(b) often leaves seat in classroom or in other situation in which remaining that no longer meet full criteria, “In partial remission” should be specified (APA dayline.infoen dayline.info), a population-based survey conducted by the. School of Management, Radboud University Nijmegen, HP Nijmegen, The Netherlands. 2 sharing scheme by the quantitative survey, and then analyzes the reasons .. dockless bike sharing system in the city (see Table 2). . work properly', 35% blame the 'unsuitable seat', 35% reflect that 'the. Sixty per cent of children with ADHD met full DSM-IV criteria for ODD. The rate of . Nijmegen Child Rearing Situation Questionnaire. ODD. Oppositional Defiant.
Prevalence of subjective dry mouth and burning mouth in hospitalized elderly patients and outpatients in relation to saliva, medication, and systematic diseases.
Feeling of dry mouth in relation to whole and minor gland saliva secretion rate. Salivary flow patterns and the health of hard and soft oral tissues.
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Relationships between medication intake, complaints of dry mouth, salivary flow rate and composition, and the rate of tooth demineralization in situ. Impact of dry mouth and hyposalivation on oral health-related quality of life of elderly Japanese.
Self-reported and clinically determined oral health status predictors for quality of life in dentate older migrant adults. Community Dent Oral Epidemiol. Aging and salivary cytokine concentrations as predictors of whole saliva flow rates among women. Minor gland and whole saliva in postmenopausal women using a low potency oestrogen oestriol Arch Oral Biol. Unstimulated salivary flow rate, pH, and buffer capacity of saliva in healthy volunteers.
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Aging and secretory reserve capacity of major salivary glands. Longitudinal influence of age, menopause, hormone replacement therapy, and other medications on parotid flow rates in healthy women. Xerostomic complaints induced by an anti-sialogogue in healthy young vs.
Minor salivary gland secretion rates and immunoglobulin A in adults and the elderly. Eur J Oral Sci. Anticholinergic medications in community-dwelling older veterans: Am J Geriatr Pharmacother. Major salivary gland output differs between users and non-users of specific medication categories.
Diagnosing, managing, and preventing salivary gland disorders. In the past, comprehensive primary care studies have been performed, for example by Barbara Starfield[ 7 ] and the Commonwealth Fund,[ 8 ] but only a limited number of European countries were included.
Furthermore, many studies that have used questionnaires from GPs and patients had a focus on specific subjects or themes rather than a multidimensional approach. This study aims to unravel the processes and contributions of primary health care to its outcomes in terms of quality, costs and equity.
The questions in the questionnaire should not only cover all themes but also be suitable for use in international surveys, which means that differences in the health care context between countries need to be taken into account. Methods Four questionnaires were developed: Because the project aims to provide insight into GP care as a whole, the GP questionnaire should also include questions beyond the scope of the tasks of the GP.
The questionnaire about what patients find important is added to weigh against their experiences. Development of the questionnaires consisted of four phases: An overview of the development process is presented in Figure 1.
The search aimed to identify validated questionnaires for primary health care physicians and patients, suitable for international comparisons. Search terms were derived from the 10 dimensions formeasuring primary health care Table 1.
In addition, attention was paid to identifying questionnaires on avoidable hospitalisation, which is not explicitly covered in the dimensions, and on equity, which has received relatively little attention in international comparative primary health care research. Questions were rephrased to fit the study approach and aim. Furthermore, new questions were formulated for gaps that were identified. The identified questions were divided between the provisional list of questions for the GP questionnaire and the Patient Experiences and Patient Values questionnaires.
Each of the questions was discussed for its relevance to the purpose of this study and the exclusion criteria in order to further increase the suitability of the questions for the surveys. In three rounds, the researchers submitted the questions to these criteria, until consensus was found.
At this stage, questions were reformulated where necessary to increase comprehensibility. Pilot survey As a final step, a pilot survey was held with GPs and patients in Belgium, the Netherlands and Slovenia, aiming to test the practicality and applicability of the survey and the comprehensibility and appropriateness of the questions.
In each country, a convenience sample of GPs around 10 was invited to participate. GPs were asked to fill in the questionnaire, which contained an extra column to add comments and questions to the questionnaire.
Furthermore, project researchers visited the general practices to recruit a random sample of patients. In each practice, four consecutive patients who agreed to fill in the questionnaire were included. This resulted in a total of completed questionnaires from patients 40 in Belgium and Slovenia and 32 in the Netherlands.
During the visits, researchers filled in a checklist, took notes of the proceedings and asked the patients to directly mention problems or questions which they did not understand. Based on the findings of the pilot a final consensus round was held in which the questionnaires were further shortened and questions which were found too difficult were rephrased.
During the pilot and the subsequent final consensus round, special attention was paid to the intelligibility of questions, because the changed wording of several questions could have affected their validity. Explicit cognitive testing, however, has not been part of the pilot study. For two reasons it was decided not to assess the psychometric properties of the draft questionnaires. First, questions dealing with factual circumstances or facilities are less suitable for such testing.
Besides, questions copied from validated questionnaires have been tested already. For instance, the questions on services that GPs offer to their patients that are derived from the European GP Task Profile study have been tested for internal consistency and scale reliability. Next, the final outcomes, namely the questionnaires, are presented. After careful screening, 13 relevant primary health care physician questionnaires were identified, an overview of which is presented in Box 2.
For the patient questionnaire, potentially relevant sources were found, which eventually resulted in 64 relevant questionnaires see Box 3. The result of this classification is presented in Table 2. As some questions were classified in more than one dimension, the total number in the figure is higher than the number of questions that emerged from the search.
