Suchergebnisse

For inpatients who spend a longer time in the hospital, the built environment plays a significant role in their experience. While many hospital boards aim to create a patient-centered hospital, few have a specific idea about what this means in terms of spatial qualities. This creates a major challenge for those involved in designing hospital environments. Therefore, we aimed to identify which elements play a role in inpatients' spatial experience, and how these elements relate and interact. Patients were followed during transport and afterward interviewed. In this way, we gained insight into their spatial experience, static, and in motion. This experience turns out to be shaped by material, social, and time-related aspects. An analysis of the interactions between these aspects yields a nuanced understanding of how inpatients' experience of the hospital environment is shaped by the spatial and social organization, movement, and perspective. This understanding should allow informing hospital boards, architects, and staff to start designing hospital buildings in a more patient-centered way.

Cette publication offre un tour d'horizon des soins aux personnes souffrant de démence : un inventaire de l'offre de soins, un aperçu des problèmes, une sélection de quelques initiatives novatrices et enjeux pour l'avenir. Le premier chapitre dépeint le contexte général au sein duquel se déroulent les soins aux personnes atteintes de démence. Il décrit d'abord les évolutions démographiques en cours. Parmi ces dernières, le vieillissement de la population joue évidemment un rôle important, auquel viennent s'ajouter des phénomènes tels que la diminution de la taille des ménages ou le nombre croissant de personnes isolées. Il traite ensuite de sept tendances sociétales et scientifiques qui déterminent dans une large mesure la forme que prendront, à l'avenir, les soins aux personnes atteintes de démence. Le deuxième chapitre dresse un état des lieux de l'offre de soins disponible en termes de services, d'intervenants et de structures pour personnes souffrant de démence. L'offre de services ou de structures tant extra-muraux, trans-muraux qu'intra-muraux est riche et variée. Certains d'entre eux sont nés des besoins des personnes souffrant de démence et de ceux de leurs aidants proches et leur sont spécifiquement destinés. D'autres services s'adressent à un groupe cible plus vaste, mais s'avèrent dans la pratique d'un grand secours dans le cas de la démence. La programmation de ces soins doit suffisante. Le troisième chapitre complète le chapitre précédent, davantage axé sur l'aspect qualitatif, par des informations quantitatives. Les données chiffrées sur la programmation de l'offre de soins mettent en lumière les services réalisés en Belgique, mais aussi en Région flamande, en Région wallonne et dans la Région de Bruxelles-Capitale. Les soins aux personnes atteintes de démence constituent aussi une préoccupation pour nos décideurs politiques. Le quatrième chapitre décrit les compétences et les mesures politiques prises aux différents niveaux de pouvoir (fédéral et régional). Il présente également les principales études qui ont été menées en vue de préparer et de soutenir les politiques en matière de démence. Dans le cinquième chapitre du rapport, les auteurs se tournent vers l'avenir. Quels projets créatifs, quelles initiatives innovantes peuvent constituer des sources d'inspiration pour les soins de demain ? Une petite sélection de bonnes pratiques dans les soins aux personnes souffrant de démence y est présentée. Il s'agit de formes d'habitat et de soins à petite échelle, de groupes de rencontre pour personnes présentant un début de démence et d'initiatives novatrices dans les soins de santé mentale.

Background: Community facilitators (CFs), such as pharmacists, policemen, teachers and clergy, may be an important community resource for patients with depression in addition to (mental) health professionals. However, they are ill prepared for such a role and little is known about their attitudes toward depression, which may affect practice.Aim: To investigate CFs' attitudes toward depression and compare them to those of (mental) health professionals and nurses.Method: Attitudes were assessed in participants ( n = 2,670) of training programmes about depression in nine countries of the European Alliance Against Depression (EAAD). The EAAD questionnaire included attitudes toward depression and its treatment, perceived causes, preferred treatment options, and knowledge of depression symptoms.Results: CFs and nurses had a more negative attitude toward patients with depression and toward antidepressants, and more limited knowledge of depression symptoms than (mental) health professionals. CFs more frequently supported non-standard treatment for depression. Nurse assistants clearly differed from registered nurses with their attitudes being among the least favourable and their knowledge the most limited of all groups.Conclusions: CFs and nurses had less favourable attitudes and more limited knowledge regarding depression when compared to mental health professionals and doctors. This may negatively affect professional collaboration, challenge optimal treatment and stigmatize patients. CFs' and nurses' knowledge and attitudes may be similar to those of the general population and be related to a lack of training in mental health issues.

