Background: Adverse Childhood Experiences (ACEs) are an overlooked risk factor for behavioural, mental and physical health disparities in children with intellectual disabilities (ID) and borderline intellectual functioning (BIF). Aims: To gain insight into the presence of the 10 original Wave II ACEs and family context risk variables in a convenience sample of children with ID and BIF in Dutch residential care. Methods and procedures: 134 case-files of children with ID (n = 82) and BIF (n = 52) were analysed quantitatively. Outcomes and results: 81.7 % of the children with ID experienced at least 1 ACE, as did 92.3 % of the children with BIF. The average number of ACEs in children with ID was 2.02 (range 0???? 8) and in children with BIF 2.88 (range 0???? 7). About 20 % of the children with moderate and mild ID experienced 4 ACEs or more. Many of their families faced multiple and complex problems (ID: 69.5 %; BIF 86.5 %). Multiple regression analysis indicated an association between family context risk variables and the number of ACEs in children. Conclusions and implications: The prevalence of ACEs in children with ID and BIF appears to be considerably high. ACEs awareness in clinical practice is vital to help mitigate negative outcomes.
Background: after hospitalisation for cardiac disease, older patients are at high risk of readmission and death. Objective: the cardiac care bridge (CCB) transitional care programme evaluated the impact of combining case management, disease management and home-based cardiac rehabilitation (CR) on hospital readmission and mortality. Design: single-blind, randomised clinical trial. Setting: the trial was conducted in six hospitals in the Netherlands between June 2017 and March 2020. Community-based nurses and physical therapists continued care post-discharge. Subjects: cardiac patients ≥ 70 years were eligible if they were at high risk of functional loss or if they had had an unplanned hospital admission in the previous 6 months. Methods: the intervention group received a comprehensive geriatric assessment-based integrated care plan, a face-to-face handover with the community nurse before discharge and follow-up home visits. The community nurse collaborated with a pharmacist and participants received home-based CR from a physical therapist. The primary composite outcome was first all-cause unplanned readmission or mortality at 6 months. Results: in total, 306 participants were included. Mean age was 82.4 (standard deviation 6.3), 58% had heart failure and 92% were acutely hospitalised. 67% of the intervention key-elements were delivered. The composite outcome incidence was 54.2% (83/153) in the intervention group and 47.7% (73/153) in the control group (risk differences 6.5% [95% confidence intervals, CI -4.7 to 18%], risk ratios 1.14 [95% CI 0.91-1.42], P = 0.253). The study was discontinued prematurely due to implementation activities in usual care. Conclusion: in high-risk older cardiac patients, the CCB programme did not reduce hospital readmission or mortality within 6 months.
Purpose: To support family caregivers of persons post-stroke adequately from the start and to develop self-management interventions, we aim to gain a better understanding of family caregivers experiences at the time of acute care and therefore achieve a better understanding of how they manage their new situation. Methods and Materials: We chose a qualitative descriptive methodology using individual semi-structured interviews with eleven family caregivers of persons post-stroke. We conducted interviews retrospectively, between 2 and 10 months post-stroke, and analysed transcripts using thematic analysis. Results: The themes (1) being in survival mode, (2) feeling supported by family and friends, (3) feeling left alone by the treatment team and (4) insisting on information emerged from the data. Conclusion: During acute care, many self-management skills are required from family caregivers but are just starting to be developed. This development can first be observed as co-management with the social network and is often combined with shared decision-making. Information-sharing, foundational for developing self-management, is essential for family caregivers and should be supported proactively by health professionals from the beginning. Further, from the start, health professionals should raise awareness about role changes and imbalances of activities among family caregivers to prevent negative influences on their health.
Family Dairy Tech Sustainable and affordable stable management systems for family dairy farms in India. An example of Dutch technology that is useful to an ?emerging economy?. Summary Problem The demand for dairy products in India is increasing. Small and medium-sized family farmers want to capitalize on this development and the Indian government wants to support them. Dutch companies offer knowledge and a wide range of products and services to improve dairy housing systems and better milk quality, in which India is interested. However, the Dutch technology is sophisticated and expensive. For a successful entry into this market, entrepreneurs have to develop affordable and robust (?frugal?) systems and products adapted to the Indian climate and market conditions. The external question is therefore: ?How can Dutch companies specialised on dairy housing systems adapt their products and offer these on the Indian market to contribute to sustainable and profitable local dairy farming??. Goal Since 2011, VHL University of Applied Sciences (VHL) is collaborating with a college and an agricultural information center Krishi Vigyan Kendra (KVK), Baramati, Pune district, Maharashtra State India. In this region many small-scale dairy farmers are active. Within this project, KVK wants to support farmers to scale up their farm form one or a few cows up to 15 to 100 cows, with a better milk quality. In this innovative project, VHL and Saxion Universities of Applied Sciences, in collaboration with KVK and several Dutch companies want to develop integrated solutions for the growing number of dairy farms in the State of Maharashtra, India. The research questions are: 1. "How can, by smart combinations of existing and new technologies, the cow-varieties and milk- and stable-management systems in Baramati, India, for family farmers be optimized in an affordable and sustainable way?" 2. "What are potential markets in India for Dutch companies in the field of stable management and which innovative business models can support entering this market?" Results The intended results are: 1. A design of an integral stable management system for small and medium-sized dairy farms in India, composed of modified Dutch technologies. 2. A cattle improvement programme for robust cows that are adapted to the conditions of Maharashtra. 3. An advice to Dutch entrepreneurs how to develop their market position in India for their technologies. 4. An advice to Indian family farmers how they can increase their margins in a sustainable way by employing innovative technologies.
