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The promotion of healthy aging has become a priority in most parts of the world and should be promoted at all ages. However, the baseline training of health and social professionals is currently not adequately tailored to these challenges. This paper reports the results of a Delphi study conducted to reach expert agreement about health and social professionals' competencies to promote healthy aging throughout the lifespan within the SIENHA project. Materials and methods: This study was developed following the CREDES standards. The initial version of the competence framework was based on the results of a scoping review and following the CanMEDS model. The expert panel consisted of a purposive sample of twenty-two experts in healthy aging with diverse academic and clinical backgrounds, fields and years of expertise from seven European countries. Agreement was reached after three rounds. The final framework consisted of a set of 18 key competencies and 80 enabling competencies distributed across six domains. The SIENHA competence framework for healthy aging may help students and educators enrich their learning and the academic content of their subjects and/or programs and incentivize innovation.

We demonstrate an application for learning multiplication problems with an adaptive algorithm that is based on a computational cognitive model of the learner's memory. The application helps learners automatise and memorise multiplications through repeated practice over three levels of difficulty. In a naturalistic setting involving more than 500 primary school students (ages 6-10) who together recorded over 300,000 responses, we observed that performance improved as learners using the application progressed through the levels. A model-based analysis of performance revealed that learners' estimated speed of forgetting decreased from the second to the third level. This is consistent with a shift towards stronger declarative knowledge and/or more efficient computation procedures. The model also identified consistent differences in the difficulty of individual multiplication facts that persisted across levels. This study demonstrates the feasibility of using an adaptive fact learning application to help young learners master multiplication, an essential mathematical skill.

In personalized-schedule learning, previous research has shown the benefit of initial attempted retrieval of study-items on short-term retention and later test performance. As a way of prior-knowledge identification, initial attempted retrieval may help to optimize learning and long-term performance further, through the removal (or ‘drop') of items from the learning set that are answered correctly on the first attempt. This study sought to support this hypothesis through a real-world, within-subjects experiment, comparing vocabulary test performance of Dutch middle school students after the use of a drop- and non-drop adaptive learning algorithm. The results show that short- and long-term item retention was higher for material studied using the drop-algorithm, while dropping items did not lead to worse retention compared to items that were kept upon initial correct responses. This suggests that initially-known items are correctly identified as ‘mastered', and that their removal from the learning material allows students to focus their efforts on unknown items, leading to increased learning gains.

While students typically prefer multiple-choice learning, open-answer questions have frequently been found to be more effective, attributed to their role in promoting recall as opposed to recognition. Here, we examine increasing the effectiveness of multiple-choice testing as a learning tool, by using foils (incorrect answer options) that are similar in meaning and word form to the correct answer. Participants studied French-Dutch vocabulary in three learning conditions: one with unrelated foils, another with open questions, and a third using multiple choice questions with related foils. The related foils were either semantically or orthographically similar to the correct answer. The results showed no significant difference between the open questions and the related foils condition, indicating comparable effectiveness. Replicating earlier studies, the unrelated foils condition yielded significantly poorer learning outcomes. Overall, these results suggest that multiple-choice testing can be a viable alternative to open answer testing when utilizing related foils.

Background: Breast cancer is the most common cancer in women, and breast reconstruction improves the patient's quality of life. Autologous breast reconstruction provides benefits of natural appearance, feel, and long-term results without implant-associated problems. However, thin patients are not always suitable for standard autologous reconstructions. In these patients, an omental flap could be a useful alternative. The aim of this review was to provide an overview of the literature regarding the clinical outcomes of omental flaps in breast reconstruction. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Medline and Embase databases up to November 1, 2023. Study outcomes were type of flap, tissue transfer, cosmetic outcomes, and short- and long-term complications. Results: Eleven studies covering 985 reconstructions in 969 patients were included. The omentum was mostly laparoscopically harvested (88.6%) and a pedicled reconstruction was mostly performed (91.2%). The most commonly reported short-term complications were wound infections at the donor site (5.8%), partial flap necrosis, and fat necrosis. In the long term, epigastric, umbilical and tunnel hernias, and epigastric bulging were observed. Satisfactory cosmetic results were reported by the patients (88.7%) and professionals (80.0%). Conclusion: Breast reconstruction using an omental flap can be performed in unilateral reconstructions with acceptable donor-site morbidity if laparoscopically harvested. In general, satisfactory cosmetic outcomes were reported and it appears to be a suitable alternative for selected patients who prefer autologous, unilateral breast reconstruction. Further research is necessary to determine the ideal candidates for this reconstruction and the long-term effects of an omentectomy in young patients.

