Zoekresultaten

Dutch health and social care : international labour mobility

The main objective of this report is to analyse and inform about international labour mobility, particularly within Europe, from the perspective of the Dutch Health and Social Care Sector. The report starts by describing the introduction of a new care system in The Netherlands. The government does not participate directly in the actual provision of care. This is a task principally for private care suppliers. Furthermore, the legal position of the Health and Social Care professions, regulated through the Individual Health Care Professions Act, and questions like the international recognition of degrees and the evaluation of foreign diplomas are discussed. This is followed by a clarification of the Dutch education system, particularly, relating to the study of medicine, nursing education and social work education. Subsequently, some core data on the ageing Dutch population are presented. The grey pressure increases and this will have an impact on health spending, health support and the future labour market. Then what follows is a description of the development of employment in the Dutch Health and Social Care Sector, per branch as well as the professions that are engaged in it. The general picture, at this moment, is that the Health and Social Care labour market is reasonably in balance. This trend will continue in the near future; shortages are expected only in the long term. All research done on the subject indicates that international mobility of medical and social professionals is still low in the Netherlands. The question remains whether a more active recruitment policy would be a solution for the expected long term shortages. The report concludes with a look at recruitment policy and some of its developments at the global, national and local level.

Comparing mixed-media and conventional slow-sand filters for arsenic removal from groundwater

Arsenic contamination of groundwater is a major public health concern worldwide. The problem has been reported mainly in southern Asia and, especially, in Bangladesh. Slow-sand filters (SSF) augmented with iron were proven to be a simple, low-cost and decentralized technique for the treatment of arsenic-contaminated sources. In this research, three pilot-scale SSF (flowrate 6 L·h−1) were tested regarding their capability of removing arsenic from groundwater in conditions similar to those found in countries like Bangladesh (70 µg As(III) L−1, 26 °C). From the three, two filters were prepared with mixed media, i.e., sand mixed with corrosive iron matter (CIM filter) and iron-coated sand (ICS filter), and a third conventional SSF was used as a reference. The results obtained showed that the CIM filter could remove arsenic below the World Health Organization (WHO) guideline concentration of 10 µg·L−1, even for inlet concentrations above 150 µg·L−1. After 230 days of continuous operation the arsenic concentration in the effluent started increasing, indicating depletion or saturation of the CIM layer. The effluent arsenic concentration, however, never exceeded the Bangladeshi standard of 50 µg·L−1 throughout the whole duration of the experiments.

Rotatable Smart TinyLab, a platform for testing integrated façades and indoor climate

Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators - A scoping review

The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included. Eight groups of barriers and facilitators were identified, thematically clustered in six themes: knowledge, skills, and attitudes; environmental context and resources; role clarity; confidence; therapeutic alliance; and patient expectations. The results of this review can be used to inform the development of implementation programs.

From grey to green infrastructure in a changing climate

Communities worldwide are critically re-examining their seasonal cultures and calendars. As cultural frameworks, seasons have long patterned community life and provided repertoires for living by annual rhythms. In a chaotic world, the seasons - winter, the monsoon and so on - can feel like stable cultural landmarks for reckoning time and orienting our communities. Seasons are rooted in our pasts and reproduced in our present. They act as schemes for synchronising community activities and professional practices, and as symbol systems for interpreting what happens in the world. But on closer inspection, seasons can be unstable and unreliable. Their meanings can change over time. Seasonal cultures evolve with environments and communities’ worldviews, values, technologies and practices, affecting how people perceive seasonal patterns and behave accordingly. Calendars are contested, especially now. Communities today find themselves in a moment of accelerated and intersecting changes - from climate to social, political, and technological - that are destabilizing seasonal cultures. How they reorient themselves to shifting patterns may affect whether seasonal rhythms serve as resources, or lead people down maladaptive pathways. A focus on seasonal cultures builds on multi-disciplinary work. The social sciences, from anthropology to sociology, have long studied how seasons order people’s sense of time, social life, relationship to the environment, and politics. In the humanities, seasons play an important role in literature, art, archaeology and history. This book advances scholarship in these fields, and enriches it with extrascientific insights from practice, to open up exiting new directions in climate adaptation. Critically questions traditional, often-static notions of seasons; re-interpreting them as more flexible, cultural frameworks adapting to changes to our societies and environments.

Effect of physical exercise on the hippocampus and global grey matter volume in breast cancer patients

BackgroundPhysical exercise in cancer patients is a promising intervention to improve cognition and increase brain volume, including hippocampal volume. We investigated whether a 6-month exercise intervention primarily impacts total hippocampal volume and additionally hippocampal subfield volumes, cortical thickness and grey matter volume in previously physically inactive breast cancer patients. Furthermore, we evaluated associations with verbal memory.MethodsChemotherapy-exposed breast cancer patients (stage I-III, 2–4 years post diagnosis) with cognitive problems were included and randomized in an exercise intervention (n = 70, age = 52.5 ± 9.0 years) or control group (n = 72, age = 53.2 ± 8.6 years). The intervention consisted of 2x1 hours/week of supervised aerobic and strength training and 2x1 hours/week Nordic or power walking. At baseline and at 6-month follow-up, volumetric brain measures were derived from 3D T1-weighted 3T magnetic resonance imaging scans, including hippocampal (subfield) volume (FreeSurfer), cortical thickness (CAT12), and grey matter volume (voxel-based morphometry CAT12). Physical fitness was measured with a cardiopulmonary exercise test. Memory functioning was measured with the Hopkins Verbal Learning Test-Revised (HVLT-R total recall) and Wordlist Learning of an online cognitive test battery, the Amsterdam Cognition Scan (ACS Wordlist Learning). An explorative analysis was conducted in highly fatigued patients (score of ≥ 39 on the symptom scale ‘fatigue’ of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), as previous research in this dataset has shown that the intervention improved cognition only in these patients.ResultsMultiple regression analyses and voxel-based morphometry revealed no significant intervention effects on brain volume, although at baseline increased physical fitness was significantly related to larger brain volume (e.g., total hippocampal volume: R = 0.32, B = 21.7 mm3, 95 % CI = 3.0 – 40.4). Subgroup analyses showed an intervention effect in highly fatigued patients. Unexpectedly, these patients had significant reductions in hippocampal volume, compared to the control group (e.g., total hippocampal volume: B = −52.3 mm3, 95 % CI = −100.3 – −4.4)), which was related to improved memory functioning (HVLT-R total recall: B = −0.022, 95 % CI = −0.039 – −0.005; ACS Wordlist Learning: B = −0.039, 95 % CI = −0.062 – −0.015).ConclusionsNo exercise intervention effects were found on hippocampal volume, hippocampal subfield volumes, cortical thickness or grey matter volume for the entire intervention group. Contrary to what we expected, in highly fatigued patients a reduction in hippocampal volume was found after the intervention, which was related to improved memory functioning. These results suggest that physical fitness may benefit cognition in specific groups and stress the importance of further research into the biological basis of this finding.