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Purpose: In response to the COVID-19 pandemic, in 2020–2022, the immutable and fragmented character of our healthcare system changed. Healthcare professionals and their institutional leads proved remarkably agile and managed to change toward collaborative care. The purpose of this paper is to examine experiences with collaborative practice in healthcare during the COVID-19 pandemic in two regions in the Netherlands, to explore and understand the relationship between policy and practice and the potential development of new collaborative care routines. Design/methodology/approach: Using a methodology informed by theories that have a focus on professional working practice (so called "activity theory") or the institutional decision-makers (discursive institutionalism), respectively, the perspective of physicians on the relationship between policy and practice was explored. Transcripts of meetings with physicians from different institutions and medical specialities about their collaborative COVID-19 care were qualitatively analysed. Findings: The findings show how change during COVID-19 was primarily initiated from the bottom-up. Cultural-cognitive and normative forces in professional, collaborative working practice triggered the creation of new relationships and sharing of resources and capacity. The importance of top-down regulatory forces from institutional leads was less evident. Yet, both (bottom-up) professional legitimacy and (top-down) institutional support are mentioned as necessary by healthcare professionals to develop and sustain new collaborative routines. Practical implications: The COVID-19 crisis provided opportunity to build better healthcare infrastructure by learning from the responses to this pandemic. Now is the time to find ways to integrate new ways of working initiated from the bottom-up with those longstanding ones initiated from top-down. Originality: This paper presents a combination of theories for understanding collaboration in healthcare, which can inform future research into collaborative care initiatives. [ABSTRACT FROM AUTHOR]

Old‐age state pension is central to European welfare states. Despite the growing number of migrants in Europe, little is known about their attitudes towards state pension. Pension systems are designed for a ‘sedentary’ population, as they require many years of contribution or residency in the country. This often affects first‐generation migrants, who arrive in the residence country only at a later point in their lives. In this paper, we draw on self‐interest theory, which is commonly used to explain individuals' support towards welfare institutions and theorize on how the migration experience adds to the standard model of self‐interest in relation to support for government spending on old‐age state pensions. Hence, we move beyond traditional indicators of self‐interest such as education and employment status and we test hypotheses on how migrant‐specific characteristics like length of stay and settlement intention in the residence country are related to migrants' support for government spending on old‐age state pensions. We use data from the Migrants' Welfare State Attitudes (MIFARE) survey (2016), the first cross‐national survey that focuses on migrants' attitudes towards the welfare state that was collected in Denmark, Germany, and the Netherlands among nine different migrant groups from within and outside the EU. We find that migrants living in the country for over 5 years and those with longer settlement intentions have a higher support for government spending on pensions. We conclude that it is crucial to take migrants' unique migration experiences into account when assessing their attitudes towards state pension. [ABSTRACT FROM AUTHOR]

The population of adults ageing in place and using home‐care services is growing rapidly worldwide. Meaning in life (MiL) of this group of clients is relevant for healthcare and social workers. MiL is associated with many positive outcomes, but can be challenging for aged persons. Objective of this study was to explore MiL in daily life of community‐dwelling aged persons who receive homecare. A hermeneutic phenomenological approach was followed. Three waves of semi‐structured interviews took place among 24 clients of a home‐care organisation in the Netherlands between November 2015 and July 2018. Photo‐elicitation was part of the interview procedure. Interpretative Phenomenological Analysis and dialogues enhanced understanding. Findings show that participants derived meaning from self, others, environment and living. The process of retaining MiL involved maintaining, adapting and discovering. We conclude that community‐dwelling aged adults can draw MiL from many sources. Retaining MiL is interwoven in everyday life and requires continuous adaptation to ever‐changing life conditions during later life. Although relevant general themes were sketched in this paper, the importance of each, and the connections between them, vary and come to light at the individual level. The themes in this paper and the cases in the appendices provide insights that may help professionals recognise MiL in their work. Besides listening to the stories of aged adults, person‐centred interventions should support aged adult's strategy to retain MiL. [ABSTRACT FROM AUTHOR]

Background: Health- and lifestyle factors account for a substantial part of all dementia cases, which opens the opportunity for primary prevention. However, the required behavioral change is complex and involves targeting multiple risk factors. mHealth interventions can potentially contribute to improving motivation in a low-cost and scalable way. Objective: To explore usage patterns, appreciation, and beliefs and attitudes regarding dementia risk reduction during the use of the MyBraincoach mobile app. Methods: Participants were community-dwelling middle-aged adults from the Netherlands and used either the standard (education) or extended (education+motivational triggers) app version for three months. Two panel studies were combined in this paper. Chi-square tests, t-tests and linear mixed models were used, adjusted for age, sex, and education. Results: Of all participants (n = 299, 50.2% male), 167 (55.9%) had installed the app. The most reported reason for non-use was technical problems (47%). Those who used the app were at baseline already more positive about dementia risk reduction than those who did not use the app. Of all users who completed the evaluation (n = 102), 78.4% (n = 80) stated that the app provided a positive approach towards brain health and 80.4% (n = 82) felt better informed. Younger (<60y) and lower educated participants evaluated the app most positively. Conclusion: Usage of the app was low, but users showed more positive beliefs and attitudes regarding dementia risk reduction. Most users evaluated the app positively and stated to have gained knowledge on the topic. Improving the use of the app must keep high priority in future studies. [ABSTRACT FROM AUTHOR]

Community housing services adopt care models such as rehabilitation, recovery-oriented care and person-centered planning to improve the quality of life of service users with an intellectual or psychiatric disability. However, the way these care models are implemented and practiced can negatively impact service users' experience with the service as their complex needs go unmet. In this paper, we conceptualize these experiences through developing the counternarrative of burdens of support. For this we draw on burden of treatment theory. We conducted ethnographic fieldwork in a community service organization in the Netherlands. This included participant observation (84 h), interviews with service users (n = 20), experts-by-experience (n = 8), family members (n = 10) and photovoice workshops. Our analysis identifies four burdens of support: burden of self-determination; re-identification; responsibilisation and re-placement. The results show that burden of support is very much a relational concept: through their support, professionals can aggravate or alleviate burden. People with intellectual or psychiatric disabilities often receive support with living in the community. Good support fits people's needs (e.g. person-centered planning), builds on people's strengths and contributes to recovery and community participation. Even when support is practiced or organized with such aims, service users can have negative experiences. In this research we call this: 'burden of support'. Examples of burden of support identified include: Clients' needs and wishes are sometimes not sufficiently attended too when working with a personal care plan. Too much responsibility is sometimes shifted to clients, which results in feelings of failing or abandonment. The focus on strengths and recovery sometimes leaves too little room for clients to voice support needs. Having to move to a different home or neighborhood as part of becoming more independent can result in many difficulties including loneliness. The research recommended that those who improve services should also alleviate these burdens. [ABSTRACT FROM AUTHOR]

Personalising aftercare for curatively treated breast cancer patients is expected to improve patient satisfaction with care. A patient decision aid can support women in making decisions about their aftercare trajectory, but is currently not available. The aim of this study was to assess the needs of patients and health professionals with regard to an aftercare decision aid to systematically develop such a decision aid. Focus groups with patients and individual interviews with health professionals were digitally recorded and coded using the Framework analysis. Although most patients felt few aftercare options were available to them, health professionals reported to provide various options on the patients' request. Patients reported difficulty in expressing their need for options to their health professional. Although most patients were unfamiliar with decision aids, the majority preferred a paper‐based patient decision aid, while most health professionals preferred an online tool. The practical implications for the intended patient decision aid are: that a digital tool with paper‐based element should be developed, the patient decision aid should facilitate both rational and intuitive processes and should provide insight in patients' preferences concerning aftercare to discuss these explicitly. [ABSTRACT FROM AUTHOR]

