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The article presents the authors' views in response to a comment on their paper "Patterns of Low and Lowest-Low Fertility in Europe," published in a 2004 issue of the journal "Population Studies." In their comment, the critics have argued that the cohort-fertility analysis in the aforesaid paper is weak on theoretical grounds and the empirical analysis is incomplete. The authors affirm that they agree with the comment that, as a society, the Netherlands differs from Southern Europe and even more from Central and Eastern Europe. Nevertheless, from a contemporary global perspective, these differences should not be overemphasized. They say that in their analyses, they used the Netherlands as a reference case of a country with an extraordinary pattern of late childbearing that is not associated with lowest-low fertility levels. However, the critics believe that these unusual characteristics invalidate the use of the Dutch example in the paper. So, this criticism is misconceived. It is precisely the unusualness of the fertility pattern in the Netherlands that makes it a useful reference point in the study of low and lowest-low fertility.

Implementation of the Nitrates Directive (NiD) and its environmental impacts were compared for member states in the Northwest of the European Union (Ireland, UK, Denmark, The Netherlands, Belgium, Northern France and Germany). The main sources of data were national reports for the third reporting period for the NiD (2004-2007) and results of the MITERRA-EUROPE model. Implementation of the NiD in the considered member states is fairly comparable regarding restrictions for where and when to apply fertilizer and manure, but very different regarding application limits for N fertilization. Issues of concern and improvement of the implementation of the NiD are accounting for the fertilizer value of nitrogen in manure, and relating application limits for total nitrogen (N) to potential crop yield and N removal. The most significant environmental effect of the implementation of the NiD since 1995 is a major contribution to the decrease of the soil N balance (N surplus), particularly in Belgium, Denmark, Ireland, The Netherlands and the UK. This decrease is accompanied by a modest decrease of nitrate concentrations since 2000 in fresh surface waters in most countries. This decrease is less prominent for groundwater in view of delayed response of nitrate in deep aquifers. In spite of improved fertilization practices, the southeast of The Netherlands, the Flemish Region and Brittany remain to be regions of major concern in view of a combination of a high nitrogen surplus, high leaching fractions to groundwater and tenacious exceedance of the water quality standards. On average the gross N balance in 2008 for the seven member states in EUROSTAT and in national reports was about 20 kg N ha-1 lower than by MITERRA. The major cause is higher estimates of N removal in national reports which can amount to more than 50kgNha~1. Differences between procedures in member states to assess nitrogen balances and water quality and a lack of cross boundary policy evaluations are handicaps when benchmarking the effectiveness of the NiD. This provides a challenge for the European Commission and its member states as the NiD remains an important piece of legislation for protecting drinking water quality in regions with many private or small public production facilities and controlling aquatic eutrophication from agricultural sources. [ABSTRACT FROM AUTHOR]

In this special issue we present three papers selected from the 18th meeting of the EURO Working Group on Transportation (EWGT) which was held in July 2015 in Delft, the Netherlands, organized by Delft University of Technology. The selected contributions reflect the diversity of topics that were addressed in this conference, which is dedicated to mathematical modeling of transportation problems. We are happy to have a small but representative sample in which three different modes of transportation are in focus: the bicycle, the car and the airplane. The editors are very grateful for all the work that authors and referees have put in creating interesting research papers in this broad field of transportation research. This editorial first explains what the EWGT is and how the EWGT conference was organized. The three contributions are then presented and put into the perspective of the Dutch edition of the EWGT conference. [ABSTRACT FROM AUTHOR]

Objectives. To review the prevalence of loneliness (during/after COVID-19) in older people. Design. Scoping review using Medline and PsycInfo for worldwide prevalence estimates (white published literature search) and Google for prevalence data inside the Euregio Meuse-Rhine (grey literature). Setting. Worldwide prevalence estimates and a focus on the Euregio Meuse-Rhine. Participants. Papers published between 2016 and 2022 and a mean age of minimum of 65 years. Measurements. Prevalence estimates for older people. Results. The white literature search yielded 37 articles. Before the onset of the COVID-19 pandemic, loneliness estimates were the highest in Nigeria (46%) and the lowest in Australia (5%) (mean prevalence was 25.6%). Loneliness was reported to be higher in specific populations, for example, people living in specific communities such as senior housing communities or with impairments, than in the general population, with a mean prevalence estimate of 47.8%. During COVID-19, the prevalence of loneliness was higher than that before the pandemic: we observed a mean prevalence of 39.4%, in comparison to 25.6 before COVID-19. The grey literature search showed that, compared to Belgium and the Netherlands (13.5% and 36.5%, respectively), loneliness estimates were the lowest in Germany, with a mean prevalence of 7.7%. Conclusion. Large international differences in the prevalence of loneliness were observed between countries and populations studied. Several hypotheses could explain such differences, including sociocultural or historical-political characteristics. Without surprise, the pandemic and associated measures were linked to a higher level of loneliness. Furthermore, recommendations for addressing loneliness, including interventions, are discussed. [ABSTRACT FROM AUTHOR]

This paper reviews the available evidence on post-war trends in Dutch private wealth inequality using a range of scattered sources. Wealth tax records suggest a substantial decline in inequality to the 1970s and, more tentatively, a gradual rise thereafter. In the post-1990 years, Gini-coefficients of private wealth inequality range from 0.8 to 0.9, which is at the high end of the international comparison. Such high levels of private wealth inequality contrast with relatively low levels of net income inequality; a paradox that the Netherlands share with other Northern European welfare states. We hypothesise that publicly funded life-time income security limits the wealth-formation by ordinary Dutch households, while the redistributive taxes required to finance this system are targeting income rather than wealth. [ABSTRACT FROM AUTHOR]

