This study investigates patients' access to surgical care for burns in a low- and middle-income setting by studying timeliness, surgical capacity, and affordability. A survey was conducted in a regional referral hospital in Manyara, Tanzania. In total, 67 patients were included. To obtain information on burn victims in need of surgical care, irrespective of time lapsed from the burn injury, both patients with burn wounds and patients with contractures were included. Information provided by patients and/or caregivers was supplemented with data from patient files and interviews with hospital administration and physicians. In the burn wound group, 50% reached a facility within 24 hours after the injury. Referrals from other health facilities to the regional referral hospital were made within 3 weeks for 74% in this group. Of contracture patients, 74% had sought healthcare after the acute burn injury. Of the same group, only 4% had been treated with skin grafts beforehand, and 70% never received surgical care or a referral. Together, both groups indicated that lack of trust, surgical capacity, and referral timeliness were important factors negatively affecting patient access to surgical care. Accounting for hospital fees indicated patients routinely exceeded the catastrophic expenditure threshold. It was determined that healthcare for burn victims is without financial risk protection. We recommend strengthening burn care and reconstructive surgical programs in similar settings, using a more comprehensive health systems approach to identify and address both medical and socioeconomic factors that determine patient mortality and disability.
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The concept of Smart Healthy Age-Friendly Environments (SHAFE) emphasises the comprehensive person-centred experience as essential to promoting living environments. SHAFE takes an interdisciplinary approach, conceptualising complete and multidisciplinary solutions for an inclusive society. From this approach, we promote participation, health, and well-being experiences by finding the best possible combinations of social, physical, and digital solutions in the community. This initiative emerged bottom-up in Europe from the dream and conviction that innovation can improve health equity, foster caring communities, and sustainable development. Smart, adaptable, and inclusive solutions can promote and support independence and autonomy throughout the lifespan, regardless of age, gender, disabilities, cultural differences, and personal choices, as well as promote happier and fairer living places.
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Social acceptance is an important aspect in the realization and implementation of various renewableenergy technologies. Our main objective with this literature review is to provide insight into publicsupport, social acceptance and societal readiness for new energy technologies in general, andhydrogen, both as an energy carrier and as an application in the built environment, in particular. 110relevant articles were identified, of which 28 have been included in this literature review, based onrelevance and year of publication (2012-2022). Generally, the findings show there is low awarenessconcerning hydrogen, as well as limited knowledge and familiarity with this new energy technology,especially concerning hydrogen storage. Despite this, there is overall moderate to high willingness toaccept hydrogen, which decreases when it comes to the local implementation of hydrogen projects.Safety and affordability were two important characteristic of a hydrogen industry that would motivatepeople to support this industry, together with climate change mitigation. Safety concerns over theflammability of hydrogen are mostly expressed when used for household activities and storage, andless so when it concerns the use of hydrogen for transportation. Communication about safety and risks,transparent interaction between all parties and the community, as well as giving the community avoice in the decision-making process, will be essential for hydrogen acceptance. Together with theresults from five case studies (deliverable 10.3 of the HyDelta 2.0 project), recommendations regardingthe elements that should and should not be included in a development and implementation strategywill be given.
