Older people today are more likely to age in their own private living environment. However, many face declining health and/or other issues that affect their ability to live independently and necessitate additional support. Such support can be provided by formal networks, but a considerable part can also be offered by informal networks of older people themselves. Going beyond these networks, older people can additionally and perhaps even more substantially benefit from vital communities. Nevertheless, even though this term is increasingly common in the literature, its meaning remains indistinct. A more thorough understanding of this concept might provide valuable knowledge that health care professionals, researchers and community workers can use to offer meaningful and effective support. The purpose of this paper is to draw on existing empirical research on vital communities to build knowledge of the different descriptions and dimensions of the concept. Arksey and O’Malley’s scoping review methodology was adopted. Our search, conducted on 23 March 2020 and updated on 06 January 2021, yielded 4433 articles, of which six articles were included in the scoping review. We deduced that the conceptualisation of a vital community is based on three dimensions: the aim of a vital community, the processes behind a vital community and the typical characteristics of a vital community. None of the selected studies have mapped all three dimensions. Nevertheless, we assume that understanding all three matters when vital communities aim to contribute to the quality of life of people ageing in place.
Background: Most studies on birth settings investigate the association between planned place of birth at the start of labor and birth outcomes and intervention rates. To optimize maternity care it also is important to pay attention to the entire process of pregnancy and childbirth. This study explores the association between the initial preferred place of birth and model of care, and the course of pregnancy and labor in low-risk nulliparous women in the Netherlands. Methods: As part of a Dutch prospective cohort study (2007–2011), we compared medical indications during pregnancy and birth outcomes of 576 women who initially preferred a home birth (n = 226), a midwife-led hospital birth (n = 168) or an obstetrician-led hospital birth (n = 182). Data were obtained by a questionnaire before 20 weeks of gestation and by medical records. Analyses were performed according to the initial preferred place of birth. Results: Low-risk nulliparous women who preferred a home birth with midwife-led care were less likely to be diagnosed with a medical indication during pregnancy compared to women who preferred a birth with obstetrician-led care (OR 0.41 95% CI 0.25-0.66). Preferring a birth with midwife-led care – both at home and in hospital - was associated with lower odds of induced labor (OR 0.51 95% CI 0.28-0.95 respectively OR 0.42 95% CI 0.21-0.85) and epidural analgesia (OR 0.32 95% CI 0.18-0.56 respectively OR 0.34 95% CI 0.19-0.62) compared to preferring a birth with obstetrician-led care. In addition, women who preferred a home birth were less likely to experience augmentation of labor (OR 0.54 95% CI 0.32-0.93) and narcotic analgesia (OR 0.41 95% CI 0.21-0.79) compared to women who preferred a birth with obstetrician-led care. We observed no significant association between preferred place of birth and mode of birth. Conclusions: Nulliparous women who initially preferred a home birth were less likely to be diagnosed with a medical indication during pregnancy. Women who initially preferred a birth with midwife-led care – both at home and in hospital – experienced lower rates of interventions during labor. Although some differences can be attributed to the model of care, we suggest that characteristics and attitudes of women themselves also play an important role.
MULTIFILE
Background: end-of-life care is not always in line with end-of-life preferences, so patients do not always die at their preferred place of death (PPD). This study aims to identify factors associated with patients' PPD and changes in PPD. Methods: we prospectively collected data on PPD at four time points within 6 months from 230 acutely hospitalised older patients who were part of the control group in a stepped-wedge randomised controlled trial. Associations between patient characteristics and preferences were calculated using multivariable (multinomial) logistic regression analysis. Results: the mean age of participants was 80.7 years. 47.8% of the patients had no PPD at hospital admission. Patients previously admitted to hospital preferred to die at home (home versus no preference: odds ratio [OR] 2.38, 95% confidence interval [CI] 1.15-4.92; home versus healthcare facility: OR 3.25, 95% CI 1.15-9.16). Patients with more chronic diseases preferred the healthcare facility as their PPD (healthcare facility versus no preference: OR 1.33, 95% CI 1.09-1.61; healthcare facility versus home: OR 1.21, 95% CI 1.00-1.47). 32 of 65 patients changed their preference during follow-up, and most of these had no PPD at hospital admission (home versus no preference: OR 0.005, 95% CI ≤0.001-0.095) and poorer self-rated well-being (OR 1.82, 95% CI 1.07-3.08). Conclusions: almost half of the patients had no PPD at baseline. Previous hospital admission, having more chronic diseases and living alone are associated with having a PPD. Introducing PPD could make older people aware of PPD and facilitate optimal palliative care.
