Abstract Background: Cardiovascular disease is the leading cause of the estimated 11–25 years reduced life expectancy for persons with serious mental illness (SMI). This excess cardiovascular mortality is primarily attributable to obesity, diabetes, hypertension, and dyslipidaemia. Obesity is associated with a sedentary lifestyle, limited physical activity and an unhealthy diet. Lifestyle interventions for persons with SMI seem promising in reducing weight and cardiovascular risk. The aim of this study is to evaluate the effectiveness and cost-effectiveness of a lifestyle intervention among persons with SMI in an outpatient treatment setting. Methods: The Serious Mental Illness Lifestyle Evaluation (SMILE) study is a cluster-randomized controlled trial including an economic evaluation in approximately 18 Flexible Assertive Community Treatment (FACT) teams in the Netherlands. The intervention aims at a healthy diet and increased physical activity. Randomisation takes place at the level of participating FACT-teams. We aim to include 260 outpatients with SMI and a body mass index of 27 or higher who will either receive the lifestyle intervention or usual care. The intervention will last 12 months and consists of weekly 2-h group meetings delivered over the first 6 months. The next 6 months will include monthly group meetings, supplemented with regular individual contacts. Primary outcome is weight loss. Secondary outcomes are metabolic parameters (waist circumference, lipids, blood pressure, glucose), quality of life and health related self-efficacy. Costs will be measured from a societal perspective and include costs of the lifestyle program, health care utilization, medication and lost productivity. Measurements will be performed at baseline and 3, 6 and 12 months. Discussion: The SMILE intervention for persons with SMI will provide important information on the effectiveness, cost-effectiveness, feasibility and delivery of a group-based lifestyle intervention in a Dutch outpatient treatment setting. Trial registration: Dutch Trial Registration NL6660, registration date: 16 November 2017.
For many EU citizens, working across the border is the only way to make a living in the EU. The battle for cheap labour has now become a well-oiled machine, in which almost all Western European countries participate. Nevertheless, the employment situation of EU Mobile Citizens, workers of low-skilled and -paid jobs, is often substandard. Challenges are housing, health care and working conditions. In addition, due to the lack of registration in municipalities, it is impossible to have an overview of the numbers and to offer effective help. This is a problem in small to medium-sized cities, where many workers live to work in agriculture, transport, construction, meat industry and logistics. For this study, 32 interviews were conducted in eleven small to medium-sized towns (SMSTs) in Sweden, Germany, the Netherlands, Ireland, Poland, and Spain. The study uses three different perspectives: EU representatives of participating regions, municipalities, and employers. The outcomes show that most SMSTs deal with a shortage of housing, and a lack of grip on the registration process of EU citizens. Although there are some success stories, most SMSTs are not in touch with each other to share these. The paper concludes with proposals for further action-research and collaborations to impact local policies.
In a study commissioned by the Association of Dutch Municipalities (VNG), the applied research group European Impact has compiled the results from interviews executed by approximately 240 European Studies students at The Hague University of Applied Sciences. The purpose of this report is to compare and contrast the situation of intra-EU labor migrants (hereafter referred to as EU mobile citizens) in regard to registration, housing, and information flows in 12 different municipalities across the EU. Based on semi-structured interviews with municipal workers and individuals from employment agencies/companies from the selected municipalities, the picture that emerges is one of divergence. There are significant variations regarding the registration procedure and information flows for EU mobile citizens across the selected municipalities. For registration, differences include where the registration takes place, the amount of collaboration between municipalities and employment agencies/companies on registering EU mobile citizens, and the importance of addresses in the registration process. Regarding information flows across the selected municipalities, there are significant variations in the amount and type of information available to EU mobile citizens, the number of languages information is available in,as well as how the information is organized (i.e. in a centralized or decentralized way). Furthermore, while all the member states in which the selected municipalities are located provide information regarding registration on the Single Digital Gateway, not all provide information about renting housing. As for housing, the results revealed that most of the selected municipalities face issues with housing and that EU mobile citizens typically find housing either via their employers or personal network. Based on the results, a list of potential best practices and policy areas that could be improved was compiled. Furthermore, in order to have a stronger overview of policy developments in the field of EU mobile citizens among different municipalities, the VNG could consider hosting a Community of Practice with different municipalities across the EU as well as monitoring Interreg Europe projects focused on improving the situation of EU mobile citizens.
