Windesheim Flevoland

Introduction Type 2 diabetes mellitus (T2DM) is a major burden on public health worldwide. To reduce adverse events and complications, effective T2DM self-management is required. Self-management and glycaemic control are generally poorer in lower educated people compared with higher educated people. This study aims to assess the (cost-)effectiveness and to conduct a process evaluation of a diabetes self-management programme, ‘Powerful Together With Diabetes’ (PTWD), which is specifically developed for patients from lower educational groups. Methods and analysis The PTWD programme is focused on attaining basic knowledge and skills for effective diabetes self-management. In a previous study (the Diabetes in Social Context (DISC) study), lower-educated participants enjoyed the PTWD programme as well as improved their T2DM-related behaviours. The design of the study is an effectiveness-implementation hybrid type 2 trial. We will conduct mixed methods effectiveness, process and economic evaluations. To investigate the (cost-)effectiveness, a two-arm quasi-experimental trial will be conducted with a parallel mixed method process evaluation. The primary outcome of the study is change in haemoglobin A1c levels from baseline to 12 months. Secondary outcomes include use of primary and secondary care, medication use, blood biomarkers, T2DM self-management health behaviours, anthropometrics, and quality of life. Data will be collected with questionnaires, physical activity trackers and registration data from general practitioner registries. To see if the results are maintained, we will also measure the outcomes 24 months after baseline. Study participants are patients from lower educational groups living with T2DM between 35 and 70 years old. Participants will be recruited through general practices, and the intervention will be held in community centres. Our aim is to include 114 participants in the intervention group and 570 participants in the control group. Ethics and dissemination This study has been approved by the Medical Ethics Committee of the Academic Medical Center in Amsterdam (#2021_222). Participants will sign an informed consent form prior to enrolment. Manuscripts with the results of the effectiveness, economic and process evaluations will be published in peer-reviewed journals. Trial registration number ISRCTN12982302 ISRCTN registry (registered on 29 March 2022).

This article situates Black feminist research on race and class as a pre-determined collaborative process, which builds on a plethora of existing scholarship as well as on the relationships and wisdoms of others. We want to pay homage to the way we arrive at our ideas about social life together. We see lived experience(s) as a fundamental aspect of our work as social scientists and Black feminist practitioners, but also acknowledge the pitfalls of this approach. Using Bryel’s transcriptions of Chantelle’s ethnographic research with Black and Black mixed-race families as an example, we aim to bring a fresh perspective to this long-standing approach, while emphasising that this leaves us open to the creation of over-individualised accounts of often-marginalised social lives. We hope to further discourses that acknowledge and celebrate the numerous, complicated and personal pathways taken by researchers as they analyse their data, specifically in methodologically insider–outsider encounters.

This paper presents the stiffness formulation of a beam element with the relevant third-order nonlinear geometric effects for relatively wide and thin rectangular beams, in particular when loaded in the plane and simultaneously deformed out of the plane. The element is initially straight in its undeformed configuration. The formulation is based on Timoshenko beam theory with nonuniform torsion and Wagner effects. The derivation is carried out by means of the Hellinger–Reissner variational principle with custom interpolation functions. The element is incorporated into the generalized strain beam formulation for multibody systems. Numerical simulations of precision flexure mechanisms show that the use of a single third-order element per flexible member can already yield adequate performance, at a significant reduction of the necessary degrees of freedom and the computation time, compared with using multiple second-order elements in the generalized strain beam formulation.

Gender can be seen not only as a binary category but also as a performance or doing that is shaped by, and shapes organizational processes and structures that are deeply embedded in (sport) organizations in multiple and complex ways. The purpose of this paper is to explore strategies for addressing the undoing of gender in sport organizations with the use of an overarching or meta-approach. Strategies that aim to undo gender require a recognition of the complexity of regimes of inequality and the need to use incremental steps in the form of small wins while acknowledging change is not linear. The complexity and multiplicity of the gendering of sport organizations should, therefore, be considered a wicked problem. The naming of heterotopias can provide directions or goals for small wins and for addressing the wicked problem of the doing of gender in sport organizations.

