Health care utilisation and problems in accessing health care of female undocumented immigrants in the Netherlands

Contains fulltext : 88419.pdf (publisher's version ) (Closed access)OBJECTIVE: To obtain information about the actual use of health care facilities by undocumented women and to identify obstacles they experience in accessing health care facilities. METHODS: A mixed methods study, with structured questionnaires and semi-structured interviews, was chosen to obtain a complete understanding. One-hundred undocumented women were recruited. Diversity was sought according to age, origin and reason for being undocumented. RESULTS: Undocumented female immigrants have unmet health care needs (56%) and low health care utilisation. Sixty-nine per cent of the women reported obstacles in accessing health care facilities. These included many personal obstacles such as shame, fear and/or lack of information. Poor language proficiency (OR 0.28;. CI 0.09-0.90) reduces utilisation of primary health care services. CONCLUSION: Health care utilisation of undocumented women is low. Undocumented women refrain from seeking health care because of personal obstacles. These women need to be identified and informed about their rights, the health care system and the duty of professional confidentiality of doctors. Finally, institutional obstacles to access care should be removed since they strengthen reluctance to seek help.1 oktober 201

Does improved functional performance help to reduce urinary incontinence in institutionalized older women? a multicenter randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Urinary incontinence (UI) is a major problem in older women. Management is usually restricted to dealing with the consequences instead of treating underlying causes such as bladder dysfunction or reduced mobility.</p> <p>The aim of this multicenter randomized controlled trial was to compare a group-based behavioral exercise program to prevent or reduce UI, with usual care. The exercise program aimed to improve functional performance of pelvic floor muscle (PFM), bladder and physical performance of women living in homes for the elderly.</p> <p>Methods</p> <p>Twenty participating Dutch homes were matched and randomized into intervention or control homes using a random number generator. Homes recruited 6–10 older women, with or without UI, with sufficient cognitive and physical function to participate in the program comprising behavioral aspects of continence and physical exercises to improve PFM, bladder and physical performance. The program consisted of a weekly group training session and homework exercises and ran for 6 months during which time the control group participants received care as usual. Primary outcome measures after 6 months were presence or absence of UI, frequency of episodes (measured by participants and caregivers (not blinded) using a 3-day bladder diary) and the Physical Performance Test (blinded). Linear and logistic regression analysis based on the Intention to Treat (ITT) principle using an imputed data set and per protocol analysis including all participants who completed the study and intervention (minimal attendance of 14 sessions).</p> <p>Results</p> <p>102 participants were allocated to the program and 90 to care as usual. ITT analysis (n = 85 intervention, n = 70 control) showed improvement of physical performance (intervention +8%; control −7%) and no differences on other primary and secondary outcome measures. Per protocol analysis (n = 51 intervention, n = 60 control) showed a reduction of participants with UI (intervention −40%; control −28%) and in frequency of episodes (intervention −51%; control −42%) in both groups; improvement of physical performance (intervention + 13%; control −4%) was related to participation in the exercise program.</p> <p>Conclusions</p> <p>This study shows that improving physical performance is feasible in institutionalized older women by exercise. Observed reductions in UI were not related to the intervention. [Current Controlled Trials ISRCTN63368283]</p

[Evaluation of decontaminated soil. II. Leaching characteristics and composition of contaminated and decontaminated soil.]

Abstract niet beschikbaarIn this study the elemental content and the leachability of As, Cd, Cu, Pb, and Zn from five contaminated and five decontaminated soils are investigated. Decontaminated soils enriched with compost and incubated for some months are also investigated. Compost is added to compensate the decrease of organic matter due to soil cleaning. The main conclusions are: - Due to soil cleaning the elemental content of the soil decreased considerably (> 50%). The methods for the cleaning of contaminated soil do not succeed in bringing down the content to limits specified by the government in the Netherlands. - Soil cleaning doesn't always lead to a reduced leaching of metals. In some cases soil cleaning leads to increased leachability, in spite of the fact that the total amount of metal in the soil decreased. - Soil cleaning leads in only one case (Kat emaille) to a soil that can be re-used as building material without isolating conditions. - The acidity is an important factor, which influences the mobility of metals. - Generally, the addition of compost and incubation for some months leads to an increase in the leachability of As, Cu en Pb.Programmabureau Speerpuntprogramma Bodemonderzoe

Research to the leaching of metals from polluted soil and soil cleaned by NTA-complex, flotation, fractionation, acid-extraction, or thermal treatment

Voor de bestudering van het uitlooggedrag van As, Cd, Cr, Cu, Hg, Ni, Pb, Sn en Zn in gereinigde en ongereinigde grond werden zes grondmonsters elk met drie reinigingsmethoden gereinigd (fractionering, complexering met NTA, flotatie, thermische reiniging en extractie met zuur bij Ph=1 en pH=3). Het uitlooggedrag werd onderzocht met een gestandaardiseerde laboratorium uitloogtest, de SOSUV-test. Uit het onderzoek blijkt, dat op basis van het uitlooggedrag reiniging door extractie met zuur bij pH=3 in het algemeen de beste resultaten geeft. Belangrijk is ook het intensief naspoelen van de grond om nog aanwezige reinigingsmiddelen te verwijderen, alsmede het conditioneren op een zekere pH. Het bleek moeilijk de zuurresten in voldoende mate te verwijderen waardoor vaak verhoogde piekbelastingen werden waargenomen in het eerste deel van de uitloogtest. Indien de gereinigde grond basisch geconditioneerd was, trad voor sommige metalen tijdelijk retentie van de emissie op. Hierin liggen mogelijkheden om ongewenste piekbelastingen te voorkomen. Aanbevolen wordt, om zowel bij de beslissing een grond al dan niet te reinigen, als bij de keuze van een reinigingsmethode, niet alleen de absolute verlaging, maar ook het uitlooggedrag van de contaminerende metalen te betrekken.Abstract not availableDGMH/AS