Purpose: Self-reliance and social participation are strongly promoted by social policy. Both concepts are linked to the concept of vulnerability, for people who do not meet these standards are labelled "vulnerable people". In this paper, the insider's perspective takes central stage by seeking to explore what it means to be labelled a "vulnerable person", and through this to further our insight into the meaning of the concept of vulnerability. Method: Thirty-three in-depth interviews were conducted with 16 allegedly vulnerable people. The data were subjected to thematic content analysis. Results: Our analysis revealed three main dimensions and eight sub-dimensions of perceived vulnerability, outlining an insider's concept of vulnerability. This concept includes manifestations of vulnerability, feelings coexisting with vulnerability, and the image of vulnerable people. Conclusion: The perception of vulnerability changes when interacting with others in society, especially with social policy implementers. In this interaction, the perceived vulnerability increases and becomes societal vulnerability. It concerns a dependency situation in which one's strength and self-determination are not recognized, and the help needed is not provided. By acknowledging the insider's perspective, social policy can fulfil a more empowering role towards "vulnerable people" and contribute to people's well-being. [ABSTRACT FROM AUTHOR]

Context Thirty years ago, it was suggested in the Edinburgh Declaration that medical school applicants should be selected not only on academic, but also on non-academic, attributes. The main rationale behind extending medical school selection procedures with the evaluation of (non-academic) personal qualities is that this will lead to the selection of students who will perform better as a doctor than those who are selected on the basis of academic measures only. A second rationale is the expectation that this will lead to a representative health workforce as a result of reduced adverse impact. The aims of this paper are (i) to describe what can be learned about the use of selection criteria other than grades from over 15 years of Dutch experience and (ii) to summarise current knowledge on the issue of adverse impact in relation to non-grades-based selection. Methods A narrative review was undertaken of the (published) evidence that has resulted from non-grades-based school-specific selection procedures in the Netherlands and from recent explorations of the effect of the use of non-grades-based selection criteria on student diversity. Results The Dutch evidence is grouped into five key themes: the effect of participation in voluntary selection procedures, the assessment of pre-university extracurricular activities, the use of work samples, Dutch experiences with situational judgement tests and the effects of changing circumstances. This is followed by several lessons learned for medical schools that aim to increase their student diversity. Conclusion Over the last 30 years, important steps towards reliable and valid methods for measuring non-academic abilities have been taken. The current paper describes several lessons that can be learned from the steps taken in the Dutch context. The importance of sharing evidence gathered around the globe and building on this evidence to reach our goal of predicting who will be a good doctor is acknowledged. [ABSTRACT FROM AUTHOR]

Background: Subjective well‐being (SWB) and quality of life (QOL) are intricately related constructs. Recent research shows both constructs share some facets, but are distinct entities. It is unclear, both internationally and in the Netherlands, if and how SLTs address SWB in clinical practice. The current study was set up to explore Dutch SLTs' perceptions of SWB in relation to the management of people with aphasia. Aims: To describe how Dutch SLTs, working with people with aphasia in a private practice or a healthcare setting, address patient's SWB during diagnosis and treatment, and to identify barriers and facilitators they experience when addressing SWB. Methods & Procedures: A qualitative research design with a phenomenological approach was used. SLTs from private practices and healthcare settings were invited to participate in individual interviews and a focus group. The data were analysed thematically using a combination of inductive and deductive methods. Outcomes & Results: Eight SLTs participated in the study. The SLTs' experiences were captured in four themes that emerged from the data: (1) SWB is a multifaceted concept and depends on patient‐specific factors: premorbid factors, life priorities and time post‐stroke; (2) SLTs experience more responsibility for patients' SWB than their profession allows; (3) collaboration between SLTs and patients, patients' network and other healthcare professionals is required to address SWB during diagnosis and treatment; and (4) misinterpretations are inevitable when SLTs or the patients' network address patients' SWB. Conclusions & Implications: The results showed that SLTs feel responsible for addressing SWB in the management of people with aphasia. Their perception of the concept of SWB is similar to the definition used in the literature and is multifaceted. They feel responsible for the part of SWB that is related to communicative functioning, but less so for the more heuristic aspects of SWB. This is related to their experienced limitation of influence on SWB, which for some leaves them feeling out of depth and uncertain about boundaries between professionals. Addressing SWB in a multidisciplinary team is therefore considered important in order to adequately and fully capture someone's SWB and reduce to clinicians' experienced burden and responsibility. What this paper addsWhat is already known on this subjectRecent studies suggest that quality of life measures may lack facets related to subjective well‐being (SWB). Aphasia is likely to impact on SWB of a stroke survivor, but it is unclear if and how SWB is addressed by speech and language therapists in diagnosis, and treatment of Dutch PWA.What this study addsThis study provides insight into the operationalization of SWB in Dutch clinical practice, including barriers SLTs experience when addressing SWB.Clinical implications of this studyMonitoring and influencing SWB of people with aphasia is a complex process, that SLTs consider only possible in multi‐disciplinary teams. Clear guidelines on roles and responsibilities between various disciplines involved are necessary to improve care for people with aphasia. [ABSTRACT FROM AUTHOR]

Background To reduce the burden of low back pain (LBP) in the Netherlands, a multidisciplinary guideline for LBP has been implemented in Dutch primary care using a multifaceted implementation strategy targeted at health care professionals (HCPs) and patients. The current paper describes the process evaluation of the implementation among HCPs. Methods The strategy aimed to improve multidisciplinary collaboration and communication, and consisted of 7 components. This process evaluation was performed using the Linnan and Steckler framework. Data were collected using a mixed methods approach of quantitative and qualitative data. Results 128 HCPs participated in the implementation study, of which 96 participated in quantitative and 21 participated in qualitative evaluation. Overall dose delivered for this study was 89 %, and the participants were satisfied with the strategy, mostly with the multidisciplinary approach, which contributed to the mutual understanding of each other's disciplines and perspectives. While the training sessions did not yield any new information, the strategy created awareness of the guideline and its recommendations, contributing to positively changing attitudes and aiding in improving guideline adherent behaviour. However, many barriers to implementation still exist, including personal and practical factors, confidence, dependence and distrust issues among the HCPs, as well as policy factors (e.g. reimbursement systems). Conclusions The data presented in this paper have shown that the strategy that was used to implement the guideline in a Dutch primary care setting was feasible, especially when using a multidisciplinary approach. However, identified barriers for implementation have been identified and should be addressed in future implementation. [ABSTRACT FROM AUTHOR]