Abstract Background Older adults account for a large proportion of hospital admissions. In this study we aim to bridge a gap between medical and psychosocial factors in predicting hospitalisation. Methods Demographic and social characteristics of community-dwelling pre-frail and frail older people were collected by questionnaires every six months during a two year follow-up. Hospital admission within this period was dichotomised as yes/no. To define pre-frailty and frailty the Fried frailty criteria were used. Analysis of risk factors for hospitalisation was performed using multivariable logistic regression. Results Hospitalised participants (n = 1803) were more often male and frail in comparison to not-hospitalised participants. They also experienced more chronic diseases (54.5% ≥ 4 chronic diseases), poorer self-perceived health (SPH) (76.4% fair to very poor) and lack of informal care (20.1%). In multivariable logistic regression male gender (Odds ratio (OR) 1.65, p

Abstract Background Although indicated, referrals for multifactorial fall risk assessments in older adults with fall related injuries presenting at the emergency department (ED) are not standard. The implementation of a transmural fall-prevention care pathway (TFCP) could bridge this gap by guiding patients to multifactorial fall risk assessments and personalised multidomain interventions in primary care. This study aims to develop and evaluate implementation strategies for a TFCP. Methods In this mixed-methods implementation study, strategies were developed using the Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change Matching Tool. These were evaluated with patients, involved healthcare professionals, and other stakeholders using the Reach, Adoption, Implementation, and Maintenance of the RE-AIM framework in two cycles. Patients of the TFCP consisted of frail community dwelling individuals aged 65 and over presenting at the ED with fall related injuries. Results During the first implementation phase, strategies were focussed on assessing readiness, adaptability, local champions, incentives and education for all involved healthcare professions in the TFCP. Only 34.4% of eligible patients were informed of the TFCP at the ED, 30.6% agreed to a fall risk assessment and 8.3% patients received the fall risk assessment. In the second phase, this improved to 67.1%, 64.6%, and 35.4%, respectively. Strategies in this phase focussed on adaptability, obtaining sustainable financial resources, local champions, assessing readiness, and education. The implementation was facilitated by strategies related to awareness, champion recruitment, educational meetings, adaptability of TFCP elements and evaluations of facilitators and barriers. Conclusion The study outlined strategies for implementing TFCPs in EDs. Strategies included increasing awareness, utilising local champions, educational initiatives, adaptability of the TFCP, and continuous monitoring of facilitators and barriers. These insights can serve as a blueprint for enhancing fall prevention efforts for older adults in emergency department settings.

Increasing mental health issues, such as emotional problems, pose a threat for the academic performance of undergraduate students. We propose a route connecting emotional problems and academic performance through executive functioning skills (EFS). Despite the abundance of research on the topic of EFS, there is a significant gap in understanding this route, specifically among a population of undergraduate students. The aim of this study was to examine whether EFS mediated the association between emotional problems and academic performance among undergraduate students. Cross-sectional data (n = 2,531) was used from a survey among Dutch undergraduate students from a large variety of faculties at a university of applied sciences. We assessed emotional problems using the Depression Anxiety Stress Scale-21, five EFS (cognitive inhibition, task initiation, sustained attention, planning, time management), and academic performance (study delay; yes/no). Mediation analyses were performed, using the Hayes PROCESS macro, adjusted for gender. We found that cognitive inhibition, task initiation, sustained attention, planning, and time management mediated the association between emotional problems and academic performance. Regarding separate EFS, no large differences were found. The data suggests that improving all EFS in undergraduates experiencing emotional problems could be a fruitful strategy for preventing academic delays.