Het lopen van een marathon wordt steeds populairder. Naast de vele positieve gezondheidseffecten van duurinspanning, kan duurinspanning ook gepaard gaan met maagdarmklachten. Zo’n 30-90% van de hardlopers heeft last van maagdarmklachten tijdens of in de uren na het hardlopen. Het ontstaan van maagdarmklachten heeft waarschijnlijk te maken met de herverdeling van het bloedvolume, resulterend in minder bloedtoevoer naar het spijsverteringskanaal en een minder goed functionerende darmbarrière. Doordat de darmbarrière minder goed functioneert kunnen er ongewenste stoffen (endotoxinen) de bloedbaan intreden en voor ontstekingsreacties zorgen. De vele micro-organismen in onze darm, gezamenlijk onze darmmicrobiota genoemd, zijn van invloed op de voedselvertering, maar ook op het functioneren van de cellen die de darmwand bekleden en de verbindingen tussen deze cellen. Mogelijk hebben hardlopers met maagdarmklachten tijdens duurinspanning te maken met een afwijkende samenstelling van de darmmicrobiota en/of metabolieten ten opzichte van hardlopers zonder klachten, waardoor de darmbarrière minder goed functioneert en er problemen kunnen optreden. Vandaar dat het voornaamste doel van ons onderzoeksproject is om te onderzoeken of er een relatie bestaat tussen de samenstelling van de darmmicrobiota en/of metabolieten en het ontstaan van maagdarmklachten tijdens duurinspanning. De onderzoeksvragen die zullen worden bestudeerd zijn: 1) Verschilt de samenstelling van de darmmicrobiota en/of metabolieten van hardlopers die wel en niet last krijgen van maagdarmklachten tijdens het lopen van een marathon? En zo ja, hoe? 2) Kan de samenstelling van de darmmicrobiota en/of metabolieten van getrainde sporters die maagdarmklachten ervaren tijdens duurinspanning positief beïnvloed worden door probiotica-suppletie, zodat de kans op en/of intensiteit van maagdarmklachten tijdens duurinspanning wordt verminderd en de sportprestatie verbeterd? Het onderzoeksproject richt zich op de identificatie van sporters die last hebben van maagdarmklachten tijdens duurinspanning. We hopen met de beoogde resultaten bij te kunnen dragen aan op de persoon gerichte preventie van maagdarmklachten door het aanpassen van de darmmicrobiota.
Carboxylated cellulose is an important product on the market, and one of the most well-known examples is carboxymethylcellulose (CMC). However, CMC is prepared by modification of cellulose with the extremely hazardous compound monochloracetic acid. In this project, we want to make a carboxylated cellulose that is a functional equivalent for CMC using a greener process with renewable raw materials derived from levulinic acid. Processes to achieve cellulose with a low and a high carboxylation degree will be designed.
The transition towards an economy of wellbeing is complex, systemic, dynamic and uncertain. Individuals and organizations struggle to connect with and embrace their changing context. They need to create a mindset for the emergence of a culture of economic well-being. This requires a paradigm shift in the way reality is constructed. This emergence begins with the mindset of each individual, starting bottom-up. A mindset of economic well-being is built using agency, freedom, and responsibility to understand personal values, the multi-identity self, the mental models, and the individual context. A culture is created by waving individual mindsets together and allowing shared values, and new stories for their joint context to emerge. It is from this place of connection with the self and the other, that individuals' intrinsic motivation to act is found to engage in the transitions towards an economy of well-being. This project explores this theoretical framework further. Businesses play a key role in the transition toward an economy of well-being; they are instrumental in generating multiple types of value and redefining growth. They are key in the creation of the resilient world needed to respond to the complex and uncertain of our era. Varta-Valorisatielab, De-Kleine-Aarde, and Het Groene Brein are frontrunner organizations that understand their impact and influence. They are making bold strategic choices to lead their organizations towards an economy of well-being. Unfortunately, they often experience resistance from stakeholders. To address this resistance, the consortium in the proposal seeks to answer the research question: How can individuals who connect with their multi-identity-self, (via personal values, mental models, and personal context) develop a mindset of well-being that enables them to better connect with their stakeholders (the other) and together address the transitional needs of their collective context for the emergence of a culture of the economy of wellbeing?
