There has probably never been such an intense debate about the layout of the countryside as the one that is currently raging. There are serious concerns about the landscape, which is being rapidly transformed by urbanization and everything associated with this process, and not only in the Netherlands but also far beyond its borders. Everyone has something to say in this society-wide debate, from local to national governments, from environmental factions to the road-user's lobby, and from those who are professionally involved to concerned private parties. In many cases it is a battle between idealized images and economic models, between agricultural reality and urban park landscapes, between ecological concerns and mobility. This issue of OASE explores the potential significance of architectonic design for transformation processes on the regional scale. Besides considering the instruments that are available to the designer to fulfil this task, the authors also consider how the design can exercise a 'positive' influence on such processes. The various contributions shed light on the potential significance of territory in contemporary design practice and offer critical reflection on the topical discourse that has evolved over recent years.
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.
Cities are constantly in transition. Spatial production worldwide is generated by governments, business, developers, informal settlers, et cetera; sometimes cities expand, but increasingly there is a process of reurbanisation of existing urban patterns contronted with deterioration, dysfunctionality, or obsolescence. In many situations, funding, power and technology determine how the course of urbanisation. Communities, groups and individuals with limited access to funding, power and technology need empowerment to exercise their right to shape and improve their own evironment, while respecting health, equity and ecology. The research centre for Smart Urban Redesign (SURD) at Zuyd University of Applied Sciences seeks to work on this empowerment for communities. This study presents SURD’s approach to neighbourhood revitalisation.
