Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks’ gestation in 2010–2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman’s rank correlations. Findings Intrapartum referral rates varied between 55–68% (nulliparous) and 20–32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6–16% (nulliparous) and 16–31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14–42% (nulliparous) and 3–13% (multiparous) and in obstetrician-led births from 46–67% and 14–28% respectively. Rates of postpartum oxytocin varied between 59–88% (nulliparous) and 50–85% (multiparous) and artificial rupture of membranes between 43–52% and 54–61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. Conclusions Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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Dit artikel behandelt ketensamenwerking en de vraag of dit containerbegrip wel tot structurele voordelen heeft geleid. Het stuk is grotendeels gebaseerd op het proefschrift ‘Work Floor Experiences of Supply Chain Partnering in the Dutch Housing Sector’.
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Self-efficacy and outcome expectations regarding client activation determine professionals’ level of actively engaging clients during daily activities. The Client Activation Self-Efficacy and Outcome Expectation Scales for nurses and domestic support workers (DSWs) were developed to measure these concepts. This study aimed to assess their psychometric properties. Cross-sectional data from a sample of Dutch nurses (n=150) and DSWs (n=155) were analysed. Descriptive statistics were used to examine floor and ceiling effects. Construct validity was assessed by testing research-based hypotheses. Internal consistency was determined with Cronbach’s alpha. The scales for nurses showed a ceiling effect. There were no floor or ceiling effects in the scales for domestic support workers. Three out of five hypotheses could be confirmed (construct validity). For all scales, Cronbach’s alpha coefficients exceeded 0.70. In conclusion, all scales had moderate construct validity and high internal consistency. Further research is needed concerning their construct validity, testretest reliability and sensitivity to change.
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Abstract from the authors: "In this paper we discuss our experiences of facilitating collaborative creative activities within healthcare. The study consists of a larger case study on innovation scouting with the staff at the emergency room backed up by a series of seven retrospective mini-case studies. By means of discussing our experiences we identify some insights and challenges. Challenges for design facilitators working in this domain relate to: 1) dealing with the clash of professional eco-systems, the informal designers’ way of working with the formal and procedural healthcare operations; 2) Positioning yourself ‘at the right table’ in order to find backing for concepts; and, 3) steering the intertwined processes of developing strategic direction and concrete products and services on the floor." Tanja van der Laan is spatial designer, lecturer and researcher, creative research group HKU Design (Hogeschool voor de Kunsten Utrecht).
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A commentary on: Older adults can improve compensatory stepping with repeated postural perturbations by Dijkstra,B.W., Horak,F.B., Kamsma,Y.P.T., and Peterson,D.S.(2015).Front.AgingNeurosci. 7:201. doi:10.3389/fnagi.2015.00201. In sum, the results of Dijkstra etal. (2015) are of importance and significance for the field of falls prevention and stability control in aging. In particular, the work highlights the importance of multidirectional step or perturbation training, due to a lack of transfer across tasks. Whether this would hold for multidirectional gait perturbations is unclear, due to the influence of forward velocity during walking. Future work should explore different types, intensities and frequencies of perturbations in order to determine the most effective strategy for improving dynamic stability control in healthy older adults and inpatients with declined locomotor performance and increased falls risk. Finally, as Dijkstra etal. (2015) and previous studies found floor effects in the adaptation of young participants, further attempts should be made to appropriately scale perturbations to participant or groupability, in order to reliably compare adaptation across different groups.
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Educational policies in the Netherlands reveal that the current mainstream participatory approach to citizenship education jeopardises students’ autonomy. Especially in Dutch post-secondary vocational education, citizenship education has been shown to be mainly aimed at socialization: initiating students into tradition, internalising rules, societal norms and values. This article reports on the findings of a research project, which is grounded in the assumption that integrating Bildung, citizenship education and critical thinking is a promising way to grapple with the perceived overemphasis on socialization strategies. We justify the interrelationship of critical thinking, Bildung, citizenship education, and professional training from two perspectives – historical and contemporary. It is only by combining these concepts, we contend, that educational professionals can create teaching materials more geared to developing autonomy, and prepare students in vocational training to navigate the political and societal dilemma’s on the work floor. Furthermore, we also clarify our perspective by offering three educational principles, used in our project to guide the design of teaching materials, that form a context for integrating citizenship, critical thinking, and Bildung in vocational education. A practical illustration is subsequently discussed.
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Can you remember the last time the ground gave way beneath you? When you thought the ground was stable, but for some reason it wasn’t? Perhaps you encountered a pothole on the streets of Amsterdam, or you were renovating your house and broke through the floor. Perhaps there was a molehill in a park or garden. You probably had to hold on to something to steady yourself. Perhaps you even slipped or fell. While I sincerely hope that nobody here was hurt in the process, I would like you to keep that feeling in your mind when reading what follows. It is the central theme of the words that will follow. The ground beneath our feet today is not as stable as the streets of Amsterdam, your park around the corner or even a poorly renovated upstairs bedroom. This is because whatever devices we use and whatever pathways we choose, we all live in hybrid physical and digital social spaces (Kitchin and Dodge 2011). Digital social spaces can be social media platforms like Twitter or Facebook, but also chat apps like WhatsApp or Signal. Crucially, social spaces are increasingly hybrid, in which conversations take place across digital spaces (WhatsApp chat group) and physical spaces (meeting friends in a cafe) simultaneously. The ground beneath our feet is not made of concrete or stone or wood but of bits and bytes.
