Background: screening for frailty might help to prevent adverse outcomes in hospitalised older adults.Objective: to identify the most predictive and efficient screening tool for frailty.Design and setting: two consecutive observational prospective cohorts in four hospitals in the Netherlands.Subjects: patients aged ≥70 years, electively or acutely hospitalised for ≥2 days.Methods: screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities were assessed.Results: follow-up data were available of 883 patients. All screening instruments were similarly predictive for adverse outcome (predictive power 0.58–0.66), but the percentage of positively screened patients (13–72%), sensitivity (24–89%) and specificity (35–91%) highly differed. The strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70–80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the validation cohort.Conclusions: the VMS-tool plus age (VMS+) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome. In clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments.

A remarkable drop in symptoms could not be linked directly to the intervention. Feasibility of the intervention was good, but controlling the intervention in a small rural community appeared to be a difficult task to accomplish.

The association between personality, attachment, psychological distress, church denomination and the God concept was studied among a sample of 208 subjects from the normal population. Subjects were Christians, members of an Orthodox reformed church or the Pentecostal church. Negative feelings towards God were associated with a high level of harm avoidance, insecure attachment and a high level of psychological distress. Psychological distress mediated the association between personality and attachment variables and negative feelings towards God. Psychological distress and church denomination were the only two independent predictors of negative feelings towards God. Moreover, results showed that the Orthodox reformed church members hold a more negative concept of God than the Pentecostal church members do. Orthodox reformed church members see God in particular as a punitive judge, independent of personality, attachment and psychological distress, suggesting a large influence of religious culture on this particular type of God concept. Results are discussed from a psychotherapeutic point of view. Finally, several ethical issues regarding psychotherapy with religious clients are addressed.

The relationship between homesickness, age, nationality, marital status, the amount of time spent in the Netherlands, and the amount of time spent abroad was studied in a group of employees ( N = 171) working for the Dutch division of a multinational high-tech company in the Netherlands. Variables found to be significantly related to homesickness were age, nationality, and the number of years spent abroad and in the Netherlands. The latter variable appeared to be the only independent predictor of homesickness. Results suggest it is not so much the newcomers who are at risk for developing homesickness but those employees in their late 30s living 6 to 8 years in a foreign country. Also, those coming from a culture and environment that differs considerably from the culture they actually have to work and live in are definitely far more at risk for developing homesickness than those coming from rather similar cultures.

No abstract