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Background: Most young children (0–3 years) attend formal childcare in Denmark, many of them fulltime. Yet recent reports of the quality of Danish childcare centers have shown that in more than one-third of nurseries, the interactions between caregivers and young children (0–3 years) are of “insufficient” quality, which constitutes a risk for affected children’s well-being and development. Effective interventions to improve childcare providers’ interactive skills are necessary. Methods: In this randomized controlled trial, we test the effectiveness of the Caregiver Interaction Profile training, which focuses on improving six core interactive skills: sensitive responsiveness, respecting children’s autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. We will recruit N = 200 childcare providers from nursery groups in Copenhagen (n = 100 training group, n = 100 waiting-list control group). Our primary outcomes are childcare providers’ six interactive skills named above, observed from video-recorded interactions in the nursery groups. The secondary goal of our study is to test whether the training boosts children’s social-emotional and linguistic development. To this end we aim to recruit N ≈ 500 children from participating childcare providers’ nursery groups (n ≈ 250 training group, n ≈ 250 waiting-list control group). We measure social-emotional and linguistic development with various standardized questionnaires, filled out by parents and childcare providers. Discussion: If the training is effective at improving childcare providers’ interactive skills, then this will be an important foundation for implementation efforts, such as offering the training as part of the educational program of childcare providers. Future research should also evaluate whether the Caregiver Interaction Profile training is effective for childcare providers of older children (3–5 years) in Danish kindergartens. Tri

Research indicates increases in coercive parenting towards children and increases in child externalizing behavior during COVID-19 as compared to the pre-pandemic period. In this preregistered study, we extended previous knowledge by investigating to what extent, and under what conditions, changes in coercive parenting and child externalizing behavior are interrelated. Ninety-five mothers and fathers of children (of age 3 prior to the pandemic) reported on coercive parenting and child externalizing behavior before and during the pandemic, and trained assistants observed the quality of mother-child and father-child attachment relationship prior to the pandemic. We employed latent change score modeling to test the extent to which changes in maternal and paternal coercive parenting and changes in child externalizing behavior across the pre-pandemic period and the onset of the first COVID-19 lockdown are interrelated. Moreover, we tested whether these linkages are moderated by changes in the other parent's coercive parenting and the quality of parent-child attachment relationship. Specifically, we tested the moderation by mother-child (fatherchild) attachment relationship quality in the relation between changes in mothers' (fathers') coercive parenting and changes in child externalizing behavior. We found that changes in mothers', but not fathers' coercive parenting were positively associated with changes in child externalizing behavior. We found no moderation by changes in the other parent's parenting or by parent-child attachment relationship quality. Our findings provide support for the transactional processes underlying mothers' and children's behavior in the context of non-normative stressful conditions. We recommend incorporating evidence-based (parenting) support for mothers, fathers, and young children in prevention strategies and recovery tools employed during and after future lockdowns and non-normative stressful events.

The current meta-analysis examined and compared the relative associations of maternal and paternal parenting behavior with children’s prosocial behavior from 29 studies. In total 502 effect sizes (N = 14,627) were subjected to Meta-Analytic Structural Equation Modeling. Controlling for the other parent, both maternal and paternal parenting behavior showed small positive pooled associations with children’s prosocial behavior (r father =.10 and r mother =.12). The partial effect sizes for paternal and maternal parenting did not differ significantly from each other and were significant regardless of parenting dimension, study design (concurrent versus predictive) and average sample age (pre-adolescence versus adolescence). High levels of paternal and maternal warmth and positive control, and low levels of paternal and maternal harshness were associated with more prosocial behavior in children.

Alzheimer’s disease (AD) and type 2 diabetes (T2D) are chronic diseases that share several pathological mechanisms, including insulin resistance and impaired insulin signalling. Their shared features have prompted the evaluation of the drugs used to manage diabetes for the treatment of AD. Insulin delivery itself has been utilized, with promising effects, in improving cognition and reducing AD related neuropathology. The most recent clinical trial involving intranasal insulin reported no slowing of cognitive decline; however, several factors may have impacted the trial outcomes. Long-acting and rapid-acting insulin analogues have also been evaluated within the context of AD with a lack of consistent outcomes. This narrative review provided insight into how targeting insulin signalling in the brain has potential as a therapeutic target for AD and provided a detailed update on the efficacy of insulin, its analogues and the outcomes of human clinical trials. We also discussed the current evidence that warrants the further investigation of the use of the mimetics of insulin for AD. These small molecules may provide a modifiable alternative to insulin, aiding in developing drugs that selectively target insulin signalling in the brain with the aim to attenuate cognitive dysfunction and AD pathologies.

