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Introduction: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. Methodology: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. Results: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21–0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. Discussion: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care. Plain Language Summary: This paper explores delays in accessing abortion care associated with financial and medical system barriers. We focus on residents of countries in Europe where abortion is available on broad grounds in the first trimester seeking abortion care outside of their country of residence. This study demonstrates an association between difficulty covering abortion costs for people facing financial insecurity and in-country care seeking and delays in accessing abortion abroad. Policy barriers, medical system barriers, as well as financial barriers may interact to delay access to care for people in European countries with broad grounds for abortion access in the first trimester but restrictions thereafter, especially for people later in pregnancy. [ABSTRACT FROM AUTHOR]

Simple Summary: Large intestinal cancer is one of the most common lifestyle-related types of cancer. However, the exact mechanism in the relation between adipose tissue, systemic inflammation and intestinal cancer remains unknown. Furthermore, there are many hypotheses regarding the pathways in which alcohol consumption, smoking, malnutrition and physical inactivity cause low-grade systemic inflammation. In this paper, we discuss the relation of lifestyle with inflammation, in terms of inflammatory markers at the time of diagnosis in intestinal cancer patients. Our findings suggest that an overall unhealthier lifestyle and a higher risk of malnutrition at the time of diagnosis were associated with elevated levels of inflammatory markers. These findings could contribute to formulating lifestyle advice in the future. Colorectal cancer is one of the most common lifestyle-related types of cancer. The exact pathophysiologic mechanism in the relation between (visceral) adipose tissue, systemic inflammation and colorectal cancer remains unknown. This study aimed to assess the association of lifestyle with markers of systemic inflammation at the time of diagnosis in stage I-III colorectal cancer patients. Patients (n = 298) with stage I-III colorectal cancer from three Dutch hospitals were included at diagnosis. Several lifestyle-related variables (MUST nutritional status score, WCRF/AICR healthy lifestyle score, active smoking, alcohol consumption and BMI) and inflammatory markers (plasma levels of IL-6, IL-8, IL-10, TNFα and 'high sensitive' hsCRP) were measured at the time of diagnosis. Confounder-adjusted multivariable linear regression models were used to analyse how the lifestyle variables were associated with the inflammatory markers. Statistically significant associations were found between a better WCRF/AICR lifestyle score and lower levels of IL-6 and hsCRP. A medium and high risk of malnutrition according to the MUST score was associated with elevated levels of both IL-8 and hsCRP. An overall unhealthier lifestyle indicated by a lower WCRF/AICR lifestyle score and a higher risk of malnutrition according to the MUST score at the time of diagnosis was associated with elevated levels of inflammatory markers. These findings can contribute to formulating lifestyle advice to improve treatment outcomes and prognosis in patients having CRC in the future. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Structuring the diagnostic section of the medical record ( MR) improves diagnosis and communication between doctors. However, little is known about the therapeutic section of the MR. The aim of this study was to gain insight into the extent to which MRs are structured for therapeutic information, to determine which therapeutic data registrars and clinical consultants consider should be recorded in the MR and to what extent registrars record this information themselves. Methods A multicentre observational study was carried out in the internal medicine outpatient clinics of five teaching hospitals in the Netherlands. Preformatted structure, importance and actual recording of therapeutic information was compared with a reference list of 35 therapeutic items based on the WHO Guide to Good Prescribing (e.g. drug name, indication for drug). Results The preformatted structure of four paper MRs and one electronic MR was assessed. Eight of the 35 therapeutic items were listed in the paper MRs and 18 items in the electronic MR. Registrars and consultants agreed on the importance of recording most of the therapeutic items in the MR, 25 and 27 out of the 35 items, respectively; however, registrars recorded only 11 of the 35 items in the paper MR and 20 of the 35 items in the electronic MR. Conclusions The structure and content of paper and electronic MRs are not adequate. While both registrars and consultants agree on the importance of recording therapeutic items in the MR, registrars fail to record most of this information in practice. The results of this study can be used as starting point for the discussion regarding the necessity of structured recording of therapeutic information in the MR and its possible benefits with regard to medication safety and training of the new generation of prescribers. [ABSTRACT FROM AUTHOR]

Adolescents in secure residential care mostly suffer from serious behavioural problems, often accompanied by trauma and adverse family circumstances. This paper presents findings of a comparison of behavioural problems and risk factors of 255 boys and girls (aged 12 to 18 years) in secure residential care in the Netherlands and their association with behavioural problems. A cross‐sectional design and standardized questionnaires were used to measure behavioural problems and individual and familial risk factors. By using independent‐sample t tests, the severity of these factors in boys and girls was compared, and by using structural equation modelling (SEM), associations between these factors and behavioural problems were investigated. The findings of the study show that post‐traumatic stress disorder (PTSD) symptoms, maladaptive emotion regulation, impaired perceived competence and internalizing behavioural problems were more severe in girls than in boys. Boys experienced more severe externalizing behavioural problems and more family problems than girls. Maladaptive emotion regulation, PTSD symptoms, perceived competence and parenting problems were related to behavioural problems. The results indicate that treatment for girls should address PTSD symptoms, perceived competence and maladaptive emotion regulation and that extra attention for family problems in the treatment of boys is warranted. [ABSTRACT FROM AUTHOR]

The Family Perceptions of Physician-Family Caregiver Communication scale (FPPFC) was developed to assess quality of physician-family end-of-life communication in nursing homes. However, its validity has been tested only in the USA and the Netherlands. The aim of this paper is to evaluate the FPPFC construct validity and its reliability, as well as the psychometric characteristics of the items comprising the scale. Data were collected in cross-sectional study in Belgium, Finland, Italy, the Netherlands and Poland. The factorial structure was tested in confirmatory factor analysis. Item parameters were obtained using an item response theory model. Participants were 737 relatives of nursing home residents who died up to 3 months prior to the study. In general, the FPPFC scale proved to be a unidimensional and reliable measure of the perceived quality of physician-family communication in nursing home settings in all five countries. Nevertheless, we found unsatisfactory fit to the data with a confirmatory model. An item that referred to advance care planning performed less well in Poland and Italy than in the Northern European countries. In the item analysis, we found that with no loss of reliability and with increased coherency of the item content across countries, the full 7-item version can be shortened to a 4-item version, which may be more appropriate for international studies. Therefore, we recommend use of the brief 4-item FPPFC version by nursing home managers and professionals as an evaluation tool, and by researchers for their studies as these four items confer the same meaning across countries. [ABSTRACT FROM AUTHOR]

The Eetscore FFQ was developed to score the Dutch Healthy Diet index 2015 (DHD2015-index) representing the Dutch food-based dietary guidelines of 2015. This paper describes the development of the Eetscore FFQ, a short screener assessing diet quality, examines associations between diet quality and participants' characteristics, and evaluates the relative validity and reproducibility of the Eetscore FFQ in a cross-sectional study with Dutch adults. The study sample consisted of 751 participants, aged 19–91 years, recruited from the EetMeetWeet research panel. The mean DHD2015-index score based on the Eetscore FFQ of the total sample was 111 (sd 17·5) out of a maximum score of 160 points and was significantly higher in women than in men, positively associated with age and education level, and inversely associated with BMI. The Kendall's tau-b coefficient of the DHD2015-index between the Eetscore FFQ and the full-length FFQ (on average 1·7-month interval, n 565) was 0·51 (95 % CI 0·47, 0·55), indicating an acceptable ranking ability. The intraclass correlation coefficient between DHD2015-index scores derived from two repeated Eetscore FFQ (on average 3·8-month interval, n 343) was 0·91 (95 % CI 0·89, 0·93) suggesting a very good reproducibility. In conclusion, the Eetscore FFQ was considered acceptable in ranking participants according to their diet quality compared with the full-length FFQ and showed good to excellent reproducibility. [ABSTRACT FROM AUTHOR]