Research to integration of column- and cascade leaching test

De SOSUV-test bestaat uit een kolomproef, een cascadeproef en een beschikbaarheidsproef, voor een schatting van de emissie van stoffen op korte/middellange en lange termijn. Hierbij wordt er van uitgegaan dat de tweede proef een voortzetting is op de eerste. In de resultaten werden dikwijls discontinuiteiten geconstateerd, juist daar waar genoemde proeven op elkaar aan dienen te sluiten. Het trekken van conclusies voor het uitlooggedrag op termijn wordt daardoor bemoeilijkt. Nagegaan werd of het discontinue uitlooggedrag verklaard en door een aangepaste proefopzet voorkomen kon worden. De experimenten werden verricht aan hoogovenslak, fosforslak, AVI-slak, AVI-vlieggas en verontreinigde grond. In de percolaten werden de elementen As, B, Ca, Cd, Cu, Fe, K, Mo, Na, Pb, V en Zn geanalyseerd. De discontinuiteit bleek deels verklaard te kunnen worden door de diffusie en de ionsterkte, die wel in de kolomproef, maar niet in de cascadeproef een rol spelen. De discontinuiteit werd voorkomen door integratie van kolomproef en cascadeproef.Abstract not availableDGMH/AS

Research to the leaching behaviour as a result of co-disposal of industrial waste materials and domestic waste.

Abstract niet beschikbaarOn request of the Province of Overijssel the National Institute of Public Health and Environmental Protection (RIVM) carried out an investigation to: 1. A test method for industrial waste materials which should be accepted at a dumping site and taking into account the influences of the percolate that has been formed already by domestic waste (co-disposal). 2. An acceptation procedure on the basis of a short test method. 3. A list of components to be tested in this procedure. 4. A list of concentration criterions in terms of leaching and composition of the waste material. The RIVM started with a survey on waste materials which have been frequently offered for dumping. In this study use was made of the Standard Leaching Test (SLT). As leaching agent synthetic rainwater (SRW) was used in order to simulate a mono-disposal of industrial waste and synthetic dumping site percolation water (SPW) was applied with a view to the behaviour of industrial wastes in co-disposal with domestic waste. Fourteen industrial wastes were leached out. The percolates were analyzed on the elements As, Cd, Cr, Cu, Hg, Pb, and Sb.Provincie Overijssel /Roozeboom

Evaluation of decontaminated soil. I. Leaching characteristics and composition of reference soils.

Abstract niet beschikbaarIn this study the leachability of metals from nineteen natural topsoils in the Netherlands has been investigated. The percolates were analyzed on the elements As, Ba, Ca, Cd, Co, Cr Cu, Hg, K, Mg, Mo, Na, Ni, Pb, Sb, Se, Sn, V and Zn. The acidity, cation exchange capacity and the content of metals, clay and organic carbon of the soils have been determined. The following features were been derived: - Relationship was found between the content of clay and the content of Ba, Cr, K, Co, Cu, Mg, Na, Ni, Sn, V and Zn and between the content of organic carbon and Cd, Pb and Hg. - The emission measured by means of the column test showed correlation with the elemental content of Ca, Cd, Co, Pb, Mg and Na. - With the exception of Co, Cu and Hg, a significant relation was found between the emission on one hand and the organic content and cation exchange capacity (CEC) of the soil on the other hand. - In general there was no significant correlation found between emission and the clay content or pH. - The emission of Ca, Mg and Na measured by means of the column test correlated well with emission measured by means of the availability test.Programmabureau Speerpuntprogramma Bodemonderzoek DGM/B

Low power multi-radio coexistence using digital compensation

Modern cell phones contain various transceivers and their number is expected to increase in the future. Multimode devices result with new problems such as serious interference between different transceivers. Different solutions for this problem are thought of compromising on power consumption, cost, size or data rate. Next to this trend, the increasing miniaturization of transistor size driven by Moore’s law has decreased the size of (mainly digital) electronics dramatically. This miniaturization has enabled an enormous computational power in handheld devices. This paper presents a solution for the multimode issues without compromising on power consumption, cost, size or data rate by making use of the available computation power in modern CMOS

Closed-loop adaptation of a nonlinear interference suppressor for local interference in multimode transceivers

In multimode transceivers, the transmitter for one communication standard induces a large interference in the receiver for another standard, exceeding the desired signal by many orders of magnitude. To linearly suppress this interference, the receiver should have a very large linear dynamic range, resulting in excessive power consumption. An adaptive memoryless nonlinearity, which requires an adaptation signal proportional to the envelope of the received interference, can be used to strongly suppress the interference without excessive power consumption. In this paper, we propose to digitally generate the adaptation signal using a model, which describes the adaptation signal in terms of the locally available baseband interference. The model is adapted during the transceiver operation such that the power of the residual interference at the output of the nonlinearity is minimized. Simulation results show that the proposed adaptation method can strongly suppress the interference while a symbol error rate close to that of an exactly linear receiver is achieved