In recent years, there have been significant changes in weather patterns, mainly caused by sharp increases in temperature, increases in carbon dioxide, and fluctuations in precipitation levels, negatively impacting agricultural production. Agricultural systems are characterized by being vulnerable to the variation of biophysical and socioeconomic factors involved in the development of agricultural activities. Agent-based models (ABMs) enable the study, analysis, and management of ecosystems through their ability to represent networks and their spatial nature. In this research, an ABM is developed to evaluate the behavior and determine the vulnerability in the sugarcane agricultural system; allowing the capitalization of knowledge through characteristics such as social ability and autonomy of the modeled agents through fuzzy logic and system dynamics. The methodol-ogy used includes information networks for a dynamic assessment of agricultural risk modeled by time series, system dynamics, uncertain parameters, and experience; which are developed in three stages: vulnerability indicators, crop vulnerability, and total system vulnerability. The development of ABM, a greater impact on the environmental contingency is noted due to the increase in greenhouse gas emissions and the exponential increase in extreme meteorological phenomena threatening the cultivation of sugarcane, making the agricultural sector more vulnerable and reducing the yield of the harvest.
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Background: Although maternity care is linked to improved health outcomes, it is often insufficiently tailored to the needs of low socioeconomic position (SEP) majority population women in high-income countries, leading to obstacles in achieving good health. Cultural competence can contribute to access to adequate care, but no systematic assessment has been conducted. This study aims to examine current evidence about the aspects of cultural competence of maternity care professionals caring for low socioeconomic position (SEP) majority population women. Methods: A scoping review was conducted. Search terms were based on the PCC elements (Participants, Concepts, and Context). Data-extraction and analysis were performed by two researchers according to a predetermined procedure. Data were grouped in the main themes of the Seeleman-framework (2009) and subsequently inductively analyzed. Results: Out of 6954 articles, 35 were eligible for data analysis. To create an overview of available evidence quality assessment of the included studies was not performed. Health professionals express a lack of knowledge and skills to assess socio-economic vulnerabilities in women and to refer to other care options regarding socio-economic vulnerabilities. Although positive experiences with professionals were mentioned, many women experience negative attitudes in terms of a lack of respect and stigmatization issues. Professionals lack the skills to build good relationships with women. Both women and health professionals reported poor communication and collaboration with health care colleagues and with social services. Conclusions: The cultural competence of health professionals in maternity care needs improvement. Professionals should be equipped with sufficient knowledge to identify deprived women and their needs and be trained in skills to effectively communicate and build care relationships. Future research should focus on the reflections of health professionals on their professional role regarding low SEP majority population women. The conditions and maternity care systems health professionals work in to serve low SEP majority women should be studied more closely. Results call for a debate about the scope of professional practice and logistical care structures regarding maternity care for low SEP majority population women. Clinical trial number: Not applicable.
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It is quite concerning that in a wealthy country, famous for having one of the most equitable health-care systems in the world with free access to care services for everyone, such an unmet need and such sex and socioeconomic inequities are found. Given England's health-care system, we wonder what the situation is like in other countries—and fear that it is probably not any better. Taking the WHO and UNICEF global report into consideration, it would be necessary to develop international guidelines for assistive technology provision, as proposed by Layton and colleagues.4 Such guidelines could have an important role in ensuring high-quality and equitable assistive technology provision across countries.
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Objective To explore predictors of district nursing care utilisation for community-living (older) people in the Netherlands using claims data. To cope with growing demands in district nursing care, knowledge about the current utilisation of district nursing care is important. Setting District nursing care as a part of primary care. Participants In this nationwide study, claims data were used from the Dutch risk adjustment system and national information system of health insurers. Samples were drawn of 5500 pairs of community-living people using district nursing care (cases) and people not using district nursing care (controls) for two groups: all ages and aged 75+ years (total N=22 000). Outcome measures The outcome was district nursing care utilisation and the 114 potential predictors included predisposing factors (eg, age), enabling factors (eg, socioeconomic status) and need factors (various healthcare costs). The random forest algorithm was used to predict district nursing care utilisation. The performance of the models and importance of predictors were calculated. Results For the population of people aged 75+ years, most important predictors were older age, and high costs for general practitioner consultations, aid devices, pharmaceutical care, ambulance transportation and occupational therapy. For the total population, older age, and high costs for pharmaceutical care and aid devices were the most important predictors. Conclusions People in need of district nursing care are older, visit the general practitioner more often, and use more and/or expensive medications and aid devices. Therefore, close collaboration between the district nurse, general practitioner and the community pharmacist is important. Additional analyses including data regarding health status are recommended. Further research is needed to provide an evidence base for district nursing care to optimise the care for those with high care needs, and guide practice and policymakers’ decision-making.
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Background Ethnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands. Methods Data of 101,882 patients diagnosed with CC in 1996–2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival. Results Adequate LN evaluation was significantly more likely for patients from ‘other Western’ countries than for the Dutch (OR 1.09; 95% CI 1.01–1.16). ‘Other Western’ patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05–1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13–0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03–2.61) was statistically explained by differences in adjuvant chemotherapy receipt. Conclusion These results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients’ health literacy when looking at ethnic differences in treatment for CC.