INTRODUCTION In addition to smoke-free policies in indoor public and workplaces, governments increasingly implement smoke-free policies at beaches, in parks, playgrounds and private cars ('novel smoke-free policies'). An important element in the implementation of such policies is public support. In the context of the ambition of the Netherlands to reach a smoke-free generation by 2040, we investigated temporal changes in public support for novel smoke-free policies. METHODS We analyzed annual cross-sectional questionnaires in a representative sample of the Dutch population from 2018 to 2022. Multivariable logistic regression was applied to model public support for each smoke-free policy area as a function of time (calendar year), smoking status, gender, and socioeconomic status. Interaction terms were added for time with smoking status and with socioeconomic status. RESULTS A total of 5582 participant responses were included. Between 2018 and 2022, support increased most for smoke-free policies regarding train platforms (+16%), theme parks (+12%), beaches (+10%), and terraces (+10%). In 2022, average support was higher than 65% for all categories of smoke-free places and highest for private cars with children (91%). Regression analyses indicated significant increases in support over time within each category of smoke-free places (adjusted odds ratio, AOR between 1.09 and 1.17 per year), except smokefree private cars with children (AOR=0.97; 95% CI: 0.89--1.05). Regardless of smoking status, support was high for places where children often go. CONCLUSIONS Support for novel smoke-free places in the Netherlands is high and increasing, in particular for places frequented by children. This indicates the potential to implement such measures in the Netherlands. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this paper was to investigate the relationship between high‐involvement human resource management, autonomy, affective organisational commitment and innovative behaviours of nursing staff who care for elderly clients. Background: Nursing teams are increasingly required to demonstrate innovative behaviours that enhance care quality. Nursing leaders need to create environments where nursing staff have sufficient autonomy and feel a sense of commitment to support these behaviours. The appropriate implementation of these processes and practices may lead to greater involvement. Methods: A cross‐sectional survey‐based research design was employed to explore the experiences of involvement practices, autonomy, affective organisational commitment and innovative behaviours of 567 nursing staff workers from four elderly care organisations in the Netherlands. Results: The results demonstrate that a bundle of high‐involvement practices positively influences innovative behaviour and that affective commitment and autonomy fully mediate this relationship. Conclusions: The study highlights the role of autonomy and commitment as routes towards translating involvement practices into nurses' innovativeness. Implications for Nursing Management: To create an innovative environment, leaders need to create a positive climate by providing nurses with opportunities to enhance their competence, relatedness and autonomy through active involvement. Leaders should, therefore, encourage involvement as a mechanism to promote innovation. [ABSTRACT FROM AUTHOR]

Aims To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Background Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Design Psychometric systematic review. Data sources A systematic literature search of the multiple databases (1990-September 2014). Review methods Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Results Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Conclusion Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Within the Dutch health care system the focus is shifting from a disease oriented approach to a more population based approach. Since every inhabitant in the Netherlands is registered with one general practice, this offers a unique possibility to perform Population Health Management analyses based on general practitioners' (GP) registries. The Johns Hopkins Adjusted Clinical Groups (ACG) System is an internationally used method for predictive population analyses. The model categorizes individuals based on their complete health profile, taking into account age, gender, diagnoses and medication. However, the ACG system was developed with non-Dutch data. Consequently, for wider implementation in Dutch general practice, the system needs to be validated in the Dutch healthcare setting. In this paper we show the results of the first use of the ACG system on Dutch GP data. The aim of this study is to explore how well the ACG system can distinguish between different levels of GP healthcare utilization.Methods: To reach our aim, two variables of the ACG System, the Aggregated Diagnosis Groups (ADG) and the mutually exclusive ACG categories were explored. The population for this pilot analysis consisted of 23,618 persons listed with five participating general practices within one region in the Netherlands. ACG analyses were performed based on historical Electronic Health Records data from 2014 consisting of primary care diagnoses and pharmaceutical data. Logistic regression models were estimated and AUC's were calculated to explore the diagnostic value of the models including ACGs and ADGs separately with GP healthcare utilization as the dependent variable. The dependent variable was categorized using four different cut-off points: zero, one, two and three visits per year.Results: The ACG and ADG models performed as well as models using International Classification of Primary Care chapters, regarding the association with GP utilization. AUC values were between 0.79 and 0.85. These models performed better than the base model (age and gender only) which showed AUC values between 0.64 and 0.71.Conclusion: The results of this study show that the ACG system is a useful tool to stratify Dutch primary care populations with GP healthcare utilization as the outcome variable. [ABSTRACT FROM AUTHOR]

The diverse nature of 21st‐century organizations has compelled leaders to minimize discrimination and bring about inclusion amongst their employees. One of the ways this can be achieved is through authentic, respectful, and inclusive leadership. The aim of the present paper was to (1) explore whether the three leadership styles can promote inclusion and curtail discrimination in the South African context and (2) ascertain whether this relationship has any bearing on well‐being across Dutch, German, Icelandic, Indonesian, and South African contexts. To reach these aims, two cross‐sectional studies have been conducted. In Study 1, 569 employees were surveyed, and results indicated that all three leadership styles loaded on a common latent factor (positive leadership) that was positively associated with both inclusion and discrimination. In Study 2, 1,926 employees were surveyed across the five countries. Results indicated that once again, the latent, positive leadership factor was positively associated with both inclusion and discrimination. Furthermore, inclusion, when compared to discrimination seemed to be a stronger mediator in the relationship between positive leadership and well‐being. We propose leadership development that will cultivate positive leadership behaviors for the benefit of employee well‐being and collaboration in increasingly diverse teams. [ABSTRACT FROM AUTHOR]

Summary: Young people living in north-west European welfare states are challenged to develop their individual strength. This is especially difficult for girls living in vulnerable circumstances, because they face a form of marginalization. Girls work is a method of professional youth work that supports girls in their identity development, making them more capable of shaping their own lives now and as adults. This is conceptualized as agency, which consist of the properties: intentionality, forethought, self-reactiveness, self-reflection. This paper examines the extent to which girls work helps girls living in vulnerable circumstances to develop their individual strength. Findings: The article is based on a questionnaire filled out by 393 girls who participate in 59 girls work activities in the Netherlands. This study shows that participation in girls work contributes to the development of intentionality of these girls (F(3,387) = 4.60, p =.004). Furthermore, girls who received an individual approach are better capable of reflecting on their actions than girls who only participated in group activities (F(2,388) = 3.10, p =.046). Applications: The findings suggest that participation in girls work contributes to the intentionality of girls in vulnerable circumstances, which is an important step in the development of agency. But to accomplish this, girls need to learn how to act upon their personal intentions. However, the findings do not show that girls work contributes to the other properties of agency, suggesting that to support girls in shaping their own lives, youth workers need to contribute more to the other levels of agency. [ABSTRACT FROM AUTHOR]