Worldwide, the drainage of peatlands has turned these systems from CO2 sinks into sources. In the Netherlands, where ∼7 % of the land surface consists of peatlands, drained peat soils contribute >90 % and ∼3 % to the country's soil-derived and total CO2 emissions, respectively. Hence, the Dutch National Climate Agreement has set targets to cut these emissions. One potential mitigation measure is the application of subsurface water infiltration systems (WISs) consisting of subsurface pipes connected to ditchwater. WISs aim to raise the water table depth (WTD) in dry periods to limit peat oxidation while maintaining current land-use practices. Here, we used automated transparent chambers in 12 peat pasture plots across the Netherlands to measure CO2 fluxes at high frequency and assess (1) the relationship between WTD and CO2 emissions for Dutch peatlands and (2) the effectiveness of WISs in mitigating emissions. Net ecosystem carbon balances (NECBs) (up to 4 years per site, 2020–2023) averaged 3.77 and 2.66 tCO2-Cha-1yr-1 for control and WIS sites, respectively. The magnitude of NECBs and the slope of the WTD–NECB relationship fall within the range of observations of earlier studies in Europe, though they were notably lower than those based on campaign-wise, closed-chamber measurements. The relationship between annual exposed carbon (C; defined as the total amount of carbon within the soil above the average annual WTD) and NECB explained more variance than the WTD–NECB relationship. The magnitude of the NECB represented 1.0 % of the annual exposed C on average, with a maximum of 2.4 %. We found strong evidence for a reducing effect of WISs on CO2 emissions, reducing emissions by 2.1 (95 % confidence interval 1.2–3.0) tCO2-Cha-1yr-1, and no evidence for an effect of WISs on the WTD–NECB and annual exposed carbon–NECB relationships. This means that relationships between either WTD or exposed carbon and NECB can be used to estimate the emission reduction for a given WIS-induced increase in WTD or exposed carbon. High year-to-year variation in NECBs calls for multi-year measurements and sufficient representative measurement years per site as demonstrated in this study with 35 site-year observations.

Abstract Background Findings from the Global Burden of Disease (GBD) study have shown that the burden of mental and substance use disorders is considerable, and unevenly distributed across demographic groups in the population. However, there is a lack of knowledge on how this burden differs by socioeconomic position. The aim of this study was to examine educational differences in years lived with disability (YLDs) from mental and substance use disorders among males and females in two high-income countries, taking comorbidity with other diseases into account. Methods The study included all registered residents in Denmark and Norway from 2011 to 2021. Diagnostic information was retrieved from records in the Norwegian National Patient Registry (NPR) and the Danish Psychiatric Central Research Register (PCRR) and used as proxy measures for disorder prevalence. Demographical and educational information was taken from administrative registries. The YLD is a measure of the non-fatal health loss in the population and was calculated by multiplying the duration of a disorder with a disability weight (DW), scaled between 0 and 1. Information on remission and DWs were retrieved from the GBD study and other sources, and disorder specific DWs were averaged by severity levels and adjusted for comorbidity. Results Educational gradients in YLD rates were found for mental and substance disorders overall, and for most of the specific disorders. The educational gradient was more pronounced for schizophrenia, intellectual disability and substance use disorders than for eating, anxiety, and affective disorders. Both higher YLD rates, and a larger attributed proportion of the total YLDs, were found for schizophrenia, intellectual disability, and substance use disorders in the groups with low versus high education. YLD rates for eating, anxiety, and affective disorders were more equal across educational levels, but constituted a smaller proportion of the total YLDs among the groups with low versus the groups with high educational level. Conclusion Most of the disease burden related to mental and substance use disorders falls on those with the fewest years of education. This should be taken into consideration when public health targets aimed at improving mental health and reducing social inequalities in health are developed and implemented.

Abstract To provide the information needed for a detailed monitoring of crop types across the European Union (EU), we present an advanced 10-metre resolution map for the EU and Ukraine with 19 crop types for 2022, updating the 2018 version. Using Earth Observation (EO) and in-situ data from Eurostat’s Land Use and Coverage Area Frame Survey (LUCAS) 2022, the methodology included 134,684 LUCAS Copernicus polygons, Sentinel-1 and Sentinel-2 satellite imagery, land surface temperature and a digital elevation model. Based on this data, two classification layers were developed using a Random Forest machine learning approach: a primary map and a gap-filling map to address cloud-covered gaps. The combined maps, covering 27 EU countries, show an overall accuracy of 79.3% for seven major land cover classes and 70.6% for all 19 crop types. The trained model was used to derive the 2022 map for Ukraine, demonstrating its robustness even in regions without labelled samples for model training.

