Mass balance of the Greenland Ice Sheet from 1992 to 2018

In recent decades, the Greenland Ice Sheet has been a major contributor to global sea-level rise1,2, and it is expected to be so in the future3. Although increases in glacier flow4–6 and surface melting7–9 have been driven by oceanic10–12 and atmospheric13,14 warming, the degree and trajectory of today’s imbalance remain uncertain. Here we compare and combine 26 individual satellite measurements of changes in the ice sheet’s volume, flow and gravitational potential to produce a reconciled estimate of its mass balance. Although the ice sheet was close to a state of balance in the 1990s, annual losses have risen since then, peaking at 335 ± 62 billion tonnes per year in 2011. In all, Greenland lost 3,800 ± 339 billion tonnes of ice between 1992 and 2018, causing the mean sea level to rise by 10.6 ± 0.9 millimetres. Using three regional climate models, we show that reduced surface mass balance has driven 1,971 ± 555 billion tonnes (52%) of the ice loss owing to increased meltwater runoff. The remaining 1,827 ± 538 billion tonnes (48%) of ice loss was due to increased glacier discharge, which rose from 41 ± 37 billion tonnes per year in the 1990s to 87 ± 25 billion tonnes per year since then. Between 2013 and 2017, the total rate of ice loss slowed to 217 ± 32 billion tonnes per year, on average, as atmospheric circulation favoured cooler conditions15 and as ocean temperatures fell at the terminus of Jakobshavn Isbræ16. Cumulative ice losses from Greenland as a whole have been close to the IPCC’s predicted rates for their high-end climate warming scenario17, which forecast an additional 50 to 120 millimetres of global sea-level rise by 2100 when compared to their central estimate

Op zoek naar weerkaatst plezier : Samenwerking tussen mantelzorgers, vrijwilligers, professionals en cliënten in de multiculturele stad

Mantelzorg en vrijwilligerswerk in de zorg worden steeds belangrijker maar tegelijkertijd steeds schaarser. Meer mensen hebben zorg nodig en minder mensen zijn beschikbaar om te zorgen, bijvoorbeeld doordat meer vrouwen zijn gaan werken. Zorg kan een bron van stress en uitputting zijn maar het kan ook voldoening geven. De manier waarop familieleden, buren, vrijwilligers en professionele zorgverleners samenwerken, heeft daar veel invloed op, blijkt uit dit onderzoek. De onderzoekers spraken 75 autochtone, Marokkaanse, Turkse en Surinaamse Amsterdammers die zorg nodig hebben, hun familieleden, vrijwilligers en professionele zorgverleners. Ze onderscheiden vijf patronen van samenwerking in vijf soorten netwerken, met grote verschillen in overbelasting en voldoening. Het boek geeft allen die beroepshalve of als vrijwilliger of mantelzorger met langdurige zorg te maken hebben, inzicht in de rol van samenwerking en netwerken in het voorkomen van overbelasting van mantelzorgers en vrijwilligers. Het boek biedt bovendien een indringend beeld van wat veranderingen in de zorg voor het alledaagse leven van mensen kunnen betekenen

Two innovative solutions for fragmented care to multi-problem patients in deprived neighbourhoods: 2 case studies

THEORY: In Western countries there is a growing awareness that the way in which health professionals work needs to be more responsive to patients’ and population health needs and problems [1] integrated care is seen as the way forward [2–4]. In the Netherlands low patient satisfaction and participation of multi-problem patients and high health care costs in two deprived neighbourhoods, initiated partnerships between one health insurer and two local authorities. Both partnerships led to cooperation between care, preventive services and social services (Amsterdam Noord and Utrecht Overvecht). Little empirical research has been done regarding the ways in which collaboration of health and social services develops. There are some studies within which authors reflect on aspirations analogue to what the partnerships aspire to. From these insights we form a theoretical framework including ideas on generalist approach [1, 5–7] population health orientation [8–10], and on supporting self-management [11–13]. PURPOSE: In two case studies we built a conceptual model in order to conceptualise this cooperation process in both neighbourhoods and explored the different structures both partnerships led to. METHODS: In a collaborative research we constructed conceptual models and explored the realized structures. Data were drawn from literature review and exploration of the developmental process in both partnerships using qualitative methods (i.e. semi-structured interviews, focus group-interviews, document review, and observations). RESULTS AND CONCLUSIONS: With the conceptual models we clarify the different paths taken in the two neighbourhoods, which resulted in two different solutions to fragmented care. We describe both structures the partnerships led to

Persons with a migration background caring for a family member with dementia:Challenges to shared care