Aims: This paper presents updated prevalence estimates of awareness, ever‐use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. Design, Setting, Participants and Measurements: A cross‐sectional analysis of adult (≥ 18 years) current smokers and ex‐smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013–17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country‐specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non‐daily). Findings NVP awareness and use were lowest in NRP countries. Generally, ever‐ and current use of NVPs were lower in MRP countries (ever‐use = 7.1–48.9%; current use = 0.3–3.5%) relative to LRP countries (ever‐use = 38.9–66.6%; current use = 5.5–17.2%) and RP countries (ever‐use = 10.0–62.4%; current use = 1.4–15.5%). NVP use was highest among high‐income countries, followed by upper–middle‐income countries, and then by lower–middle‐income countries. Conclusions: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Interaction between staff and patients with a diagnosis of personality disorder in forensic settings is important for quality of care, but research is lacking on what determines this interaction. What the paper adds to existing knowledge?: Insight, emotion‐focused coping and emotion regulation of staff influence the interaction between staff and these patients.Staff who understand their own thoughts, feelings and behaviour better (more insight) needed less support, encouragement or back‐up from their patients. Staff who cope by getting upset, blaming themselves or fantasizing about solutions (emotion‐focused coping) on the contrary needed more support from their patients.Emotion regulation had an impact on the relation between coping and hostile staff behaviour. When staff get upset (emotion‐focused coping) and try to think differently about the situation (reappraisal), this makes them behave in a more hostile manner towards their patients. When staff suppress their emotions and also distract themselves or engage in social activities (avoidance‐focused coping), they behave in a less hostile manner towards their patients. What are the implications for practice?: In order to provide compassionate care for their patients, staff ought to be trained in self‐compassion. This may help them not to get upset, blame themselves or fantasize about solutions and to understand their own thoughts, feelings and behaviour better. As a result, staff may need less support, encouragement or back‐up from their patients.Context is important: Staff ought to suppress their emotions when emotions run high, but only when they also care for themselves by distracting themselves or engaging in social activities. Facing and regulating their emotions by changing what they think about the situation (reappraisal) may be more appropriate once emotions have settled down. This may help staff to remain compassionate towards their patients in the long run and avoid burn‐out or compassion fatigue due to ignoring their own needs and boundaries. Introduction: Research is lacking on what determines interaction between staff and patients with a diagnosis of personality disorder in forensic settings. Aim: To test whether coping, self‐reflection, insight and emotion regulation are related to the behaviour of staff towards these patients, and to test the possible moderating and mediating effect of emotion regulation. Method: Using a cross‐sectional design, 76 direct care staff of a forensic clinic completed questionnaires on all variables. Relations were tested using simple linear regression, mediation and moderation analyses. Results: Insight and emotion‐focused coping of staff were related to seeking less and more support from patients, respectively. Emotion regulation by reappraisal combined with emotion‐focused coping was associated with more hostile behaviour by staff, and suppression combined with avoidance‐focused coping with less hostile behaviour. Conclusion: Insight, emotion‐focused coping and emotion regulation of staff influence the quality of care of patients with a diagnosis of personality disorder in forensic settings. Future research ought to include contextual factors. Implications for practice: Enhancing self‐compassion may improve insight and reduce emotion‐focused coping. Context is important: Taking the needs of staff into account may involve suppressing emotions combined with avoidance in a highly emotional situation while facing and reappraising the situation when emotions are low. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Client aggression in forensic psychiatry is associated with burnout symptoms in nursing staff. It is unclear what mechanisms contribute to this relationship.The type and severity of aggression might be of importance in the association between client aggression and burnout symptoms, but also the personality characteristics and emotional intelligence of nursing staff.It is unknown whether wearable devices that measure arousal can be used to detect chronic stress and burnout symptoms. What does this paper add to existing knowledge?: Especially, physical aggression as experienced by nursing staff is associated with staff's burnout symptoms (e.g., emotional exhaustion and depersonalization). Further research on the aggression questionnaire is necessary.The stress management skill of nursing staff is an important factor to consider in the association between burnout symptoms and client aggression.The wearable device was not useful for detecting burnout symptoms. What are the implications for practice?: Nursing staff who experience (physical) aggression should be carefully monitored and should receive social support from their management to aid their well‐being. Contrary to intuition, nurses who reported a higher number of stress management skills might have to be monitored more closely if necessary. Introduction: Aggressive behaviour of forensic clients is associated with burnout symptoms in nursing staff. The role of staff characteristics as moderators is unclear. Aim: We explored the association between type and severity of aggressive behaviour as experienced by nursing staff and staff's burnout symptoms. In addition, the moderating roles of personality characteristics and emotional intelligence (EI) were studied. Moreover, the usefulness of ambulatory skin conductance assessments in detecting arousal related to burnout symptoms was studied. Method: A total of 114 forensic nursing staff members filled out questionnaires and wore an ambulatory device. Results: Experiencing physical aggression was positively associated with staff's burnout symptoms. Stress management skills, a subscale of EI, but not personality, moderated this relationship. Skin conductance was not associated with burnout symptoms. Remarkably, the association between aggression and burnout symptoms was highest for staff reporting a higher number of stress management skills. Discussion: Longitudinal research is necessary to establish causality between client aggression and staff burnout symptoms. In addition, further research is necessary on the validity of the aggression measure used in the current study. Implication for practice: Nursing staff who experience physical aggression frequently should receive social support for this, and staff who report high stress management skills should be monitored more carefully after having been confronted with aggression. [ABSTRACT FROM AUTHOR]

Purpose The focus of scientific research on the parental well-being has been mainly placed on parents of pre-school children. However, recent findings indicated that parents of pre-school children show lower levels of depression and higher levels of self-efficacy and self-esteem, compared to parents of older children. The purpose of this paper is to establish to what extent the parent-adolescent relationship, coping strategies and co-parent relationship, influences the parental well-being.Design/methodology/approach This study was conducted to establish to what extent the parent-adolescent relationship, coping strategies and co-parent relationship, influences the parental well-being of parents in a sample of 310 Dutch parents with children aged 12-18. Participants filled out questionnaires on the parental well-being and coping. Path analysis using a structural equation model (SEM) was performed.Findings The SEM revealed that active problem-focused coping strategies were predictive of higher levels of parenting-related well-being. The satisfaction of the relationship with the co-parent predicted both higher levels of parenting- and individual-related well-being. Lower levels of parenting-related well-being were significantly related to more problems in the parent-adolescent relationship, which, in turn, were related to decreased individual-related well-being.Research limitations/implications Future studies on the influence of coping strategies and the co-parent relationship satisfaction are recommended to create greater understanding of the underlying mechanisms and their positive effect on the parental well-being.Practical implications This study could lead to improvements in the support system for parents raising adolescents.Originality/value The present study shows that the parent-child relationship is an important predictive factor in parental well-being. This study also shows that the more highly parents scored on co-parent relationship satisfaction, the less they saw parenting as a burden and the more they felt they had the parenting skills to control the behavior of their child. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about the subject: Working in long‐term care is seen as a stressful, physically and mentally demanding occupation, and thus, nursing staff are at risk for work and stress‐related diseases. In older patients, psychiatric illnesses often occur in combination with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well‐being of nurses is unknown. What this paper adds to existing knowledge: Nursing staff working on specialized units for patients with combined care needs experience high levels of self‐efficacy in combination with strong feelings of self‐rated competence. Although levels of burnout are relatively low, mental healthcare nursing staff is more at risk for burnout when working in specialized settings for patients with combined care needs than nursing home staff working in specialized settings for these patients. Nursing staff characteristics, such as years of working experience and age, seem more important in relation to staff well‐being than patient characteristics in specialized settings for combined care needs. What are the implications for practice: Staff well‐being might benefit from specializing care, so that patients with similar care needs are placed together and care is focused. The presence of specialized care units for older patients with combined care needs can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. Abstract: Introduction: In older patients, psychiatric illnesses frequently exist in tandem with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well‐being of nursing staff is unknown. Aim: To investigate whether care characteristics of patients with combined care needs are related to the mental well‐being of nursing staff. Method: Well‐being of nursing staff was studied within a larger exploratory observational cross‐sectional study that examined the differences and similarities of specialized combined care units in Dutch mental healthcare and nursing home settings. Results: Nursing staff across settings, with more than 5 years of work experience, felt competent in caring for patients with combined care needs. No significant effects of care characteristics of patients with combined care needs on the work‐related well‐being of nursing staff were shown. Both mental health nursing staff and older employees, however, were found to be more at risk for burnout. Implications/Conclusion: Staff well‐being might benefit from placing patients with combined care needs together, so care is focused. The presence of specialized care units can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Fifty to eighty percent of patients suffering from chronic kidney disease (CKD) experience a form of sexual dysfunction (SD), even after renal transplantation. Despite this, inquiring about SD is often not included in the daily practice of renal care providers. Objectives: This paper explores the perspectives of renal social workers regarding sexual care for patients and evaluates their practice, attitude towards responsibility and knowledge of SD. Design: A cross‐sectional study was conducted using a 41‐item online survey. Participants: Seventy‐nine members of the Dutch Federation of Social Workers Nephrology. Results: It was revealed that 60% of respondents discussed SD with a fifth of their patients. Frequency of discussion was associated with experience (p = 0.049), knowledge (p = 0.001), supplementary education (p = 0.006), and the availability of protocols on sexual care (p = 0.007). Main barriers towards discussing SD consisted of ‘culture and religion’ (51.9%), ‘language and ethnicity’ (49.4%), and ‘presence of a third person’ (45.6%). Sufficient knowledge of SD was present in 28% of respondents. The responsibility for discussion was 96% nephrologists and 81% social workers. Conclusion: This study provides evidence that a part of Dutch nephrology social workers do not provide sexual care regularly, due to insufficient experience and sexual knowledge, absence of privacy and protocols and barriers based on cultural diversity. According to the respondents the responsibility for this aspect of care should be multidisciplinary. Recommendations include a need for further education on the topic, private opportunities to discuss SD and multidisciplinary guidelines on sexual care. [ABSTRACT FROM AUTHOR]

