Kinderen met een lage sociaaleconomische status (SES) hebben een verhoogd risico op een suboptimale start in het leven met hogere kosten voor de gezondheidszorg. Deze studie onderzoekt de effecten van SES op individueel (maandelijks huishoudinkomen) en contextuele SES (huishoudinkomen en buurtdeprivatie), en perinatale morbiditeit op de zorgkosten in het vroege leven (0-3 jaar). Conclusie: Meer buurtdeprivatie was direct gerelateerd aan hogere zorgkosten bij jonge kinderen. Bovendien was een lager huishoudinkomen consistent en onafhankelijk gerelateerd aan hogere zorgkosten. Door de omstandigheden voor lage SES-populaties te optimaliseren, kan de impact van lage SES-omstandigheden op hun zorgkosten positief worden beïnvloed.
MULTIFILE
De ontwikkelingen en veranderingen in de gezondheidszorg maken het noodzakelijk dat verpleegkundigen door middel van bij- en nascholing hun deskundigheid op peil houden. Deskundigheid is de basis waarop herregistratie in het BIG-register zal gaan plaatsvinden. Per 1 januari 2009 moeten zorgverleners na vijf jaar hun deskundigheid aantonen door te voldoen aan de werkervaringseis en, als ze daar niet aan voldoen, de scholingseis1. Deskundigheidsbevordering en Lifelong Learning - levenslang leren - gaan hand in hand. Lifelong Learning is het principe dat mensen gedurende hun hele leven in staat en gemotiveerd zijn om te leren en dat de omgeving daartoe mogelijkheden biedt2, 3. E-learning wordt geassocieerd met leeractiviteiten die plaatsvinden op een zelfgekozen moment waarbij een met een computernetwerk verbonden computer interactief gebruikt wordt. ‘Any place, any time’ is een wezenlijk aspect van e-learning. E-learning is belangrijk voor het levenslang leren van verpleegkundigen.
DOCUMENT
Organisatiecoaches manifesteren zich op de markt voor organisatieverandering. Regelmatig verschijnen in vaktijdschriften publicaties over organisatiecoaching. Vakorganisaties ontwikkelen een apart register voor begeleiders van organisaties. Ook zijn er verschillende opleidingen op het gebied van organisatiecoaching, meestal op post-bachelorniveau, en dus ook een op masterniveau. Ik beschrijf organisatiecoaching in dit hoofdstuk als uitdaging voor coaches. Organisatiecoaching is dan te zien als een professionele activiteit van iemand die een specifieke rol inneemt bij organisatieverandering: een rol die niet meer zozeer alleen tussen coaching en advisering in te positioneren is. Binnen de master Organisatiecoaching wordt het innemen van een rol als organisatiecoach gezien in een gebied tussen maar liefst vier verschillende rollen in: tussen een rol als coach, bedrijfsopleider, expertadviseur en verandermanager. Coachen op organisatieniveau vraagt om het vormgeven van drie activiteiten die steeds in een wisselende mate voorkomen: 1. Adviseren over organisatievraagstukken die een ontwikkelkarakter hebben. 2. Ontwerpen van een leerarchitectuur die het mogelijk maakt om zowel aan individuele als aan collectieve leerprocessen te werken. 3. Begeleiden van dat leerproces op zo’n manier dat ze zelfsturing in zowel het werk als bij het leerproces stimuleren. Organisatiecoaching kan een uitdaging vormen voor coaches die hun impact willen vergroten. Het vraagt van coaches de bereidheid om de complexiteit van organisaties binnen te treden en daarbij de grenzen van de oorspronkelijke professie op te rekken.