Background: In countries where the majority of young children are enrolled in professional childcare, the childcare setting constitutes an important part of children’s caregiving environment. Research consistently shows that particularly the quality of the daily interactions and relationship between young children and their professional caregivers have long-term effects on a range of developmental child outcomes. Therefore, professional caregivers’ capacity for establishing high quality interactions with the children in their care is an important target of intervention. Methods: A prospective, parallel, cluster-randomized wait-list controlled trial is used to test the efficacy of the attachment- and mentalization theory informed Circle of Security (COS) approach adapted to the childcare setting (COS-Classroom) on caregiver interactive skills and mind-mindedness. Participants are professional caregivers of children aged 0–2.9 years working in center-based childcare in Denmark. Approximately 31 childcare centers, corresponding to an estimated 113 caregivers, are expected to participate. The primary outcome is caregiver Sensitive responsiveness measured with the Caregiver Interactive Profile Scales (CIP-scales). Secondary outcomes include caregiver Mind-mindedness, the five remaining CIP-scales (Respect for autonomy, Structure and limit setting, Verbal communication, Developmental stimulation, and Fostering positive peer interactions), and caregivers’ resources to cope with work-related stress. Data on structural factors (e.g., staff stability, caregiver-child ratio, and level of pre-service education), caregiver attachment style, acceptability and feasibility of the COS-C together with qualitative data on how the participants experience the COS-C is additionally collected to investigate moderating and confounding effects. Discussion: Examining the effectiveness of the COS-C in center-based childcare contributes to the knowledge of evidence-based intervention progra

Background: In countries where the majority of young children are enrolled in professional childcare, the childcare setting constitutes an important part of children’s caregiving environment. Research consistently shows that particularly the quality of the daily interactions and relationship between young children and their professional caregivers have long-term effects on a range of developmental child outcomes. Therefore, professional caregivers’ capacity for establishing high quality interactions with the children in their care is an important target of intervention. Methods: A prospective, parallel, cluster-randomized wait-list controlled trial is used to test the efficacy of the attachment- and mentalization theory informed Circle of Security (COS) approach adapted to the childcare setting (COS-Classroom) on caregiver interactive skills and mind-mindedness. Participants are professional caregivers of children aged 0–2.9 years working in center-based childcare in Denmark. Approximately 31 childcare centers, corresponding to an estimated 113 caregivers, are expected to participate. The primary outcome is caregiver Sensitive responsiveness measured with the Caregiver Interactive Profile Scales (CIP-scales). Secondary outcomes include caregiver Mind-mindedness, the five remaining CIP-scales (Respect for autonomy, Structure and limit setting, Verbal communication, Developmental stimulation, and Fostering positive peer interactions), and caregivers’ resources to cope with work-related stress. Data on structural factors (e.g., staff stability, caregiver-child ratio, and level of pre-service education), caregiver attachment style, acceptability and feasibility of the COS-C together with qualitative data on how the participants experience the COS-C is additionally collected to investigate moderating and confounding effects. Discussion: Examining the effectiveness of the COS-C in center-based childcare contributes to the knowledge of evidence-based intervention progra

The current study assessed (1) the importance of six caregiver interactions skills (sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions) as rated by several stakeholders, (2) the quality of caregiver interactive skills, and (3) the effectiveness of a training program in early child care centers (children 0- to 6-year-olds) in Bangladesh. Using a quasi-experimental study design, 20 caregivers were allocated to the experimental condition (receiving a training) and 20 caregivers to the control condition (no training). Research Findings: Results showed that the importance of the six caregiver interactive skills was acknowledged by parents, managers/factory owners, and caregivers. Caregivers scored on average in the inadequate range for five out of the six CIP skills (except structuring and limit setting). Using a newly developed training program, quality of caregiver interactive skills improved. Finally, caregivers’ overall training satisfaction as rated at posttest was high. The relatively low scores on caregiver interactive skills underscore that it is important to assess and monitor pedagogical quality in child care. Practice or Policy: Our findings indicate that the quality of caregiver–child interactions in the Bangladesh child care context can be strengthened by training.