Abstract In the last two decades, an exponentially growing number of meta-analyses (MAs) synthesize thousands of peer-reviewed studies on the environmental impacts of farming practices (FPs). This paper describes the iMAP-FP evidence library, a comprehensive dataset on the effects of 34 categories of FPs (such as agronomic practices, cropping and livestock systems, land management options and mitigation techniques) on 34 impacts including climate mitigation, soil health, environmental pollution, water use, nutrients cycling, biodiversity, and agricultural productivity. Through systematic screening, 570 MAs published since 2000 were selected and categorized according to the type of FP. We assessed their impacts, the geographic regions covered, and their quality. We extracted 3,811 effects and their statistical significance associated with sustainable FPs (intervention) compared to a control (typically conventional agriculture) across 223 different intervention-control pairs. Our dataset is accompanied with an online free-access library, which includes a catalogue of synthetic reports summarizing the available evidence on each evaluated FP.

Background: Centralization of care jeopardizes interns' learning experiences and necessitates educational changes. Here we present the development and evaluation of a structured digital curriculum, offered in addition to the clinical internship, to address these challenges. Methods: The structured digital curriculum was implemented in a the VUmc/Amsterdam UMC surgical internship program in the Netherlands. The curriculum used a modular format built around a skill or clinical condition. Each module included background information, digital elements like e-learnings and interactive vlogs, and self-assessments. From April 1st to June 30th, 2022, we conducted a mixed-methods evaluation comparing interns' experiences between the conventional and digital curriculum through surveys and interviews. Results: Thirty-nine interns (28.1 %) completed the survey, 17 (24.2 %) from the traditional curriculum and 22 (31.9 %) from the structured blended curriculum. Results from the interviews triangulated and complemented survey results. Interns appreciated both curricula (course marks 7.4 ± 2.0 vs. 8.1 ± 1.1, P = 0.207). The intervention cohort specifically appreciated the structured and comprehensive presentation of available study materials, which resulted in a sense of empowerment. Conclusions: Integrating a structured digital curriculum to support clinical internships provides interns with comprehensive, readily accessible knowledge, refines their understanding of clinical topics, and results in feelings of empowerment. The combination of clinical and digital education ensures adequate exposure to subjects vital for future doctors, even if clinical exposure is limited. Thus, using a structured digital curriculum prepares the intern and helps the internship program to adequately navigate future medical challenges. Key message: Centralization of care jeopardizes interns' learning experiences and necessitates educational changes. A structured digital curriculum can empower interns in this scenario by providing readily accessible knowledge which refines their understanding of clinical topics.

There is increasing interest in examining the development of frontal EEG power in relation to self-regulation in early childhood. However, the majority of previous studies solely focuses on the brain’s alpha rhythm and little is known about the differences between young boys and girls. The aim of the current study was therefore to gain more insight into the neural mechanisms involved in the emergence of self-regulation. The sample consisted of 442 children and data were collected at approximately 5 months, 10 months, and around 3 years of age. Latent growth curve models indicated that,while the neurobiological foundations of self-regulation are established during infancy,it is the maturation of the frontal alpha rhythm that contributes to variations in both observed and parent-reported self-regulation. In addition, it appears that boys might have a greater reliance on external regulation than girls during early childhood, as evident by higher scores of girls on both measures of self-regulation. More insight into the role of external regulators in brain maturation can help to implement interventions aimed at establishing bottom-up self-regulatory skills early in life, in order to provide the necessary foundations for the emergence of top-down self-regulatory skills in the preschool period.