Systematic coding of observed human behaviour (SCOBe) is used across disciplines and topics but methodological reporting is often incomplete. We developed internationally generated, interdisciplinary guidelines for methodological reporting of such research. Using Delphi methodology, a working group of 22 experts sought group consensus in three rounds. Participants first assessed an initial set of reporting criteria (round 1). Next, in interactive meetings participants revised these criteria and reached consensus on reporting content (rounds 2 & 3). We present 20 criteria constituting the first comprehensive reporting guidelines for SCOBe research using existing, newly developed, or modified coding systems. The criteria encompass three procedural domains: 1. Research context; 2. Properties of the coding scheme; and 3. Application of the coding scheme. The presented guidelines will assist in substantiating and assessing the quality of SCOBe research. We encourage researchers to adopt these guidelines, to enhance quality of mono- and interdisciplinary research.

Background: Case management (CM) aims to facilitate access to and integration of health care and social services. We investigated the feasibility and effectiveness of CM. Methods: Randomized controlled trial with 219 patients and 114 caregivers randomly allocated to CM (109/59) or care as usual (110/55). CM was based on early and continuous online monitoring of problems and needs. Outcomes were assessed every 6 months with the Hospital Anxiety and Depression Scale (HADS). Secondary outcome domains were participant restrictions, life satisfaction, self-efficacy, caregiver burden, and needs. Multilevel modeling was used. Feasibility aspects were protocol delivery, participants' and case managers' satisfaction, and factors affecting implementation. Results: There were no significant differences between groups. Participation restrictions and unmet needs decreased in both groups within 6 months. Monitoring was successful in 38, and 10 participants asked the CM for support. CM consisted mostly of providing information. Discussion: CM based on early and continuous online monitoring does not have benefit in identifying and addressing problems early after relatively mild injury. Unsuccessful monitoring may have hindered access to the case manager and prevented us from evaluating CM as a complex intervention. It remains a challenge to early identify those who could benefit from care coordination.

Introduction Early Warning Score (EWS) protocols are based on intermittent vital sign measurements, and aim to detect clinical deterioration in a timely manner. Despite its predictive value, its effectiveness remains suboptimal. An important limitation appears to be poor compliance with the EWS protocol and its variation between general wards. The current research does not yet provide an understanding of EWS compliance and variation in different nursing wards. Aim To explore the variation in nurses' compliance with the EWS protocol among patients with and without complications and between different nursing wards. Methods In a retrospective single-center cohort study, all patient files from three nursing wards of a tertiary teaching hospital in the Netherlands were reviewed over a 1-month period. Compliance was divided into three categories:1) calculation accuracy, 2) monitoring frequency end 3) clinical response. Results The cohort of 210 patients contained 5864 measurements, of which 4125 (70.6 %) included EWS. Significant differences in the measured vital signs within incomplete measurements were found among nursing wards. Compliance to monitoring frequency was higher within EWSs of 0–1 (78.4 %) than within EWSs of ≥2 (26.1 %). The proportion of correct follow-up was significantly higher in patients with complications, as was the correct clinical response to an EWS of ≥3 (84.8 % vs. 55.0; p = .011). Conclusion Our results suggest suboptimal compliance with the EWS protocol, with large variations between patients with and without complications and between different general care wards. Nurses tended to be more compliant with the EWS protocol for patients with complications.