Background: Accounting for patients' perspective has become increasingly important. Based on the Consumer Quality Index method (founded on Consumer Assessment of Healthcare Providers and Systems) a questionnaire was recently developed for Dutch cancer patients. As a next step, this study aimed to adapt and pilot this questionnaire for international comparison of cancer patients experience and satisfaction with care in six European countries.Method: The Consumer Quality Index was translated into the local language at the participating pilot sites using cross-translation. A minimum of 100 patients per site were surveyed through convenience sampling. Data from seven pilot sites in six countries was collected through an online and paper-based survey. Internal consistency was tested by calculating Cronbach's alpha and validity by means of cognitive interviews. Demographic factors were compared as possible influencing factors.Results: A total of 698 patients from six European countries filled the questionnaire. Cronbach's alpha was good or satisfactory in 8 out of 10 categories. Patient satisfaction significantly differed between the countries. We observed no difference in patient satisfaction for age, gender, education, and tumor type, but satisfaction was significantly higher in patients with a higher level of activation.Conclusion: This European Cancer Consumer Quality Index(ECCQI) showed promising scores on internal consistency (reliability) and a good internal validity. The ECCQI is to our knowledge the first to measure and compare experiences and satisfaction of cancer patients on an international level, it may enable healthcare providers to improve the quality of cancer care. [ABSTRACT FROM AUTHOR]

The article discusses the Provincial Council of Utrecht in the Netherlands during the Enlightenment. This paper focuses on the marginal groups of Catholics stranded in Protestant republic and their dilemma of being cut off by the papacy. This gave a picture of afflicted member in the early church where sympathetic churchmen in Catholic Europe came to their aid in the role of epistolary communicants. Civic humanism is the central theme in this paper where the characteristics of apostolic church is given full account.

Background: To examine and compare the research productivity on selected fields related to health literacy of the current members of the European Union, the four candidate countries waiting to join the EU, Norway, Switzerland, and the United States. Methodology/Principal findings: A bibliometric analysis (1991-2005). Data sources included papers published by authors from each country separately. The 25 European countries produce less than 1/3 health literacy research when compared to the U.S. (13,710 and 49,523 articles were published by authors with main affiliation in the European Union and the four candidate countries, and the U.S., respectively). The Netherlands and Sweden (followed by Germany, Italy, and France) are the European countries with the highest number of research published in fields related to health literacy. After adjustment for population Sweden, Finland, and Norway, were on the top of the relevant list. In addition, Sweden, Finland, and Ireland, were on the top of the list of countries regarding research productivity on the selected fields after adjustment for gross domestic product (GDP). Conclusions/Significance: Inequalities in research published on the topic of health literacy exist among Europe, Norway, Switzerland, and the U.S. More research may need to be done in all areas of health literacy in Europe and the potential detrimental effects of this gap should be further investigated. [ABSTRACT FROM AUTHOR]

Eutrophication by human activities is increasingly affecting ecosystem functioning and plant community composition. So far, studies mainly focus on the effects of atmospheric nitrogen deposition, surface water eutrophication or soil nutrient accumulation. Groundwater pollution of spring habitats, however, has received much less attention, although numerous papers report groundwater nutrient enrichment worldwide. This study presents a survey on groundwater pollution (with emphasis on nitrate and phosphate) and bryophyte composition in 51 ambient petrifying springs in 5 NW European countries, which were compared to published data from 173 other sites in 11 European countries. The reviewed dataset covers a broad range of unpolluted to heavily polluted springs with nitrate concentrations between 0.7 and 3227 μmol l−1. Most petrifying springs in the rural lowlands of NW Europe were found to have elevated concentrations of nitrate and phosphate with the most polluted springs occurring in The Netherlands. The cover of individual characteristic bryophyte species significantly correlates with groundwater nutrient concentrations indicating that nutrient pollution of spring waters affects bryophyte composition. Palustriella commutata, Eucladium verticillatum and Brachythecium rivulare prefer unpolluted petrifying springs whereas Cratoneuron filicinum and Pellia endiviifolia show a much broader tolerance to groundwater pollution. In order to sustain at least the basic conditions for the typical bryophyte composition of petrifying springs habitats, threshold values of 288 μmol (18 mg l−1) NO 3 − l−1 and 0.42 μmol (0.04 mg l−1) ortho-PO 4 3- l−1 were defined. Data analysis of the spring water composition indicates that the main source for nutrient and nutrient induced base cation enrichment are nitrate losses from intensively used agricultural fields. The anthropogenically induced but regionally different chemical processes in subsoil and aquifers can result in different levels of nutrient pollution in springs. Further regulations for nitrate and phosphate application are required to conserve and restore groundwater fed ecosystems in Europe. • A study on Groundwater pollution of petrifying springs. • A correlative study on 51 springs in NW-European countries. • Including data from 173 sites in 11 European countries. • Threshold values of 288 μmol NO 3 − l−1 and 0.42 μmol ortho-PO 4 2- l−1 were defined. • Main source of groundwater pollution are nitrate losses from agricultural. [ABSTRACT FROM AUTHOR]

This article presents information about several study programs and conferences. A new four-year program on European Management and Organizations in Transition has been approved by the European Science Foundation beginning in 1993. It will be directed by professor Anna Grandori and professor Richard Whitley. A conference on Educational innovation in Economics and Business Administration will be held during December 9-11, 1993 in Maastricht, the Netherlands. The central theme of the conference will be "Innovation in Economics and Business Administration Education: The Case of Problem-Based Learning". The conference is designed to bring together faculty members, policy-makers, and educational researchers to address issues which will emerge whenever faculty decide to implement new educational approaches or to improve educational quality. In addition to paper presentations and workshops, a meeting will be held to organize a Network of Faculties of economics and business administration. The general aim of the network will be to provide mutual support to member institutions that wish to adapt their curriculum to highly innovative programs.