For each of the dimensions, the researchers selected questions potentially relevant to this study. An example of a question which was not included in the first selection phase is about the health plans of the patients. This question is country specific and not suitable for comparison between countries.
After this first phase, questions for GPs and for patients remained. For instance, as more and more GPs work part-time, the question about the number of GP colleagues working in the same practice was further specified to include the number of full-time equivalents FTEs in addition to the absolute number.
The number of remaining questions after each round is indicated in Figure 1.
Coworking in Nijmegen
Figure 1 Phases in the development of the questionnaires. Pilot The pilots showed that the questionnaires were reasonably well understood and easily administered, suggesting acceptable clarity and applicability. However, both the GP and Patient Experiences questionnaires were too long, as the average time needed for completion exceeded the set limits of 30 minutes for GPs and 20 minutes for patients. Furthermore, in the GP questionnaire mistakes were identified e.
The pilot resulted in a further reduction of the questionnaire, reformulation of several questions and the development of a short practice questionnaire about general characteristics of the practice e. GP questionnaire The final GP questionnaire see Appendix A — available online contains 60 questions 25 of which have two or more subquestions. The majority of the questions have prestructured multiple choice answers.
In 13 questions, GPs are also asked to fill in numerical answers e. Appendix A available online also provides an overview of the thematic content of each of the questions and the sources used for the questions. Three questions focus on the background of the GP and four on the characteristics of the practice e.
Special attention is paid to medical record keeping. These topics were involvement of GPs in disease management programmes, equity in access and patient involvement in the decision-making process.
Patient Experiences questionnaire The Patient Experiences questionnaire, dealing with the experiences of patients with their GP see Appendix B — available onlinecontains 41 multiple choice questions 10 of which have two or more subquestions. Many questions ask to what extent the patient agrees with a statement.
These questions also include the time the GP has available for the patient, the availability of home visits and waiting times. To mirror the questions in the GP questionnaire about autonomy, patients are asked about their involvement in decision making and referrals. Finally, two questions specifically related to avoidable hospitalisation were included. As few questions were found on patient autonomy, new questions had to be developed on this theme.
Patient Values questionnaire Next, a Patient Values questionnaire was developed. Measuring what patients consider important enables the weighting of their experiences. Again, most questions are statements with multiple choice answers. A few questions ask the patient to choose from a list what they consider most important and fill in a number.
Three questions contain statements asking patients about the importance of certain aspects of care e. Finally, four questions focus on communication between GPs and patients. Most questions were based on the European Practice Assessment indicators.
The development of questionnaires for a multicountry study on broad themes such as quality, costs and equity in primary care requires a balance between methodological requirements and practical feasibility.
Meeting locations in Nijmegen
Indeed, all dimensions deserved to be thoroughly investigated, although theymay be difficult tomeasure reliably, but it must be accepted that only a limited set of questions can be asked. Nonetheless, the QUALICOPC consortium has been able to produce the four questionnaires—as far as possible—based on existing, validated questionnaires and tested through a pilot survey in three countries.
A limitation of the pilot survey is that it was carried out in only three countries. However, much attention has been paid to having valid translations in each language.
In each country, an official back-and-forth translation procedure is used for the questionnaires, in which translators are asked to take comprehensibility into account. This may have resulted in a loss of validity and needs to be taken into account in the analysis phase. Indeed, Rinck et al. Similarly, Vrijsen et al. This way, automatic behaviors, just like strategic safety behaviors, might deteriorate the quality of a social interaction and elicit a truly more negative evaluation by others, which in turn maintains social anxiety.
It is based on the idea that human beings have a tendency to automatically approach pleasant stimuli while avoiding unpleasant or threatening ones Chen and Bargh ; Solarz Thus, inevitable automatic evaluation of a stimulus is thought to influence subsequent behavior, even when stimulus valence is not task-relevant Lange et al.
In a common version of the AAT, participants are placed in front of a computer screen and a joystick, and are asked to categorize pictures according to irrelevant attributes such as background color or format, either by pulling the joystick towards themselves approach or by pushing the joystick away avoidance.
When the joystick is pulled, the displays increase in size, as if approached, and decrease in size when being pushed. The AAT has shown to be a useful tool to investigate implicit avoidance behavior in different anxious populations Rinck and Becker and first evidence is available for implicit avoidance tendencies of social stimuli in SAs.
In line with this finding, Lange et al. In addition, happy crowds were avoided as well. Moreover, Roelofs et al. Here, participants did not pull or push a joystick, but responded with comparable arm-flexion to press an upper button or arm-extensions to press a lower button placed on a vertical column. Participants were not asked to respond to e. However, two studies indicate that implicit avoidance tendencies of SAs in a neutral context increase during actual social stress. These studies investigated implicit avoidance tendencies at baseline and right after a socially stressful situation Trier Social Stress Task; Roelofs et al.
With their version of an AAT, they showed that SAs, compared to participants without SA, were faster in avoiding than approaching emotional faces in the social stress condition compared to baseline.
However, one main purpose of safety or avoidance behaviors in SA is to prevent social stress from occurring and, therefore, should be most frequent in anticipation or during social stress and not after a social task.
Moreover, in daily life SAs are mostly confronted with social interaction stress instead of stress caused by giving speeches or extreme performance evaluations as in the Trier Social Stress Test. Therefore, the present study will investigate implicit avoidance tendencies of SAs in anticipation of an upcoming conversation. The aim of the present study was to assess implicit approach and avoidance behavior under neutral conditions and in anticipation of an upcoming conversation with an unknown person in high and low SAs.