Background: The incidence of human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is increasing in high income countries. HPV-associated OPC generally presents as an invasive disease, often with lymph node involvement, in relatively young patients with minimal or no history of smoking and alcohol consumption. Knowledge on HPV-associated OPC among primary care professionals is essential for disease recognition and early start of treatment. Aim: To examine the knowledge on HPV-associated OPC among GPs in the Netherlands. Design & setting: A cross-sectional postal survey among GPs in the Netherlands. Method: A 12-item questionnaire was sent to 900 randomly selected general practices. Outcome measures included awareness of the link between HPV and OPC, epidemiological trends, and patient characteristics. Data were statistically analysed for sex, years after graduation, and self-rated knowledge of OPC. Results: A total of 207 GPs participated in this study. Seventy-two per cent recognised HPV as a risk factor for OPC and 76.3% were aware of the increasing incidence rate of HPV-associated OPC. In contrast, 35.7% of participants knew that patients with HPV-associated OPC are more often male, and just over half (53.6%) of the participants were aware of the younger age of these patients. Conclusion: More than one-quarter of GPs in the Netherlands are unaware of HPV as a causative factor for OPC. Furthermore, there is a gap in knowledge on characteristics of patients with HPV-associated OPC. Further training on these topics could improve disease recognition and, ultimately, patient survival. [ABSTRACT FROM AUTHOR]

Women report more psychological distress than men, which may be related to both biological sex and socio-cultural gender. We tested whether associations between gender and distress differ for women and men. The cross-sectional sample consisted of 678 Dutch people (54% women). Gender roles were assessed as masculinity and femininity. A composite gender norm score was calculated by summing gendered sociodemographics. Multivariate regressions examined sex, gender, and their interaction for depressive symptoms, anxiety, and perceived stress, additionally adjusted. Women reported more psychological distress. People scoring higher on masculine gender roles, but not feminine gender roles, reported lower psychological distress. A higher gender norm score was related to more depressive symptoms and perceived stress. This association was only present in men and was explained by health-related covariates. This research shows that there is a need to further elaborate on the discrepancies between sex and gender in health psychology research to better understand individual differences. [ABSTRACT FROM AUTHOR]

Objectives: We explored characteristics of people with an accumulation of health problems related to old age requesting euthanasia or physician-assisted suicide (EAS) and identified characteristics associated with granting EAS requests. Methods: We conducted a cross-sectional questionnaire study among Dutch physicians on characteristics of these people requesting EAS (n = 123). Associations between characteristics and granting a request were assessed using logistic regression analyses. Results: People requesting EAS were predominantly >80 years old (82.4%), female (70.0%), widow/widower (71.7%), (partially) care-dependent (76.7%), and had a life expectancy >12 months (68.6%). The most prevalent health problems were osteoarthritis (70.4%) and impaired vision and hearing (53.0% and 40.9%). The most cited reasons to request EAS were physical deterioration (68.6%) and dependence (61.2%). 44.7% of requests were granted. Granting a request was positively associated with care dependence, disability/immobility, impaired vision, osteoporosis, loss of control, suffering without prospect of improvement and a treatment relationship with the physician >12 months. Conclusion: Enhanced understanding of people with an accumulation of health problems related to old age requesting EAS can contribute to the ongoing debate on the permissibility of EAS in people without life-threatening conditions. [ABSTRACT FROM AUTHOR]

Background: Observational studies performed in Asian populations suggest that eating rate is related to BMI. This paper investigates the association between self-reported eating rate (SRER) and body mass index (BMI) in a Dutch population, after having validated SRER against actual eating rate. Methods: Two studies were performed; a validation and a cross-sectional study. In the validation study SRER (i.e., 'slow', 'average', or 'fast') was obtained from 57 participants (men/women = 16/41, age: mean ± SD = 22.6 ± 2. 8 yrs., BMI: mean ± SD = 22.1 ± 2.8 kg/m²) and in these participants actual eating rate was measured for three food products. Using analysis of variance the association between SRER and actual eating rate was studied. The association between SRER and BMI was investigated in cross-sectional data from the NQplus cohort (i.e., 1473 Dutch adults; men/women = 741/732, age: mean ± SD = 54.6 ±11.7 yrs., BMI: mean ± SD = 25.9 ± 4.0 kg/m²) using (multiple) linear regression analysis. Results: In the validation study actual eating rate increased proportionally with SRER (for all three food products P < 0.01). In the cross-sectional study SRER was positively associated with BMI in both men and women (P = 0.03 and P < 0.001, respectively). Self-reported fast-eating women had a 1.13 kg/m² (95% CI 0.43, 1.84) higher BMI compared to average-speed-eating women, after adjusting for confounders. This was not the case in men; self-reported fast-eating men had a 0.29 kg/m² (95% CI -0.22, 0.80) higher BMI compared to average-speed-eating men, after adjusting for confounders. Conclusions: These studies show that self-reported eating rate reflects actual eating rate on a group-level, and that a high self-reported eating rate is associated with a higher BMI in this Dutch population. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether patients with basal ganglia calcifications (BGC) should undergo infectious disease testing as part of their diagnostic work-up. We investigated the occurrence of possibly associated infections in patients with BGC diagnosed with Fahr's disease or syndrome and consecutively performed a systematic review of published infectious diseases associated with BGC. Methods: In a cross-sectional study, we evaluated infections in non-immunocompromised patients aged ≥ 18 years with BGC in the Netherlands, who were diagnosed with Fahr's disease or syndrome after an extensive multidisciplinary diagnostic work-up. Pathogens that were assessed included the following: Brucella sp., cytomegalovirus, human herpesvirus type 6/8, human immunodeficiency virus (HIV), Mycobacterium tuberculosis, rubella virus, and Toxoplasma gondii. Next, a systematic review was performed using MEDLINE and Embase (2002–2023). Results: The cross-sectional study included 54 patients (median age 65 years). We did not observe any possible related infections to the BGC in this population. Prior infection with Toxoplasma gondii occurred in 28%, and in 94%, IgG rubella antibodies were present. The positive tests were considered to be incidental findings by the multidisciplinary team since these infections are only associated with BGC when congenitally contracted and all patients presented with adult-onset symptoms. The systematic search yielded 47 articles, including 24 narrative reviews/textbooks and 23 original studies (11 case series, 6 cross-sectional and 4 cohort studies, and 2 systematic reviews). Most studies reported congenital infections associated with BGC (cytomegalovirus, HIV, rubella virus, Zika virus). Only two studies reported acquired pathogens (chronic active Epstein–Barr virus and Mycobacterium tuberculosis). The quality of evidence was low. Conclusions: In our cross-sectional study and systematic review, we found no convincing evidence that acquired infections are causing BGC in adults. Therefore, we argue against routine testing for infections in non-immunocompromised adults with BGC in Western countries. [ABSTRACT FROM AUTHOR]

To assess the cultural competence (CC) of GP trainees and GP trainers. Design and setting: A cross-sectional survey study was conducted at the GP Training Institute of Amsterdam UMC. We included 92 GP trainees and 186 GP trainers. We measured the three domains of cultural competency: 1) knowledge, 2) culturally competent attitudes and 3) culturally competent skills. Regression models were used to identify factors associated with levels of CC. Participants rated their self-perceived CC at the beginning and end of the survey, and the correlation between self-perceived and measured CC was assessed. Approximately 94% of the GP trainees and 81% of the GP trainers scored low on knowledge; 45% and 42%, respectively, scored low on culturally competent attitudes. The level of culturally competent skills was moderate (54.3%) or low (48.4%) for most GP trainees and GP trainers. The year of residency and the GP training institute were significantly associated with one or more (sub-)domains of CC in GP trainees. Having >10% migrant patients and experience as a GP trainer were positively associated with one or more (sub-) domains of cultural competence in GP trainers. The correlation between measured and self-perceived CC was positive overall but very weak (Spearman correlation coefficient ranging from −0.1–0.3). The level of cultural competence was low in both groups, especially in the knowledge scores. Cultural competence increased with experience and exposure to an ethnically diverse patient population. Our study highlights the need for cultural competence training in the GP training curricula. General practitioner (GP) trainees find cross-cultural consultations stressful due to a self-perceived lack of cultural competence (CC). The level of CC in general practice is as yet unknown. On average, the level of CC was low for the majority of GP trainees and GP trainers, especially for the scores on knowledge. CC increased with experience and exposure to an ethnically diverse patient population. GP trainees and trainers perceived a lack of covered education on various topics related to the care of migrants. Our study highlights the need for cultural competence training in the GP training curricula. [ABSTRACT FROM AUTHOR]

