Background: Health care organizations supporting individuals with intellectual disabilities (IDs) carry out a range of interventions to support and improve a healthy lifestyle. However, it is difficult to implement an active and healthy lifestyle into daily support. The presence of numerous intervention components,multiple levels of influence, and the explicit use of theory are factors that are considered to be essential for implementation in practice. A comprehensive written lifestyle policy provides for sustainability of a lifestyle approach. It is unknown to what extent these crucial factors for successful implementation aretaken into consideration by health care organizations supporting this population.Aim: To analyze the intervention components, levels of influence, explicit use of theory, and conditions for sustainability of currently used lifestyle interventions within lifestyle approaches aiming at physical activity and nutrition in health care organizations supporting people with ID.Methods: In this descriptive multiple case study of 9 health care organizations, qualitative data of the lifestyle approaches with accompanying interventions and their components were compiled with a newly developed online inventory form.Results: From 9 health care organizations, 59 interventions were included, of which 31% aimed to improve physical activity, 10% nutrition, and 59% a combination of both. Most (49%) interventions aimed at the educational component and less at daily (19%) and generic activities (16%) and the evaluationcomponent (16%). Most interventions targeted individuals with ID and the professionals whereas social levels were underrepresented. Although 52% of the interventions were structurally embedded, only 10 of the 59 interventions were theory-driven.Conclusion: Health care organizations could improve their lifestyle approaches by using an explicit theoretical basis by expanding the current focus of the interventions that primarily concentrate on their clients and professionals toward also targeting the social and external environment as well as theintroduction of a written lifestyle policy. This policy should encompass all interventions and should be the responsibility of those in the organization working with individuals with ID. In conclusion, comprehensive, integrated, and theory-driven approaches at multiple levels should be promoted.
Introduction In 2016 a new form of integrated community treatment for patients with serious mental illnesses was implemented in two neighborhoods in the city of Utrecht (335000 inhabitants) in the Netherlands. Treatment is characterized by close collaboration of psychiatric care, somatic care (i.e. general practitioner, nurse practitioner), supported housing and other facilities, i.e. the police officer, and is provided in the direct neighborhood of the patients. This ‘neighborhood based integrated mental health care’ should not contribute solely to clinical recovery, but also specifically to social and personal recovery. Objectives The aim of this research was to investigate the experience of patients with serious mental illnesses themselves receiving this new form of neighborhood-based integrated mental health care. More specific the question is studied if and how neighborhood-based integrated mental health care supports personal and social recovery. Methods To assess the experience of patients in depth qualitative semi-structured interviews were conducted with 20 patients. Patients were asked to participate in interviews directly by the researchers, by their case managers and by experts by experience. Interview topics included personal and social recovery, resilience and self-efficacy related to the collective effort of caregivers. Qualitative data was analyzed by three independent researches with the qualitative computer program Tarzan. Strategies to enhance quality of data analysis (respondent validation) and validity (attention to negative cases) were used. Results The study will be finished in January 2019. Conclusions The results, a brief description of the collaborative care methodology offered and experiences of patients, and conclusions will be presented at the ENMESH conference.
Abstract Background. Fever in children is common and mostly caused by self-limiting infections. However, parents of febrile children often consult in general practice, in particular during out-of-hours care. To improve management, it is important to understand experiences of GPs managing these consultations. Objective. To describe GPs’ experiences regarding management of childhood fever during out-ofhours care. Methods. A descriptive qualitative study using purposeful sampling, five focus group discussions were held among 37 GPs. Analysis was based on constant comparative technique using open and axial coding. Results. Main categories were: (i) Workload and general experience; (ii) GPs’ perceptions of determinants of consulting behaviour; (iii) Parents’ expectations from the GP’s point of view; (iv) Antibiotic prescribing decisions; (v) Uncertainty of GPs versus uncertainty of parents and (vi) Information exchange during the consultation. GPs felt management of childhood fever imposes a considerable workload. They perceived a mismatch between parental concerns and their own impression of illness severity, which combined with time–pressure can lead to frustration. Diagnostic uncertainty is driven by low incidences of serious infections and dealing with parental demand for antibiotics is still challenging. Conclusion. Children with a fever account for a high workload during out-of-hours GP care which provides a diagnostic challenge due to the low incidence of serious illnesses and lacking longterm relationship. This can lead to frustration and drives antibiotics prescription rates. Improving information exchange during consultations and in the general public to young parents, could help provide a safety net thereby enhancing self-management, reducing consultations and workload, and subsequent antibiotic prescriptions.