Background: Youth-led Participatory Action Research (YPAR) involves children throughout the process of developing and implementing interventions. Combining YPAR with a structural approach for designing and planning interventions, such as Intervention Mapping (IM), may further improve implementation and effectiveness of interventions. This paper describes how YPAR and IM were combined in the Kids in Action study. Methods: The Kids in Action study aims to improve health behaviors of 9–12-year old children living in a low socioeconomic neighborhood in Amsterdam, by co-designing interventions with these children. At each of four schools 6–8 children (N = 18–24 total per year) and two academic researchers formed participatory groups that met weekly or every fortnight during two school years. An IM expert panel advised the participatory groups on the application of IM. Results: Following the IM protocol, we conducted a participatory needs assessment with children, parents and professionals, in IM-step 1. In IM-step 2, the IM expert panel constructed matrices of program objectives, and the children provided feedback. In collaboration with children programs were designed and produced using an iterative process during IM-steps 3–4. In IM-step 5, the participatory groups and professional community partners designed the implementation plan. Finally, in IM-step 6, the protocol of the process and effect evaluation – executed by academic researchers with input from children – was developed. Conclusions: By combining YPAR and IM, several interventions have been developed and implemented, varying from a school water policy to extracurricular sports activities. Sharing responsibility with children was challenging when combining IM with YPAR. In YPAR children are given as much autonomy as possible, while traditional IM development work is primarily done by academic researchers. Strengths in combining IM and YPAR include the involvement of the end-users - children - throughout the process while at the same time developing interventions based on existing evidence. Time-management, a multidisciplinary team, and flexibility are important conditions when combining IM with YPAR. A strong community project group, with professionals who were willing to help children develop and execute their ideas, was an important success factor. This study can serve as an example to other YPAR studies developing interventions using the IM protocol. [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]

Background: Challenging behaviour is a common problem among people with ID and in services for people with ID. This paper aims to provide an overview of the views and preferences of people with ID on challenging behaviour. Method: Semi‐structured interviews were conducted with thirteen adults with mild to moderate ID and seven proxies (family or close associates of adults with ID who were unable to communicate and/or with severe or profound ID) in the Netherlands. The interviews were audio‐recorded, transcribed and analysed thematically. Results: People with ID and (a history of) challenging behaviour have clear views and preferences on factors related to challenging behaviour, assessments, non‐pharmacological and pharmacological interventions and health professionals' approach. Conclusions: The identified views and preferences of people with ID are not always in accordance with current procedures and treatments for challenging behaviour and should be included in future care processes and research. [ABSTRACT FROM AUTHOR]

Introduction: There is growing acknowledgement of the benefits of incorporating a bio-psychosocial model of understanding pain within physical therapist practice1. Consequently this has led to an increasing interest in interventions such Pain neuroscience education (PNE). However, pain management strategies developed by clinicians in one culture may not necessarily be understood, appropriate, or effective in another culture2 Methods: This study is part of a broader research in the development of culturally sensitive pain neuroscience education for the Lebanese population. Therefore, the purpose of this paper is to first gain an in-depth understanding of the Lebanese physiotherapists' perceptions towards the management of chronic low back pain as well as the knowledge regarding PNE. A qualitative one-to-one semi-structured interviews with 10 practicing physical therapists were conducted. The transcribed text from the interviews was analyzed using inductive thematic analysis. Results: Several themes were generated, identified, and constructed by the researchers: (1) physiotherapists use of a biomechanical approach. (2) Poor knowledge about the bio-psychosocial approach or PNE. (3) Barrier and facilitation for the implementation of PNE. Discussion: The preliminary results showed a limited knowledge of the bio-psychosocial approach, or PNE, and that the Lebanese physical therapist use more a biomechanical approach in the treatment and assessment of people with chronic low back pain. Process evaluation: The results showed that training is needed for physiotherapists to deliver a broader model of care, and that future research should focus on developing a culturally sensitive PNE material. [ABSTRACT FROM AUTHOR]

Objectives: High-quality teaching performance is important to ensure patient safety and encourage residents' learning. This study aims to explore the content and phrasing of suggestions for improvement that residents provide to support excellent teaching performance of their supervisors.Methods: From February 2010 to November 2011, 577 residents were invited to evaluate 501 teachers from both surgical and medical residency training programmes from 20 hospitals. Feedback was collected through a validated formative feedback system named System for Evaluation of Teaching Qualities. Two researchers independently coded the suggestions for improvement with literature-based coding schemes on (1) content and (2) linguistic characteristics. Besides these qualitative outcomes, descriptive statistics were calculated using SPSS.Results: In total, 422 residents (73%) evaluated 488 teachers (97%), yielding 4184 evaluations. Of all teachers, 385 (79%) received suggestions for improvement focusing on teaching skills (TS), 390 (80%) on teaching attitude (TA) and 151 (31%) on personal characteristics. For 13%-47% of the suggestions for improvement, residents added (1) the location or situation where the observed TS or TA had taken place, (2) concrete examples of what teachers could do to improve or (3) (expected) effects of what the change in TS or TA would mean for residents.Conclusions: Residents provide mainly relevant suggestions for improvement that mirror important aspects of teaching performance. However, these comments often lack specific phrasing limiting their value for performance improvement. Therefore, residents are recommended to increase the specificity of the suggestions for improvement. The paper provides directions to phrase narrative feedback. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore sensemaking of incidents by health care professionals through an analysis of the role of professional identity in narratives of incidents. Using insights from social identity theory, the authors argue that incidents may create a threat of professional identity, and that professionals make use of identity management strategies in response to this identity threat.Design/methodology/approach: The paper draws on a qualitative analysis of incident narratives in 14 semi-structured interviews with physicians, nurses, and residents at a Dutch specialist hospital. The authors used an existing framework of identity management strategies to categorize the narratives.Findings: The analysis yielded two main results. First, nurses and residents employed multiple types of identity management strategies simultaneously, which points to the possible benefit of combining different strategies. Second, physicians used the strategy of patronization of other professional groups, a specific form of downward comparison.Research Limitations/implications: The authors discuss the implications of the findings in terms of the impact of identity management strategies on the perpetuation of hierarchical differences in health care.Practical Implications: The authors argue that efforts to manage incident handling may profit from considering social identity processes in sensemaking of incidents.Originality/value: This is the first study that systematically explores how health care professionals use identity management strategies to maintain a positive professional identity in the face of incidents. This study contributes to research on interdisciplinary cooperation in health care. [ABSTRACT FROM AUTHOR]

This paper examines the impact of two prevailing and seemingly opposed ideologies in child welfare in Western societies over the last century ('family support' and 'child protection') on social work practice. It scrutinises social work practice in two cases of Dutch-Curaçaoan single-mother families experiencing multiple problems. An ethnographic approach was chosen to study the two families in depth. It shows that, although the cases share many characteristics and circumstances, the social work outcomes diverge. This suggests there is a thin dividing line between support and protection. We argue that the interrelationships between the two base categories and social work practice can be better understood through a historicizing conceptualization of discourses. We suggest that an ethnographic enquiry is suitable for grasping the processual dimensions of social work practice with families as it leads to a more in-depth understanding of, paraphrasing Foucault: the historical interweaving of relations of discourse, of power, of everyday life and of truth. [ABSTRACT FROM AUTHOR]

