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Patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD) are at substantial risk of atherothrombotic events. The COMPASS trial showed that patients with stable CAD or PAD experienced significant benefits after treatment with rivaroxaban in combination with acetylsalicylic acid (ASA) compared with ASA alone. This paper aims to provide insight into the clinical and economic consequences of treatment with rivaroxaban from a Dutch societal perspective. The clinical and economic implications of rivaroxaban in terms of the number of events prevented, costs, the incremental cost per life-years gained (LYG), and incremental cost per quality-adjusted life-years (QALYs) were determined based on a cost-effectiveness model for patients with stable CAD or PAD and in high-risk subgroups (i.e. patients with CAD and PAD, CAD and prior myocardial infarction and renal impairment, CAD and heart failure) using results from the Cardiovascular OutcoMes for People Using Anticoagulation Strategies (COMPASS) trial. Patients treated with rivaroxaban have an expected increased discounted life expectancy of 0.67 years. In high-risk groups discounted incremental life expectancy ranged from 1.33 to 1.90 years. The incremental cost-effectiveness ratio for the full COMPASS population was €9,760/LYG and €12,033/QALY, whereas, for high-risk subgroups of patients with underlying conditions, incremental cost-effectiveness ratios ranged from €2,966/LYG to €5,052/LYG and from €3,940/QALY to €6,815/QALY. Results from the sensitivity analyses revealed that the model results were robust to variations in single or multiple input parameters at once. The cost-effectiveness analysis showed that rivaroxaban in combination with ASA is a cost-effective treatment option in stable CAD or PAD patients. Rivaroxaban in combination with ASA is even more cost-effective in high-risk subgroups. [ABSTRACT FROM AUTHOR]

This paper argues that time-geography can make a contribution to contemporary ‘rematerialized’ geographies, because the interconnections among social processes, human corporeality and inanimate material artefacts within the landscape were among Hägerstrand's central concerns. Time-geography needs none the less to be extended in several ways to make it more reconcilable with current thinking about materiality in geography. The possibility of combining Hägerstrand's framework with notions from (post) actor-network approaches is therefore explored. It is suggested that concepts and notions from the latter may contribute to the advancement of the conceptualization of action at a distance and agency in general in time-geography, as well as the incorporation of the immaterial realm into space—time diagrams. The resulting materially heterogeneous time-geography is a framework for studying the spacing and timing of different material entities that is sensitive to the role of artefacts and their local connectedness with other material forms. Some of its elements are illustrated briefly through an empirical study of the roles played by a few mundane artefacts in working parents ‘coping with child-care responsibilities on working days. The case study suggest that these artefacts not only enable goal fulfilment and routinization but also result in further spacing and timing practices, and can introduce uncertainty and novelty to existing orders. [ABSTRACT FROM AUTHOR]

The modernization of reproductive behaviour in the Netherlands was late and slow in comparison to other European countries. In this paper marital fertility (Ig) and nuptiality (Im) between 1850 and 1960 are described and analysed, in this way adding the Dutch case to the studies of the European Fertility Project. In the analysis a model is used in which economy, attitudes and infant mortality are the (clusters of) independent variables, and either Ig or Im is the dependent one. To avoid multicollinearity the interdependencies of the explaining factors are eliminated. An analysis is made of both the level and the development of fertility and nuptiality. The model used fits the data well, and the distinction between level and development is of great importance. If analyzed statistically the variance in Im and Ig between the provinces can for the most part be explained by the attitudinal factor, while when analyzing the changes in nuptiality and marital fertility the economic factor has the strongest explanatory power. [ABSTRACT FROM AUTHOR]