Everyone has the right to participate in society to the best of their ability. This right also applies to people with a visual impairment, in combination with a severe or profound intellectual and possibly motor disability (VISPIMD). However, due to their limitations, for their participation these people are often highly dependent on those around them, such as family members andhealthcare professionals. They determine how people with VISPIMD participate and to what extent. To optimize this support, they must have a good understanding of what people with disabilities can still do with their remaining vision.It is currently difficult to gain insight into the visual abilities of people with disabilities, especially those with VISPIMD. As a professional said, "Everything we can think of or develop to assess the functional vision of this vulnerable group will help improve our understanding and thus our ability to support them. Now, we are more or less guessing about what they can see.Moreover, what little we know about their vision is hard to communicate to other professionals”. Therefore, there is a need for methods that can provide insight into the functional vision of people with VISPIMD, in order to predict their options in daily life situations. This is crucial knowledge to ensure that these people can participate in society to their fullest extent.What makes it so difficult to get this insight at the moment? Visual impairments can be caused by a range of eye or brain disorders and can manifest in various ways. While we understand fairly well how low vision affects a person's abilities on relatively simple visual tasks, it is much more difficult to predict this in more complex dynamic everyday situations such asfinding your way or moving around during daily activities. This is because, among other things, conventional ophthalmic tests provide little information about what people can do with their remaining vision in everyday life (i.e., their functional vision).An additional problem in assessing vision in people with intellectual disabilities is that many conventional tests are difficult to perform or are too fatiguing, resulting in either no or the wrong information. In addition to their visual impairment, there is also a very serious intellectual disability (possibly combined with a motor impairment), which makes it even more complex to assesstheir functional vision. Due to the interplay between their visual, intellectual, and motor disabilities, it is almost impossible to determine whether persons are unable to perform an activity because they do not see it, do not notice it, do not understand it, cannot communicate about it, or are not able to move their head towards the stimulus due to motor disabilities.Although an expert professional can make a reasonable estimate of the functional possibilities through long-term and careful observation, the time and correct measurement data are usually lacking to find out the required information. So far, it is insufficiently clear what people with VZEVMB provoke to see and what they see exactly.Our goal with this project is to improve the understanding of the visual capabilities of people with VISPIMD. This then makes it possible to also improve the support for participation of the target group. We want to achieve this goal by developing and, in pilot form, testing a new combination of measurement and analysis methods - primarily based on eye movement registration -to determine the functional vision of people with VISPIMD. Our goal is to systematically determine what someone is responding to (“what”), where it may be (“where”), and how much time that response will take (“when”). When developing methods, we take the possibilities and preferences of the person in question as a starting point in relation to the technological possibilities.Because existing technological methods were originally developed for a different purpose, this partly requires adaptation to the possibilities of the target group.The concrete end product of our pilot will be a manual with an overview of available technological methods (as well as the methods themselves) for assessing functional vision, linked to the specific characteristics of the target group in the cognitive, motor area: 'Given that a client has this (estimated) combination of limitations (cognitive, motor and attention, time in whichsomeone can concentrate), the order of assessments is as follows:' followed by a description of the methods. We will also report on our findings in a workshop for professionals, a Dutch-language article and at least two scientific articles. This project is executed in the line: “I am seen; with all my strengths and limitations”. During the project, we closely collaborate with relevant stakeholders, i.e. the professionals with specific expertise working with the target group, family members of the persons with VISPIMD, and persons experiencing a visual impairment (‘experience experts’).
Het Godivapp Applied in Pediatric Primary care (GoAPP) project ontwikkelt, onderzoekt en realiseert de implementatie van een e-health applicatie voor uitwisseling van videomateriaal in zelfstandige praktijken (MKB) in de eerstelijnsgezondheidszorg. Voor een goede analyse van bewegingsproblemen bij baby?s uit risicogroepen is het van belang de motorische ontwikkeling te meten en te volgen in de tijd. Kinderfysiotherapeuten gebruiken hiervoor een observatie-instrument, de Alberta Infant Motor Scale (AIMS). In 2014 en 2015 heeft de GODIVA-onderzoeksgroep (GrOss motor Development of Infants using home Video registration with the AIMS) van Hogeschool Utrecht een methode ontworpen, waarbij de ontwikkeling gevolgd kan worden aan de hand van video?s gemaakt door ouders. De methode wordt door professionals gezien als een aanvulling op bestaande methoden, die het monitoring van kinderen doelmatiger en transparanter maakt. De methode past uitstekend in de huidige e-health ontwikkeling en zelfmanagement/empowerment van ouders. Voor research met de videomethode is een prototype applicatie ontwikkeld waarmee op veilige wijze de filmbeelden verstuurd kunnen worden en opgeslagen. Het prototype is nog niet geschikt voor gebruik binnen de beroepspraktijk. Eerstelijns Kinderfysiotherapiepraktijken zouden graag de applicatie gebruiken. Zij verwachten dat het een waardevolle uitbreiding is van hun mogelijkheden en een kans om als praktijk te innoveren. Zij zien, als zelfstandige ondernemers, echter ook belemmeringen, zoals ICT-ondersteuning en een passende tarifering van een videoconsult. Voor deze kleine bedrijven spelen ook betaalbaarheid en gebruiksgemak een essentiële rol. Binnen GoAPP zijn vijf perspectieven voor innovatie en implementatie van e-health bij elkaar gebracht: eindgebruikers, zorginhoudelijk, harde technologie, zachte technologie en bedrijfskundig perspectief. Georganiseerd rondom drie werkpakketten wordt interdisciplinair onderzoek gedaan naar (1) optimalisatie van het videoportal, (2) implementatie, en (3) bedrijfskundige haalbaarheid, via ontwerpgericht onderzoek, literatuuronderzoek, implementatieanalyse en business-case onderzoek. Een vierde werkpakket richt zich op doorgroei van het netwerk kinderfysiotherapeuten naar een Community of Practice. Doel: Een innovatieve videomethode voor het observeren van de motoriek van zuigelingen, geschikt voor eerstelijnspraktijken kinderfysiotherapie, met een passend implementatieplan en business modelling.
About half of the e-waste generated in The Netherlands is properly documented and collected (184kT in 2018). The amount of PCBs in this waste is projected to be about 7kT in 2018 with a growth rate of 3-4%. Studies indicate that a third of the weight of a PCB is made or recoverable and critical metals which we need as resources for the various societal challenges facing us in the future. Recycling a waste PCB today means first shredding it and then processing it for material recovery mostly via non-selective pyrometallurgical methods. Sorting the PCBs in quality grades (wastebins) before shredding would however lead to more flexibility in selecting when and which recovery metallurgy is to be used. The yield and diversity of the recovered metals increases as a result, especially when high-grade recycling techniques are used. Unfortunately, the sorting of waste PCBs is not easily automated as an experienced operator eye is needed to classify the very inhomogeneous waste-PCB stream in wastebins. In this project, a knowledge institution partners with an e-waste processor, a high-grade recycling technology startup and a developer of waste sorting systems to investigate the efficiency of methods for sensory sorting of waste PCBs. The knowledge gained in this project will lead towards a waste PCB sorting demonstrator as a follow-up project.
