Objective: Self-management is a core theme within chronic care and several evidence-based interventions (EBIs) exist to promote self-management ability. However, these interventions cannot be adapted in a mere copy-paste manner. The current study describes and demonstrates a planned approach in adapting EBI’s in order to promote self-management in community-dwelling people with chronic conditions. Methods: We used Intervention Mapping (IM) to increase the intervention’s fit with a new context. IM helps researchers to take decisions about whether and what to adapt, while maintaining the working ingredients of existing EBI’s. Results: We present a case study in which we used IM to adapt EBI’s to the Flemish primary care context to promote self-management in people with one or more chronic disease. We present the reader with a contextual analysis, intervention aims, and content, sequence and scope of the resulting intervention. Conclusion: IM provides an excellent framework in providing detailed guidance on intervention adaption to a new context, while preserving the essential working ingredients of EBI’s. Practice Implications: The case study is exemplary for public health researchers and practitioners as a planned approach to seek and find EBI’s, and to make adaptations.
In c.1330 the Antwerp public servant Jan van Boendale composed Der Leken Spieghel (The Layman's Mirror), a free adaption of several earlier Latin treatises on education. Van Boendale evidently wanted to ensure that a clear and reliable handbook was available to the laity, who lacked sufficient training in Latin to access the original texts. Der Leken Spieghel consists of four books, each divided into numerous smaller sections. This article presents a fresh translation of paragraph 113, which outlines the four characteristics needed to conduct an honourable life.
Background Literature on self-management innovations has studied their characteristics and position in healthcare systems. However, less attention has been paid to factors that contribute to successful implementation. This paper aims to answer the question: which factors play a role in a successful implementation of self-management health innovations? Methods We conducted a narrative review of academic literature to explore factors related to successful implementation of self-management health innovations. We further investigated the factors in a qualitative multiple case study to analyse their role in implementation success. Data were collected from nine self-management health projects in the Netherlands. Results Nine factors were found in the literature that foster the implementation of self-management health innovations: 1) involvement of end-users, 2) involvement of local and business partners, 3) involvement of stakeholders within the larger system, 4) tailoring of the innovation, 5) utilisation of multiple disciplines, 6) feedback on effectiveness, 7) availability of a feasible business model, 8) adaption to organisational changes, and 9) anticipation of changes required in the healthcare system. In the case studies, on average six of these factors could be identified. Three projects achieved a successful implementation of a self-management health innovation, but only in one case were all factors present. Conclusions For successful implementation of self-management health innovation projects, the factors identified in the literature are neither necessary nor sufficient. Therefore, it might be insightful to study how successful implementation works instead of solely focusing on the factors that could be helpful in this process.
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Het landelijk gebied staat voor ingrijpende veranderingen. In 2050 zal het een geheel ander aanzien hebben. Keuzes van nu, bepalen hoe het toekomstige landschap eruit zal zien. De Europese Commissie en het Rijk zetten hierin de toon waarbij provincies de cruciale uitvoerende regio’s gaan worden. Binnen dit dynamische kader moeten op gebiedsniveau maatwerkoplossingen worden gevonden waarbij publiek/private belanghebbenden samenwerken. Een van de grote landbouw-uitdagingen is de opgave om emissies te reduceren en integraal te verduurzamen. Er is onderzoek nodig om kringlopen (beter) te sluiten, reststromen te verwaarden en onze natuurlijke leefomgeving te beschermen. Uitstoot van CO2, stikstof en methaan heeft aantoonbare schadelijke gevolgen voor onze kwetsbare natuur en het milieu. Hoewel de landbouwsector thans negatief bijdraagt aan de staat van ons milieu kan zij tegelijkertijd ook onderdeel worden van voorgestane oplossingen. Door nabewerkingen van meststromen, kunnen kostbare nutriënten worden teruggewonnen en duurzaam biogas/groengas worden geproduceerd. Aeres, Saxion en VHL (SPRONG-groep), bedrijven en (semi-publieke) overheden kiezen voor een gezamenlijke profilering gericht op een Emissiearme Landbouw en MEstverwaarding iN een gebiedsgerichte contexT (ELEMENT). Het ELEMENT-programma biedt (agrarische) ondernemers uit de mestverwaardingsketen kennis over het hergebruik van meststoffen (verwaarding), sluiten van nutriëntenkringlopen, CO2-neutrale (voedsel)productie, samenwerkingsconcepten voor de optimalisatie van (individuele) bedrijfsresultaten en nieuwe handelingsperspectieven door best practices, business cases en fysieke (mestvergistings en mestverwaardings)installaties te ontwikkelen en te testen. Bovendien worden voornoemde handelingsperspectieven duurzaam verbonden én ingepast in het landelijk/provinciaal geformuleerde gebiedsbeleid en gestelde doelen. Het ELEMENT-programma levert waardevolle bijdragen aan maatschappelijke opgaven in de Sustainable Development Goals, missies van het Horizon Europe-programma gericht op ‘adaption to climate change’, het Gemeenschappelijk Landbouwbeleid (GLB) gericht op milieubescherming, levendige plattelandsgebieden, toekomstbestendigheid van de agrarische sector en aan de missies van de KIA-LWV, KIA-Energietransitie & Duurzaamheid én KIA-Sleuteltechnologieën. Het ELEMENT- programma onderscheidt zich door de actuele integrale aanpak voor nieuwe gebiedsgerichte (landbouw)concepten.