Individuals with mild intellectual disabilities (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behavior are difficult to reach by mainstream healthcare facilities and support organizations and frequently avoid the care they need. To improve the care for this client group in the Netherlands, the (Flexible) Assertive Community Treatment (ACT) model—originally developed for people with severe mental illness—was adapted and implemented by five organizations specialized in the care for people with MID/BIF and mental health problems or challenging behavior. After an introduction of the original ACT model and a description of the international state of the art of ACT for people with (M)ID/BIF, this paper describes the (Flexible) ACT‐MID/BIF model as developed and implemented in the Netherlands. Professionals' and clients' experiences with this new type of care are reported as well. Implications for clinical practice, policy and research are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The potential of service robots for seniors is given increasing attention as the ageing population in Western countries will continue to grow as well as the demand for home care. In order to capture the experience of living with a robot at home, a multi-perspective evaluation was conducted. Methods: Older adults (n = 10) were invited to execute an actual interaction scenario with the Care-O-bot® robot in a home-like environment and were questioned about their experiences. Additionally, interviews were conducted with the elderly participants, informal carers (n = 7) and professional caregivers (n = 11). Results: Seniors showed to be more keen to accept the robot than their caregivers and relatives. However, the robot in its current form was found to be too limited and participants wished the robot could perform more complex tasks. In order to be acceptable a future robot should execute these complex tasks based on the personal preferences of the user which would require the robot to be flexible and extremely smart, comparable to the care that is delivered by a human carer. Conclusions: Developing the functional features to perform activities is not the only challenge in robot development that deserves the attention of robot developers. The development of social behaviour and skills should be addressed as well. This is possible adopting a person-centred design approach, which relies on validation activities with actual users in realistic environments, similar to those described in this paper. Implications for rehabilitation: Attitude of older adults towards service robots Potential of service robotsfor older adults [ABSTRACT FROM AUTHOR]

Abstract: Background: Family‐centred services (FCS) is widely regarded as the best practice approach in early interventions. Creating a therapeutic environment, which also stimulates collaboration between parents and service professionals, is a way to conform to the principles of FCS. The present paper describes the project entitled @home, involving the implementation of home consultations by a specialized team working with children aged 0–5 years at our rehabilitation centre in the Netherlands. The objectives of this article are to (a) describe the development and implementation of home consultations as part of regular care and (b) share the experiences of parents and service providers with home consultations. Method: The implementation process was divided into 3 steps: (1) interviewing experts, (2) adjusting current rehabilitation trajectories, and (3) service providers offering consultations to children at home. The experiences with the home consultations were immediately incorporated in the system, making the implementation an iterative process. Results: In 82% of the 133 home conducted consultations, the service professionals reported that it was more valuable to offer home consultations than seeing the child at the rehabilitation centre. The semistructured interviews revealed that parents and service providers found that they received and provided more tailored advice, perceived a more equal partnership between service professionals and parents, and reported that the home consultations provided a good natural therapeutic environment where a child can be itself and where the child performs best. Conclusion: By using the @home system based on the 3 service models, home consultations are now part of the regular paediatric rehabilitation system at our rehabilitation centre. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) is a key factor of lifestyle behavior enhancing general health and fitness, especially in people after total hip or knee replacement (THR and TKR). Orthopaedic surgeons can play a primary role in advocating the benefits of an active lifestyle. Aim of the study was 1) to assess the attitude of orthopaedic surgeons towards PA for people after THR/TKR and 2) to compare the attitude between a Northern European (the Netherlands) and a Southern European (Italy) country and analyze which factors influence the attitude towards PA. Methods: A cross-cultural study. An (online) survey was distributed among orthopaedic surgeons in Italy and the Netherlands. Chi-square and Mann–Whitney tests were used to compare surgeons' and clinics' characteristics, and questionnaires' scores, respectively. A linear regression analysis was conducted to assess which surgeon characteristics influence attitude towards PA. Results: A cohort of 159 surgeons (103 Italians and 56 Dutch) was analyzed. The median score of overall orthopaedic surgeons' attitude towards PA was positive (57 out of 72). Dutch surgeons showed a more positive attitude compared to Italian surgeons (p < 0.01). Main difference was found in the "Physical activity concern" factor, where Italian surgeons showed more concern about the negative effects of PA on the survival of the prosthesis. The regression analyses showed that "Country" and "Type of clinic" were associated with the surgeons' attitude. Conclusions: Overall, the orthopaedic surgeons' attitude towards PA for people with THR and TKR was positive. However, Dutch surgeons seem to be more positive compared to the Italian. The country of residence was the item that most influenced attitude. Further investigations are needed to untangle specific factors, such as cultural, socioeconomic, or contextual differences within the variable "country" that may influence orthopaedic surgeons' attitudes towards PA. [ABSTRACT FROM AUTHOR]

Migration scholars have long regarded the trajectory of the third generation as a critical test of assimilation; however, scholarship to date has been limited and largely focused on socioeconomic attainment. In this article, we rely on a large dataset of adolescent respondents in England, Germany, and the Netherlands to compare the second and third generations in terms of their social networks and cultural identities. The third generation shows stronger ties to the native fourth-plus generation alongside weaker ties to coethnics. We document comparable, albeit more moderate, dynamics of assimilation over generations in regard to national and ethnic identification, along with substantial variation by country of destination and ethnic origin group. Our results point to a dominant trend of assimilation at the third generation and suggest future challenges to provide a more durable assessment of postwar migration waves two generations after settlement. [ABSTRACT FROM AUTHOR]

Why is it that many people fail to seek retirement planning advice when doing so is clearly indicated? Distrust of financial intermediaries is often presented as the common answer. But this paper shows that trust issues are only part of the answer; an appreciable proportion of individuals experience anxiety at the prospect of visiting a financial adviser. In the present investigation, financial adviser anxiety is studied among 950 Dutch adults over the age of 50. Anxiety levels were measured using a six-item scale that was administered as part of a larger nationwide investigation on retirement attitudes and behaviour. Findings revealed that nearly one-third of respondents reported having moderate to severe levels of anxiety at the prospect of visiting a financial professional. Furthermore, a hierarchical regression analysis revealed that strong predictors of anxiety included one's educational level, income, age, level of future time perspective, risk tolerance, financial knowledge and scepticism regarding whether advice from a financial professional can be trusted. A cluster analysis using demographic and psychological covariates identified three separate groups of older adults that were found to differ in terms of their mean level of anxiety. Those who had low levels of education and low incomes were found to disproportionately display high levels of financial adviser anxiety. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report on a process and impact evaluation of the Positief Educatief Programma (Positive Education Programme (PEP)), a whole school approach to supporting children’s well-being and creating a positive school climate in primary schools in the Netherlands. PEP adopts a competence skill enhancement approach with a focus on developing children’s positive emotions and strengths.Design/methodology/approach A process and impact evaluation was performed within the context of two schools piloting the programme. Employing questionnaires and interviews, the evaluation sought to examine the implementation of PEP, participants’ experiences with key components and the programme impact of PEP.Findings The findings reveal largely positive attitudes towards PEP. Staff and parents were positive about the core components of PEP. Results from standardised questionnaires provide preliminary evidence about the positive impact of PEP on children’s self-reported well-being and problem behaviour, teachers’ awareness of children’s strengths and overall school climate. The provision of practical strategies and activity-based resources was considered essential to the ongoing implementation of PEP.Research limitations/implications This study reports on findings from two implementation schools and therefore lacks generalisability. Further research using more robust research methods exploring the effectiveness of PEP when compared with “business as usual” is needed.Originality/value School frameworks aimed at creating a positive school climate and promoting well-being at the whole school level have not been carried out in the Netherlands to date. The results from this study provide a unique insight into the implementation and perceived impact of a whole school framework in the context of two primary schools. [ABSTRACT FROM AUTHOR]