Previous literature has discussed the different views, the diverse goals and scope of ethics education, and the need for a more homogenous curriculum in medical ethics. Since ethics is about values, and values are partly influenced by culture, we question to what extent teachers' perceptions concerning learning goals of medical ethics curricula are similar or different in two different countries, and if differences in learning goals are acceptable or problematic. We conducted in-depth interviews with 36 medical ethics teachers, 20 from Indonesia and 16 from the Netherlands, and explored what they think are the important learning goals. We found three similar goals, with slightly different perceptions, between the two groups: (1) being professional, (2) dealing with ethical problems, and (3) being part of society. We also found four other goals that differed between the two countries: (4) understanding one-self and (5) learning from others from the Netherlands; (6) being faithful/pious and (7) obeying rules/standards from Indonesia. We suggest that despite similar goals shared globally, there might be differences in how teachers in different cultural contexts perceive the goals with their local values and translate them into the curricula. Differences in learning goals are common and natural, often reflected by historical and sociocultural contexts, and should not become a barrier for teachers in different regions to collaborate. Understanding these differences may be an important goal for teachers themselves to broaden their knowledge and perspectives. [ABSTRACT FROM AUTHOR]

Second trimester abortion has been legal in the Netherlands since 1984. Factors influencing second trimester abortion in the Netherlands may be different from those that play a role in first trimester abortions. This is important for professionals in counselling and education. In this paper national registration data are used to complement data from a small, qualitative, exploratory file study conducted in three clinics, on the factors associated with second trimester abortions. In 2006, 6.6% of all abortions registered in the National Abortion Registry took place after 12 weeks of gestation. In the qualitative data, relationship problems with the partner were mentioned more frequently as the main reason for second trimester abortions than for first trimester abortions. Factors associated with delay in obtaining an abortion were young age, inability to recognise pregnancy, ambivalence towards the pregnancy, having to travel to the Netherlands for abortion and to a lesser extent being an immigrant from specific countries. Information should be provided for young women and women from specific immigrant groups on early awareness of pregnancy, contraception and reduction of fear about seeking abortion and sexuality education should be provided. Aux Pays-Bas, l'avortement du deuxième trimestre est légal depuis 1984. Les facteurs qui l'influencent dans ce pays peuvent différer de ceux qui jouent un rôle dans l'avortement du premier trimestre. Cette distinction est importante pour les conseillers et les éducateurs. Dans cet article, les données de l'enregistrement national complètent les résultats d'une petite étude qualitative et exploratoire menée dans trois dispensaires sur les facteurs associés aux avortements du deuxième trimestre. En 2006, 6,6% des avortements recensés dans le registre national des avortements avaient eu lieu après 12 semaines de gestation. Dans les données qualitatives, les problèmes de relation avec le partenaire étaient mentionnés plus fréquemment comme principale raison de l'avortement du deuxième trimestre que du premier trimestre. Les facteurs associés au retard pour obtenir un avortement étaient le jeune âge, l'incapacité à déceler la grossesse, l'ambivalence à l'égard de la grossesse, l'obligation de se rendre aux Pays-Bas pour y avorter et, dans une moindre mesure, la qualité d'immigrante originaire de certains pays. Les jeunes femmes et les femmes issues de certains groupes d'immigrants doivent être informées des signes précoces de la grossesse et de la contraception ; il faut réduire leurs craintes de demander un avortement et dispenser une éducation sexuelle. Desde 1984, el aborto en el segundo trimestre es legal en los Países Bajos, donde los factores que influyen en éste pueden ser diferentes a aquellos relacionados con el aborto en el primer trimestre. Esto es importante para los profesionales en consejería y enseñanza. En este artículo se utilizan datos del registro nacional para complementar los datos de un pequeño estudio exploratorio cualitativo, realizado en tres clínicas, sobre los factores asociados con el aborto en el segundo trimestre. En 2006, el 6.6% de todos los abortos registrados en el Registro Nacional de Abortos ocurrieron después de 12 semanas de gestación. En los datos cualitativos, los problemas en la relación de pareja fueron mencionados como el motivo principal para tener un aborto en el segundo trimestre, con más frecuencia que para el aborto en el primer trimestre. Los factores asociados con la demora en obtener un aborto fueron: temprana edad, incapacidad de reconocer el embarazo, ambivalencia hacia el embarazo, tener que viajar a los Países Bajos para tener un aborto y, en menor medida, ser inmigrante de determinado país. Las mujeres jóvenes y mujeres de determinados grupos de inmigrantes deben recibir información sobre el reconocimiento temprano del embarazo, la anticoncepción y la reducción del temor de buscar servicios de aborto y educación sexual. [ABSTRACT FROM AUTHOR]