Behavioral parent training (BPT) is a theory-driven, evidence-based, and widely used intervention strategy for preventing and decreasing children’s disruptive

The province of South Holland is one of the biggest drivers of the Dutcheconomy with almost a quarter of the gross national product earned in thisregion. The agrifood sector is the largest contributor with an annual turnover ofabout € 5.5 billion. About half of the surface of the province is dedicated to thissector, entailing many jobs and steering innovation worldwide. In line with theambitious target of the Dutch government the province aims to be fully circularin 2050. This means the agrifood sector is facing an enormous transition.However, the sector faces several major socio-spatial and environmentalchallenges. The current monoculture food landscapes contribute to 20% ofGHG emissions, consumes 67% of fresh water, and results in subsidence,salination and lack of biodiversity. Additionally, with the challenge to build230.000 houses and the space needed for energy transition and nature,the pressure on space increases. The distribution of these negativeexternalities results in socio-spatial inequality, placing a burden on mainlylower income communities, including a lower socio-economic positionfor farmers. Nature-inclusive agriculture has the potential to tackle theseissues as an overarching framework. How can the agrifood sector in theProvince of South Holland transition to a nature inclusive circular system?This project aims to have a 100% nature-inclusive agrifood sector in 2050.To reach this goal, this project starts by further investigating the currentlinear system and its environmental social and spatial issues. It can beconcluded that the socio-spatial challenges are most present in the fringeswithin the province. Hence, a regional vision and strategy are proposedthat transform the linear-manufacture-waste model into a circular andnature-inclusive agrifood sector, through re-activation of the fringes inthe province. The fringes offer a high potential for implementation of avariety of nature-inclusive and circular functions, that can be establishedthrough sta, AR2U086 R&D Studio – Spatial Strategies for the Global Metropolis, Architecture, Urbanism and Building Sciences | Urbanism

The province of South Holland is one of the biggest drivers of the Dutch economy with almost a quarter of the gross national product earned in this region. The agrifood sector is the largest contributor with an annual turnover of about € 5.5 billion. About half of the surface of the province is dedicated to this sector, entailing many jobs and steering innovation worldwide. In line with the ambitious target of the Dutch government the province aims to be fully circular in 2050. This means the agrifood sector is facing an enormous transition. However, the sector faces several major socio-spatial and environmental challenges. The current monoculture food landscapes contribute to 20% of GHG emissions, consumes 67% of fresh water, and results in subsidence, salination and lack of biodiversity. Additionally, with the challenge to build 230.000 houses and the space needed for energy transition and nature, the pressure on space increases. The distribution of these negative externalities results in socio-spatial inequality, placing a burden on mainly lower income communities, including a lower socio-economic position for farmers. Nature-inclusive agriculture has the potential to tackle these issues as an overarching framework. How can the agrifood sector in the Province of South Holland transition to a nature inclusive circular system? This project aims to have a 100% nature-inclusive agrifood sector in 2050.To reach this goal, this project starts by further investigating the current linear system and its environmental social and spatial issues It can be concluded that the socio-spatial challenges are most present in the fringes within the province. Hence, a regional vision and strategy are proposed that transform the linear-manufacture-waste model into a circular and nature-inclusive agrifood sector, through re-activation of the fringes in the province. The fringes offer a high potential for implementation of a variety of nature-inclusive and circular functions, that can b

Objective: Our objective is twofold: First, to examine whether, to what extent and for whom (by sex and educational attainment) work-to-family conflict (W→F-conflict) and family-to- work conflict (F→W-conflict) increased from the pre-Covid-19 period to the first lockdown period. Second, to examine whether and to what extent the negative associations between W→F-conflict/F→W-conflict and perceived parenting (positive encouragement, coercive parenting and the parent-child relationship) became stronger. Background: During the first Covid-19 lockdown, parents were asked to provide childcare and home-schooling for their children while also being expected to fulfil their work obligations. Under these circumstances, this study was set out to examine how W→F- conflict/F→W-conflict, perceived parenting and their associations were affected. Method: Multilevel regression models were applied to longitudinal data collected among 55 employed mothers and 76 employed fathers with a 3-year-old child at wave 1. Results: We found that F→W-conflict/W→F-conflict increased most strongly among highly educated mothers, followed by lower/medium educated mothers and highly educated fathers, while no increase or even a decrease was observed among lower/medium educated fathers. We found some associations between W→F-conflict/F→W-conflict with perceived parenting, but these did not consistently become stronger during the Covid-19 wave. Although overall heightened levels of conflict did not strongly spill over to mothers’ and fathers’ perceived parenting, our results showed that for some parents conflict clearly increased with negative implications for their perceived parenting. Conclusion: With some noteworthy exceptions, increases in F→W-conflict/W→F-conflict did not coincide with decreases in perceived parenting, indicating that most parents did not let increased conflict between work and family affect their parenting. Key words: Covid-19, work-family conflict, parenting