Aim: To explore motivation, organisational climate, work engagement and related factors within the practice environment of nurse practitioners. Background: Motivation in the workplace, organisational climate and work engagement are important to motivate nurse practitioners and prevent early exit. However, little is known about related factors. Design: A cross‐sectional design using a digital survey with multiple‐choice and open‐ended questions. Data were collected from 1 November 2019 to 30 March 2020. Methods: The survey contained demographic and job‐related data, instruments on motivation in the workplace, organisational climate and work engagement. Three open‐ended questions were added to invite respondents to tell about their next career step, (dis)satisfaction with salary and additional comments. Quantitative data were not normally distributed (Kolmogorov–Smirnov test). Kruskal Wallis tests and Mann–Whitney U tests were used to test the relationship between independent and dependent variables. Answers on the open‐ended questions were coded and categorised in themes. The STROBE checklist was followed. Results: In total 586 questionnaires were completed. The majority of the respondents were female (85%), and their mean age was 47 years (range 26–66 years). Aged 45 or over, more work experience, working in nursing homes, experiencing more autonomy, collaboration with other nurse practitioners, a firmly anchored position, satisfaction with salary and developmental opportunities contributed positively to the practice environment. Answers on the open‐ended questions supported the quantitative results. Conclusions: Work motivation, organisational climate and work engagement are positively related to a large variety of personal and work‐related factors. Therefore, policymakers and professional organisations should be aware of the impact of these influencing factors to enhance an inspiring work environment. Relevance to Clinical Practice: Awareness of factors that influence nurse practitioners' practice environment can be used as a tool to screen and improve the present work environment. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nurses play an important role in monitoring and supporting patients and their relatives at the end of life., To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity., The limited literature available indicates that palliative care for psychiatric patients needs to be improved., What this paper adds to existing knowledge? This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision., Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders., Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses., What are the implications for research and practice? Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group., Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored., Abstract Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2 years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored. [ABSTRACT FROM AUTHOR]

Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper was to assess the perceptions and attitudes of modern medical practitioners (MMPs) and traditional medical practitioners (TMPs) about traditional medical practice and to analyze the utilization of traditional medicine in Eritrea. Methods: The data for this study were collected in a 10-month period from January to October 2004. A cross-sectional study was conducted in three sub-zones of Eritrea: Dekemhare, Ghinda, and Maekel. A total of 500 (250 each) MMPs and TMPs, and 1657 households were included in the study. Data were collected both by questionnaire and an interview (with key informants). Results: Our study reveals that there is a significant difference in perception and attitude between MMPs and TMPs about traditional medical practice in Eritrea. Their differences lie not only in their way of thinking but also in their perceptions of man and health. Our study further shows that in most rural communities in Eritrea, the use of traditional medicine and self-care is extensive. This is the case even in the presence of the supposedly free/subsidized health care available in government health centers. Conclusions: Higher confidence in traditional medicine for the treatment of serious illnesses, irrespective of availability of western medical service in many parts of Eritrea, indicates the need for selective integration of traditional medical practice with the primary healthcare system of the country. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Interventions aimed at improving guideline adherence should take into account the specific features of the target users; however, it is unclear how general practitioners ( GPs) evaluate the different types of interventions. The aim of this paper was to identify GPs' preferences for interventions to improve guideline adherence in practice and whether these differ across key guideline recommendations. Method An electronic survey was conducted among 703 GPs working in the south-western part of the Netherlands. Each survey focused on two of four guidelines: cerebrovascular accident, eye inflammation, thyroid disorders and urinary tract infection. GPs were asked to rate potential interventions in terms of their usefulness in improving guideline adherence in general and for specific key guideline recommendations. Results 264 GPs (38%) completed the questionnaire. In general, GPs preferred interactive small group meetings (84% rated this as much or very much encouraging), audit and feedback (53%), organizational interventions (50%) and the use of local opinion leaders (50%) as methods for improving guideline adherence. Financial interventions (24%), distribution of educational materials (22%) and big group educational meetings (21%) were of least interest. Some interventions were preferred by GPs irrespective of the specific key recommendations (e.g. audit and feedback), while ratings for other interventions differed across key recommendations (reminders/computer support). Conclusions To implement guidelines, interventions need to be identified that are acceptable and appealing to the target group. GPs seem to have general and recommendation-specific preferences regarding interventions, these should be taken into account when developing plans for guideline implementation to encourage the uptake of guidelines in practice. [ABSTRACT FROM AUTHOR]

Background: Palliative care in primary care and nursing home settings is becoming increasingly important. A multidimensional palliative care approach, provided by a multiprofessional team, is essential to meeting patients' and relatives' values, wishes, and needs. Factors that hamper the provision of palliative care in this context have not yet been fully explored. Objectives: To identify the barriers to providing palliative care for patients at home or in nursing homes as perceived by healthcare professionals. Design: Cross-sectional survey study. Methods: A convenience sample of nurses, doctors, chaplains, and rehabilitation therapists working in primary care and at nursing homes in the Netherlands is used. The primary outcome is barriers, defined as statements with ⩾20% negative response. The survey contained 56 statements on palliative reasoning, communication, and multiprofessional collaboration. Data were analyzed using descriptive statistics. Results: In total, 249 healthcare professionals completed the survey (66% completion rate). The main barriers identified in the provision of palliative care were the use of measurement tools (43%), consultation of an expert (31%), estimation of life expectancy (29%), and documentation in the electronic health record (21% and 37%). In primary care, mainly organizational barriers were identified, whereas in nursing homes, most barriers were related to care content. Chaplains and rehabilitation therapists perceived the most barriers. Conclusion: In primary care and nursing homes, there are barriers to the provision of palliative care. The provision of palliative care depends on the identification of patients with palliative care needs and is influenced by individual healthcare professionals, possibilities for consultation, and the electronic health record. An unambiguous and systematic approach within the multiprofessional team is needed, which should be patient-driven and tailored to the setting. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates intakes of risk micronutrients from non-fortified foods, fortified foods and food supplements in different age and gender sub-groups of the Dutch population. Methods: This is a secondary analysis of the Dutch National Food Consumption Survey (DNFCS 2012–2016, N = 4313, 1–79 years). The proportion of the population with Habitual Intakes below the Estimated Average Requirement (EAR) and above the Upper Level (UL) for calcium, iron, zinc, vitamin A, vitamin B6, folate, vitamin D and vitamin E from non-fortified foods, fortified foods and total intake including food supplements was calculated using Statistical Program to Assess Dietary Exposure (SPADE). Results: More than 50% of the population had an intake below the EAR for calcium, iron, vitamin D and folate. Intakes were inadequate for certain sub-groups for the other vitamins and minerals. Adolescents and women were the population sub-groups most likely to have an intake below the EAR. For zinc, vitamin A and folic acid, more than 1% of toddlers exceeded the UL from the total intake. A negligible proportion exceeded the UL for the other vitamins and minerals. Conclusion: Inadequate intakes were found for several micronutrients in various population sub-groups despite an apparently well-nourished population. Intakes of zinc, folic acid and vitamin A from food supplements in toddlers and preschoolers should be investigated further to ensure they do not exceed recommended amounts. These results can be used to inform policy makers and to design nutritional interventions to improve micronutrient intakes in the Netherlands. [ABSTRACT FROM AUTHOR]