Background: Gatekeeper training for community facilitators, to identify and respond to those at risk of suicide, forms an important part of multi-level community-based suicide prevention programmes. Aims: This study examined the effects of gatekeeper training on attitudes, knowledge and confidence of police officers in dealing with persons at risk of suicide. Methods: A total of 828 police officers across three European regions participated in a 4-hour training programme which addressed the epidemiology of depression and suicidal behaviour, symptoms of depression, warning signs and risk factors associated with suicidal behaviour, motivating help-seeking behaviour, dealing with acute suicidal crisis and informing bereaved relatives. Participants completed internationally validated questionnaires assessing stigmatising attitudes, knowledge about depression and confidence in dealing with suicidal persons pre- and post-training. Results: There were significant differences among countries in terms of previous exposure to suicidal persons and extent of previous training. Post-training evaluation demonstrated significant improvements in stigmatising attitudes, knowledge and confidence in all three countries. Conclusion: The consistently positive effects of gatekeeper training of police officers across different regions support inclusion of this type of training as a fundamental part of multi-level community-based suicide prevention programmes and roll-out, nationally and internationally.

Background: Evidence-based best practices for incorporation into an optimal multilevel intervention for suicide prevention should be identifiable in the literature. Aims: To identify effective interventions for the prevention of suicidal behavior. Methods: Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases. Steps include risk-of-bias assessment, data extraction, summarization of best practices, and identification of synergistic potentials of such practices in multilevel approaches. Results: Six relevant systematic reviews were found. Best practices identified as effective were as follows: training general practitioners (GPs) to recognize and treat depression and suicidality, improving accessibility of care for at-risk people, and restricting access to means of suicide. Although no outcomes were reported for multilevel interventions or for synergistic effects of multiple interventions applied together, indirect support was found for possible synergies in particular combinations of interventions within multilevel strategies. Conclusions: A number of evidence-based best practices for the prevention of suicide and suicide attempts were identified. Research is needed on the nature and extent of potential synergistic effects of various preventive activities within multilevel interventions.

The 'European Alliance Against Depression' community-based intervention approach simultaneously targets depression and suicidal behaviour by a multifaceted community based intervention and has been implemented in more than 115 regions worldwide. The two main aims of the European Union funded project "Optimizing Suicide Prevention Programmes and Their Implementation in Europe" were to optimise this approach and to evaluate its implementation and impact. This paper reports on the primary outcome of the intervention (the number of completed and attempted suicides combined as 'suicidal acts') and on results concerning process evaluation analysis. Interventions were implemented in four European cities in Germany, Hungary, Portugal and Ireland, with matched control sites. The intervention comprised activities with predefined minimal intensity at four levels: training of primary care providers, a public awareness campaign, training of community facilitators, support for patients and their relatives. Changes in frequency of suicidal acts with respect to a one-year baseline in the four intervention regions were compared to those in the four control regions (chi-square tests). The decrease in suicidal acts compared to baseline in the intervention regions (-58 cases, -3.26%) did not differ significantly (χ2 = 0.13; p = 0.72) from the decrease in the control regions (-18 cases, -1.40%). However, intervention effects differed between countries (χ2 = 8.59; p = 0.04), with significant effects on suicidal acts in Portugal (χ2 = 4.82; p = 0.03). The interviews and observations explored local circumstances in each site throughout the study. Hypothesised mechanisms of action for successful implementation were observed and drivers for 'added-value' were identified: local partnership working and 'in-kind' contributions; an approach which valued existing partnership strengths; and synergies operating across intervention levels. It can be assumed that significant events during the implementation phase had a certain impact on the observed outcomes. However, this impact was, of course, not proven. ; publishersversion ; published

Background: Depression incurs significant morbidity and confers increased risk of suicide. Many individuals experiencing depression remain untreated due to systemic and personal barriers to care. Guided Internet-based psychotherapeutic programs represent a promising means of overcoming such barriers and increasing the capacity for self-management of depression. However, existing programs tend to be available only in English and can be expensive to access. Furthermore, despite evidence of the effectiveness of a number of Internet-based programs, there is limited evidence regarding both the acceptability of such programs and feasibility of their use, for users and health care professionals. Objective: This paper will present the protocol for the development, implementation, and evaluation of the iFightDepression tool, an Internet-based self-management tool. This is a cost-free, multilingual, guided, self-management program for mild to moderate depression cases. Methods: The Preventing Depression and Improving Awareness through Networking in the European Union consortium undertook a comprehensive systematic review of the available evidence regarding computerized cognitive behavior therapy in addition to a consensus process involving mental health experts and service users to inform the development of the iFightDepression tool. The tool was implemented and evaluated for acceptability and feasibility of its use in a pilot phase in 5 European regions, with recruitment of users occurring through general practitioners and health care professionals who participated in a standardized training program. Results: Targeting mild to moderate depression, the iFightDepression tool is based on cognitive behavioral therapy and addresses behavioral activation (monitoring and planning daily activities), cognitive restructuring (identifying and challenging unhelpful thoughts), sleep regulation, mood monitoring, and healthy lifestyle habits. There is also a tailored version of the tool for young people, incorporating less formal language and additional age-appropriate modules on relationships and social anxiety. The tool is accompanied by a 3-hour training intervention for health care professionals. Conclusions: It is intended that the iFightDepression tool and associated training for health care professionals will represent a valuable resource for the management of depression that will complement existing resources for health care professionals. It is also intended that the iFightDepression tool and training will represent an additional resource within a multifaceted approach to improving the care of depression and preventing suicidal behavior in Europe. ; publishersversion ; published