Agri-environmental schemes (AES) implemented by farmer collectives for meadow bird protection in The Netherlands create complex landscape mosaics due to the variability of options and combinations farmers use. We propose a method to simplify this complexity, using the number of meadow birds potentially benefiting as the measure of success, and evaluate how AES combinations affect management success as a function of monetary investments. Between 2016 and 2022, we conducted field surveys to measure the density and distribution of Black-tailed Godwits across three land-use types: AES, site-protected areas, and intensive agriculture. AES fields were categorized into nest protection, inundation, delayed mowing, and herb-rich grasslands. We analysed the relationship between these managements, the area they cover, and godwit numbers, while also examining land area and subsidies. Intensive agriculture covered 74.3 % of the area but hosted only 23.2 % of the godwit population at low densities (0.063 godwits/ha). In contrast, protected areas (6.2 % of the area) and AES fields (19.5 %) supported 24.7 % and 52.1 % of the population at higher densities (0.48 and 0.46 godwits/ha, respectively). Among AES types, delayed mowing and herb-rich grasslands showed the highest godwit densities (0.66 and 1.25 godwits/ha, respectively) covering smaller areas (6 % and 1.1 %). These AES types pay the highest subsidies, while nest protection, covering 10.5 % of the area with lower godwit densities, pays the lowest. Although AES fields hosted about half of the godwit population, area-wise the focus remained on nest protection, and with intensive agriculture dominated the landscape. This may limit effectiveness at a population level, calling for re-evaluating conservation priorities and funding.

Objectives To determine the prevalence of food insecurity among individuals with coeliac disease (CeD) and non-coeliac gluten sensitivity (NCGS) in the Netherlands and explore its association with diet quality and other barriers to adherence to a gluten-free diet.Design Mixed-method design comprising a survey and semistructured interviews.Setting An online survey was distributed through social media accounts and the newsletter of the Dutch Association for Celiac Disease. Community-dwelling patients were surveyed and interviewed between June and November 2023.Participants and outcome measures In total 548 adults with CeD and NCGS in the Netherlands who adhered to a gluten-free diet completed the survey including questions related to demographics, household food insecurity, financial stress and diet quality. Regression analyses were conducted to assess associations between food insecurity and diet quality, and between food insecurity and perceived difficulty of gluten-free eating and cooking. Additionally, semistructured interviews with eight food insecure adults with CeD were conducted.Results The prevalence of food insecurity was 23.2%, with 10.4% reporting very low food security. Very low food insecurity was associated with poorer diet quality (β=−5.5; 95% CI=−9.2 to –1.9; p=0.003). Food insecurity was associated with heightened perceived barriers across multiple themes. In age, income and education adjusted models, compared with food secure participants, low food secure participants were more likely to experience difficulty regarding skills (OR=2.5; 95% CI=1.5 to 4.3; p≤0.001), social circumstances (OR=2.6; 95% CI=1.1 to 6.4; p=0.038), resources (OR=2.5; 95% CI=1.5 to 4.4; p=0.001) and naturally gluten-free products (OR=1.8; 95% CI=1.0 to 3.1; p=0.045) in gluten-free eating and cooking. Participants with very low food security were more likely to experience difficulty regarding skills (OR=4.4; 95% CI=2.4 to 8.1; p≤0.001) and resources (OR=4.2; 95% CI=2.3 to 7.8; p

Diverse communities of arable plants contribute to the long-term sustainability of agroecosystems and support a large variety of ecosystem services. Agricultural intensification influences the composition and structure of these communities and is one of the major drivers of biodiversity loss in Europe. Several European Union (EU) policies seek to reverse agroecosystems degradation and need biodiversity data-based indicators. Here we focus on arable fields with crops and arable plants. Open access to biodiversity data, such as through the Global Biodiversity Information Facility (GBIF), opens multiple options to develop large-scale indicators. We investigate whether occurrences of certain weeds from GBIF could become indicators of lower levels of agricultural intensification. For this, we designed an EU-scale data-driven proof of concept, using a 2018 EU28-wide 10 m resolution map of maize and a total of 2,082,796 occurrences data for 156 weed species associated to this crop. A total of 12 arable plants sensitive to intensification were identified that could possibly become indicators. We also show how GBIF data is able to capture the effect of proxies for agricultural intensification on plant communities associated with crops. Even with the limitations of studying only one crop for a single year, we present some of the potential of these data to assess the condition of agroecosystems. Novel integration of biodiversity relevant observations across scales will need to underpin the characterization of agroecosystems to inform farm, as well as landscape management and policy impact evaluation.