The Wound‐QoL assesses the impact of chronic wounds on patients' health‐related quality of life (HRQoL). A 17‐item and a shortened 14‐item version are available. The Wound‐QoL‐17 has been validated for multiple languages. For the Wound‐QoL‐14, psychometric properties beyond internal consistency were lacking. We aimed to validate both Wound‐QoL versions for international samples representing a broad range of European countries, including countries for which validation data had yet been pending. Patients with chronic wounds of any aetiology or location were recruited in Austria, Lithuania, the Netherlands, Poland, Slovakia, Spain, Switzerland and Ukraine. Psychometric properties were determined for both Wound‐QoL versions for the overall sample and, if feasible, country‐wise. We included 305 patients (age 68.5 years; 52.8% males). Internal consistency was high in both Wound‐QoL‐17 (Cronbach's α: 0.820–0.933) and Wound‐QoL‐14 (0.779–0.925). Test–retest reliability was moderate to good (intraclass correlation coefficient: 0.618–0.808). For Wound‐QoL‐17 and Wound‐QoL‐14, convergent validity analyses showed highest correlations with global HRQoL rating (r = 0.765; r = 0.751) and DLQI total score (r = 0.684; r = 0.681). Regarding clinical data, correlations were largest with odour (r = −0.371; r = −0.388) and wound size (r = 0.381; r = 0.383). Country‐wise results were similar. Both Wound‐QoL versions are valid to assess HRQoL of patients with chronic wounds. Due to its psychometric properties and brevity, the Wound‐QoL‐14 might be preferrable in clinical practice where time is rare. The availability of various language versions allows for the use of this questionnaire in international studies and in clinical practice when foreign language patients are being treated. [ABSTRACT FROM AUTHOR]

A child's disability, long-term illness, or mental ill-health is known to affect siblings' health, social life, school engagement, and quality of life. This article addresses a research gap by its focus on young sibling carers and the impact of providing care to a sibling. A cross-national survey study was conducted in 2018–2019 (Italy, the Netherlands, Slovenia, Sweden, Switzerland, the UK) to examine the incidence of adolescent sibling carers, the extent of care they provide, and their self-reported health, well-being, and school situation. The survey was completed by 7146 adolescents, aged 15–17, and 1444 of them provided care to family members with health-related conditions. Out of these, 286 were identified as Sibling Carers and 668 as Parent Carers, while 181 had both sibling(s) and parent(s) with health-related conditions, and thus were identified as Sibling–Parent Carers. Sibling Carers and Sibling–Parent Carers carried out higher levels of caring activities compared to Parent Carers. They reported both positive aspects of caring, such as increased maturity, and negative aspects, such as mental ill-health, impact on schooling and a lack of support. To reduce the negative aspects of a sibling carer role, it is important to recognise them and to implement early preventive measures and formal support. [ABSTRACT FROM AUTHOR]

Purpose: Achieving greater health and social care integration is a policy priority in many countries, but challenges remain. We focused on governance and accountability for integrated care and explored arrangements that shape more integrated delivery models or systems in Italy, the Netherlands and Scotland. We also examined how the COVID-19 pandemic affected existing governance arrangements. Design/methodology/approach: A case study approach involving document review and semi-structured interviews with 35 stakeholders in 10 study sites between February 2021 and April 2022. We used the Transparency, Accountability, Participation, Integrity and Capability (TAPIC) framework to guide our analytical enquiry. Findings: Study sites ranged from bottom-up voluntary agreements in the Netherlands to top-down mandated integration in Scotland. Interviews identified seven themes that were seen to have helped or hindered integration efforts locally. Participants described a disconnect between what national or regional governments aspire to achieve and their own efforts to implement this vision. This resulted in blurred, and sometimes contradictory, lines of accountability between the centre and local sites. Flexibility and time to allow for national policies to be adapted to local contexts, and engaged local leaders, were seen to be key to delivering the integration agenda. Health care, and in particular acute hospital care, was reported to dominate social care in terms of policies, resource allocation and national monitoring systems, thereby undermining better collaboration locally. The pandemic highlighted and exacerbated existing strengths and weaknesses but was not seen as a major disruptor to the overall vision for the health and social care system. Research limitations: We included a relatively small number of interviews per study site, limiting our ability to explore complexities within sites. Originality: This study highlights that governance is relatively neglected as a focus of attention in this context but addressing governance challenges is key for successful collaboration. [ABSTRACT FROM AUTHOR]

Background The European Union has used Healthy Life Years (HLY) as an indicator to monitor the health of its aging populations. Scholarly and popular interest in HLY across countries has grown, particularly regarding the ranking of countries. It is important to note that HLY is based on self-assessments of activity limitations, raising the possibility that it might be influenced by differences in health reporting behaviours between populations, a phenomenon known as differential item functioning (DIF). Methods We estimated DIF-adjusted HLY at age 50 for Belgium, France, Germany, Greece, Italy, the Netherlands, Spain, and Sweden to determine the extent to which differences in HLY might be influenced by reporting heterogeneity across countries. We used anchoring vignettes, taken from the 2004 Survey of Health, Ageing and Retirement in Europe, to estimate DIF-adjusted prevalence rates of activity limitations measured by the Global Activity Limitations Indicator (GALI). The Sullivan method was used to calculate DIF-adjusted HLY. Results Changes in HLY before and after adjustment ranged from a 1.20-year decrease for men in Italy to a 1.61-year increase for women in Spain. Adjustment for DIF produced changes in the rankings of the countries by HLY, with upward and downward movements of up to three positions. Conclusion Our results show that DIF is likely to affect HLY estimates, thereby posing a challenge to the validity of comparisons of HLY across European countries. The findings suggest that HLY should be used to monitor population health status within a country, rather than to make comparisons across countries. [ABSTRACT FROM AUTHOR]

Internet usage is a salient developmental factor in adolescents' lives. Although relevant correlates of Internet use have been documented earlier, there is a lack of information on lower socioeconomic status groups. This is important, as these adolescents have increased risk of negative online experiences. The current survey aimed to explore Internet use and parental involvement amongst adolescents from areas of socio-economic disadvantage in 30 urban schools across five European countries. A total of 2594 students participated, of whom 90% were 14–16 years. Virtually all adolescents of socioeconomic disadvantage had Internet access, with 88.5% reporting spending more than two hours per day online, often on apps such as Instagram, Snapchat, and YouTube. Almost one-third of adolescents did not talk with their parents about their Internet use and almost two-thirds indicated that their parents were only a little or not interested in their Internet use. A consistent finding across countries was that girls more often talked with their parents about their Internet use and more often reported that their parents were interested in their Internet use than boys. The results suggest that parents have an important task in explicitly showing interest in their adolescents' Internet use, with special attention needed for boys. [ABSTRACT FROM AUTHOR]