Decision-making on transport infrastructure projects in the Netherlands has been facing a remarkable wind of change in recent years. In the 1990s, academics and practitioners in policy analysis, public policy and planning all claimed that the traditional policy analysis methods were obsolete, yet they have experienced a sudden resurgence since 2000 in the form of OEEI (Overview of Economic Effects of Infrastructure), a refined application of cost-benefit analysis (CBA). This paper delves into why this new version of CBA has become so politically successful despite predictions made to the contrary. In addition, it focuses on whether this resurgence may lead to 'econocracy' (conceptual hegemony by economists and their ideologies and methods over other approaches), and, if so, how this can be prevented. [ABSTRACT FROM AUTHOR]

Objective. To explore the views and experiences of general practitioners (GPs) in relation to recognition, recording, and treatment of mental health problems of undocumented migrants (UMs), and to gain insight in the reasons for underregistration of mental health problems in the electronic medical records. Design. Qualitative study design with semi-structured interviews using a topic guide. Subjects and setting. Sixteen GPs in the Netherlands with clinical expertise in the care of UMs. Results. GPs recognized many mental health problems in UMs. Barriers that prevented them from recording these problems and from delivering appropriate care were their low consultation rates, physical presentation of mental health problems, high number of other problems, the UM's lack of trust towards health care professionals, and cultural differences in health beliefs and language barriers. Referrals to mental health care organizations were often seen as problematic by GPs. To overcome these barriers, GPs provided personalized care as far as possible, referred to other primary care professionals such as social workers or mental health care nurses in their practice, and were a little less restrictive in prescribing psychotropics than guidelines recommended. Conclusions. GPs experienced a variety of barriers in engaging with UMs when identifying or suspecting mental health problems. This explains why there is a gap between the high recognition of mental health problems and the low recording of these problems in general practice files. It is recommended that GPs address mental health problems more actively, strive for continuity of care in order to gain trust of the UMs, and look for opportunities to provide mental care that is accessible and acceptable for UMs. [ABSTRACT FROM AUTHOR]

The contribution to psychotrauma literature from Dutch authors has a long tradition. The relatively high lifetime prevalence of trauma and posttraumatic stress disorder (PTSD) is not unique for the Netherlands and does not fully explain the interest in trauma and its consequences. In this overview of psychotraumatology in the Netherlands, we will discuss some of the key events and processes that contribute to the current interest. We outlined the historical basis and development of the field in the Netherlands, including the impact of World War II, the effects of major man-made or natural disasters, engagement in military conflicts, as well as smaller scale traumatic events like sexual abuse and traffic accidents. The liberal and open culture may have reduced stigma to trauma, while other sociocultural aspects may have contributed to increased prevalence. Finally, we describe Dutch psychotraumatology today and how history and culture have shaped the current scientific basis. [ABSTRACT FROM AUTHOR]

We investigated the role that urbanization and plague may have played in changes in life expectancy amongst artists in the Low Countries who were born between 1450 and 1909. Artists can be considered to be representative of a middle-class population living mostly in urban areas. The dataset was constructed using biographical information collected by the Rijksbureau voor Kunsthistorische Documentatie in The Hague, the Netherlands. As early as the beginning of the sixteenth century, life expectancy at age 20 amongst the artists had reached 40 years. After a substantial decline in the late sixteenth and the early seventeenth centuries, when plague hit the region, life expectancy at age 20 began to rise again, and this upward trend accelerated after 1850. The life expectancy of female artists commonly exceeded that of males, and sculptors had better survival prospects than painters. In comparison with elite groups in the Low Countries and elsewhere in Europe, life expectancy amongst the artists was rather high. [ABSTRACT FROM AUTHOR]