There are two main coping styles regarding information seeking under medical threat; monitoring (information-seeking) and blunting (information-avoiding). The aim of this study is to (1) determine factors associated with a monitoring or blunting coping style in gastro-intestinal stromal tumour (GIST) patients and (2) investigate its association with psychological distress, cancer-related concerns, health-related quality of life and satisfaction with healthcare. In a cross-sectional study, Dutch GIST patients completed the shortened version of the Threatening Medical Situations Inventory to determine their coping style, the Hospital Anxiety and Depression Scale, Cancer Worry Scale, EORTC QLQ-C30 and part of the EORTC QLQ-INFO25. A total of 307 patients were classified as blunters (n = 175, 57%) or monitors (n = 132, 43%). Coping style was not associated with tumour or treatment variables, but being a female (OR 2.5; 95%CI 1.5–4.1; p= <.001) and higher educated (OR 5.5; 95%CI 2.5–11.9, p= <.001) were associated with higher odds of being a monitor. Monitors scored significantly lower on emotional functioning (mean = 86.8 vs mean = 90.9, p=.044), which is considered a trivial difference, more often experienced severe fear of cancer recurrence or progression (53.0% vs 37.7%, p=.007), and had more concerns about dying from GIST in the future (60.6% vs 47.4%, p=.025). Compared to blunters, monitors were less satisfied with the received healthcare and information, and would have liked to receive more information. GIST patients with a monitoring coping style experience a higher emotional burden. Additionally, monitors exhibit a greater need for information. Although this need for information could potentially result in fears and concerns, recognising it may also create an opening for tailored communication and information. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations between quality of life (QoL) and 1) immunotherapy and other cancer treatments received three months before QoL measurements, and 2) the comorbidities at the time of completion or in the year prior to QoL measurements, among patients with advanced cancer. Methods: A cross-sectional study is conducted on patients with advanced cancer in the Netherlands. The data come from the baseline wave of the 2017–2020 eQuiPe study. Participants were surveyed via questionnaires (including EORTC QLQ-C30). Using multivariable linear and logistic regression models, we explored statistical associations between QoL components and immunotherapy and other cancer treatments as well as pre-existing comorbidities while adjusting for age, sex, socio-economic status. Results: Of 1088 participants with median age 67 years, 51% were men. Immunotherapy was not associated with global QoL but was associated with reduced appetite loss (odds ratio (OR) = 0.6, 95%CI = [0.3,0.9]). Reduced global QoL was associated with chemotherapy (adjusted mean difference (β) = − 4.7, 95% CI [− 8.5,− 0.8]), back pain (β = − 7.4, 95% CI [− 11.0,− 3.8]), depression (β = − 13.8, 95% CI [− 21.5,− 6.2]), thyroid diseases (β = − 8.9, 95% CI [− 14.0,− 3.8]) and diabetes (β = − 4.5, 95% CI [− 8.9,− 0.5]). Chemotherapy was associated with lower physical (OR = 2.4, 95% CI [1.5,3.9]) and role (OR = 1.8, 95% CI [1.2,2.7]) functioning, and higher pain (OR = 1.9, 95% CI [1.3,2.9]) and fatigue (OR = 1.6, 95% CI [1.1,2.4]). Conclusion: Our study identified associations between specific cancer treatments, lower QoL and more symptoms. Monitoring symptoms may improve QoL of patients with advanced cancer. Producing more evidence from real life data would help physicians in better identifying patients who require additional supportive care. [ABSTRACT FROM AUTHOR]

Purpose -- For accountability purposes, performance information sharing and clear divisions of responsibilities between medical specialists and executive boards are critical. The purpose of this paper is to explore whether these aspects of clinical governance have been taken up by executive boards and medical specialists in the Netherlands. Design/methodology/approach -- This cross-sectional study aimed to explore the information-sharing between medical specialists and executive boards in Dutch hospitals as one key aspect of clinical governance. Between November 2010 and February 2011, 67 medical staff board chairs and 40 chief executive officers completed an online questionnaire concerning information-sharing and the clinical governance practices within their respective hospitals. Findings -- Almost all respondents acknowledged the importance of information-sharing. However, the actual sharing differed per type of performance information. Policy/management information was shared more often than patient care information. Similarly, medical specialists differ in the degree of responsibility the take for specific clinical governance tasks. Almost all were involved in managing complication registries (99 per cent), while few managed hospital accreditation (55 per cent). Research limitations/implications -- With executive boards and medical specialists being increasingly dependent of a shared budget, they have an extra incentive to share information and to take up clinical governance tasks. The study showed that Dutch medical specialists are sharing many types of performance information with the executive board, but that this should be increased to comply with the codes. Thus far, few hospital managers in the study have formalised this in an information protocol, which is potentially the next step for other hospital staff to incorporate as well. Those who have an information protocol seem to be aware of the business case for quality. Originality/value -- This study is the first attempt to explore to what extent Dutch medical specialists share performance information with their respective executive boards and take up clinical governance tasks. [ABSTRACT FROM AUTHOR]

In this paper, we focus on task restructuring as one of the most frequently occurring types of change in our contemporary knowledge society. In spite of its evident prevalence, research on task restructuring and employee well-being has been scarce until now. Based on Conservation of Resources (COR) theory and the Job Demands-Resources (JD-R) model, we argue that task restructuring is negatively related with employee well-being (in terms of emotional exhaustion and vigour). Furthermore, we advance that opportunities for learning through reflection and experimentation, as well as recently acquired KSAOs can serve as buffers in the relationship between task restructuring and well-being. Hierarchical regression analyses and simple slope analyses were conducted in order to test the research hypotheses on a large sample of the Dutch working population (N = 1711). Task restructuring had a positive association with emotional exhaustion and a negative one with vigour. Furthermore, recently acquired KSAOs, as well as opportunities for reflection and experimentation, buffered the relationship between task restructuring and emotional exhaustion. Opportunities for reflection and experimentation moderated the relationship between task restructuring and vigour as well. This study suggests that workplace learning can mitigate the negative relationship between task restructuring and well-being. [ABSTRACT FROM AUTHOR]

Purpose: Increasing age, high quadriceps strength, and low hamstring muscle strength are associated with hamstring strain injury in soccer. The authors investigated the age-related variation in maximal hamstring and quadriceps strength in male elite soccer players from under-13 (U-13) to the senior level. Methods: A total of 125 elite soccer players were included from a Danish professional soccer club and associated youth academy (first tier; U-13, n = 19; U-14, n = 16; U-15, n = 19; U-17, n = 24; U-19, n = 17; and senior, n = 30). Maximal voluntary isometric force was assessed for the hamstrings at 15° knee joint angle and for the quadriceps at 60° knee joint angle (0° = full extension) using an external-fixated handheld dynamometer. Hamstring-to-quadriceps strength (H:Q) ratio and hamstring and quadriceps maximal voluntary isometric force levels were compared across age groups (U-13 to senior). Results: Senior players showed 18% to 26% lower H:Q ratio compared with all younger age groups (P ≤.026). Specific H:Q ratios (mean [95% confidence interval]) were as follows: senior, 0.45 (0.42–0.48); U-19, 0.61 (0.55–0.66); U-17, 0.56 (0.51–0.60); U-15, 0.59 (0.54–0.64); U-14, 0.54 (0.50–0.59); and U-13, 0.57 (0.51–0.62). Hamstring strength increased from U-13 to U-19 with a significant drop from U-19 to the senior level (P =.048), whereas quadriceps strength increased gradually from U-13 to senior level. Conclusion: Elite senior soccer players demonstrate lower H:Q ratio compared with youth players, which is driven by lower hamstring strength at the senior level compared with the U-19 level combined with a higher quadriceps strength. This discrepancy in hamstring and quadriceps strength capacity may place senior-level players at increased risk of hamstring muscle strain injuries. [ABSTRACT FROM AUTHOR]

Aim The aims of this paper are, first, to identify the determinants of the 'intention to leave' of nurses working at a general hospital, and, second, to provide recommendations for various stakeholders targeting prevention of premature leaving to various post-exit destinations. Background Nurse turnover is a serious problem, especially given the increased need for professional medical care because of demographic changes, and puts severe pressure on health-care management staff. In order to meet future requirements for nursing staff, it is of utmost importance to empirically study their intention to leave either their department or hospital, and to identify the determinants of these various intentions to leave. Method A cross-sectional survey was completed by 318 nurses working at various departments at a general hospital in Eindhoven, the Netherlands. Data were collected in May 2011. Using binary regression analysis, various determinants of nurses' reported post-exit career choices could be identified. Conclusion Nurses' intention to leave is determined by their general satisfaction with management and leadership quality, their satisfaction with pay and benefits, their job satisfaction and work-to-home interference issues they have to deal with, but not by career development opportunities. Implications for nursing management Preventing nurses from leaving their department or hospital requires careful attention from management and human resources professionals working in hospitals. In particular, the line managers who actually supervise nurses on a daily basis are key in ensuring that nurses are satisfied with their management and with the rewards they receive, and are able to cope with work-home interference. [ABSTRACT FROM AUTHOR]