Background The holistic concept of physical literacy (PL) has gained growing attention in recent research, policy, and practice. Many important policy documents of the physical activity and educational fields (e.g., Global Action Plan on Physical Activity 2018–2030 by the World Health Organization, UNESCO’s Quality Physical Education guidelines for policymakers) have specified PL. However, a clear framework for action is needed, as most initiatives across the world are fragmented, lack a prospective orientation, can benefit from conceptual clarification, and are not linked to effective translation into practice. Therefore, we aim to consensually develop a Global Physical Literacy (GloPL) Action Framework to define goals and principles (asking what is needed) as well as actions and ways (asking how these can be achieved) to move PL forward. Materials and methods We apply a three-stage group Delphi technique involving three representation groups: (a) geographical representatives to achieve global coverage of perspectives; (b) representatives of special thematic interest reflecting prominent gaps of current PL activities; and (c) representatives of societies from the broad field of physical activity and health to facilitate dissemination. The process will begin with an individual pre-Delphi exercise, in which experts generate initial ideas for the framework, followed by a four-eye document analysis to derive themes for the discussion. Subsequently, the experts will meet face-to-face in three online rounds to discuss and prioritize the themes. Interspersed formal voting with pre-defined agreement thresholds (via descriptive statistics) will inform the inclusion of themes within the final framework. Conclusions A global consensus on goals, principles, actions, and ways for the development of PL has the potential to provide a largely accepted roadmap for future activities in research, policy, and practice. The co-production approach will help disseminate the GloPL Action Framework and benefit work in relevant application fields of physical activity and health worldwide.

Background Amnestic mild cognitive impairment (aMCI), considered as the prodromal stage of Alzheimer’s disease, is characterized by isolated memory impairment and cerebral gray matter volume (GMV) alterations. Previous structural MRI studies in aMCI have been mainly based on univariate statistics using voxel-based morphometry. Objective We investigated structural network differences between aMCI patients and cognitively normal older adults by using source-based morphometry, a multivariate approach that considers the relationship between voxels of various parts of the brain. Methods Ninety-one aMCI patients and 80 cognitively normal controls underwent structural MRI and neuropsychological assessment. Spatially independent components (ICs) that covaried between participants were estimated and a multivariate analysis of covariance was performed with ICs as dependent variables, diagnosis as independent variable, and age, sex, education level, and site as covariates. Results aMCI patients exhibited reduced GMV in the precentral, temporo-cerebellar, frontal, and temporal network, and increased GMV in the left superior parietal network compared to controls (pFWER < 0.05, Holm-Bonferroni correction). Moreover, we found that diagnosis, more specifically aMCI, moderated the positive relationship between occipital network and Mini-Mental State Examination scores (pFWER < 0.05, Holm-Bonferroni correction). Conclusions Our results showed GMV alterations in temporo-fronto-parieto-cerebellar networks in aMCI, extending previous results obtained with univariate approaches.

In the last decade, Positive Health has taken the Netherlands by storm, having been widely adopted in Dutch healthcare and the public sector at large. But does this new concept deliver on its promises? In their chapter on Positive Health, Van der Linden and Schermer tackle this question by approaching it as a conceptual engineering project. Positive Health, they conclude, ultimately falls short in achieving its aims. But given this disappointing verdict, how can the new health concept’s success be explained? In this short reflection, I draw on my ethnographic fieldwork into Positive Health and key works in Science and Technology Studies to gain insight in the concept’s eager uptake. As I demonstrate, following Positive Health ‘in the wild’ affords a deeper understanding of its social and material life. This not only helps explain the concept’s widespread adoption, but also opens up new vistas for conceptual engineering as a scholarly approach.

Obesity is a chronic disease, and while weight loss is achievable, long-term weight loss maintenance is difficult and relapse common for people living with obesity. Aiming to meet the need for innovative approaches, digital behavior change interventions show promise in supporting health behavior change to maintain weight after initial weight loss. Implementation of such interventions should however be part of the design and development processes from project initiation to facilitate uptake and impact. Based on the development and implementation process of eCHANGE, an evidence-informed application-based self-management intervention for weight loss maintenance, this manuscript provides suggestions and guidance into; (1) How a service design approach can be used from initiation to implementation of digital interventions, and (2) How a technology transfer process can accelerate implementation of research-based innovation from idea to market.