European countries are experiencing population decline, and the tacit assumption in most analyses is that this decline may have detrimental effects on welfare. In this paper, we use a survey conducted in the Netherlands to find out whether population decline is always met with fear. A number of results stand out. Population size preferences differ by geographic proximity, as the majority of respondents favor a decline in the global population, but support a stationary population closer to home. Population decline is clearly not always met with fear: 31% of respondents would like the population to decline at the national level, and they generally perceive decline to be accompanied by non-material welfare gains (improved environment), as well as material welfare losses (tax increases, economic stagnation). In addition to these driving forces, it appears that attitudes toward immigrants are very strong determinants of views regarding population growth at the local and the national levels. Immigrants seem to inspire greater fear than the prospect of population decline. [ABSTRACT FROM AUTHOR]

This paper investigates the strategies, structures and performance of large Dutch firms in the period 1963-2003, and compares the results with those of other European companies. Did Dutch companies develop corporate strategies and structures comparable to other European companies in response to the Treaty of Rome 1957, which signalled the start of gradual European economic integration? In this period Dutch firms became larger and increasingly active outside their national borders. This article describes the strategies and structures of large firms in this period, in order to investigate how firms dealt with the changing environment and also how firms anticipated and benefited from these changes. In addition, it analyses the corporate performance effects of changes in the environment and strategies and structures. With a strong preference for related diversification, Dutch companies showed a strategy comparable with three large European countries. Initially, many Dutch companies opted for the multidivisional structure, but after the 1980s the functional holding gradually became the most important structure. The choice of structure, however, was not critical to performance, in contrast to the choice of strategy. The related diversified strategy turned out to be the best performing strategy. [ABSTRACT FROM AUTHOR]

The European natural gas market is characterized by declining indigenous resources, particularly in the UK and the Netherlands, and a growing dependence on a small number of large exporters who, as a consequence, see their market power increasing. In this paper we analyze long-run scenarios for the European natural gas markets in a model, NATGAS, that explicitly includes both factors, resource constraints and producers' market power. Finite resources lead to interdependencies of current production decisions and future opportunities. These decisions in turn depend on the potential for large producers to set market prices above marginal costs. We analyze the impact of conditions on the global LNG market on market shares of pipeline gas suppliers, as well as on the speed of depletion of indigenous European resources. We focus on how shadow prices of resource constraints affect substitution patterns in the various scenarios. [ABSTRACT FROM AUTHOR]

Europe has come to recognize that its regions have a major role to play in achieving its cohesion and competitiveness objectives. EU policies and Structural Fund principles are therefore increasingly geared towards enhancing regional capacities. Regions across Europe are responding, with varying results so far. The Randstad, in the Netherlands, presents itself as a 'far from best' example. Despite continued and serious attempts to strengthen capacities and institutions, the region still lacks effective governance. This paper explores the question why it is next to impossible to establish a framework for effective governance in the Randstad and distils some lessons for other regions in Europe. [ABSTRACT FROM AUTHOR]

This paper examines the bases of opposition to immigrant minorities in Western Europe, focusing on The Netherlands. The specific aim of this study is to test the validity of predictions derived from two theories-realistic conflict, which emphasizes considerations of economic well-being, and social identity, which emphasizes considerations of identity based on group membership. The larger aim of this study is to investigate the interplay of predisposing factors and situational triggers in evoking political responses. The analysis is based on a series of three experiments embedded in a public opinion survey carried out in The Netherlands (n = 2007) in 1997-98. The experiments, combined with parallel individual-level measures, allow measurement of the comparative impact of both dispositionally based and situationally triggered threats to economic well-being and to national identity at work. The results show, first, that considerations of national identity dominate those of economic advantage in evoking exclusionary reactions to immigrant minorities and, second, that the effect of situational triggers is to mobilize support for exclusionary policies above and beyond the core constituency already predisposed to support them. [ABSTRACT FROM AUTHOR]

Modal shift in freight transport entails moving freight from road to rail, inland waterways, and short sea shipping. In current Dutch and European freight transport policy, modal shift is foreseen to play an important role to mitigate external effects of freight transport. Policy efforts on modal shift are legitimate because the size of the external costs of freight transport are considerable. But can modal shift policies also be effective? In other words, can policy efforts on modal shift result in a decrease of external costs and infrastructure costs due to freight transport? Our research approach falls apart into three steps. In the first step we analyse the transported weight by road on four international freight corridors in North-western Europe that could be transported against at least 10% lower private costs by rail or inland waterways. The share of road transport (transported weight) on the corridors in total road transport in the Netherlands is about 10%. The weight of the cargo that could potentially be shifted on the basis of the transport cost criterium is called the modal shift potential (MSP). We estimate the MSP for the base year 2018 and for the future year 2050. Also in this step, we translate the MSP into changes in transport performance per transport mode. In the second step we determine differences in external costs and user dependent infrastructure costs per unit of transport performance (tonkm) between the transport modes road, rail, and inland waterways. The following external effects are included: greenhouse gas emissions (tank-to-wheel), air pollutant emissions (tank-to-wheel), noise, traffic accidents, congestion, and emissions from fuel and electricity production (well-to-tank) for freight vehicles. Including all these effects, we take a more integral approach than existing studies on the effect of modal shift on the external costs of freight transport. In the third step, we combine the results of steps 1 and 2 and calculate the changes in external costs and infrastructure costs that result from the MSP's. We find MSP's of between 35 and 55%, depending on the market segment (container, or non-container transport, and year). These percentages may seem substantial, but we emphasize that on the freight transport corridors rail and inland waterways are (very) competitive to road. Estimates for the decrease in external- and user dependent infrastructure costs if the MSP's are fully realized point to reductions of €67 million to €150 million for the Netherlands, and €87 million to €136 million abroad for 2018 (considering all countries through which the corridors pass). We emphasize that these are maximum annual savings which can only be achieved if all non-transport cost obstacles for modal shift can be removed. For 2050 estimating a maximum and minimum for the change in external- and infrastructure costs is impossible due to uncertainties in the development of the transport costs and the external costs of freight transport. Because for the year 2018 the MSP's result in a decrease of external costs and infrastructure costs from freight transport on the corridors, we conclude that in the coming years policy efforts on modal shift can be effective. We can however not conclude anything about the efficiency: are the benefits of policy efforts on modal shift larger than the costs? If that is not the case, taking modal shift measures can eventually not be justified from an economic welfare point of view. [ABSTRACT FROM AUTHOR]