Parental stress is a known risk factor for coercive parenting and for lower coparenting quality. In the present study, we examined whether and how changes in parental stress of mothers and fathers from the pre-COVID-19 period (T1) into the height of the first lockdown in the Netherlands (T2) were linked to changes in coercive parenting of mothers and fathers and to changes in coparenting quality. A total of 96 families (46.9% lower or medium and 53.1% higher educational background), with mother, father, and child (53.1% girls; T1: Mage = 3.44 years, SD = 0.32; T2: Mage = 4.72 years, SD = 0.61) participated. To examine interrelations between parental stress (reported using the Parental Stress Scale), coparenting, and coercive parenting (both reported using the Parenting And Family Adjustment Scales), a multivariate Latent Change Score (LCS) model was employed. Higher initial levels of parental stress were associated with higher initial levels of coercive parenting and lower initial levels of coparenting quality. Similarly, stronger increases in parental stress were associated with stronger increases in coercive parenting and with stronger decreases in coparenting quality. Directions of associations and effect sizes were similar for mothers and fathers in all analyses. The results from the present study indicate the importance of a family systems perspective in prevention and intervention programs. Promotion of systematic family-based preventive and intervention activities by the government might support families during challenging times, as during the novel COVID-19 pandemic

Behavioral parent training (BPT) is a theory-driven, evidence-based, and widely used intervention strategy for preventing and decreasing children's disruptive behavior problems, indirectly via improved parenting behavior. However, not all families benefit equally from BPT. To date, our knowledge of who benefits (and who does not) and our understanding of why some families benefit more than others is limited. An important challenge for research and practice is finding ways to tailor interventions to the needs of an individual family and increase their effectiveness. We put forward family systems theory as a tool to gain more insight into which families (do not) benefit from BPT and why. We synthesize the theoretical foundations and empirical support for the putative mechanisms through which the functioning of family systems may explain BPT effectiveness and propose ways in which family systems theory can help strengthen the design, implementation, and evaluation of BPT programs.

The province of South Holland is one of the biggest drivers of the Dutcheconomy with almost a quarter of the gross national product earned in thisregion. The agrifood sector is the largest contributor with an annual turnover ofabout € 5.5 billion. About half of the surface of the province is dedicated to thissector, entailing many jobs and steering innovation worldwide. In line with theambitious target of the Dutch government the province aims to be fully circularin 2050. This means the agrifood sector is facing an enormous transition.However, the sector faces several major socio-spatial and environmentalchallenges. The current monoculture food landscapes contribute to 20% ofGHG emissions, consumes 67% of fresh water, and results in subsidence,salination and lack of biodiversity. Additionally, with the challenge to build230.000 houses and the space needed for energy transition and nature,the pressure on space increases. The distribution of these negativeexternalities results in socio-spatial inequality, placing a burden on mainlylower income communities, including a lower socio-economic positionfor farmers. Nature-inclusive agriculture has the potential to tackle theseissues as an overarching framework. How can the agrifood sector in theProvince of South Holland transition to a nature inclusive circular system?This project aims to have a 100% nature-inclusive agrifood sector in 2050.To reach this goal, this project starts by further investigating the currentlinear system and its environmental social and spatial issues. It can beconcluded that the socio-spatial challenges are most present in the fringeswithin the province. Hence, a regional vision and strategy are proposedthat transform the linear-manufacture-waste model into a circular andnature-inclusive agrifood sector, through re-activation of the fringes inthe province. The fringes offer a high potential for implementation of avariety of nature-inclusive and circular functions, that can be establishedthrough sta, AR2U086 R&D Studio – Spatial Strategies for the Global Metropolis, AR2U088 R&D Methodology for Urbanism, Architecture, Urbanism and Building Sciences | Urbanism