MULTIFILE
This thesis provides an examination of judgement autonomy of Dutch commercial real estate valuers in relation to client orientation. The valuation of commercial real estate such as offices or retail properties requires in-depth analysis due to its uniqueness by location, building type and usage details. Essentially, a register-valuer is qualified and instructed to assess a property value to one’s best cognitive effort and inform others of this outcome by means of a valuation report. In the Netherlands, concerns over independence risks and client-related judgement risks of valuers have been raised by regulative authorities as the Dutch Central Bank (DNB) and the Dutch Authority for the Financial Markets (AFM). A significant part of these concerns followed the 2008 financial crisis, which appeared to be at least partially driven by unreliable and incomparable valuations of Dutch commercial real estate (AFM, 2014; DNB, 2012; 2015). Among other things, these concerns led to the instigation of the Nederlands Register Vastgoed Taxateurs (NRVT) in 2015. NRVT is a new Dutch central register of valuation practitioners set up in order to improve self-regulation, quality control and compliance of valuation practitioners. Currently, the chamber for commercial real estate valuation holds about 2,000 commercial valuation registrations (NRVT, 2020). The introduction of NRVT, and other measures taken, reflect an instrumental view towards enhancing professionalism of Dutch valuers. This view is based on a systematic orientation to professional conduct in which good practice is primarily objectively determined (Van Ewijk, 2019). However, Wassink and Bakker (2016) point out that individuals make personal choices in order to deal with work complexity. Insight into and reflection on individual choices is part of what is referred to as normative aspects of professionalisation: what norms prevail in individual judgement and decision-making and why (Van Ewijk, 2019). In this regard, insight into judgement reasoning of valuation practitioners may contribute to normative levels of professional development of valuers. The need for such is expressed through community concerns over how individual judgement autonomy may become subdued due to instrumental-driven developments taking place in the sector. The combination of authoritative concerns over professional quality in the Netherlands and lack of (scientific) insight on how client influence affects judgement in valuation practice poses a problem: How may practitioners address client-related judgement bias risks and improve valuation accuracy from this viewpoint, if little is known on how such risks may occur in daily practice? The seemingly scarce scientific insights available in this regard in the Netherlands may also prevent educational programs to adequately address valuer independence and objectivity risks in relevant training programs. In order to address this knowledge gap, the present PhD research examines the following research problem: 169 Summary “How does client orientation affect professional judgement autonomy of commercial real estate valuers in the Netherlands?” The term ‘client orientation’ should be broadly interpreted and may refer to valuers’ perception, understanding and meaning given to alleged, actual or anticipated client-related aspects. Information on such client aspects is not required for the performance of valuation instructions. It should also be noted that this research examines the context of how client orientation may affect valuer judgement reasoning patterns during work practice, yet not its effect in terms of decision on final value opinion.
MULTIFILE
Abstract—A survey was conducted among 20 Dutch hospitals about radiation protection for interventional fluoroscopy. This was a follow-up of a previous study in 2007 that led to several recommendations for radiation protection for interventional fluoroscopy. The results indicate that most recommendations have been followed. However, radiation-induced complications from interventional procedures are still often not recorded in the appropriate register. Furthermore, even though professionals with appropriate training in radiation protection are usually involved in interventional procedures, this often is not the case when these procedures are carried out outside the radiology department. Although this involvement is not required by Dutch law, it is recommended to have radiation protection professionals present more often at interventional procedures. Further improvements in radiation protection for interventional fluoroscopy may come from a comparison of dose-reducing practices among hospitals, the introduction of diagnostic reference levels for interventional procedures, and a more thorough form of screening and follow-up of patients
DOCUMENT
One of the freedoms enjoyed by European Union (EU) citizens is the freedom of movement for workers within the EU (since 2011). This includes the rights of movement and residence for workers, the right to work in another Member State and be treated on an equal footing with nationals of that Member State. EU Mobile Citizens (EUMCs) are often not treated on an equal footing. In the Netherlands, the struggle to register and house EUMCs has been continuous since the start of the enlargement of the EU with the EU-11 in 2004. For this study student-led research was used to look at registration and housing policies in three countries, Sweden, Spain, and Germany to look for good practices applicable in the Dutch context. Students interviewed a municipal worker and a business representative (employer of EUMCs) in seven selected municipalities. The findings from this exploration highlight the complexity of addressing the needs of EU Mobile Citizens within local governance structures. Across the case studies, three critical themes emerged that shaped the dynamics of registration and housing for EUMCs: the capacity of local governments, the roles of employers, and the influence of national-level policies.
