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Objective: To identify the 100 most-cited articles in DH and analyze their characteristics. Material and Methods: A search was performed on the Web of Science (WoS) and the 100 most-cited articles were selected. The following data were extracted: citations, year of publication, authorship, institution, country, journal, language, study design, topic of interest, conflict of interest (COI), and sponsorship. The VOSviewer software was used to visualize bibliometric networks. Poisson regression analysis was performed to measure associations between several citations and the characteristics of the studies. Results: The number of citations ranged from 346 to 48. The most-cited article was published in 1997 by Holland in the Journal of Clinical Periodontology. This journal published the most papers, followed by the Journal of Oral Rehabilitation and Journal of Dentistry. Laboratory research, review, and clinical trial were the study designs most prevalent. Reviews (p<0.05; PR= 1.853) and method development studies (p<0.05; PR= 1.853) had a more chance to present more citations. The main topics of interest were the clinical effectiveness of desensitizers and in vitro analysis of dentin morphology. Sponsorship and COI were underreported. England and USA presented the greatest number of citations and connections in the coauthorship network map. Conclusion: Most of the articles were original research, and their topics of interest were mainly the clinical effectiveness of desensitizing agents and dentin morphology. [ABSTRACT FROM AUTHOR]

Background: Palliative care is insufficiently integrated in the continuum of care for older people. It is unclear to what extent healthcare policy for older people includes elements of palliative care and thus supports its integration. Aim: (1) To develop a reference framework for identifying palliative care contents in policy documents; (2) to determine inclusion of palliative care in public policy documents on healthcare for older people in 13 rapidly ageing countries. Design: Directed documentary analysis of public policy documents (legislation, policies/strategies, guidelines, white papers) on healthcare for older people. Using existing literature, we developed a reference framework and data extraction form assessing 10 criteria of palliative care inclusion. Country experts identified documents and extracted data. Setting: Austria, Belgium, Canada, Czech Republic, England, Japan, Mexico, Netherlands, New Zealand, Singapore, Slovenia, South Korea, Spain. Results: Of 139 identified documents, 50 met inclusion criteria. The most frequently addressed palliative care elements were coordination and continuity of care (12 countries), communication and care planning, care for family, and ethical and legal aspects (11 countries). Documents in 10 countries explicitly mentioned palliative care, nine addressed symptom management, eight mentioned end-of-life care, and five referred to existing palliative care strategies (out of nine that had them). Conclusions: Health care policies for older people need revising to include reference to end-of-life care and dying and ensure linkage to existing national or regional palliative care strategies. The strong policy focus on care coordination and continuity in policies for older people is an opportunity window for palliative care advocacy. [ABSTRACT FROM AUTHOR]

Climatic changes can cause unpredictability in flood regimes that traditional flood risk management (FRM) approaches may struggle with. Therefore, flood resilience is seen as a supplementation to these approaches, putting a larger emphasis on flood acceptance and minimising consequences. An (emergent) group contributing towards flood resilience is civil society. This paper examines how civil society contributions can be furthered and guided in the Netherlands as well as exploring potential limitations in doing so. To achieve this, England is used as a good practice example due to a more developed and defined role for civil society being present here. Data were collected on both actual (England and the Netherlands) and potential (The Netherlands) civil society contributions. These were compared to identify potential avenues for Dutch civil society contributions to flood resilience that can be further investigated. The research shows that the most promising avenues are improving advocacy from citizens, improving local flood awareness and developing relationships between FRM authorities and existing citizen groups that can be harnessed and mobilised to support flood resilience. Additionally, the research also provides insights into potential limitations for transferring resilience approaches from one context to another beyond the cases discussed in this publication. [ABSTRACT FROM AUTHOR]