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Background: Functional decline is common in nursing home residents. Nursing staff can help prevent this decline, by encouraging residents to be more active in functional activities. Questionnaires measuring the extent to which nursing staff encourage functional activity among residents are lacking. In addition, there are no measurement instruments to gain insight into nursing staff perceived barriers and facilitators to this behavior. The aim of this study was to develop, and study the usability, of the MAastrIcht Nurses Activities INventory (MAINtAIN), an inventory assessing a) the extent to which nursing staff perceive to perform behaviors that optimize and maintain functional activity among nursing home residents and b) the perceived barriers and facilitators related to this behavior. Methods: Using a mixed-methods approach the MAINtAIN was developed and its usability was studied. Development was based on literature, expert opinions, focus group (N = 3) and individual interviews (N = 14) with residents and staff from nine nursing homes in the Netherlands. Usability was studied in a cross-sectional study with 37 nurses and certified nurse assistants; data were analyzed using descriptive statistics. Results: Development of the MAINtAIN resulted in two distinctive parts: MAINtAIN-behaviors and MAINtAIN-barriers. MAINtAIN-behaviors, targeting nursing staff behavior to optimize and maintain functional activity, includes 19 items covering activities of daily living, household activities, and miscellaneous activities. MAINtAIN-barriers addresses the perceived barriers and facilitators related to this behavior and comprises 33 items covering barriers and facilitators related to the residents, the professionals, the social context, and the organizational and economic context. The usability study showed that the inventory was not difficult to complete, that items and response options were clear,and that the number of missing values was low. Few items showed a floor or ceiling effect. Conclusions: The newly developed inventory MAINtAIN provides a usable method for researchers and nursing homes to obtain insight into nursing staff perceived behavior in optimizing functional activity among residents and their perceived barriers and facilitators related to this behavior. Outcomes of the MAINtAIN may contribute to change in nursing staff behavior and may improve nursing care. Further research with regard to the psychometric properties of the MAINtAIN is recommended.
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This module for Involving Anthropology presents an account of one of the plenary debates held at the International Union of Anthropological and Ethnological Sciences (IUAES) World Congress held at Manchester University, 5-10 August 2013. The module begins with a brief introduction to provide the context for the debate, which included two speakers for (Amita Baviskar and Don Nonini) and two speakers against (Helen Kopnina and Veronica Strang) the motion: ‘Justice for people must come before justice for the environment’. The introduction is followed by an edited transcript of John Gledhill’s welcome and introduction, the texts of the arguments made by each speaker for and against the motion (with the exception of Veronica Strang, whose presentation is being published elsewhere a summary of the comments and questions subsequently invited from the floor of the hall, and then a transcript of the responses of the presenters. https://doi.org/10.1080/00664677.2015.1102229 https://www.linkedin.com/in/helenkopnina/
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BACKGROUND: Intensive care unit (ICU) stays often lead to reduced physical functioning. Change in physical functioning in patients in the ICU is inadequately assessed through available instruments. The de Morton Mobility Index (DEMMI), developed to assess mobility in elderly hospitalized patients, is promising for use in patients who are critically ill.OBJECTIVE: The aim of this study was to evaluate the clinimetric properties of the DEMMI for patients in the ICU.DESIGN: A prospective, observational reliability and validity study was conducted.METHODS: To evaluate interrater and intrarater reliability (intraclass correlation coefficients), patients admitted to the ICU were assessed with the DEMMI during and after ICU stay. Validity was evaluated by correlating the DEMMI with the Barthel Index (BI), the Katz Index of Independence in Activities of Daily Living (Katz ADL), and manual muscle testing (MMT). Feasibility was evaluated based on the percentage of participants in which the DEMMI could be assessed, the floor and ceiling effects, and the number of adverse events.RESULTS: One hundred fifteen participants were included (Acute Physiology and Chronic Health Evaluation II [APACHE II] mean score=15.2 and Sepsis-related Organ Failure Assessment [SOFA] mean score=7). Interrater reliability was .93 in the ICU and .97 on the wards, whereas intrarater reliability during the ICU stay was .68. Validity (Spearman rho coefficient) during the ICU stay was .56, -.45, and .57 for the BI, Katz ADL, and MMT, respectively. The DEMMI showed low floor and ceiling effects (2.6%) during and after ICU discharge. There were no major adverse events.LIMITATIONS: Rapid changes in participants' health status may have led to underestimation of intrarater reliability.CONCLUSION: The DEMMI was found to be clinically feasible, reliable, and valid for measuring mobility in an ICU population. Therefore, the DEMMI should be considered a preferred instrument for measuring mobility in patients during and after their ICU stay.
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