The current study assessed (1) the importance of six caregiver interactions skills (sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions) as rated by several stakeholders, (2) the quality of caregiver interactive skills, and (3) the effectiveness of a training program in early child care centers (children 0- to 6-year-olds) in Bangladesh. Using a quasi-experimental study design, 20 caregivers were allocated to the experimental condition (receiving a training) and 20 caregivers to the control condition (no training). Research Findings: Results showed that the importance of the six caregiver interactive skills was acknowledged by parents, managers/factory owners, and caregivers. Caregivers scored on average in the inadequate range for five out of the six CIP skills (except structuring and limit setting). Using a newly developed training program, quality of caregiver interactive skills improved. Finally, caregivers’ overall training satisfaction as rated at posttest was high. The relatively low scores on caregiver interactive skills underscore that it is important to assess and monitor pedagogical quality in child care. Practice or Policy: Our findings indicate that the quality of caregiver–child interactions in the Bangladesh child care context can be strengthened by training.

The current meta-analysis examined and compared the relative associations of maternal and paternal parenting behavior with children’s prosocial behavior from 29 studies. In total 502 effect sizes (N = 14,627) were subjected to Meta-Analytic Structural Equation Modeling. Controlling for the other parent, both maternal and paternal parenting behavior showed small positive pooled associations with children’s prosocial behavior (r father =.10 and r mother =.12). The partial effect sizes for paternal and maternal parenting did not differ significantly from each other and were significant regardless of parenting dimension, study design (concurrent versus predictive) and average sample age (pre-adolescence versus adolescence). High levels of paternal and maternal warmth and positive control, and low levels of paternal and maternal harshness were associated with more prosocial behavior in children.

Background: Over the last decade, there has been an increasing awareness for the potential harm of the administration of too much oxygen. We aimed to describe self-reported attitudes towards oxygen therapy by clinicians from a large representative sample of intensive care units (ICUs) in the Netherlands.Methods: In April 2019, 36 ICUs in the Netherlands were approached and asked to send out a questionnaire (59 questions) to their nursing and medical staff (ICU clinicians) eliciting self-reported behaviour and attitudes towards oxygen therapy in general and in specific ICU case scenarios.Results: In total, 1361 ICU clinicians (71% nurses, 24% physicians) from 28 ICUs returned the questionnaire. Of responding ICU clinicians, 64% considered oxygen-induced lung injury to be a major concern. The majority of respondents considered a partial pressure of oxygen (PaO2) of 6-10 kPa (45-75 mmHg) and an arterial saturation (SaO(2)) of 85-90% as acceptable for 15 minutes, and a PaO2 7-To kPa (53-75 mmHg) and SaO(2) 90-95% as acceptable for 24-48 hours in an acute respiratory distress syndrome (ARDS) patient. In most case scenarios, respondents reported not to change the fraction of inspired oxygen (FiO(2)) if SaO(2) was 90-95% or PaO2 was 12 kPa (90 mmHg).Conclusion: A representative sample of ICU clinicians from the Netherlands were concerned about oxygen-induced lung injury, and reported that they preferred PaO2 and SaO(2) targets in the lower physiological range and would adjust ventilation settings accordingly.

Background: Over the last decade, there has been an increasing awareness for the potential harm of the administration of too much oxygen. We aimed to describe self-reported attitudes towards oxygen therapy by clinicians from a large representative sample of intensive care units (ICUs) in the Netherlands.Methods: In April 2019, 36 ICUs in the Netherlands were approached and asked to send out a questionnaire (59 questions) to their nursing and medical staff (ICU clinicians) eliciting self-reported behaviour and attitudes towards oxygen therapy in general and in specific ICU case scenarios.Results: In total, 1361 ICU clinicians (71% nurses, 24% physicians) from 28 ICUs returned the questionnaire. Of responding ICU clinicians, 64% considered oxygen-induced lung injury to be a major concern. The majority of respondents considered a partial pressure of oxygen (PaO2) of 6-10 kPa (45-75 mmHg) and an arterial saturation (SaO(2)) of 85-90% as acceptable for 15 minutes, and a PaO2 7-To kPa (53-75 mmHg) and SaO(2) 90-95% as acceptable for 24-48 hours in an acute respiratory distress syndrome (ARDS) patient. In most case scenarios, respondents reported not to change the fraction of inspired oxygen (FiO(2)) if SaO(2) was 90-95% or PaO2 was 12 kPa (90 mmHg).Conclusion: A representative sample of ICU clinicians from the Netherlands were concerned about oxygen-induced lung injury, and reported that they preferred PaO2 and SaO(2) targets in the lower physiological range and would adjust ventilation settings accordingly.