The recent COVID-19 pandemic affected various aspects of life. Several studies established the consequences of pandemic lockdown on air quality using satellite remote sensing. However, such studies have limitations, including low spatial resolution or incomplete spatial coverage. Therefore, in this paper, we propose a machine learning-based scheme to solve the pre-mentioned limitations by training an optimized space-time extra trees model for each year of the study period. The results have shown that our trained models reach a prediction accuracy up to 95% when predicting the missing values in the MODIS MCD19A2 Aerosol Optical Depth (AOD) product. The outcome of the mentioned scheme was a geo-harmonized atmospheric dataset for aerosol optical depth at 550 nm with 1 km spatial resolution and full coverage over Europe. As an application, we used the proposed machine learning based prediction approach in AOD levels analysis. We compared the mean AOD levels between the lockdown period from March to June in 2020 and the mean AOD values of the same period for the past 5 years. We found that AOD levels dropped over most European countries in 2020 but increased in several eastern and western countries. The Netherlands had the most significant average decrease in AOD levels (19%), while Spain had the highest average increase (10%). Moreover, we analyzed the relationship between the relative percentage difference of AOD and four meteorological variables. We found a positive correlation between AOD and relative humidity and a negative correlation between AOD and wind speed. The value of the proposed prediction scheme is further emphasized by taking into consideration that the reconstructed dataset can be used for future air quality studies concerning Europe. [ABSTRACT FROM AUTHOR]

The article presents information about the book "Institutions and Regional Labour Markets in Europe." The book contains twelve papers that take an institutional perspective in comparing the performance of European labor markets in different regional socioeconomic settings. The papers discuss the spatial-institutional perspective on the labor market in Europe; general changes in the European labor market; regional and institutional changes in European labor markets; regional labor markets and institutions in Great Britain; institutions and regional labor markets in the Netherlands; institutions and regional return to education in Sweden; institutions and regional labor markets in Spain.

This paper refutes Stark and lannaccone's recent argument about secularization in Europe as applied to the Netherlands. Relevant Dutch evidence shows that both organized religion and subjective religiosity have declined in the Netherlands since the 1950s. Any deregulation and increases in pluralism that occurred in that period did not have the theoretically expected effects. The anomalous Dutch case casts further doubt on the explanatory power of "supply-side" theories in the sociology of religion. [ABSTRACT FROM AUTHOR]

This paper presents some empirical evidence, for Belgium, the Netherlands and France, on the so-called 'administrative inflation' hypothesis. The hypothesis might be defined as saying that price increases are higher in more concentrated industries, given positive changes in demand and costs. Empirically speaking, it implies that, for a cross-section of industries, wholesale-price changes are a positive function of concentration ratios, for given increases in demand and unit costs. Although any relevant evidence would be an interesting contribution to the present discussion about the Common Market's antitrust policy, the hypothesis has never been confronted-to my knowledge-with data from European Economic Community (E.E.C.) countries. The evidence presented in this paper is limited to the 1958-65 period, because of the difficulty in collecting comparable data form earlier years. As we were more familiar with Belgian data, Belgium was selected as a test case to detetmine the most appropriate empirical specification of the hypothesis. A few changes in Weiss's approach proved to be beneficial and are discussed in section it together with the data and results obtained for Belgium. In section III, results for the Netherlands are compared with the Belgian evidence on the basis of an analysis of covariance. Section IV introduces France while the last section draws some conclusions as to the validity of the hypothesis in a European framework.

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other's experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills. [ABSTRACT FROM AUTHOR]

Background: From October 2018, adalimumab biosimilars could enter the European market. However, in some countries, such as Netherlands, high discounts reported for the originator product may have influenced biosimilar entry. Objectives: The aim of this paper is to provide a European overview of (list) prices of originator adalimumab, before and after loss of exclusivity; to report changes in the reimbursement status of adalimumab products; and discuss relevant policy measures. Methods: Experts in European countries received a survey consisting of three parts: 1) general financing/co-payment of medicines, 2) reimbursement status and prices of originator adalimumab, and availability of biosimilars, and 3) policy measures related to the use of adalimumab. Results: In May 2019, adalimumab biosimilars were available in 24 of the 30 countries surveyed. Following introduction of adalimumab biosimilars, a number of countries have made changes in relation to the reimbursement status of adalimumab products. Originator adalimumab list prices varied between countries by a factor of 2.8 before and 4.1 after loss of exclusivity. Overall, list prices of originator adalimumab decreased after loss of exclusivity, although for 13 countries list prices were unchanged. When reported, discounts/rebates on originator adalimumab after loss of exclusivity ranged from 0% to approximately 26% (Romania), 60% (Poland), 80% (Denmark, Italy, Norway), and 80–90% (Netherlands), leading to actual prices per pen or syringe between €412 (Finland) and €50 – €99 (Netherlands). To leverage competition following entry of biosimilar adalimumab, only a few countries adopted measures specifically for adalimumab in addition to general policies regarding biosimilars. In some countries, a strategy was implemented even before loss of exclusivity (Denmark, Scotland), while others did not report specific measures. Conclusion: Even though originator adalimumab is the highest selling product in the world, few countries have implemented specific policies and practices for (biosimilar) adalimumab. Countries with biosimilars on the market seem to have competition lowering list or actual prices. Reported discounts varied widely between countries. [ABSTRACT FROM AUTHOR]

The article offers information on several symposiums including The World Congress of Neuroradiology in Bologna in Europe from October 4-9, 2010, OARS World Congress on Osteoarthritis from September 23-26 in Brussels, Belgium and Musculoskeletal Disorders in Primary Care Research Congress 2010 from October 11-13, 2010 in Rotterdam.