Against the backdrop of growing international concern for a narrowing view of early literacy, this study was initiated to determine how teachers of four-year-olds view their task of fostering early literacy. This paper reports on the first steps to design and validate an instrument which captures teachers’ perceptions of early literacy content goals; developmentally appropriate and effective pedagogical practices related to each content goal; and their own competencies to offer a suitable environment for developing early literacy. The content validity of the instrument was evaluated by an expert screening; the reliability and practicality of the instrument were assessed through a pilot study involving 20 teachers from 2 countries. Validation findings indicate that the instrument appears to be reliable. The findings from the pilot run show that teachers focus on decoding skills most; there is some attention to book orientation and understanding, and relatively little to the functions of written language. [ABSTRACT FROM AUTHOR]

Many ethnoreligious-minority foster children in several western countries, including the Netherlands, are placed and permanently live with ethnically and religiously non-matched foster families (i.e., in trans-religious foster care). We examine whether and which moral dilemmas exist around the issue of how religion should be weighted in trans-religious foster care to provide ethnoreligious-minority foster children with healthy identity development. We applied a thematic analysis to 17 qualitative interviews (seven foster parent/foster child dyads and three foster parents) taken from two pre-existing datasets. We retrieved five moral dilemmas in trans-religious foster care placements, which are discussed in relation to the following ethical arguments: (1) pressure from birth parents and parents of foster children to abide by their religious praxis; (2) objections of the foster family to the faith of the birth family; (3) a switch to the faith of the foster family by the foster child; (4) challenges to the religious identity searches of foster children due to ethnoreligious boundary drawing between majority and minority groups; and (5) the impact of religious traditions on the bodily integrity of foster children. We argue that it is in the best interest of foster children to have a foster family who, when making (some) religious choices on their behalf, is sensitive to the particular child and their developing identity with regard to their religious ideas and beliefs. Foster families need support regarding religious reflection and religious self-determinism in their foster children. [ABSTRACT FROM AUTHOR]

Background: The "health workforce" crisis has led to an increased interest in health professional education, including MPH programs. Recently, it was questioned whether training of mid- to higher level cadres in public health prepared graduates with competencies to strengthen health systems in low- and middle-income countries. Measuring educational impact has been notoriously difficult; therefore, innovative methods for measuring the outcome and impact of MPH programs were sought. Impact was conceptualized as "impact on workplace" and "impact on society," which entailed studying how these competencies were enacted and to what effect within the context of the graduates' workplaces, as well as on societal health.Methods: This is part of a larger six-country mixed method study; in this paper, the focus is on the qualitative findings of two English language programs, one a distance MPH program offered from South Africa, the other a residential program in the Netherlands. Both offer MPH training to students from a diversity of countries. In-depth interviews were conducted with 10 graduates (per program), working in low- and middle-income health systems, their peers, and their supervisors.Results: Impact on the workplace was reported as considerable by graduates and peers as well as supervisors and included changes in management and leadership: promotion to a leadership position as well as expanded or revitalized management roles were reported by many participants. The development of leadership capacity was highly valued amongst many graduates, and this capacity was cited by a number of supervisors and peers. Wider impact in the workplace took the form of introducing workplace innovations such as setting up an AIDS and addiction research center and research involvement; teaching and training, advocacy, and community engagement were other ways in which graduates' influence reached a wider target grouping. Beyond the workplace, an intersectoral approach, national reach through policy advisory roles to Ministries of Health, policy development, and capacity building, was reported. Work conditions and context influenced conduciveness for innovation and the extent to which graduates were able to have effect. Self-selection of graduates and their role in selecting peers and supervisors may have resulted in some bias, some graduates could not be traced, and social acceptability bias may have influenced findings.Conclusions: There was considerable impact at many levels; graduates were perceived to be able to contribute significantly to their workplaces and often had influence at the national level. Much of the impact described was in line with public health educational aims. The qualitative method study revealed more in-depth understanding of graduates' impact as well as their career pathways. [ABSTRACT FROM AUTHOR]

Background: Nonprofessional caregivers are highly important in the everyday life of patients with depression. Yet, they may experience increased levels of burden, stress, depression, and anxiety. Therefore, there is a need for interventions that relieve symptoms and are accessible and time-efficient. This paper describes the protocol of a pilot study to evaluate (1) the feasibility of an online self-management intervention, E-care 4 caregivers, for the nonprofessional caregiver of patients with depression, and (2) the initial effects of E-care 4 caregivers on psychological distress, subjective burden, symptoms of anxiety and depression, and quality of life.Methods/design: The study is a randomized controlled trial in which we are comparing the E-care 4 caregivers online intervention with a wait list control group. Eighty-four nonprofessional caregivers of patients with depression aged 18 years or older are being recruited from among the general population. Feasibility is determined by semistructured telephone interviews evaluating the subjects' satisfaction with the intervention and by using a questionnaire on the user-friendliness of the system. The primary outcome measure used to examine the initial effects of the intervention is psychological distress. Secondary outcome measures are subjective burden, symptoms of anxiety and depression, level of mastery, and quality of life. Assessments will be done at baseline and 6 weeks later. Statistical analysis of the effects of the intervention will be carried out on the basis of the intention-to-treat principle.Discussion: E-care 4 caregivers could potentially benefit nonprofessional caregivers, as well as patients and professionals indirectly.Trial Registration: Netherlands Trial Register identifier: NTR5268 . Registered on 30 June 2015. [ABSTRACT FROM AUTHOR]

This paper aims to improve our understanding of demonstrators' atmosphere perceptions, that is, demonstrators' affective state, which is induced by the protest environment. We examined how demonstrators perceive protest atmosphere, why they do so, and whether atmosphere perceptions influence demonstrators' future collective action preparedness. We hypothesized that demonstrators' atmosphere perceptions diverge on a dimension of pleasure, and relate to their grievance (i.e., perceived societal intolerance), group identification, empowerment, and perceived police aggression. A pleasant atmosphere perception was expected to stimulate a demonstrator's future action preparedness. We tested these hypotheses with a mixed-methods dataset of two Dutch protests, staged by Lesbians, Gays, Bisexuals, and Transgenders and anti-monarchists. Our analyses revealed that demonstrators' atmosphere perceptions diverge on a dimension of pleasure, and relate to group identification, empowerment, and, for anti-monarchists, perceived societal intolerance. A pleasant atmosphere perception deters a demonstrator's future action preparedness and also stimulates his or her group identification and empowerment, which, then, stimulate his or her action preparedness. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: Dichotomous "gap" thinking about professionals and managers has important limits. The purpose of this paper is to study the specific ontology of "the gap" in which different forms of distances are defined.Design/methodology/approach: In order to deepen the knowledge of the actual day-to-day tasks of Dutch healthcare executives an ethnographic study of the daily work of Dutch healthcare executives and an ontological exploration of the concept "gap" was provided. The study empirically investigates the meaning given to the concept of "distance" in healthcare governance practices.Findings: The study reveals that healthcare executives have to fulfil a dual role of maintaining distance and creating proximity. Coping with different forms of distances seems to be an integral part of their work. They make use of four potential mechanisms to cope with distance in their healthcare organization practices.Originality/value: The relationship between managers and professionals is often defined as a dichotomous gap. The findings in this research suggest a more dynamic picture of the relationship between managers and professionals than is currently present in literature. This study moves "beyond" the gap and investigates processes of distancing in-depth. [ABSTRACT FROM AUTHOR]