The HAS professorship Future Food Systems is performing applied research with students and external partners to transform our food system towards a more sustainable state. In this research it is not only a question of what is needed to achieve this, but also how and with whom. The governance of our food system needs rethinking to get the transformative momentum going in a democratic and constructive manner. Building on the professorship’s research agenda and involvement in the transdisciplinary NWA research project, the postdoc will explore collective ownership and inclusive participation as two key governance concepts for food system transformation. This will be done in a participatory manner, by learning from and with innovative bottom-up initiatives and practitioners from the field. By doing so, the postdoc will gain valuable practical insights that can aid to new approaches and (policy) interventions which foster a sustainable and just food system in the Netherlands and beyond. A strong connection between research and education is created via the active research involvement of students from different study programs, supervised by the postdoc (Dr. B. van Helvoirt). The acquired knowledge is embedded in education by the postdoc by incorporating it into HAS study program curricula and courses. In addition, it will contribute to the further professional development of qualitative research skills among HAS students and staff. Through scientific, policy and popular publications, participation in (inter)national conferences and meetings with experts and practitioners, the exposure and network of the postdoc and HAS in the field of food systems and governance will be expanded. This will allow for the setting up of a continuous research effort on this topic within the professorship via follow-up research with knowledge institutes, civic society groups and partners from the professional field.
DISTENDER will provide integrated strategies by building a methodological framework that guide the integration of climate change(CC) adaptation and mitigation strategies through participatory approaches in ways that respond to the impacts and risks of climatechange (CC), supported by quantitative and qualitative analysis that facilitates the understanding of interactions, synergies and tradeoffs.Holistic approaches to mitigation and adaptation must be tailored to the context-specific situation and this requires a flexibleand participatory planning process to ensure legitimate and salient action, carried out by all important stakeholders. DISTENDER willdevelop a set of multi-driver qualitative and quantitative socio-economic-climate scenarios through a facilitated participatory processthat integrates bottom-up knowledge and locally-relevant drivers with top-down information from the global European SharedSocioeconomic Pathways (SSPs) and downscaled Representative Concentration Pathways (RCPs) from IPCC. A cross-sectorial andmulti-scale impact assessment modelling toolkit will be developed to analyse the complex interactions over multiple sectors,including an economic evaluation framework. The economic impact of the different efforts will be analyse, including damage claimsettlement and how do sectoral activity patterns change under various scenarios considering indirect and cascading effects. It is aninnovative project combining three key concepts: cross-scale, integration/harmonization and robustness checking. DISTENDER willfollow a pragmatic approach applying methodologies and toolkits across a range of European case studies (six core case studies andfive followers) that reflect a cross-section of the challenges posed by CC adaptation and mitigation. The knowledge generated byDISTENDER will be offered by a Decision Support System (DSS) which will include guidelines, manuals, easy-to-use tools andexperiences from the application of the cases studies.
‘Dieren in de dijk’ aims to address the issue of animal burrows in earthen levees, which compromise the integrity of flood protection systems in low-lying areas. Earthen levees attract animals that dig tunnels and cause damages, yet there is limited scientific knowledge on the extent of the problem and effective approaches to mitigate the risk. Recent experimental research has demonstrated the severe impact of animal burrows on levee safety, raising concerns among levee management authorities. The consortium's ambition is to provide levee managers with validated action perspectives for managing animal burrows, transitioning from a reactive to a proactive risk-based management approach. The objectives of the project include improving failure probability estimation in levee sections with animal burrows and enhancing risk mitigation capacity. This involves understanding animal behavior and failure processes, reviewing existing and testing new deterrence, detection, and monitoring approaches, and offering action perspectives for levee managers. Results will be integrated into an open-access wiki-platform for guidance of professionals and in education of the next generation. The project's methodology involves focus groups to review the state-of-the-art and set the scene for subsequent steps, fact-finding fieldwork to develop and evaluate risk reduction measures, modeling failure processes, and processing diverse quantitative and qualitative data. Progress workshops and collaboration with stakeholders will ensure relevant and supported solutions. By addressing the knowledge gaps and providing practical guidance, the project aims to enable levee managers to effectively manage animal burrows in levees, both during routine maintenance and high-water emergencies. With the increasing frequency of high river discharges and storm surges due to climate change, early detection and repair of animal burrows become even more crucial. The project's outcomes will contribute to a long-term vision of proactive risk-based management for levees, safeguarding the Netherlands and Belgium against flood risks.