Background: Relatively little knowledge is available to date about health literacy among the general population in Europe. It is important to gain insights into health literacy competences among the general population, as this might contribute to more effective health promotion and help clarify socio-economic disparities in health. This paper is part of the European Health Literacy Survey (HLS-EU). It aims to add to the body of theoretical knowledge about health literacy by measuring perceived difficulties with health information in various domains of health, looking at a number of competences. The definition and measure of health literacy is still topic of debate and hardly any instruments are available that are applicable for the general population. The objectives were to obtain an initial measure of health literacy in a sample of the general population in the Netherlands and to relate this measure to education, income, perceived social status, age, and sex. Methods: The HLS-EU questionnaire was administered face-to-face in a sample of 925 Dutch adults, during July 2011. Perceived difficulties with the health literacy competences for accessing, understanding, appraising and applying information were measured within the domains of healthcare, disease prevention and health promotion. Multiple linear regression analyses were applied to explore the associations between health literacy competences and education, income, perceived social status, age, and sex. Results: Perceived difficulties with health information and their association with demographic and socio-economic variables vary according to the competence and health domain addressed. Having a low level of education or a low perceived social status or being male were consistently found to be significantly related to relatively low health literacy scores, mainly for accessing and understanding health information. Conclusions: Perceived difficulties with health information vary between competences and domains of health. Health literacy competences are associated with indicators of socio-economic position and with the domain in which health information is provided. [ABSTRACT FROM AUTHOR]

Background: It is well known that the prevalence of overweight and obesity is considerably higher among youth from lower socio-economic families, but there is little information about the role of some energy balance-related behaviors in the association between socio-economic status and childhood overweight and obesity. The objective of this paper was to assess the possible mediation role of energy balance-related behaviors in the association between parental education and children's body composition. Methods: Data were obtained from the cross sectional study of the "EuropeaN Energy balance Research to prevent excessive weight Gain among Youth" (ENERGY) project. 2121 boys and 2516 girls aged 10 to 12 from Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain were included in the analyses. Data were obtained via questionnaires assessing obesity related dietary, physical activity and sedentary behaviors and basic anthropometric objectively measured indicators (weight, height, waist circumference). The possible mediating effect of sugared drinks intake, breakfast consumption, active transportation to school, sports participation, TV viewing, computer use and sleep duration in the association between parental education and children's body composition was explored via MacKinnon's product-of-coefficients test in single and multiple mediation models. Two different body composition indicators were included in the models, namely Body Mass Index and waist circumference. Results: The association between parental education and children's body composition was partially mediated by breakfast consumption, sports participation, TV viewing and computer use. Additionally, a suppression effect was found for sugared drinks intake. No mediation effect was found for active transportation and sleep duration. The significant mediators explained a higher proportion of the association between parental education and waist circumference compared to the association between parental education and BMI. Conclusions: Tailored overweight and obesity prevention strategies in low SES preadolescent populations should incorporate specific messages focusing on the importance of encouraging daily breakfast consumption, increasing sports participation and decreasing TV viewing and computer use. However, longitudinal research to support these findings is needed. [ABSTRACT FROM AUTHOR]

Aims. To demonstrate the principles and application of Mokken scaling. Background. The history and development of Mokken scaling is described, some examples of applications are given, and some recent development of the method are summarised. Design. Secondary analysis of data obtained by cross-sectional survey methods, including self-report and observation. Methods. Data from the Edinburgh Feeding Evaluation in Dementia scale and the Townsend Functional Ability Scale were analysed using the Mokken scaling procedure within the 'R' statistical package. Specifically, invariant item ordering (the extent to which the order of the items in terms of difficulty was the same for all respondents whatever their total scale score) was studied. Results. The Edinburgh Feeding Evaluation in Dementia scale and the Townsend Functional Ability Scale showed no violations of invariant item ordering, although only the Townsend Functional Ability Scale showed a medium accuracy. Conclusion. Mokken scaling is an established method for item response theory analysis with wide application in the social sciences. It provides psychometricians with an additional tool in the development of questionnaires and in the study of individuals and their responses to latent traits. Specifically, with regard to the analyses conducted in this study, the Edinburgh Feeding Evaluation in Dementia scale requires further development and study across different levels of severity of dementia and feeding difficulty. Relevance to clinical practice. Good scales are required for assessment in clinical practice and the present paper shows how a relatively recently developed method for analysing Mokken scales can contribute to this. The two scales used as examples for analysis are highly clinically relevant. [ABSTRACT FROM AUTHOR]

Gobbens R.J., van Assen M.A., Luijkx K.G. & Schols J.M. (2012) Testing an integral conceptual model of frailty. Journal of Advanced Nursing 68(9), 2047-2060. Abstract Aim. This paper is a report of a study conducted to test three hypotheses derived from an integral conceptual model of frailty. Background. The integral model of frailty describes the pathway from life-course determinants to frailty to adverse outcomes. The model assumes that life-course determinants and the three domains of frailty (physical, psychological, social) affect adverse outcomes, the effect of disease(s) on adverse outcomes is mediated by frailty, and the effect of frailty on adverse outcomes depends on the life-course determinants. Methods. In June 2008 a questionnaire was sent to a sample of community-dwelling people, aged 75 years and older ( n = 213). Life-course determinants and frailty were assessed using the Tilburg Frailty Indicator. Adverse outcomes were measured using the Groningen Activity Restriction Scale, the WHOQOL-BREF and questions regarding healthcare utilization. The effect of seven self-reported chronic diseases was examined. Results. Life-course determinants, chronic disease(s), and frailty together explain a moderate to large part of the variance of the seven continuous adverse outcomes (26-57%). All these predictors together explained a significant part of each of the five dichotomous adverse outcomes. The effect of chronic disease(s) on all 12 adverse outcomes was mediated at least partly by frailty. The effect of frailty domains on adverse outcomes did not depend on life-course determinants. Conclusion. Our finding that the adverse outcomes are differently and uniquely affected by the three domains of frailty (physical, psychological, social), and life-course determinants and disease(s), emphasizes the importance of an integral conceptual model of frailty. [ABSTRACT FROM AUTHOR]

zwijnenberg n.c. & bours g.j.j.w. (2012) Nurse practitioners and physician assistants in Dutch hospitals: their role, extent of substitution and facilitators and barriers experienced in the reallocation of tasks. Journal of Advanced Nursing 68(6), 1235-1246. Abstract Aims. This paper is a report of a study exploring the role of nurse practitioners and physician assistants, the extent of substitution and the barriers and facilitators experienced by them as a consequence of substitution in public hospitals. Background. Nurse practitioners and physician assistants are emerging worldwide. However, despite the large amount of evidence showing the added value of these professionals, little evidence is available concerning the role, extent of substitution and facilitators and barriers experienced by them as a consequence of substitution. Methods. Interviews were conducted and a questionnaire was completed by 43 nurse practitioners and 13 physician assistants employed in public hospitals in the south of the Netherlands in 2007. Results. Nurse practitioners and physician assistants performed a broad spectrum of tasks, but differed significantly in the time spent and the kind of tasks performed. Nurse practitioners spent 25% (10·4 hours; sd = 5·5) and physician assistants 40% (18·7 hours; sd = 7·6) of their time on medical procedures. They both also performed new tasks or tasks for which there previously was insufficient capacity. Many of them experienced policy/organizational, legal, financial or facility problems in the reallocation of tasks. Conclusion. Nurse practitioners and physician assistants have wide ranging but different responsibilities in public hospitals. By performing medical procedures and new tasks or tasks for which there was not enough capacity, they function as substitutes and supplements for doctors. However, barriers are affecting the extent of substitution. The challenge ahead is to remove the barriers experienced by nurse practitioners and physician assistants. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 133-143 The professional nursing practice environment and nurse-reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered. [ABSTRACT FROM AUTHOR]

Workplace conflict is a potent stressor, but most previous research has focused on its effect on productivity and performance rather than on individual well-being. This paper examines the moderating roles of an individual's internal locus of control and a problem-solving conflict management strategy. In the cross-sectional study, among 774 health care workers in the Netherlands, employees' internal locus of control did moderate the relationship between experienced conflict at work and psychological strain, which was measured using a 13-item Dutch adaptation of the Occupational Stress Indicator. In addition, this moderation was mediated by the active conflict management strategy of problem solving; people with a more internal locus of control use a problem-solving conflict management strategy more often and, as a result, experience less psychological strain in cases of workplace conflict. Implications for conflict theory, for future research, and for practice are discussed. [ABSTRACT FROM AUTHOR]