Whereas various studies have examined the effects of in-service training, relatively little is known about effective approaches for improving interaction skills among pre-service teachers for early childhood education and care. In this study, the evidence-based in-service Caregiver Interaction Profile training course was implemented in Dutch pre-service teacher training. The pre-service teachers on the program with relatively low scores at the pretest showed a significant growth in relation to four interaction skills: sensitive responsiveness, respect for autonomy, structuring and limit setting, and verbal communication. We discuss these results in the context of effective professional development in early childhood education and care.

There is consensus in the literature that self-esteem stems from relationships with others. In particular, it is assumed that parents play an important role in the development of children’s self-esteem, also in adolescence. Despite the importance of parent–child attachment relationships for adolescents’ self-esteem, we know very little about the extent to which fathers and mothers uniquely contribute to adolescents’ self-esteem. The current study aims to contribute to acquiring knowledge in this research area in three ways. First, by separating the potential influences of father–child and mother–child attachment relationships on sons’ and daughters’ self-esteem, the current study is able to investigate the individual contribution of the father–child and mother–child attachment relationship to female and male adolescent’s self-esteem. Second, by controlling for changes in the quality of the parental relationship and peer relationships the current study is able to isolate linkages between changes in adolescents’ percei

Research Findings: This small-scale study features the 1st comparative exploration of the pedagogical quality of parent-led child care and regular child care in The Netherlands. The quality of the interaction skills and the affective relationships between adults and children was evaluated and compared with those of regular child care centers. On average parents in parent-led child care had interactions with adequate to good sensitive responsiveness, respect for autonomy, structuring and limit setting, and verbal communication. Developmental stimulation and fostering positive peer interactions proved to be weaker areas. Parents’ perceptions of the affective relationship with children in the group were characterized by a high level of closeness and a low level of dependency and conflict. Parents experienced a greater degree of closeness but also more conflict and in particular greater dependency with their own children than with the other children. A comparison between parent-led centers and regular urban child care centers revealed some small but significant differences in pedagogical quality. Practice or Policy: Parents can play a more active role in both the design and implementation of child care. It seems interesting to pilot new child care formats in which parents and professional staff collaborate more closely.

EARLI SIG 5 Conference 2018 - Learning and Development in Early Childhood, Berlin, Germany, 29-31 August, 2018, Item does not contain fulltext

Quality-adjusted life years are used in cost-effectiveness analyses (CEAs). To calculate QALYs, a "utility" (0-1) is used for each health state induced or prevented by the intervention. We aimed to estimate the impact of quality of life (QoL) assumptions (utilities and durations of health states) on CEAs of cervical cancer screening. To do so, 12 alternative sets of utility assumptions were retrieved from published cervical cancer screening CEAs. Two additional sets were based on empirical QoL data that were integrally obtained through two different measures (SF-6D and EQ-5D) from eight groups of women (total n=3,087), from invitation for screening to diagnosis with cervical cancer. Per utility set we calculated the number of quality-adjusted days lost (QADL) for each relevant health state in cervical cancer screening, by multiplying the study-specific assumed disutilities (i.e., 1-utility) with study-specific durations of the loss in QoL, resulting in 14 "QADL-sets." With microsimulation model MISCAN we calculated cost-effectiveness of 342 alternative screening programs (varying in primary screening test [Human Papillomavirus (HPV) vs. cytology], starting ages, and screening interval) for each of the 14 QADL-sets. Utilities used in CEAs appeared to differ largely. We found that ten QADL-sets from the literature resulted in HPV and two in cytology as preferred primary test. The SF-6D empirical QADL-set resulted in cytology and the EQ-5D one in HPV as preferred primary test. In conclusion, assumed utilities and health state durations determine cost-effectiveness of cervical cancer screening. Also, the measure used to empirically assess utilities can be crucial for CEA conclusions.