MULTIFILE
Abstract Background: People with severe mental illness (SMI) often suffer from long-lasting symptoms that negatively influence their social functioning, their ability to live a meaningful life, and participation in society. Interventions aimed at increasing physical activity can improve social functioning, but people with SMI experience multiple barriers to becoming physically active. Besides, the implementation of physical activity interventions in day-to-day practice is difficult. In this study, we aim to evaluate the effectiveness and implementation of a physical activity intervention to improve social functioning, mental and physical health. Methods: In this pragmatic stepped wedge cluster randomized controlled trial we aim to include 100 people with SMI and their mental health workers from a supported housing organization. The intervention focuses on increasing physical activity by implementing group sports activities, active guidance meetings, and a serious game to set physical activity goals. We aim to decrease barriers to physical activity through active involvement of the mental health workers, lifestyle courses, and a medication review. Participating locations will be divided into four clusters and randomization will decide the start of the intervention. The primary outcome is social functioning. Secondary outcomes are quality of life, symptom severity, physical activity, cardiometabolic risk factors, cardiorespiratory fitness, and movement disturbances with specific attention to postural adjustment and movement sequencing in gait. In addition, we will assess the implementation by conducting semi-structured interviews with location managers and mental health workers and analyze them by direct content analysis. Discussion: This trial is innovative since it aims to improve social functioning in people with SMI through a physical activity intervention which aims to lower barriers to becoming physically active in a real-life setting. The strength of this trial is that we will also evaluate the implementation of the intervention. Limitations of this study are the risk of poor implementation of the intervention, and bias due to the inclusion of a medication review in the intervention that might impact outcomes. Trial registration: This trial was registered prospectively in The Netherlands Trial Register (NTR) as NTR NL9163 on December 20, 2020. As the The Netherlands Trial Register is no longer available, the trial can now be found in the International Clinical Trial Registry Platform via: https:// trial search. who. int/ Trial2. aspx? Trial ID= NL9163.
DOCUMENT
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.
DOCUMENT
What is, exactly, an art of the working class today? Art owned by the working class? Made by the working class? Produced in the service of the working class? An art production chain owned by its workers? Art that operates within a working-class aesthetic register? This article gleans perspectives from various thinkers and discourses to build a contemporary understanding of class composition and artistic labor.
LINK
Background: Parents influence their children’s nutrition behavior. The relationship between parental influences and children’s nutrition behavior is often studied with a focus on the dyadic interaction between the parent and the child. However, parents and children are part of a broader system: the family. We investigated the relationship between the family nutrition climate (FNC), a family-level concept, and children’s nutrition behavior. Methods: Parents of primary school-aged children (N = 229) filled in the validated family nutrition climate (FNC) scale. This scale measures the families’ view on the consumption of healthy nutrition, consisting of four di erent concepts: value, communication, cohesion, and consensus. Parents also reported their children’s nutrition behavior (i.e., fruit, vegetable, water, candy, savory snack, and soda consumption). Multivariate linear regression analyses, correcting for potential confounders, were used to assess the relationship between the FNC scale (FNC-Total; model 1) and the di erent FNC subscales (model 2) and the child’s nutrition behavior. Results: FNC-Total was positively related to fruit and vegetable intake and negatively related to soda consumption. FNC-value was a significant predictor of vegetable (positive) and candy intake (negative), and FNC-communication was a significant predictor of soda consumption (negative). FNC-communication, FNC-cohesion, and FNC-consensus were significant predictors (positive, positive, and negative, respectively) of water consumption. Conclusions: The FNC is related to children’s nutrition behavior and especially to the consumption of healthy nutrition. These results imply the importance of taking the family-level influence into account when studying the influence of parents on children’s nutrition behavior. Trial registration: Dutch Trial Register NTR6716 (registration date 27 June 2017, retrospectively registered), METC163027, NL58554.068.16, Fonds NutsOhra project number 101.253.
DOCUMENT
