Background The number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC. Methods The bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, ‘Effective Public Health Practice Project’. The primary outcome measure was VBAC rates. Results 238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates. Conclusions This systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were performed during the late 1980s-1990s. An opinion leader educational strategy confers benefit for increasing VBAC rates. This strategy should be further studied in different maternity care settings and with professionals other than physicians only.
MULTIFILE
The aim of this systematic review was to examine the association between malnutrition and oral health in older people (≥ 60 years of age). A comprehensive systematic literature search was performed in four databases (PubMed, CINAHL, Dentistry and Oral Sciences Source, and Embase) for literature from January 2000 to May 2020. Both observational and intervention studies were screened for eligibility. Two reviewers independently screened the search results to identify potential eligible studies, and assessed the methodological quality of the full-text studies. A total of 3240 potential studies were identified. After judgement for relevance, 10 studies (cross-sectional (n = 9), prospective cohort (n = 1)) met the inclusion criteria. Three studies described malnourished participants as having fewer teeth, or functional (tooth) units (FTUs), compared to well-nourished participants. Four studies reported soft tissue problems in malnourished participants, including red tongue with blisters, and dry or cracked lips. Subjective oral health was the topic in six studies, with poorer oral health and negative self-perception of oral health in malnourished elderly participants. There are associations between (at risk of) malnutrition and oral health in older people, categorized in hard and soft tissue conditions of the mouth, and subjective oral health. Future research should be focused on longitudinal cohort studies with proper determination of malnutrition and oral health assessments, in order to evaluate the actual association between malnutrition and oral health in older people.
This literature review applies Wenger’s community of practice framework as a theoretical lens to generate insight about the complex collaborative processes of living labs. The authors explore this model with insights from the literature on labs and then set out to understand higher educational living labs. The findings show that current research on lab practices is limited, the field is scattered, and there is little common perspective across disciplines. The authors advocate for more research on the actual social processes. Only then can living labs hold their promise of integrating learning and innovation in higher education.
The research proposal aims to improve the design and verification process for coastal protection works. With global sea levels rising, the Netherlands, in particular, faces the challenge of protecting its coastline from potential flooding. Four strategies for coastal protection are recognized: protection-closed (dikes, dams, dunes), protection-open (storm surge barriers), advancing the coastline (beach suppletion, reclamation), and accommodation through "living with water" concepts. The construction process of coastal protection works involves collaboration between the client and contractors. Different roles, such as project management, project control, stakeholder management, technical management, and contract management, work together to ensure the project's success. The design and verification process is crucial in coastal protection projects. The contract may include functional requirements or detailed design specifications. Design drawings with tolerances are created before construction begins. During construction and final verification, the design is measured using survey data. The accuracy of the measurement techniques used can impact the construction process and may lead to contractual issues if not properly planned. The problem addressed in the research proposal is the lack of a comprehensive and consistent process for defining and verifying design specifications in coastal protection projects. Existing documents focus on specific aspects of the process but do not provide a holistic approach. The research aims to improve the definition and verification of design specifications through a systematic review of contractual parameters and survey methods. It seeks to reduce potential claims, improve safety, enhance the competitiveness of maritime construction companies, and decrease time spent on contractual discussions. The research will have several outcomes, including a body of knowledge describing existing and best practices, a set of best practices and recommendations for verifying specific design parameters, and supporting documents such as algorithms for verification.
Worldwide, a third of all adults is suffering from feelings of loneliness, with a peak at young adulthood (15-25 years old). Loneliness has serious consequences for mental and physical health and should therefore be urgently addressed. However, existing interventions targeting loneliness mainly focus on older adults [1], and rarely consider the physical living environment, while studies prove that the physical environment (e.g. amenities, green, walkability, liveliness) has a significant impact on loneliness. Collaboration between the psychosocial and physical domains is key, to gain insight into the mechanisms and pathways linking characteristics of the physical living environment and loneliness among young adults and which spatial interventions are effective in managing loneliness. The main research questions are thus: how are physical environment and loneliness related, and which interventions should be implemented? The I BELONG proposal aims to build a European consortium that will address these questions. WP1 encompasses collaboration and networking activities that will form the basis for future collaboration, for instance a European research grant application. WP2 will provide insight in the pathways linking spatial attributes and loneliness. This will be achieved by doing a systematic literature review, a photovoice and interview study to collect data on specific locations that affect young people’s experiences with loneliness, and Group Model Building with experts. Building on this, WP3 aims to co-create spatial interventions with partners and young adults, and test ‘proof of concept’ interventions with virtual environments among young adults. WP3 will result in a spatial intervention toolkit. This project has both societal and scientific impact, as it will provide knowledge on pathways between physical environment characteristics and feelings of loneliness among young people, evidence of what spatial interventions work, and design guidelines that can be used in urban design and management that can contribute to managing loneliness and related health risks.