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

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Copyright of Social & Cultural Geography is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In some countries, such as the Netherlands and Norway, point-of-care testing (POCT) is more widely implemented in general practice compared to countries such as England and Australia. To comprehend what is necessary to realize the benefits of POCT, regarding its integration in primary care, it would be beneficial to have an overview of the structure of healthcare operations and the transactions between stakeholders (also referred to as value networks). The aim of this paper is to identify the current value networks in place applying to POCT implementation at general practices in England, Australia, Norway and the Netherlands and to compare these networks in terms of seven previously published factors that support the successful implementation, sustainability and scale-up of innovations. Methods: The value networks were described based on formal guidelines and standards published by the respective governments, organizational bodies and affiliates. The value network of each country was validated by at least two relevant stakeholders from the respective country. Results: The analysis revealed that the biggest challenge for countries with low POCT uptake was the lack of effective communication between the several organizations involved with POCT as well as the high workload for general practitioners (GPs) aiming to implement POCT. It is observed that countries with a single national authority responsible for POCT have a better uptake as they can govern the task of POCT roll-out and management and reduce the workload for GPs by assisting with set-up, quality control, training and support. Conclusion: Setting up a single national authority may be an effective step towards realizing the full benefits of POCT. Although it is possible for day-to-day operations to fall under the responsibility of the GP, this is only feasible if support and guidance are readily available to ensure that the workload associated with POCT is limited and as low as possible. [ABSTRACT FROM AUTHOR]

The decision to remand a defendant into custody pre-trial is one of the most controversial criminal justice decisions because it deprives individuals of their liberty while they are presumed to be innocent of a crime. Indeed, pre-trial detention decisions can have significant consequences for defendants, which need to be balanced against the potential implications of bail for public safety and the course of criminal proceedings. Despite this, court-based bail and remand decision-making remains relatively underexplored. In this paper, we compare court-based bail/remand decision-making in England and Wales and The Netherlands. We focus on (i) the procedure and structure of decision-making, (ii) the substantive relevant legal frameworks, (iii) the courts in which the decisions are made and the decision-makers in those courts, (iv) the conditions characterizing the decision task, and (v) the court's reasoning of bail and remand in custody decisions. Using a comparative and multi-disciplinary approach, relying on Law, Criminology, and Psychology, we make predictions about bail and remand in custody rates in the two jurisdictions as well as the decision performance of court-based decision-makers. These predictions are then evaluated using available (official) statistics and past research. We identify the need to collect more nuanced statistical data on bail and remand in custody rates and point to potentially fruitful avenues for future research. A comparative, multi-disciplinary, evidence-based approach can underpin remand reform in England and Wales, The Netherlands, and beyond. [ABSTRACT FROM AUTHOR]

Introduction: Drug reimbursement decisions are often made based on a price set by the manufacturer. In some cases, this price leads to public and scientific debates about whether its level can be justified in relation to its costs, including those related to research and development (R&D) and manufacturing. Such considerations could enter the decision process in collectively financed health care systems. This paper investigates whether manufacturers' costs in relation to drug prices, or profit margins, are explicitly mentioned and considered by health technology assessment (HTA) organisations. Method: An analysis of reimbursement reports for cancer drugs was performed. All relevant Dutch HTA-reports, published between 2017 and 2019, were selected and matched with HTA-reports from three other jurisdictions (England, Canada, Australia). Information was extracted. Additionally, reimbursement reports for three cases of expensive non-oncolytic orphan drugs prominent in pricing debates in the Netherlands were investigated in depth to examine consideration of profit margins. Results: A total of 66 HTA-reports concerning 15 cancer drugs were included. None of these reports contained information on manufacturer's costs or profit margins. Some reports contained general considerations of the HTA organisation which related prices to manufacturers' costs: six contained a statement on the lack of price setting transparency, one mentioned recouping R&D costs as a potential argument to justify a high price. For the case studies, 21 HTA-reports were selected. One contained a cost-based price justification provided by the manufacturer. None of the other reports contained information on manufacturer's costs or profit margins. Six reports contained a discussion about lack of transparency. Reports from two jurisdictions contained invitations to justify high prices by demonstrating high costs. Conclusion: Despite the attention given to manufacturers' costs in relation to price in public debates and in the literature, this issue does not seem to get explicit systematic consideration in the reimbursement reports of expensive drugs. [ABSTRACT FROM AUTHOR]