While the creation of an energy deficit (ED) is required for weight loss, it is well documented that actual weight loss is generally lower than what expected based on the initially imposed ED, a result of adaptive mechanisms that are oppose to initial ED to result in energy balance at a lower set-point. In addition to leading to plateauing weight loss, these adaptive responses have also been implicated in weight regain and weight cycling (add consequences). Adaptions occur both on the intake side, leading to a hyperphagic state in which food intake is favored (elevated levels of hunger, appetite, cravings etc.), as well as on the expenditure side, as adaptive thermogenesis reduces energy expenditure through compensatory reductions in resting metabolic rate (RMR), non-exercise activity expenditure (NEAT) and the thermic effect of food (TEF). Two strategies that have been utilized to improve weight loss outcomes include increasing dietary protein content and increasing energy flux during weight loss. Preliminary data from our group and others demonstrate that both approaches - especially when combined - have the capacity to reduce the hyperphagic response and attenuate reductions in energy expenditure, thereby minimizing the adaptive mechanisms implicated in plateauing weight loss, weight regain and weight cycling. Past research has largely focused on one specific component of energy balance (e.g. hunger or RMR) rather than assessing the impact of these strategies on all components of energy balance. Given that all components of energy balance are strongly connected with each other and therefore can potentially negate beneficial impacts on one specific component, the primary objective of this application is to use a comprehensive approach that integrates all components of energy balance to quantify the changes in response to a high protein and high energy flux, alone and in combination, during weight loss (Fig 1). Our central hypothesis is that a combination of high protein intake and high energy flux will be most effective at minimizing both metabolic and behavioral adaptations in several components of energy balance such that the hyperphagic state and adaptive thermogenesis are attenuated to lead to superior weight loss results and long-term weight maintenance.
More and more aged people are joining the traffic, either using a passenger car or through a special low speed two-seater for in-city use. For elderly people, self-management in staying mobile is an essential part of their quality of life. However, with increased involvement of elderly in traffic, the risk of serious accidents increases, especially in cities. Fortunately, a rapid development of innovative technology is shown in vehicle design, with focus on advanced driver support, herewith referred to as ‘ambient intelligence’. This holds a promise to improve the safety situation, under the condition that adaption to the elderly driver’s need is accounted for. And that is not a straightforward issue, since ‘no size fits all’. With increasing age, we see an increased variety in driving skills with emphasis on cognitive, perceptual and physical limitations. In addition, people may suffer from diseases with a neurological background or other (cardiopulmonary disease, obesity or diabetes). The partners in this project have expressed the need to survey the feasibility of ‘ambient intelligence’ technology for low-speed vehicles also addressing E-Health functions to bring people safely home or involve medical help in case of health-critical situations. The MAX Mobiel make their vehicle available for that, and will help to guard the elder customer demand. The HAN Automotive Research team carries out the research, in cooperation with the HAN professorship on E-Health. Hence, both the automotive technology part of the HAN University of Applied Sciences as well as expertise from the Health oriented part of the HAN are included, being essential to successfully extend the relevant technologies to a fully integrated elderly driver support system, in the future. Noldus Information Technology is involved on the basis of their knowledge in human monitoring (drive lab) and data synchronization. The St. Maartenskliniek (Nijmegen) brings in their experience with people being restricted in physical or neurological sense.