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Abstract: Electronic and electrical waste (e-waste) is growing fast. The purpose of this study is to examine young consumers’ purchase intention of refurbished electronic devices (REDs) such as laptop, tablet, mobile phone and game console. From literature review the factors that influence young consumers’ purchase intention were identified as ‘environmental awareness’, ‘social acceptance’, ‘seller/brand reputation and availability’, and ‘affordability and value’. For each factor a few statements were developed and used as independent variables in a questionnaire. One statement was added about purchase intention as dependent variable. A Pearson correlation coefficient test us showed a clear positive correlation of ‘environmental awareness’ and ‘affordability and value’ with the intention to purchase REDs, but not for the other two factors. This analysis contributes to knowledge on young consumers’ perceptions of refurbished electronic devices and can inform the design of innovative value propositions and new business models for REDs that contribute to a circular economy
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The central research question in this study is: Which meaning is given to sustainability within a Dutch housing association and does making sense of the concept of sustainability lead to sustainable strategic choices? The chosen research strategy is a longitudinal case study in the Dutch housing association Welbions. Data was collected in three periods between 2009 and 2018. Welbions associates sustainability mainly with the financial position, costs and affordability, and interprets the concept as investment measures in energy savings, reducing the usage of gas and CO2-emissions which are aimed at in covenants. From the listed factors influencing strategic decision-making, the economic, technical and personal frames appeared to be used mostly. The organizational and ethical frame were used only once, and the aesthetic frame was not used at all. Noteworthy is that ecological developments were not mentioned. Frames derived from the decision criteria showed a dominating economic frame. Making sense of sustainability does not result in sustainability-based actions, or choice. This indicates that sustainable values have not gained a position in strategic decision-making, compared to traditional values such as cost-efficiency and affordability.
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Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
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Innovatieve modellen voor realisering huisvesting voor middeninkomensMensen met een middeninkomen hebben moeite hun woonwensen te vervullen. Daarom bestaat er behoefte aan nieuwe samenwerkingsverbanden en organisatie- en financieringsmodellen om huisvesting voor deze groep te realiseren. Dit heeft ertoe geleid dat op diverse plaatsen coalities van partijen zijn gevormd waarin gemeenten samenwerken met (mkb-)bedrijven zoals bijvoorbeeld Rizoem.Binnen dit project heeft het lectoraat Gezonde Stad van de Hanzehogeschool Groningen samen met de gemeente Groningen en Rizoem onderzocht welke bestaande en nieuwe samenwerkingsverbanden en organisatie- en financieringsmodellen mensen met een middeninkomen kunnen helpen om hun woonwensen te realiseren en welke ondersteuning deze mensen hierbij nodig hebben.Hiertoe zijn bestaande innovatieve samenwerkingsverbanden en organisatie- en financieringsmodellen geïnventariseerd en is het project Meerhoven in Groningen nader onderzocht. Hier heeft Rizoem in samenwerking met de gemeente Groningen 18 sociale huurwoningen en 10 betaalbare koopwoningen gerealiseerd, waarbij alle woningen identiek zijn en huur en koop door elkaar staan. Verder zijn nieuwe werkwijzen verkend, m.n. de aanpak van de gemeente Amsterdam met betrekking tot ondersteuning bij de opzet van wooncoöperaties en de betaalbaarheidsagenda van de gemeente Zwolle om meer woningen met een lage middenhuur in de stad te krijgen en te houden. Ook is nader onderzocht welke knelpunten mensen met een middeninkomen ervaren die zelf huisvesting willen realiseren en wat voor ondersteuning zij hierbij nodig hebben.Het onderzoek vond plaats door middel van deskresearch, interviews en expert meetings met medewerkers van verschillende gemeenten, bewonersinitiatieven, woningcorporaties, adviesbureaus, architecten en onderzoekers. De ontwikkelde kennis is verspreid via verschillende bijeenkomsten. Verder worden de verslagen van de expert meetings, het verslag van het onderzoek in Meerhoven en het projectverslag via onder meer de website van het lectoraat Gezonde Stad gedeeld.
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Green gas is an attractive option for a local energy transition to combat climate change, notably in rural communities. As local initiatives require local acceptance, the study used a questionnaire methodology to capture opinions and intentions toward green gas in a panel of rural respondents (N = 403) and evaluated the green gas message framing to help improve communication strategies. This survey experiment used four frames in a 2 × 2 setup: an energy value core frame of responsibility for nature versus autonomy and a focus frame emphasizing the collective (i.e., the community) versus the individual (i.e., the household). Our findings highlight that the association with sustainability proves vital for a positive assessment of green gas, but its affordability is an issue. Moderated mediation analysis showed that subjective knowledge moderates between frames and intentions toward green gas: responsibility for nature contributes significantly, but only in the collective focus frame. These results are valuable in creating effective communication strategies about green gas adoption in the future.