Background: Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East. Methods: A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care. Results: The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East. Conclusions: This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran. [ABSTRACT FROM AUTHOR]

Background: Professionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people with ID. This paper describes the shifts in care approaches and attitudes that relatives and professionals perceive as the death of a person with ID approaches, as well as the values underlying these shifts. Methods: A qualitative design was used to reconstruct the cases of twelve recently deceased people with ID. Relatives and professionals who were closest to the person at the end of their life were interviewed. Interviews were transcribed verbatim and data were analyzed inductively, using elements of thematic analysis. Results: Five shifts were found: 1) adapting to a new strategy of comforting care, taking over tasks and symptom relief, 2) interweaving of emotional and professional involvement, 3) stronger reliance on the joint interpretation of signals expressing distress and pain, 4) magnified feeling of responsibility in medical decisions, 5) intensified caring relationship between ‘two families': relatives and care staff. Six relational values were behind these shifts: ‘being there’ for the person with ID, ‘being responsive’ to the person's needs, ‘reflection' on their own emotions and caring relationships, ‘attentiveness' to the ID person's wishes and expressions of distress, ‘responsibility' for taking joint decisions in the best interests of the person, and ‘openness to cooperation and sharing' the care with others. Conclusions: End-of-life care for people with ID involves curtailing expectations of participation and skill acquirement, and an increase in teamwork featuring intensified comforting care, symptom management and medical decision making. Three caring relationships need to be fostered: the relationship with the person with ID, relationships among professionals and the relationship between relatives and professionals. ID care services should invest particularly in the emotional support and expertise level of care staff, and in the collaboration between relatives and professionals. [ABSTRACT FROM AUTHOR]

The article discusses a study which explored Dutch midwives' experiences with the implementation of a brief health counselling intervention to prevent prenatal alcohol use. Topics covered include the effects of prenatal alcohol exposure on neurobehavior of children, the importance of the intervention and the relevance of the study to clinical practice.

Previous studies of the relationship between interethnic attitudes and the ethnic composition of neighbourhoods have overlooked the impact of neighbourhood problems in ethnically concentrated neighbourhoods. This paper examines the influence of neighbourhood disorder and decline (i.e. increasing disorder) on interethnic attitudes, controlling for the ethnic composition of the neighbourhood. Neighbourhood disorder and decline are measured by indicators of social and physical neighbourhood problems. Additionally, we examine the extent to which the impact of (increasing) disorder on interethnic attitudes depends on the particular ethnic composition of the neighbourhood. Using a geocoded data set covering 1435 neighbourhoods in The Netherlands, we analyse interethnic attitudes among four ethnic minority groups and the native Dutch population. Multilevel analyses show that for both ethnic minority and native Dutch residents neighbourhood decline is associated with negative attitudes towards ethnic minority groups, particularly in neighbourhoods with many ethnic minority residents. [ABSTRACT FROM PUBLISHER]

Aim: To understand self‐employed long‐term‐care workers' experiences of precariousness, and to unravel how their experiences are shaped at the intersection of gender, class, race, migration and age. Background: In the Netherlands, increasing numbers of nurses and nursing aides in long‐term care (LTC) opt for self‐employment. Societal organizations and policy makers express concerns about this development, as self‐employment is seen as a risk factor for poor health. Self‐employment is not necessarily precarious work but can contribute to the precariousness of specific groups. Knowledge about inequities among self‐employed nurses and nursing aides in long‐term care is lacking. Design: A participatory, qualitative interview study. The research team consisted of four academic researchers and five (un)paid care workers. Methods: Semi‐structured interviews with 23 self‐employed nurses and nursing aides in LTC (2019–2020). Data were analysed from an intersectional perspective. Results: First, we describe that feeling precarious as a hired employee—due to increasing workloads, health risks, poverty and discrimination—shapes care workers' choice for self‐employment. Second, we describe inequities between self‐employed care workers who could (financially) afford to turn to self‐employment as a health strategy and those who felt squeezed out of the organizations due to poverty or discrimination. They more often dealt with precarious work in the context of precarious lives, negatively impacting their health. Third, we describe how negotiating an entrepreneurial identity with a caring identity required material sacrifices and thus contributed to self‐employed care workers' financial precariousness, particularly as women. Conclusion: Our findings indicate that working in LTC is becoming increasingly precarious for all care workers, both for hired and self‐employed, with younger, lower‐paid and racialized women with unpaid caring responsibilities seemingly most at risk for precariousness. Impact Our findings urge policy makers and care organizations to develop gender and diversity‐sensitive policy responses to address these inequities. [ABSTRACT FROM AUTHOR]

BACKGROUND: The efficacy of an indicated prevention strategy for long-term absence due to sickness has been demonstrated and is implemented in multinational companies. Such a strategy may also be beneficial for small and medium-sized enterprises (SMEs). However, due to the different contexts, adoption, and implementation of this strategy in SMEs may be quite different. OBJECTIVE: This study aims to investigate the opportunities, barriers, and facilitators for adoption and implementation of this preventive strategy, as anticipated by employers and employees of SMEs. METHODS: A qualitative needs assessment was conducted using semi-structured interviews with higher managers (n = 15) and a focus group with employees (n = 8). Purposive sampling was used, and data were analyzed using content analysis. RESULTS: Employers had positive expectations concerning the gains of the preventive strategy, whereas employees had more reservations. Anticipated gains and intentions to implement the preventive strategy were rooted in underlying conceptions of the causes of sickness absence and the responsibilities of stakeholders. One key barrier shared across employers and employees concerned the potential lack of confidentiality. For employees, the role of the occupational health professional in the prevention of sickness absence was perceived as uncommon. Employers stressed lack of capacity and resources as a barrier, whereas employees stressed lack of follow-up by the employer as a barrier. CONCLUSIONS: SMEs are considerably receptive to the implementation of an indicated prevention strategy for long-term absence. Insight into the barriers and facilitators gives clues for wider and optimal implementation across a wider range of organizational settings. [ABSTRACT FROM AUTHOR]

In passenger railway operations, unforeseen events require railway operators to adjust their timetable and their resource schedules. The passengers will also adapt their routes to their destinations. When determining the new timetable and rolling stock schedule, the railway operator has to take passenger behavior into account. The operator should increase the capacity of trains for which the operator expects more demand than on a regular day. Furthermore, the operator could increase the frequency of the trains that serve stations with an additional demand. This paper describes a real-time disruption management approach which integrates the rescheduling of the rolling stock and the timetable by taking the changed passenger demand into account. The timetable decisions are limited to additional stops of trains at stations at which they normally would not call. Several variants of the approach are suggested, with the difference in how to determine which additional stops should be executed. Real-time rescheduling requires fast solutions. Therefore a heuristic approach is used. We demonstrate the performance of the several variants of our algorithm on realistic instances of Netherlands Railways, the major railway operator in the Netherlands. [ABSTRACT FROM AUTHOR]