BACKGROUND AND OBJECTIVES: By shedding light on the reasons why persons with a migration background (PwM) may take up the role of family caregiver of a person with dementia, and how this relates to gender norms, we aim to elucidate cultural and social dynamics that impede care sharing.  RESEARCH DESIGN AND METHODS: A qualitative study of 12 PwM who provide care, or have recently provided care, for a family member with dementia was conducted through semi-structured interviews. Identified themes and patterns were analyzed with the help of Hochschild's interpretive framework of framing and feeling rules.  FINDINGS: Our findings illuminate how motivations to provide care are framed through two moral framing rules, reciprocal love and filial responsibility, and how these framing rules are accompanied by the feeling rule of moral superiority over non-caregiving family members. We show how shared dementia care is impeded though these moral framing and feeling rules, and how gender norms impact on an unequal distribution of care-tasks.  IMPLICATIONS: Healthcare practitioners should identify the moral dialectics of caregiving. This means that, on the one hand, they should be aware that moral framing rules may pressure women into exclusive caregiving, and that this can lead to health problems in the long term. On the other, healthcare practitioners should recognize that providing care can create a deep sense of pride and moral superiority. Therefore, showing acknowledgement of the caregiver contribution is a crucial step in creating trust between the caregiver and healthcare practitioner. Furthermore, asking for support should be normalized. Governmental advertisements on care-support can achieve this

Dementia care-sharing and migration: An intersectional exploration of family carers' experiences

Background and objectives: Previous studies show that persons with a migration background (PwM) caring for a family member with dementia often experience access barriers to formal care services, and that family carers often perform the lion's share of care. Yet research offering a detailed account on their experiences of dementia care-sharing is sparse. In this paper, we respond to this knowledge gap by exploring how different social categories impact on practices of care-sharing in our participants and their families. Research design and methods: A qualitative study of six PwM who provide care for a family member with dementia was conducted through two methods: semi-structured, life-story interviews followed by “shadowing” our participants in their daily lives. We were guided by intersectionality as an analytical lens in exploring the multifaceted experiences of care-sharing. Findings: Throughout our analysis, intersections of migration history and social class stood out the most. We elucidate how they influence the attainment of necessary skills to organize and share care-tasks as well as perceptions of “good care.” Additionally, our findings illustrate how one's position within the family, the presence or absence of supportive social networks, religion, gendered care norms, and relationship to the care-recipient are relevant to experiences of care-sharing. Implications: Rather than overemphasizing ethnicity and culture, practice and policy should take into account that intersections of various social categories affect care-sharing and the type of support that is (or is not) organized

Dementia care-sharing and migration: An intersectional exploration of family carers' experiences

Background and objectives Previous studies show that persons with a migration background (PwM) caring for a family member with dementia often experience access barriers to formal care services, and that family carers often perform the lion's share of care. Yet research offering a detailed account on their experiences of dementia care-sharing is sparse. In this paper, we respond to this knowledge gap by exploring how different social categories impact on practices of care-sharing in our participants and their families. Research design and methods A qualitative study of six PwM who provide care for a family member with dementia was conducted through two methods: semi-structured, life-story interviews followed by “shadowing” our participants in their daily lives. We were guided by intersectionality as an analytical lens in exploring the multifaceted experiences of care-sharing. Findings Throughout our analysis, intersections of migration history and social class stood out the most. We elucidate how they influence the attainment of necessary skills to organize and share care-tasks as well as perceptions of “good care.” Additionally, our findings illustrate how one's position within the family, the presence or absence of supportive social networks, religion, gendered care norms, and relationship to the care-recipient are relevant to experiences of care-sharing. Implications Rather than overemphasizing ethnicity and culture, practice and policy should take into account that intersections of various social categories affect care-sharing and the type of support that is (or is not) organized

INTEGRATING PRIMARY CARE AND PUBLIC HEALTH

The recent joint issue of the American Journal of Public Health and the American Journal of Preventive Medicine highlighted the potential of integrating public health and primary care. The key message of this issue is that this integration is promising, timely, and urgently needed in order to measurably improve the US community's health in the 21st century. At the same time authors tempered their expectations. Multiple, promising-though often unsustainable-attempts have been made in the past.(1) (Am J Public Health. Published online ahead of print August 16, 2012: e1. doi:10.2105/AJPH.2012.300977

Patients with multimorbidity and their experiences with the healthcare process: a scoping review

The number of patients with multimorbidity (two or more conditions) is increasing. Observational research has shown that having multiple health problems is associated with poorer outcomes in terms of health, quality of care, and costs. Thus, it is imperative to understand how patients with multimorbidity experience their healthcare process. Insight into patient experiences can be used to tailor healthcare provision specifically to the needs of patients with multimorbidity. To synthesize self-reported experiences with the healthcare process of patients with multimorbidity, and identify overarching themes. A scoping literature review that evaluates both qualitative and quantitative studies published in PubMed, Embase, MEDLINE, and PsycINFO. No restrictions were applied to healthcare setting or year of publication. Studies were included if they reported experiences with the healthcare process of patients with multimorbidity. Patient experiences were extracted and subjected to thematic analysis (interpretative), which revealed overarching themes by mapping their interrelatedness. Overall, 22 empirical studies reported experiences of patients with multimorbidity. Thematic analysis identified 12 themes within these studies. The key overarching theme was the experience of a lack of holistic care. Patients also experienced insufficient guidance from healthcare providers. Patients also perceived system-related issues such as problems stemming from poor professional-to-professional communication. Patients with multimorbidity experience a range of system- and professional-related issues with healthcare delivery. This overview illustrates the diversity of aspects that should be considered in designing healthcare services for patients with multimorbidit