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Background Despite the compelling case for engaging parents in speech and language therapy, research indicates that speech and language therapists (SLTs) currently have a leading role in the goal-setting process of therapy for children with developmental language disorder (DLD). Therefore, we set out to develop a tool that aims to support the dialogue between SLTs and parents and enhance shared decision-making about children's communicative participation goals. We used co-design techniques with SLT–practitioners to include their perspectives throughout the design process. Although co-design has been used for some years in healthcare research, it is still a relatively new research methodology in the field of speech and language therapy. Aims To provide a detailed description of the co-design process that led to the development of a physical artefact that can support SLTs to engage parents of children with DLD in collaborative goal-setting. Methods & Procedures The Design Council's Double Diamond model was used to develop a tool in co-design, together with eight SLTs, who participated in all stages of the development process. Usability was tested in actual goal-setting conversations between four SLTs and 11 parents of a child with DLD resulting in stepwise improvements. In addition, usability of the first and final prototypes was tested with five usability criteria that were rated on a 10-point scale by 64 SLTs. Outcomes & Results The co-design process resulted in the development of a physical prototype of the tool called ‘ENGAGE’, consisting of a metal ‘tree trunk’ on which parents can stick magnetic ‘leaves’ containing potential participation goals for their child. The ‘tree’ shape represents a child's development and opportunities for growth. This first prototype received marks between 7.0 and 8.0 out of 10 on attractiveness, user-friendliness, safety, functionality and affordability. After several iterations, there were significantly higher marks for attractiveness, user-friendliness and safety in favour for the final prototype. Marks for functionality and affordability did not change significantly. Conclusions & Implications As researchers we usually develop pen-and-paper tools, interview protocols, apps or questionnaires to support clinical practice. Including the SLTs’ perspectives in the design process resulted in a tree-shaped physical artefact that, according to the SLTs, helps to order information and encourages and guides their dialogue with parents. We strongly advocate the inclusion of end-users in developing innovative user-centred tools for speech and language therapy and we hope that this will become widespread practice.
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Background: Despite the compelling case for engaging parents in speech and language therapy, research indicates that speech and language therapists (SLTs) currently have a leading role in the goal-setting process of therapy for children with developmental language disorder (DLD). Therefore, we set out to develop a tool that aims to support the dialogue between SLTs and parents and enhance shared decision-making about children's communicative participation goals. We used co-design techniques with SLT–practitioners to include their perspectives throughout the design process. Although co-design has been used for some years in healthcare research, it is still a relatively new research methodology in the field of speech and language therapy. Aims: To provide a detailed description of the co-design process that led to the development of a physical artefact that can support SLTs to engage parents of children with DLD in collaborative goal-setting. Methods & Procedures: The Design Council's Double Diamond model was used to develop a tool in co-design, together with eight SLTs, who participated in all stages of the development process. Usability was tested in actual goal-setting conversations between four SLTs and 11 parents of a child with DLD resulting in stepwise improvements. In addition, usability of the first and final prototypes was tested with five usability criteria that were rated on a 10-point scale by 64 SLTs. Outcomes & Results: The co-design process resulted in the development of a physical prototype of the tool called ‘ENGAGE’, consisting of a metal ‘tree trunk’ on which parents can stick magnetic ‘leaves’ containing potential participation goals for their child. The ‘tree’ shape represents a child's development and opportunities for growth. This first prototype received marks between 7.0 and 8.0 out of 10 on attractiveness, user-friendliness, safety, functionality and affordability. After several iterations, there were significantly higher marks for attractiveness, user-friendliness and safety in favour for the final prototype. Marks for functionality and affordability did not change significantly. Conclusions & Implications: As researchers we usually develop pen-and-paper tools, interview protocols, apps or questionnaires to support clinical practice. Including the SLTs’ perspectives in the design process resulted in a tree-shaped physical artefact that, according to the SLTs, helps to order information and encourages and guides their dialogue with parents. We strongly advocate the inclusion of end-users in developing innovative user-centred tools for speech and language therapy and we hope that this will become widespread practice.
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