• This study explores the attitude-behaviour dynamics of train travel during COVID-19. • We analyse 4-wave longitudinal data of train users in the Netherlands. • Train use affects the attitude toward train travel and vice versa. • Fear of infection reduces future train use. • Higher train use reduces future fear of infection. Research on the relationships between travel-related attitudes and travel behaviour has recently been reinvigorated by new theorizing as well as new empirical models. While traditional theories assume a rather static role of attitudes, i.e. acting as stable predispositions that cause behaviours in a unidirectional manner, recent models assume that attitudes and behaviours mutually influence each other over time. This study aims at better understanding attitude-behaviour dynamics by capitalizing on the circumstances presented by the ongoing COVID-19 pandemic. It assesses how the fear of COVID-19 infection and (the attitude towards) working-from-home influence train use as well as train use attitudes. To explore the (within-person) reciprocal relationships between these variables, random-intercept cross-lagged panel models were estimated using a 4-wave longitudinal dataset collected during the COVID-19 pandemic from a large panel of train travellers in the Netherlands. The results indicate that train use and the attitude towards train use reciprocally influence each other. Those with stronger fears of infection in one wave tend to use the train less in a subsequent wave, but higher use of the train in one wave also reduces the fear of infection in the next. We also found that working from home (WFH) and travelling by train operate as substitutes for one another. Moreover, people who work from home frequently become more fearful of infection. All the findings are consistent with cognitive dissonance theory that people develop attitudes that align with their behaviours. The paper concludes with several policy implications related to changing attitudes and promoting train use. [ABSTRACT FROM AUTHOR]

Although many studies have concluded that men and women engage in domestic violence at equal levels, existing studies have hardly focused on gender specific risk factors for domestic violence perpetration. Therefore, this study aimed to examine gender differences in criminogenic risk factors between Dutch male and female forensic outpatients who were referred to forensic treatment for domestic violence. Clinical structured assessments of criminogenic risk factors were retrieved for 366 male and 87 female outpatients. Gender differences were not only found in the prevalence and interrelatedness of criminogenic risk factors, but also in associations between criminogenic risk factors and treatment dropout. In men, risk factors related to the criminal history, substance abuse, and criminal attitudes were more prevalent than in women, whereas risk factors related to education/work, finances, and the living environment were more prevalent in women. Further, having criminal friends, having a criminal history, and drug abuse were associated with treatment dropout in men, whereas a problematic relationship with family members, housing instability, a lack of personal support, and unemployment were associated with treatment dropout in women. Finally, network analyses revealed gender differences in risk factor interrelatedness. The results provide important insights into gender specific differences in criminogenic risk factors for domestic violence, which support clinical professionals in tailoring treatment to the specific needs of male and female perpetrators of domestic violence. [ABSTRACT FROM AUTHOR]

Background: Tooth brushing with fluoride toothpaste is a key recommendation in evidence-based guidelines for caries prevention. Parents generally have sufficient knowledge to practice tooth brushing for their child, yet many experience barriers to actually implement the behaviour. Common barriers are associated with difficult child behaviour, stress, poor family organisation and management of routines. These underlying determinants of tooth brushing behaviour should be addressed in caries-preventive interventions. The 'Uitblinkers' intervention is a semi-structured interview method developed for oral healthcare professionals (OHPs), with the aim to improve the practice of twice daily tooth brushing in children. The interview method focusses on 1) identifying parents' barriers to tooth brushing, and 2) promoting parenting strategies (related to tooth brushing) to tackle the identified barriers. The intervention applies principles from learning theory, including stimulus control, operant conditioning and authoritative parenting. This paper describes a study protocol to evaluate the effect of the intervention. Methods: This non-randomised cluster-controlled trial will be conducted in 40 general dental practices in The Netherlands. Intervention practices will implement the intervention in addition to care as usual, while control practices will only provide care as usual. From each dental practice, a random sample of 3 to 4-year-old children will be recruited. The intervention consists of three sessions between an OHP and parent, in which parenting strategies for identified barriers are discussed. The primary study outcome is children's dental caries experience after 24 months. Secondary outcomes include parents' self-efficacy in brushing their children's teeth, tooth brushing frequency in children and children's dental plaque scores. Differences in outcomes between the intervention and control group will be assessed using logistic and negative binomial regression. The feasibility of the intervention will be assessed through process evaluation. Discussion: Findings of this study will ascertain whether promoting parenting strategies is a successful method to improve tooth brushing in children and to prevent childhood dental caries in a clinical dental setting. Trial registration: This trial is registered with the Netherlands National Trial Register (registration date: 7 September 2018; trial registration number: NTR7469). [ABSTRACT FROM AUTHOR]

Immigration has become an increasingly politicised issue in many European countries. While prior research emphasises the role of party cues and education in shaping public attitudes to immigration, we know less about the impact of these two factors when they place individuals under cross-pressures. This study explores how exposure to cross-pressures arising from the incongruence between party cues and the values one is expected to hold as a function of educational attainment affects immigration attitudes. The empirical analysis relies on cross-sectional analyses of public preferences in ten European countries and longitudinal analyses of public attitudes in the Netherlands. The results point to attitudinal moderation among party supporters with lower levels of education due to exposure to incongruent party cues. Highly educated party supporters appear to be insensitive to such incongruent cues. Supplemental data for this article can be accessed online at: https://doi.org/10.1080/01402382.2021.1975447. [ABSTRACT FROM AUTHOR]

Awareness that high-status adolescents can be targets of aggression has grown in recent years. However, questions remain about the associations of the confluence of victimization and popularity with adjustment. The current study fills this gap by examining the joint and unique effects of victimization and popularity on aggression and alcohol use. Participants were 804 Dutch adolescents (50.2% boys, Mage = 13.65) who were followed for one year. High-status victims were more aggressive and drank more alcohol than lower-status victims. High-status victims were also more proactively and indirectly aggressive and self-reported more bullying than high-status non-victims. Thus, the findings demonstrated a conjoined risk of victimization and popularity for some types of aggression. [ABSTRACT FROM AUTHOR]

There have been strong debates in many European countries about religious identity enactment of Muslims, with the wearing of the headscarf in public places being a central symbolic topic. This study investigated the importance of the context (private versus three public contexts) for tolerance of Muslim identity enactment (e.g., the wearing of headscarves) among a national sample of Dutch majority group members. Using an experimental design, it was found that tolerance was highest in the private context, followed by the street context and then the contexts of work. Furthermore and in all contexts, tolerance of Muslims persuading others to start enacting their religious identity in a similar way was lower than tolerance of identity enactment itself. Moreover, both types of tolerance were found to differ by context only for majority members who were highly concerned about the continuity of their ingroup's cultural identity (i.e., cultural continuity). It is concluded that context‐related and action‐related variance, as well as cultural continuity, are important for majority members' tolerance of Muslim minority identity enactment. [ABSTRACT FROM AUTHOR]

After surgery for congenital heart disease in children and adolescents, an active lifestyle is important to achieve and maintain good physical fitness. This study aimed to describe physical activity, as well as the use of patients' and parents' preferences for rehabilitative care after surgery for congenital heart disease. This cross-sectional study included patients aged 4–16 years old, who had undergone surgery for congenital heart disease 2 years prior to the study onset. Patients and/or parents were invited to complete questionnaires on physical activity, and on their preferences for, and -use of, rehabilitative care after surgery. Forty-five of the 92 eligible patients and/or parents completed the questionnaires. The median age of the children was 12.2 years (IQR 7.8–16.1). Two children (4%) met the recommendations for taking part in moderate physical activity and 13 (29%) having done so for vigorous physical activity. Postoperatively 15 children (33%) had had physical therapy in primary care. More than 50% of the patients/parents would have preferred to have had more information on physical activity and to have taken part in an individual exercise program delivered during their primary care. The majority of eligible patients do not meet public health recommendations for engaging in physical activity and do not use physical therapy after surgery for congenital heart disease. The majority of patients and parents preferred more information as well as individual physical therapy treatments. Two years after surgery for congenital heart disease children and adolescents are less active compared to typically developing peers. Patients with a congenital heart disease and their parents need more information and support regarding stimulation of physical activity and physical fitness after heart surgery. In the postoperative process, a well-structured and supportive (individual) rehabilitation program should be introduced to improve physical activity and physical fitness. [ABSTRACT FROM AUTHOR]