The purpose of the paper is to develop the theory that structural or procedural changes in institutions precede changes in education in a society. It examines the development of pre-modern institutions in Western Europe in the 16th and 17th centuries and the influences this had on growth in literacy rates within these states. Literacy rates in Western European countries during the Middle Ages were below twenty percent of the population. For most countries, literacy rates did not experience significant increases until the Enlightenment and industrialization. Two early exceptions to this broad trend were the Netherlands and England, which had achieved literacy rates above fifty percent of their populations by the mid-seventeenth century. The explanations for these divergent trends are the structural changes in formal institutions that embodied capital markets, protected private property, and overall established the initial steps in developing modern political institutions. This created incentives to invest more in schools per capita as well as incentives for a middle class to invest more in literacy and numeracy skills for a market-exchange economy that was becoming more specialized in division of labor.

Widespread use of the Internet in 21st century society is not risk-free. This paper studies the comorbidity of some problematic uses of Internet with depression in order to assess their correlation. With that aim, a meta-analysis of 19 samples obtained from 13 different studies (n=33,458) was carried out. The subjects of these studies are adolescents between the ages of 12 and 18 years ([mu]=15.68) from different cultures and continents (Europe, Euro-Asia, America and Asia). The effect size obtained from the use of a random-effects model (r=0.3, p<0.000) is significant, moderate and positive, thus confirming the relation between pathologic uses of the Internet and depression. Moreover, meta-regression test results showed that 9% of the variance (R2=0.09) is associated with the male gender, while age and culture are not significant variables. The variability rate of the studies is high (I2=87.085%), as a consequence of heterogeneity rather than publication bias, as Egger's regression test shows (1-tailed p-value=0.25; 2-tailed p-value=0.50, and [sigma]=1.57). Therefore, the need for specific interventions in secondary education dealing with this issue is evident to ensure that it does not extend into adult life.

This paper contributes to the debate on Europe's modern economic growth using the statistical concept of long-range dependence. Different regimes, defined as periods between two successive endogenously estimated structural shocks, matched episodes of pandemics and war. The most persistent shocks occurred at the time of the Black Death and the twentieth century's world wars. Our findings confirm that the Black Death often resulted in higher income levels but reject the view of a uniform long-term response to the Plague. In fact, we find a negative impact on incomes in non-Malthusian economies. In the North Sea Area (Britain and the Netherlands), the Plague was followed by positive trend growth in output per capita and population, heralding the onset of modern economic growth and the Great Divergence in Eurasia. [ABSTRACT FROM AUTHOR]

The European Reference Network for rare liver diseases (ERN RARE-LIVER) is a Europe-wide network of paediatric and adult hepatologists from expert centres in close collaboration with patient advocates from the various disease-areas covered in our ERN. The ERN is focused on providing more equitable care across Europe and creates a network of both medical specialists and patient experts in rare liver disease. This position paper summarizes the achievements of the first year and plots the route for the near future for ERN RARE-LIVER, as discussed during a strategy meeting that took place 27 and 28 February 2018 in Nijmegen, the Netherlands. ERN RARE-LIVER has established itself as a group with experts, hospitals and patients. One of the tools to improve communication is the clinical patient management system (CPMS) that allows access to expert consultation by European physicians confronted with a patient with rare liver disease. ERN RARE-LIVER will function as the platform to improve healthcare by initiating registries, foster research efforts and coordinate development of clinical guidelines in Europe. [ABSTRACT FROM AUTHOR]

The presence of a weekly cycle in the abundance of an atmospheric constituent is a typical fingerprint for the anthropogenic nature of its emission sources. However, while ammonia is mainly emitted as a consequence of human activities, a weekly cycle has never been detected in its abundances at large scale. We expose here for the first time the presence of a weekend effect in the NH3 total columns measured by the IASI satellite sounder over the main agricultural source regions in Europe: northwestern Europe (Belgium-the Netherlands-northwest Germany), the Po Valley, Brittany, and, to a lesser extent, the Ebro Valley. A decrease of 15% relative to the weekly mean is seen on Sunday–Monday observations in northwestern Europe, as a result of reduced NH3 emissions over the weekend. This is confirmed by in situ NH3 concentration data from the National Air Quality Monitoring Network in the Netherlands, where an average reduction of 10% is found around midnight on Sunday. The identified weekend effect presents a strong seasonal variability, with two peaks, one in spring and one in summer, coinciding with the two main (manure) fertilization periods. In spring, a reduction on Sunday–Monday up to 53 and 26% is found in the NH3 satellite columns and in situ concentrations, respectively, as fertilization largely drives atmospheric NH3 abundances at this time of the year. [ABSTRACT FROM AUTHOR]

Student learning outcomes assessment examines whether programs cover the material stated in their learning goals, whether students are learning the material, and the impact on student retention, graduation, post-graduation outcomes, and institutional accreditation, with the aim of providing faculty with data that can be used to help programs evolve or improve. While there is a plethora of research regarding effective methods of assessment used in the United States, little has been written regarding cross-national comparisons of assessment methodologies. This paper examines the current state of assessment in several nations and regions, and draws parallels in practices across countries. A literature search using the term "outcomes assessment" yielded 228 articles, of which, only 35 described practices outside the United States. Generally, searches on the terms "outcomes assessment" and "global" tend to return studies of outcomes assessment of teaching about global issues as it is practiced in the United States, rather than results about outcomes assessment practices used in other countries.

Background: Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach. Methods: We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists. Results: Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care. Conclusions: According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care. [ABSTRACT FROM AUTHOR]

Objectives To measure changes in prevalence and predictors of home smoking bans (HSBs) among smokers in four European countries after the implementation of national smoke-free legislation. Design Two waves of the International Tobacco Control Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data were used from Ireland, France, Germany and the Netherlands. Two pre-legislation waves from the UK were used as control. Participants 4634 respondents from the intervention countries and 1080 from the control country completed both baseline and follow-up and were included in the present analyses. Methods Multiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation. Results Most smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child. Generalised Estimating Equation models indicated that the change in total HSB in the intervention countries was greater than that in the control country. Conclusions The findings suggest that smoke-free legislation does not lead to more smoking in smokers' homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate smokers to establish total smoking bans in their homes. [ABSTRACT FROM AUTHOR]

The article presents the author's views on the influence of the European Union (EU) on the national criminal law of member states. She investigates how the third EU Anti-money laundering directive is transposed in the Netherlands and Belgium taking a comparative law approach. She discusses how the EU directive strives for and the discretion it allows for EU member countries in the implementation process, how it affects the way the European Criminal Law influences domestic criminal law. She also explores how the results of a directive can be achieved or frustrated. She believes that the degree of harmonisation determines whether European countries are allowed to adopt stricter rules or whether they have to implement the directive directly.

