation and for bullying including sexual bullying (although the prevalence rates for bullying were low and thus results should be treated with caution). There were generally more positive impacts on students with lower educational levels including less suicidal ideation and less bullying.Research limitations/implications - Limitations were the dropping out of several schools during the study and the low level of fidelity of the curriculum. Social emotional learning (SEL) programs can be part of a health promoting school framework but should be more tailored to disadvantaged school populations.Originality/value - The findings indicate that students with a less optimal starting position, when it comes to health related behaviours, benefit most from a SEL programme. This indicates that schools with disadvantaged school populations could benefit most from a Health Promoting School approach. Show less
Pauwels, E.K.J.; Volterrani, D.; Mariani, G.; Kostkiewics, M. 2014