Veterinarians play an important role in the reduction of antimicrobial use in farm animals. This study aims to quantify opinions of veterinarians from the Netherlands and Flanders regarding antimicrobial use and resistance issues in farm animals. An online survey was sent out to 678 and 1100 farm animal veterinarians in Flanders and the Netherlands, of which 174 and 437 were returned respectively. Suboptimal climate conditions were regarded as the most important cause for high antimicrobial use in farm animals. Flemish veterinarians also regarded insufficient biosecurity measures and farmers' mentality as important determinants, while the Dutch respondents ranked insufficient immunity of young animals and economic considerations of farmers as major causes. The majority of Dutch respondents (63.8 per cent) supported the existing national policy, which aimed to halve veterinary antimicrobial use, while the Flemish (32.9 per cent) were less supportive of such a policy. Improvements in housing and climate conditions, biosecurity measures and strict control of specific infectious diseases were seen as important and promising measures to reduce antimicrobial use. To reduce antimicrobial use in farm animals, some shared approaches might be applicable in both countries. However, cultural, political and societal differences between Flanders and the Netherlands require differentiated approaches to reduce veterinary antimicrobial use. [ABSTRACT FROM AUTHOR]

Background/aims: Patient-reported outcomes (PROs) are increasingly considered important. We developed a web-based application to electronically assess PROs in routine dermatological practice. We assessed (1) the relevance of PRO measurement according to health care providers and patients, (2) the feasibility of our application in routine practice according to health care providers, supporting staff and patients, and (3) barriers/facilitators for implementation according to health care providers and supporting staff. Methods: Health care providers, supporting staff and patients completed study-specific questionnaires. Also, website statistics were analysed. Results: 3/6 clinics participated, including 9 professionals and 80 patients. Both health care providers and patients rated PRO measurement as relevant. However, implementation was only moderately feasible. Time constraints and logistical problems were mentioned as barriers, and motivated patients and supportive staff as facilitators. Conclusion: Electronic PRO assessment in routine practice is not self-evident. Adjustments in logistics are recommended to optimize implementation, using a plan-do-study-act approach. [ABSTRACT FROM AUTHOR]

Social psychological research on nostalgia has mainly considered this emotion at the individual level rather than the group level. The current paper proposes that group-based nostalgia for the nation (i.e., national nostalgia) is likely to be related to a positive in-group orientation and a negative out-group orientation, because it fosters an exclusionary and essentialist sense of national identity that is based on ancestry and common descent (i.e., ethnic national identity). This prediction was tested in three survey studies. Study 1 was conducted among a broad sample of the native Dutch population, and demonstrated that national (and not personal) nostalgia is positively related to national in-group identification and out-group prejudice. Study 2 replicated the findings of Study 1 among a nationally representative sample of the native Dutch population, and provided support for the mediation by ethnic national identity. Study 3 replicated the findings of Study 2 and additionally demonstrated that national nostalgia positively predicts tendencies to protect national in-group identity, via a stronger sense of ethnic national identity. These findings demonstrate the potential of group-based nostalgia to have positive and negative consequences for group dynamics at the same time. [ABSTRACT FROM AUTHOR]

Objectives: On the basis of the experience of the Netherlands, this critical commentary will argue why activity-based funding (ABF) in mental health care is a disastrous path that Australia should not take.Conclusions: ABF leads to an exponential growth in health care spending as it encourages diagnostic inflation and overproductivity. It also leads to fraud and an increased bureaucracy that goes hand in hand with demoralisation among health workers. And finally, the increasing treatment claims leads to the reintroduction of productivity limitations, waiting lists and ultimately austerity measures in order to halt the untamed growth of spending. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little is known why some organizations employ vulnerable workers and others do not. OBJECTIVE: To explore the relationships between the attitude, intention, skills and barriers of employers and employment of vulnerable workers. METHODS: We included 5,601 inclusive organizations (≥1% of employees had a disability, was long-term unemployed or a school dropout) and 6,236 non-inclusive organizations of the Netherlands Employers Work Survey 2014–2019. We operationalized employer factors based on the Integrative Model of Behavioral Prediction as attitude (negative impact), intention (mission statement regarding social inclusion), skills (human resources policies and practices), and barriers (economic conditions and type of work). We used multivariate-adjusted logistic regression models. RESULTS: Compared to non-inclusive organizations, inclusive organizations had a more negative attitude (OR:0.81) and a stronger intention to employ vulnerable workers (OR:6.09). Regarding skills, inclusive organizations had more inclusive human resources practices (OR:4.83) and initiated more supporting human resources actions (OR:4.45). Also, they adapted more work conditions towards the needs of employees (OR:1.52), negotiated about work times and absenteeism (OR:1.49), and had general human resources practices on, for example, employability (OR:1.78). Inclusive organizations had less barriers reflected by better financial results (OR:1.32), more employment opportunities (OR:1.33) and more appropriate work tasks (OR:1.40). CONCLUSIONS: Overall, inclusive organizations reported more positive results on the employer factors of the Integrative Model of Behavioral Prediction, except for a more negative attitude. The more negative attitude might reflect a more realistic view on the efforts to employ vulnerable groups, and suggests that other unmeasured emotions and beliefs are more positive. [ABSTRACT FROM AUTHOR]

Background: The specific palliative care needs and problems of patients with a substance use disorder and multiple problems, and those of their proxies, are under recognized Besides, the organization of palliative care, including the division of health care professionals' responsibilities, is often unclear. Perspectives of patients and proxies are hardly known. We describe the outline of a study designed to explore how palliative care for patients with a substance use disorder is organized in the Netherlands and to explore problems and needs, as well as possible improvements from the healthcare professionals', patients' and proxies' perspective. The aim of this protocol paper is to provide insights in ways to conduct research with vulnerable research participants and to offer a detailed description of the study design. The broader study aims to gain insight in and formulate recommendations on how to improve palliative care for patients with a substance use disorder. Methods: A qualitative study with patients, proxies and healthcare professionals. Semi - structured interviews will be held with 10 – 15 patients who suffer from a severe substance use disorder. They are in a palliative care trajectory and either diagnosed with a chronic or life-threatening disease or, as a result of addictive behavior, a physical deterioration without the prospect of cure. Semi - structured interviews will also be held with 5 – 10 proxies. Healthcare professionals, volunteers and/or 'experts - by - experience' ( n = 24 – 40) will be participating in semi - structured group interviews. All (group) interviews will be thematically analyzed. Additionally, a strengths, weaknesses, opportunities and threats (SWOT) analysis will be applied to the group interview data with the aim to summarize and concretize the findings. Discussion: Everyone has a right to an optimal end-of-life phase of life and a dignified dying process. This study will provide valuable knowledge about palliative care for patients with a substance use disorder and explicitly bring to light the needs and problems of the patients and their proxies and healthcare professionals in a palliative care phase. [ABSTRACT FROM AUTHOR]