This article discusses a new social and political phenomenon in Europe, which has become evident along with the visibility of Islam in the European public space. Revealing the current social-political context in Western Europe, which is mainly characterized by a growing drift of securitization of Islam and migration, this paper argues that there are two simultaneously running processes regarding the changing nature of Euro-Islam, which seem to are antithetical: individualization of Islam vs. institutionalization of Islam. Drawing upon the findings of the field research in Germany, France, Belgium and the Netherlands, this article shows that while the processes of globalization seem to prompt younger generations with Muslim background to liberate themselves from the constraints of their patriarchal parental and community culture, western states as well as ethnocultural and religious brokers tend to reify, or reinforce, their existing communal and religious boundaries. That is to say that the descendants of migrants seem to have been squeezed between individualization and institutionalization of Islam. [ABSTRACT FROM AUTHOR]

The article discusses the increase in market concentration of European banking sector due to liberalization, internationalization and deregulation of financial market in eurozone. The article states that the official interest rate changes in bank mortgage rates to about half of eurozone average reflecting the Dutch mortgage contracts with high maturity than other European countries. The article also discusses the detection of price leadership in monitoring market for mortgage loans.

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The 1980s and 1990s have been decades of quite good economic growth in North America and much of Western Europe. But how have the fruits of growth been shared? This paper reviews changing income distributions in the U.S., Germany and the Netherlands. These three countries may be taken as exemplars and leading economic performers in "the three worlds of welfare capitalism" (Esping-Andersen, 1990). The U.S. is a liberal welfare-capitalist state, Germany a corporatist state, and the Netherlands (less clearly) a social democratic welfare-capitalist state. The paper focuses particularly on income changes in the bottom, middle and top quintiles and takes a ten year period into account. Previous analyses have shown that labor and market income dispersion are increasing, with increased returns to human capital. The potential impact of government through the tax-transfer system has been largely ignored. All three governments redistribute income from the rich to the poor. However, the paper shows that only the Dutch government has redistributed sufficiently to ensure that the bottom quintile has gained along with others. In Germany and the U.S. the poorest quintile was considerably worse off in absolute terms at the end of the decade.than the beginning. The German government somewhat counteracted the trend towards greater income dispersion by redistributing to the poorest quintile, so the loss of market income was partly compensated. In the U.S. the impact of government on the poorest quintile stayed about the same, so this group ended up with about the same decrease in disposable income as market income. The U.S., Germany and the Netherlands are the only three countries for which ten or more consecutive years of panel data are available. The data come from the PSID-GSOEP Equivalent File 1980-97 and from a comparable file constructed from the Dutch SEP data.

This literature review aims to examine the approach given to open science policy in the different studies. The main findings are that the approach given to open science has different aspects: policy framing and its geopolitical aspects are described as an asymmetries replication and epistemic governance tool. The main geopolitical aspects of open science policies described in the literature are the relations between international, regional, and national policies. There are also different components of open science covered in the literature: open data seems much discussed in the works in the English language, while open access is the main component discussed in the Portuguese and Spanish speaking papers. Finally, the relationship between open science policies and the science policy is framed by highlighting the innovation and transparency that open science can bring into it.

Background: To be able to provide high-quality palliative care, there need to be a number of organizational structures available in the nursing homes. It is unclear to what extent such structures are actually present in nursing homes in Europe. We aim to examine structural indicators for quality of palliative care in nursing homes in Europe and to evaluate the differences in terms of availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives. Methods: A PACE cross-sectional study (2015) of nursing homes in Belgium, England, Finland, Italy, the Netherlands and Poland. Nursing homes (N = 322) were selected in each country via proportional stratified random sampling. Nursing home administrators (N = 305) filled in structured questionnaires on nursing home characteristics. Organization of palliative care was measured using 13 of the previously defined IMPACT structural indicators for quality of palliative care covering four domains: availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives. We calculated structural indicator scores for each country and computed differences in indicator scores between the six countries. Pearson's Chi-square test was used to compute the p-value of each difference. Results: The availability of specialist palliative care teams in nursing homes was limited (6.1–48.7%). In Finland, Poland and Italy, specialist advice was also less often available (35.6–46.9%). Up to 49% of the nursing homes did not provide a dedicated contact person who maintained regular contact with the resident and relatives. The 24/7 availability of opioids for all nursing home residents was low in Poland (37.5%). Conclusions: This study found a large heterogeneity between countries in the organization of palliative care in nursing homes, although a common challenge is ensuring sufficient structural access to specialist palliative care services. Policymakers and health and palliative care organizations can use these structural indicators to identify areas for improvement in the organization of palliative care. [ABSTRACT FROM AUTHOR]

Background: The objective of this work was to analyse the prevalence trends of multimorbidity among European community-dwelling adults.Methods: A temporal series study based on waves 1, 2, 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 274,614) from 15 European countries were selected for the period 2004-2017. Prevalence, adjusted by age, Average Annual Percentage Change (APC) and 95% confidence interval (95% CI) were all calculated. Trend analyses were realised by period, age groups and groups of diseases.Results: The results showed a large variability in the prevalence of multimorbidity in adults aged 50 and over among European countries. Increase in the prevalence of multimorbidity in the countries of central Europe (Austria, Belgium, Czech Republic, France, Germany and Switzerland) and Spain in both sexes, and in the Netherlands among men. Stability was observed in northern and eastern European countries. Musculoskeletal and neurodegenerative groups showed more significant changes in the trend analyses.Conclusions: This information can be useful for policy makers when planning health promotion and prevention policies addressing modifiable risk factors in health. [ABSTRACT FROM AUTHOR]