Contains fulltext : 169281.pdf (publisher's version ) (Open Access), Background: Previous studies underscore the need to improve caregiver-child interactions in early child care centers. Objective: In this study we used a randomized controlled trial to examine whether a 5-week video feedback training can improve six key interactive skills of caregivers in early child care centers: Sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. Method: A total of 139 caregivers from 68 early child care groups for 0- to 4-year-old children in Dutch child care centers participated in this RCT, 69 in the intervention condition and 70 in the control condition. Caregiver interactive skills during everyday interactions with the children were rated from videotape using the Caregiver Interaction Profile (CIP) scales at pretest, posttest, and follow-up 3 months after the posttest. Results: Results at posttest indicate a significant positive training effect on all six caregiver interactive skills. Effect sizes of the CIP training range between d = 0.35 and d = 0.79. Three months after the posttest, caregivers in the intervention group still scored significantly higher on sensitive responsiveness, respect for autonomy, verbal communication, and fostering positive peer interactions than caregivers in the control group with effect sizes ranging between d = 0.47 and d = 0.70. Conclusions: This study shows that the quality of caregiver-child interactions can be improved for all six important caregiver skills, with a relatively short training program. Possible ways to further improve the training and to implement it in practice and education are discussed.

Contains fulltext : 177775.pdf (publisher's version ) (Open Access), This study examined the effects of a newly developed on-site consultancy programme to improve global quality of the child care environment in non-parental child care centres for 0- to 4-year-old children as measured with the ITERS-R/ECERS-R. Using a randomised controlled trial with a pretest, posttest, and follow-up test, we compared 35 experimental group with 33 control group. The consultancy programme comprised three consultations in total. Analysis on the items that were specifically targeted during the consultancy showed a significant improvement on these targeted items between pretest and posttest and between posttest and follow-up. The effect of the consultancy programme on the total scores (including the non-targeted items) was not significant.

This study examined the effects of a newly developed on-site consultancy programme to improve global quality of the child care environment in non-parental child care centres for 0- to 4-year-old children as measured with the ITERS-R/ECERS-R. Using a randomised controlled trial with a pretest, posttest, and follow-up test, we compared 35 experimental group with 33 control group. The consultancy programme comprised three consultations in total. Analysis on the items that were specifically targeted during the consultancy showed a significant improvement on these targeted items between pretest and posttest and between posttest and follow-up. The effect of the consultancy programme on the total scores (including the non-targeted items) was not significant.

Objective: Women exposed to diethylstilbestrol in utero (DES) have an increased risk of clear cell adenocarcinoma (CCA) of the vagina and cervix, while their risk of non-CCA invasive cervical cancer is still unclear. Methods: We studied the risk of pre-cancerous (CIN) lesions and non-CCA invasive cervical cancer in a prospective cohort of 12,182 women with self-reported DES exposure followed from 2000 till 2008. We took screening behavior carefully into account. Incidence was obtained through linkage with the Netherlands Nationwide Pathology database (PALGA). General population data were also derived from PALGA. Results: The incidence of CIN1 was increased (Standardized Incidence Ratio (SIR). =2.8, 95% Confidence Interval (CI). =2.3 to 3.4), but no increased risk was observed for CIN2. + (CIN2, CIN3 or invasive cancer) compared to the screened general population (SIR. =1.1, 95% CI. =0.95 to1.4). Women with DES-related malformations had increased risks of both CIN1 and CIN2. + (SIR. =4.1, 95%CI. =3.0 to 5.3 and SIR. =1.5, 95%CI. =1.1 to 2.0, respectively). For CIN2. +, this risk increase was largely restricted to women with malformations who were more intensively screened. Conclusions: An increased risk of CIN1 among DES daughters was obse

Background: Despite the introduction of Human papillomavirus (HPV) vaccination in national immunization programs (NIPs), vaccination rates in most countries remain relatively low. An understanding of the reasons underlying decisions about whether to vaccinate is essential in order to promote wider spread of HPV vaccination. This is particularly important in relation to policies seeking to address shortfalls in current HPV campaigns. The aim of this study was to explore prevailing perspectives concerning HPV vaccination among girls, boys, and parents, and so to identify potential determinants of HPV vaccination decisions in these groups. Method: Perspectives were explored using Q-methodology. Forty-seven girls, 39 boys, and 107 parents in the Netherlands were asked to rank a comprehensive set of 35 statements, assembled based on the health belief model (HBM), according to their agreement with them. By-person factor analysis was used to identify common patterns in these rankings, which were interpreted as perspectives on HPV vaccination. These perspectives were further interpreted and described using data collected with interviews and open-ended questions. Results: The analysis revealed four perspectives: "prevention is better than cure," "fear of unknown side effects," "lack of information and awareness," and "my body, my choice." The first two perspectives and corresponding determinants of HPV vaccination decisions were coherent and distinct; the third and fourth perspectives were more ambiguous and, to some extent, incoherent, involving doubt and lack of awareness and information (perspective 3), and overconfidence (perspective 4). Conclusions: Given the aim of publically funded vaccination programs to minimize the spread of HPV infection and HPV-related disease and the concerns about current uptake levels, our results indicate that focus should be placed on increasing awareness and knowledge, in particular among those in a modifiable phase.