We examined the emigration intentions of native-born Dutch residents and their subsequent emigration behaviour from 2005 to 2010. Data were collected from two surveys on emigration intentions, one conducted locally and one nationally. A number of novel results stand out. First, intentions were good predictors of future emigration: 34 per cent of those who had stated an intention to emigrate actually emigrated within the 5-year follow-up period. Second, the personality of potential migrants and their discontent with the quality of the public domain in the Netherlands (e.g., crowded space and inadequate access to unspoilt nature, pollution, crime level, mentality of people) were the strongest contributors to the motivation to move abroad. Third, the main difference between movers and those who stated intentions to emigrate but had not (yet) followed through was their state of health: healthy people were more likely to follow through with their migration intentions than those in poorer health. [ABSTRACT FROM PUBLISHER]

While researchers have often found that Europeans who report faith-based beliefs or practices have larger families than those who do not, there is a lack of evidence on the reasons for these links. This study investigated whether having a first child affects parents' level of church attendance and whether the frequency of church attendance at different times in life predicts a person's (almost) completed fertility. Drawing on five waves of a large-scale Dutch panel survey, the study used data that cover a substantial part of the respondents' reproductive period (1987–2005). In contrast to findings from the USA, the results suggest a one-way influence: having a first child does not predict a change in church attendance, but church attendance is a strong predictor of future childbearing. [ABSTRACT FROM PUBLISHER]

Due to women's increased participation in the labour force, more and more family-households are now juggling paid labour and care-giving in space and time and do so in many different ways. Much research and policy about how households try to establish a satisfactory work-life balance singles out particular coping strategies, such as telecommuting or the mobilizing of informal help by relatives or friends. While insightful, foregrounding single strategies may oversimplify the complex reality of everyday life, in which people often skilfully weave together multiple coping strategies. As well, advances in information and communication technologies (ICTs) have further diversified the arsenal of possible coping strategies, but the academic literature has yet to verify whether ICT usage complements or substitutes the adoption of other coping strategies. Adopting a holistic quantitative approach this study assesses which combinations of coping strategies prevail and which role ICTs play in this regard among one- and dual-earner households in the Utrecht-Amersfoort-Hilversum area of the Netherlands. We also examine systematic variations in strategy combination by socio-demographics, ICT possession, affordability and skills, social network factors, employment and commute factors, spatial factors, lifestyle orientation and other factors. We identify several distinct combinations of strategies and find that ICT-related strategies are frequently adopted by highly educated employed parents in the Netherlands attempting to achieve a satisfying work-life balance and tend to complement other types of strategies. Which combinations of strategies have been adopted depends most strongly on the presence of young children, but also on employment factors and characteristics of the environment surrounding the dwelling and main workplace. [ABSTRACT FROM AUTHOR]

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The study presented here analyses the reciprocal relationship for men between employment career and union formation and examines whether this relationship changed across twentieth-century birth cohorts. Competing hypotheses about trends are described, using notions of role-specialization, spouse support, and uncertainty. The study is based on an investigation of the life histories of 2,795 men in the Netherlands who were born between the 1930s and the 1960s, and confirms earlier findings by showing that employment fosters marriage while marriage protects men from becoming unemployed. There is also a relationship between employment and cohabitation but it is weaker in both directions. However, the relationship between marriage or cohabitation and occupational mobility is less clear, suggesting that the economic benefits of marriage cannot be generalized to the occupational domain. Although it is commonly believed that the link for men between career and marriage has weakened over time, our comparison of birth cohorts shows that in fact this is not the case. [ABSTRACT FROM AUTHOR]

This article examines the Dutch pattern of remarriage during the nineteenth century, using data from the vital registration system (marriages and deaths), and the population registers for the cities of Breda (South Netherlands) and Gouda (West Netherlands). A group of 6500 widows and widowers were followed from the moment they were widowed until they either remarried or died whilst widowed. Migrating widows and widowers were also followed to their new destinations. Proportional hazards analysis shows that the principal factor which determined the probability of remarriage was age at bereavement. The probability of remarriage was much greater for men than for women, and for the childless than for widowed persons with children. If a widowed person with a child or children wished to remarry, he or she was more likely to do so, if the child was young. The situation of widowed persons who remarried was close to that of those who married for the first time; the partner had to be relatively young and childless. Neither occupation nor religion significantly affected the chance of remarriage during the period studied, but in Gouda the probabilities of remarriage were generally higher than in Breda. [ABSTRACT FROM AUTHOR]