Objective The novel concept of Family-Integrated Care (FICare) requires nurses to be parents' partners in neonatal care. We combined analyses of real-life parent-nurse conversations and interviews to elucidate nurses' role in providing psychosocial support to parents. Findings inform the development of communication training on topicalizing parents' feelings. Methods Conversation analysis of 15 audio-recorded parent-nurse conversations, and thematic analysis of interviews with 2 nurses. Results In parent-nurse conversations, nurses showed a “balancing act” in formulating parents' feelings, revealing the complexities of addressing parents' feelings. Overall, parents confirmed nurses' formulations, but also expanded or modified them, or indicated restricted conversational space. In the interviews, nurses discussed four purposes of conversations with parents, emphasizing elaborating on parents' feelings, while discussing associated challenges. Conclusion Our conversation analysis revealed a continuum of nurses' formulations of parents' feelings, and nurses' reflections illuminated how and when the formulations were used to invite parents' “feelings talk”. Innovation This study is the first to use conversation analysis to analyze parent-nurse conversations. Additionally, it pioneers combining these analyses with interviews, inviting nurses to reflect on how to incorporate the findings into FICare. This combination strongly informs the development of tailored communication training, drawing from real-life conversations and nurses' articulated needs.

This study presents the outcomes of a 5-year personalized integrative coaching program for adults with obesity (body mass index BMI ≥ 30 kg/m²), based upon a systems health perspective, during the first 2 years. This longitudinal study, which had an evolutionary design, included all adults who enrolled in the program. Health-related quality of life (HRQoL) was measured with the Short Form-36 (SF-36), and physical outcomes included weight, waist circumference, aerobic capacity, lipid profile, and HbA1c. Subsequently, participants completed questionnaires (e.g., the Symptom Checlist-90 (SCL-90) and the Checklist Individual Strength (CIS)). Seventy-nine adults with a mean BMI of 39.5 kg/m² (SD 5.3) were included. Forty-four participants completed 2 years in the program. Compared to baseline, there were significant improvements in the SF-36 subscales ‘physical functioning’ (MD 9.9 points, 95% CI: 2.1–17.5, p = 0.013) and ‘general health perceptions’ (MD 9.3 points, 95% CI 2.9–15.7, p = 0.006). Furthermore, significant improvements in physical outcomes and psychosocial questionnaires (e.g., weight loss (MD 3.5 kg, 95% CI: 1.2–5.7, p = 0.003), waist circumference (MD 5.1 cm, 95% CI: 2.4–7.8, p < 0.001), and CIS fatigue (MD 6.8, 95% CI: 3.1–10.5, p = 0.001) were observed. This study highlights the importance of a systems health perspective supporting the development of a personalized integrative coaching program for adults with obesity in a ‘real-world’ setting.

Background: The group climate within residential youth care institutions is considered a transactional process, both within a group of youth from various cultural backgrounds and between them and their group workers. The ongoing interaction between the cultural characteristics of these girls may influence the quality of the group climate. This study aimed to provide an in-depth account of the living group climate experiences and perceptions of Dutch girls with a Moroccan cultural background in Dutch residential groups. Method: Interpretative phenomenological analysis was employed to explore the girls’ group climate experiences. Result: Three major themes emerged, namely (a) level of involvement of Moroccan girls in their living group, (b) perceptions of Moroccan girls’ sense of belonging in a living group, and (c) cultural and religious equality or disparity results in two interaction patterns. The findings revealed that equality or disparity in language, culture, and religion affect Moroccan girls’ experiences and perceptions of the living group climate. A crucial finding was that cultural and religious disparity leads to interaction patterns wherein the girls pre-emptively exclude themselves from receiving support from native group workers. Conclusion: Professionals must be aware of the cultural and religious dynamics, including the interplay and impact of cultural and religious equality and disparity, influencing Moroccan girls’ group climate experiences.