Contains fulltext : 169281.pdf (publisher's version ) (Open Access), Background: Previous studies underscore the need to improve caregiver-child interactions in early child care centers. Objective: In this study we used a randomized controlled trial to examine whether a 5-week video feedback training can improve six key interactive skills of caregivers in early child care centers: Sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. Method: A total of 139 caregivers from 68 early child care groups for 0- to 4-year-old children in Dutch child care centers participated in this RCT, 69 in the intervention condition and 70 in the control condition. Caregiver interactive skills during everyday interactions with the children were rated from videotape using the Caregiver Interaction Profile (CIP) scales at pretest, posttest, and follow-up 3 months after the posttest. Results: Results at posttest indicate a significant positive training effect on all six caregiver interactive skills. Effect sizes of the CIP training range between d = 0.35 and d = 0.79. Three months after the posttest, caregivers in the intervention group still scored significantly higher on sensitive responsiveness, respect for autonomy, verbal communication, and fostering positive peer interactions than caregivers in the control group with effect sizes ranging between d = 0.47 and d = 0.70. Conclusions: This study shows that the quality of caregiver-child interactions can be improved for all six important caregiver skills, with a relatively short training program. Possible ways to further improve the training and to implement it in practice and education are discussed.

Contains fulltext : 177775.pdf (publisher's version ) (Open Access), This study examined the effects of a newly developed on-site consultancy programme to improve global quality of the child care environment in non-parental child care centres for 0- to 4-year-old children as measured with the ITERS-R/ECERS-R. Using a randomised controlled trial with a pretest, posttest, and follow-up test, we compared 35 experimental group with 33 control group. The consultancy programme comprised three consultations in total. Analysis on the items that were specifically targeted during the consultancy showed a significant improvement on these targeted items between pretest and posttest and between posttest and follow-up. The effect of the consultancy programme on the total scores (including the non-targeted items) was not significant.

This thesis demonstrates that an extract of Teucrium polium, a Mediterranean herb with folklore reputation for the treatment of diabetes, does indeed have antidiabetic properties. It promotes insulin secretion from pancreactic beta cells and also has some insulin-like properties. For example, it promotes glucose uptake and storage as glycogen in muscle cells. The plant extract might be an impactful target for future drug discovery efforts for the treatment of type 2 diabetes and related disorders.

© 2016 Federation of European Biochemical SocietiesHigh mobility group box 1 (HMGB1), a chromatin protein, interacts with DNA and controls gene expression. However, when HMGB1 is released from apoptotic or damaged cells, it triggers proinflammatory reactions by interacting with various receptors, mainly receptor for advanced glycation end-products (RAGE) and toll-like receptors (TLRs). The self-association of HMGB1 has been found to be crucial for its DNA-related biological functions. It is influenced by several factors, such as ionic strength, pH, specific divalent metal cations, redox environment and acetylation. This self-association may also play a role in the interaction with RAGE and TLRs and the concomitant inflammatory responses. Future studies should address the potential role of HMGB1 self-association on its interactions with DNA, RAGE and TLRs, as well as the influence of physicochemical factors in different cellular environments on these interactions.

Background:High-risk human papillomavirus (hrHPV)-positive women require triage to identify those with cervical high-grade intraepithelial neoplasia and cancer (≥CIN3 (cervical intraepithelial neoplasia grade 3)). FAM19A4 methylation analysis, which detects advanced CIN and cancer, is applicable to different sample types. However, studies comparing the performance of FAM19A4 methylation analysis in hrHPV-positive self-samples and paired physician-taken scrapes are lacking.Methods:We compared the performance of FAM19A4 methylation analysis (and/or HPV16/18 genotyping) in self-samples and paired physician-taken scrapes for ≥CIN3 detection in hrHPV-positive women (n=450,18-66 years).Results:Overall FAM19A4 methylation levels betwe

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