Background: Monovalent meningococcal C conjugate vaccine (MCCV) was introduced into the routine immunization program in many countries in Europe and worldwide following the emergence of meningococcal serogroup C (MenC) in the late 1990s. This systematic literature review summarizes the immediate and long-term impact and effectiveness of the different MCCV vaccination schedules and strategies employed.Methods: We conducted a systematic literature search for peer-reviewed, scientific publications in the databases of MEDLINE (via PubMed), LILACS, and SCIELO. We included studies from countries where MCCV have been introduced in routine vaccination programs and studies providing the impact and effectiveness of MCCV published between 1st January 2001 and 31st October 2017.Results: Forty studies were included in the review; 30 studies reporting impact and 17 reporting effectiveness covering 9 countries (UK, Spain, Italy, Canada, Brazil, Australia, Belgium, Germany and the Netherlands). Following MCCV introduction, significant and immediate reduction of MenC incidence was consistently observed in vaccine eligible ages in all countries with high vaccine uptake. The reduction in non-vaccine eligible ages (especially population > 65 years) through herd protection was generally observed 3-4 years following introduction. Vaccine effectiveness (VE) was mostly assessed through screening methods and ranged from 38 to 100%. The VE was generally highest during the first year after vaccination and waned over time. The VE was better maintained in countries employing catch-up campaigns in older children and adolescents, compared to routine infant only schedules.Conclusions: MCCV were highly effective, showing a substantial and sustained decrease in MenC invasive meningococcal disease. The epidemiology of meningococcal disease is in constant transition, and some vaccination programs now include adolescents and higher valent vaccines due to the recent increase in cases caused by serogroups not covered by MCCV. Continuous monitoring of meningococcal disease is essential to understand disease evolution in the setting of different vaccination programs. [ABSTRACT FROM AUTHOR]

Background Tobacco-control policies have been suggested to reduce smoking among adolescents. However, there is limited evidence on the real-world costs of implementation in different settings. In this study, we aimed at estimating the costs of school smoking bans, school prevention programmes and non-school bans (smoking bans in non-educational public settings, bans on sales to minors and bans on point-of-sale advertising), implemented in Finland, Ireland, the Netherlands, Belgium, Germany, Italy and Portugal, for 2016. Methods We retrospectively collected costs related to the inspection, monitoring and sanctioning activities related to bans and educational activities related to smoking prevention programmes. We used an 'ingredients-based' approach, identifying each resource used, quantity and unit value for one full year, under the state perspective. Costs were measured at national, regional, local and school-level and were informed by data on how these activities were performed in reality. Results Purchasing power parities adjusted-costs varied between €0.02 and €0.74 (average €0.24) per person (pp) for bans implemented outside schools. Mean costs of school smoking bans ranged from €3.31 to €34.76 (average €20.60), and mean costs of school educational programmes from €0.75 to €4.65 (average €2.92). Conclusions It is feasible to estimate costs of health policies as implemented in different settings. Costs of the tobacco control policies evaluated here depend mainly on the number of person-hours allocated to their implementation, and on the scale of intervention. Non-school bans presented the lowest costs, and the implementation of all policies cost up to €36 pp for 1 year. [ABSTRACT FROM AUTHOR]

Cultural background is an important variable influencing neuropsychological performance. Multinational projects usually involve gathering data from participants from different countries and/or different cultures. Little is known about the influence of culture on neuropsychological testing results in children and especially in European children. The objectives of this study were to compare neuropsychological performance of children from six European countries (Belgium, Germany, Italy, The Netherlands, Poland and Spain) using a comprehensive neuropsychological battery and to apply a statistical procedure to reduce the influence of country/cultural differences in neuropsychological performance. As expected, the results demonstrated differences in neuropsychological performance among children of the six countries involved. Cultural differences remained after adjusting for other confounders related to neuropsychological execution, such as sex, type of delivery, maternal age, gestational age and maternal educational level. Differences between countries disappeared and influence of culture was considerably reduced when standardised scores by country and sex were used. These results highlight the need for developing specific procedures to compare neuropsychological performance among children from different cultures to be used in multicentre studies. [ABSTRACT FROM AUTHOR]

Commercially motivated junk news–i.e. money-driven, highly shareable clickbait with low journalistic production standards–constitutes a vast and largely unexplored news media ecosystem. Using publicly available Facebook data, we compared the reach of junk news on Facebook pages in the Netherlands to the reach of Dutch mainstream news on Facebook. During the period 2013–2017 the total number of user interactions with junk news significantly exceeded that with mainstream news. Over 5 Million of the 10 Million Dutch Facebook users have interacted with a junk news post at least once. Junk news Facebook pages also had a significantly stronger increase in the number of user interactions over time than mainstream news. Since the beginning of 2016 the average number of user interactions per junk news post has consistently exceeded the average number of user interactions per mainstream news post. [ABSTRACT FROM AUTHOR]

Objectives: Value of information (VOI) analysis provides information on opportunity cost of a decision in healthcare by estimating the cost of reducing parametric uncertainty and quantifying the value of generating additional evidence. This study is an application of the VOI methodology to the problem of choosing between home telemonitoring and nurse telephone support over usual care in chronic heart failure management in the Netherlands. Methods: The expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) analyses were based on an informal threshold of €20K per quality-adjusted life-year. These VOI-analyses were applied to a probabilistic Markov model comparing the 20-year costs and effects in three interventions. The EVPPI explored the value of decision uncertainty caused by the following group of parameters: treatment-specific transition probabilities between New York Heart Association (NYHA) defined disease states, utilities associated with the disease states, number of hospitalizations and ER visits, health state specific costs, and the distribution of patients per NYHA group. We performed the analysis for two population sizes in the Netherlands—patients in all NYHA classes of severity, and patients in NYHA IV class only. Results: The population EVPI for an effective population of 2,841,567 CHF patients in All NYHA classes of severity over the next 20 years is more than €4.5B, implying that further research is highly cost-effective. In the NYHA IV only analysis, for the effective population of 208,003 patients over next 20 years, the population EVPI at the same informal threshold is approx. €590M. The EVPPI analysis showed that the only relevant group of parameters that contribute to the overall decision uncertainty are transition probabilities, in both All NYHA and NYHA IV analyses. Conclusions: Results of our VOI exercise show that the cost of uncertainty regarding the decision on reimbursement of telehealth interventions for chronic heart failure patients is high in the Netherlands, and that future research is needed, mainly on the transition probabilities. [ABSTRACT FROM AUTHOR]