Societal change in western societies may impact emotional and behavioural problems of adolescents. Firm epidemiological evidence of changes in emotional and behavioural problems during the last decade is lacking. Insight into secular changes in emotional and behavioural problems among adolescents from various sociodemographic groups is crucial for adequate and targeted policy making. Therefore, the purpose of this study was to examine 10-year time trends in emotional and behavioural problems among adolescents, and potential differences in time trends between sociodemographic groups. Analyses were based on annually repeated cross-sectional data including 56,159 multi-ethnic students (13-14 years old) in the second year of various levels of secondary education in Amsterdam, The Netherlands, using the internationally validated Strengths and Difficulties Questionnaire. In general, emotional and behavioural problems increased over a 10-year time period (i.e., relative increase of total difficulties by 19%). This increase was mainly due to an increase in hyperactivity/inattention problems, while peer-relationship problems decreased. Time trends differed somewhat by sex: total difficulties and emotional problems increased in girls but remained fairly stable in boys. In Amsterdam, emotional and behavioural problems in adolescents seemingly increased over time, especially hyperactivity/inattention problems. Further research is needed to clarify the underlying causes. We cannot totally exclude potential confounders underlying our findings. Our findings can inform policies to target health programs at sociodemographic groups at increased risk. [ABSTRACT FROM AUTHOR]

paans w., sermeus w., nieweg r.M.B. & van der schans c.P. (2010) Prevalence of accurate nursing documentation in patient records. Journal of Advanced Nursing 66(11), 2481-2489. Aim. This paper is a report of a study conducted to describe the accuracy of nursing documentation in patient records in hospitals. Background. Accurate nursing documentation enables nurses to systematically review the nursing process and to evaluate the quality of care. Assessing nurses' reports in patient records can be helpful for improving the accuracy of nursing documentation. Method. In 2007-2008, we screened patient records ( n = 341) from 35 wards in 10 hospitals in the Netherlands. The D-Catch instrument was used to quantify the accuracy of the (1) record structure, (2) admission data, (3) nursing diagnosis, (4) nursing interventions, (5) progress and outcome evaluations and (6) legibility of nursing reports. Items 2-5 were measured as a sum score of quantity criteria (1-4) and quality criteria (1-4), whereas Items 1 and 6 were measured on a 4-point Likert scale that addressed only quality criteria. Findings. The domain 'accuracy of the interventions' had the lowest accuracy scores: 95% of the records revealed a scale score not higher than 5. However, the domain 'admission' had the highest scores: 80% of the records revealed a scale score over 5. Conclusion. Effective documentation systems that support nurses in linking diagnoses, interventions and progress and outcome evaluations could be helpful. To improve the accuracy of the documentation, further research is needed on what factors influence nursing documentation. Comparable outcomes from other studies indicate that applying our study findings to international contexts might support the development of universal criteria for accurate nursing documentation. [ABSTRACT FROM AUTHOR]

This paper reports on a study that looked into the relationship between the composition of the international classroom (a classroom composed of students from multiple nationalities), educational interventions aimed at intercultural learning, and domestic students' levels of Cultural Intelligence (CQ). Using cross-sectional data from 10,243 students enrolled in eleven different higher educational institutions in the Netherlands, we applied multilevel analyses to examine whether the composition of an international classroom, internationalization at home activities and the interaction between the two were related to students' levels of CQ. Results show that Dutch domestic students who are members of a class with a higher number of international students reported higher levels of motivational CQ, but not of the other three dimensions of CQ. Educational interventions aimed at intercultural learning were reported as being positively related to all dimensions of CQ. The findings underscore that when it comes to students' overall CQ, the international composition of their classroom is not enough to explain differences in CQ levels. Therefore, this study advocates the use of intentionally designed educational interventions next to the informal interactions in a diverse classroom when it comes to fostering cultural intelligence among domestic students. [ABSTRACT FROM AUTHOR]

Purpose: The European Organisation for Research and Treatment of Cancer (EORTC) quality of life core questionnaire (QLQ-C30) is a validated and widely-used Patient-Reported Outcome Measure for measuring the health-related quality of life (HRQoL) of cancer patients. To facilitate interpretation of results obtained in studies using the EORTC QLQ-C30, we generated normative data for the Dutch general population, stratified by age and sex. Methods: Dutch participants were selected from a larger cross-sectional online panel research study collecting EORTC QLQ-C30 general population normative data across 15 countries. EORTC QLQ-C30 raw scores based on a 4-point response scale were transformed to linear scores ranging from 0 to 100. Transformed scores were weighted based on the United Nations population distribution statistics and presented by age and sex/age. Differences in scale scores of ≥ 10 points in HRQoL were applied to indicate clinical relevance. Results: One thousand respondents completed the online survey. Stratified by age, clinically meaningful differences were observed, with worse physical functioning scores and better emotional functioning scores with increased age. Symptom scores remained stable across age groups, except for small age differences observed for fatigue, nausea/vomiting, diarrhoea, and financial difficulties. Stratified by sex/age, men generally scored better for both functioning and symptoms. However, these differences were not clinically meaningful. Conclusions: These updated normative EORTC QLQ-C30 for the Dutch general population can be used to better interpret HRQoL data obtained from Dutch cancer patients. Being part of a larger international study, these data can further be used for inter-country comparisons in multi-national studies. [ABSTRACT FROM AUTHOR]

Background Discordance between physicians' and patients' prognostic perceptions in advanced cancer care threatens informed medical decision-making and end-of-life preparation, yet this phenomenon is poorly understood. We sought to: (1) describe the extent and direction of prognostic discordance, patients' prognostic information preferences in cases of prognostic discordance, and physicians' awareness of prognostic discordance; and (2) examine which patient, physician, and caregiver factors predict prognostic discordance. Materials and Methods Oncologists and advanced cancer patients (median survival ≤12 months; n = 515) from 7 Dutch hospitals completed structured surveys in a cross-sectional study. Prognostic discordance was operationalized by comparing physicians' and patients' perceptions of the likelihood of cure, 2-year mortality risk, and 1-year mortality risk. Results Prognostic discordance occurred in 20% (likelihood of cure), 24%, and 35% (2-year and 1-year mortality risk) of physician-patient dyads, most often involving patients with more optimistic perceptions than their physician. Among patients demonstrating prognostic discordance, the proportion who preferred not knowing prognosis varied from 7% (likelihood of cure) to 37% (1-year mortality risk), and 45% (2-year mortality risk). Agreement between physician-perceived and observed prognostic discordance or concordance was poor (kappa = 0.186). Prognostic discordance was associated with several patient factors (stronger fighting spirit, self-reported absence of prognostic discussions, an information source other than the healthcare provider), and greater physician-reported uncertainty about prognosis. Conclusion Up to one-third of the patients perceive prognosis discordantly from their physician, among whom a substantial proportion prefers not knowing prognosis. Most physicians lack awareness of prognostic discordance, raising the need to explore patients' prognostic information preferences and perceptions, and to tailor prognostic communication. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of a premenopausal risk‐reducing salpingo‐oophorectomy (RRSO) in women at increased risk of ovarian cancer on objective and subjective cognition at least 10 years after RRSO. Design: A cross‐sectional study with prospective follow‐up, nested in a nationwide cohort. Setting: Multicentre in the Netherlands. Population or Sample: 641 women (66% BRCA1/2 pathogenic variant carriers) who underwent either a premenopausal RRSO ≤ age 45 (n = 436) or a postmenopausal RRSO ≥ age 54 (n = 205). All participants were older than 55 years at recruitment. Methods: Participants completed an online cognitive test battery and a questionnaire on subjective cognition. We used multivariable regression analyses, adjusting for age, education, breast cancer, hormone replacement therapy, cardiovascular risk factors and depression. Main Outcome Measures: The influence of RRSO on objective and subjective cognition of women with a premenopausal RRSO compared with women with a postmenopausal RRSO. Results: After adjustment, women with a premenopausal RRSO (mean time since RRSO 18.2 years) performed similarly on objective cognitive tests compared with women with a postmenopausal RRSO (mean time since RRSO 11.9 years). However, they more frequently reported problems with reasoning (odds ratio [OR] 1.8, 95% confidence interval [95% CI] 1.1–3.1) and multitasking (OR 1.9, 95% CI 1.1–3.4) than women with a postmenopausal RRSO. This difference between groups disappeared in an analysis restricted to women of comparable ages (60–70 years). Conclusions: Reassuringly, approximately 18 years after RRSO, we found no association between premenopausal RRSO and objective cognition. [ABSTRACT FROM AUTHOR]