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Do individual characteristics influence how the quality of work is related to the use of a workflow management system (WFM) in a Dutch social insurance organisation? This key question is addressed in this paper. Building upon DeLone and McLean’s model, we investigated the effects of gender, age, education, system experience and computer skills on the relationship between the level of user satisfaction with a WFM system and the perceived quality of work. The expected effects of individual characteristics were tested using survey data collected from 143 end users of a large Dutch social insurance organisation that recently deployed a WFM system. The results of the regression analysis show that: 1 user satisfaction has a positive relationship with quality of work 2 age has a significant moderating influence on the perceived quality of work 3 gender and system experience have no moderating effects 4 education and system computer skills (as individual characteristics) had a degree of moderating effects. These results imply that it is valuable to focus on older employees when deploying information technology as WFM systems, i.e., by improving their computer skills in particular.
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Very little is known about the personal goals of homeless people and how these relate to their quality of life (QoL). By using survey data on 407 homeless adults upon entry to the social relief system in 2011, we examined the personal goals of homeless adults and the association between their perceived goal-related self-efficacy and their QoL. A hierarchical regression analysis was used to analyse the association between QoL and goal-related self-efficacy, relative to factors contributing to QoL, such as demographic characteristics, socioeconomic resources, health and service use. Results indicate that the majority of homeless adults had at least one personal goal for the coming 6 months and that most goals concerned housing and daily life (94.3%) and finances (83.6%). The QoL of homeless adults appeared to be lower in comparison with general population samples. General goal-related self-efficacy was positively related to QoL (β = 0.09, P = 0.042), independent of socioeconomic resources (i.e. income and housing), health and service use. The strongest predictors of QoL were psychological distress (β = −0.45, P < 0.001), income (β = 0.14, P = 0.002) and being institutionalised (β = 0.12, P = 0.004). In conclusion, the majority of homeless adults entering the social relief system have personal goals regarding socioeconomic resources and their goal-related self-efficacy is positively related to QoL. It is therefore important to take the personal goals of homeless people as the starting point of integrated service programmes and to promote their goal-related self-efficacy by strength-based interventions.
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As migrant populations age, the care system is confronted with the question how to respond to care needs of an increasingly diverse population of older adults. We used qualitative intersectional analysis to examine differential preferences and experiences with care at the end of life of twenty-five patients and their relatives from Suriname, Morocco and Turkey living in The Netherlands. Our analysis focused on the question how–in light of impairment–ethnicity, religion and gender intersect to create differences in social position that shape preferences and experiences related to three main themes: place of care at the end of life; discussing prognosis, advance care, and end-of-life care; and, end-of-life decision-making. Our findings show that belonging to an ethnic or religious minority brings forth concerns about responsive care. In the nursing home, patients’ minority position and the interplay thereof with gender make it difficult for female patients to request and receive responsive care. Patients with a strong religious affiliation prefer to discuss diagnosis but not prognosis. These preferences are at interplay with factors related to socioeconomic status. The oversight of this variance hampers responsive care for patients and relatives. Preferences for discussion of medical aspects of care are subject to functional impairment and faith. Personal values and goals often remain unexpressed. Lastly, preferences regarding medical end-of-life decisions are foremost subject to religious affiliation and associated moral values. Respondents’ impairment and limited Dutch language proficiency requires their children to be involved in decision-making. Intersecting gendered care roles determine that mostly daughters are involved. Considering the interplay of aspects of social identity and their effect on social positioning, and pro-active enquiry into values, goals and preferences for end-of-life care of patients and their relatives are paramount to achieve person centred and family-oriented care responsive to the needs of diverse communities.
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BackgroundThe closing of schools and sports clubs during the COVID-19 lockdown raised questions about the possible impact on children’s motor skill development. Therefore, we compared motor skill development over a one-year period among four different cohorts of primary school children of which two experienced no lockdowns during the study period (control cohorts) and two cohorts experienced one or two lockdowns during the study period (lockdown cohorts).MethodsA total of 992 children from 9 primary schools in Amsterdam (the Netherlands) participated in this study (age 5 – 7; 47.5% boys, 52.5% girls). Their motor skill competence was assessed twice, first in grade 3 (T1) and thereafter in grade 4 (T2). Children in control group 1 and lockdown group 1 were assessed a third time after two years (T3). Motor skill competence was assessed using the 4-Skills Test, which includes 4 components of motor skill: jumping force (locomotion), jumping coordination (coordination), bouncing ball (object control) and standing still (stability). Mixed factorial ANOVA’s were used to analyse our data.ResultsNo significant differences in motor skill development over the study period between the lockdown groups and control groups (p > 0.05) were found, but a difference was found between the two lockdown groups: lockdown group 2 developed significantly better than lockdown group 1 (p = 0.008). While socioeconomic status was an effect modifier, sex and motor ability did not modify the effects of the lockdowns.ConclusionsThe COVID-19 lockdowns in the Netherlands did not negatively affect motor skill development of young children in our study. Due to the complexity of the factors related to the pandemic lockdowns and the dynamic systems involved in motor skill development of children, caution must be taken with drawing general conclusions. Therefore, children’s motor skill development should be closely monitored in the upcoming years and attention should be paid to individual differences.
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