Both England and the Netherlands have seen efforts to liberalise their audit markets for local government in recent decades. According to economic theory, these should benefit buyers as increased competition produces lower prices and improved quality. Increasing the number of competing audit firms in markets traditionally dominated by few large firms is widely seen as a key ingredient to this process. However, liberalisation has taken different paths in England, compared to the Netherlands. In England, a national‐level collaborative purchasing arrangement has seen a small number of large firms competing, whilst in the Netherlands, a free market has led to the withdrawal by Big‐4 firms and rapidly growing market share by mid‐tier and small firms. In this paper, we analyse contrasting market developments in local public audit in England and the Netherlands and accordingly analyse the underlying factors through applying an established framework for market analysis from industrial economics, Porter's five forces framework, together with an institutional logics approach to further understand the factors involved. We find the Porter framework a useful tool to identify structural differences between markets but one that requires further analysis to explain underlying dynamics, which in the case of Dutch and English local public audit markets is effectively provided by the use of concepts from institutional logics including a historical contingency analysis. [ABSTRACT FROM AUTHOR]

Recently England and Netherlands have changed their consent system from Opt In to Opt Out. The reflections shared in this paper give insight and may be helpful for other nation considering likewise. Strong support in England for the change in legislation led to Opt Out being introduced without requiring a vote in parliament in 2019. In Netherlands the bill passed by the smallest possible majority in 2018. Both countries implemented a public campaign to raise awareness. In England registration on the Donor Register is voluntary. Registration was required in Netherlands for all residents 18 years and older. For those not already on the register, letters were sent by the Dutch Government to ask individuals to register. If people did not respond they would be legally registered as having "no objection." After implementation of Opt Out in England 42.3% is registered Opt In, 3.6% Opt Out, and 54.1% has no registration. In contrast in Netherlands the whole population is registered with 45% Opt In, 31% Opt Out and 24% "No Objection." It is too soon to draw conclusions about the impact on the consent rate and number of resulting organ donors. However, the first signs are positive. [ABSTRACT FROM AUTHOR]

Purpose: The use of patient-reported outcome (PRO) measures in clinical practice is increasing. Following the creation of a 'User's Guide to Implementing PRO Assessment in Clinical Practice' by the International Society for Quality of Life Research (ISOQOL), volunteers from ISOQOL sought to create a Companion Guide to assist health care providers with the scientific and practical considerations involved in implementing and using PRO measures in clinical care by using information from real-world case studies. This paper summarizes the key issues presented in the Companion Guide.Methods: Ten respondents, who were members of the ISOQOL's CP-SIG and worked in various clinical areas, participated in a survey or telephone interview. Participants were from Canada (n = 2), Denmark (n = 1), England (n = 2), Holland (n = 1), and the United States (n = 4).Results: Based on the information provided by respondents, a Companion Guide was produced, organized according to the nine questions presented in the User's Guide. An additional section for key take-home messages was also provided. This guide provides examples of issues and considerations related to the implementation of PRO measures in clinical practice.Conclusions: Respondents provided insight into their experiences and emphasized that PRO initiatives were likely to be more successful if there is purposeful, designed integration into clinical practice, meaningful substantive engagement with all stakeholders and access to necessary organizational resources. The ability to leverage existing technology as well as realistic and stakeholder consensus-driven expectations for planning and timing were also key to the successful implementation of PRO measures. [ABSTRACT FROM AUTHOR]

Purpose Managerial quality improvement (QI) in terms of accountability management has become central to healthcare institutions. Yet, managerial QI is largely considered irrelevant by healthcare professionals. In consequence, the implementation of managerial QI implementation is hampered. Knowledge brokering is discussed as a means to foster the implementation of (QI) knowledge in healthcare. Yet, the benefit of knowledge brokering for managerial QI has so far been neglected. Therefore, this research asks how knowledge brokering can support the implementation of managerial QI.Design/methodology/approach This article builds on a single case study approach as a unit of analysis. Qualitative data collection comprises 21 semi-structured interviews at the managerial and clinical levels, 220 h of participant observation and document analysis.Findings This paper identifies three strategies of how brokers implement managerial QI into a hospital by means of knowledge brokering: prioritizing, obscuring and redefining. The strategies help to transform multiple external QI demands into one managerial QI strategy. Yet the strategies also reduce non-managerial perspectives on QI, which generates frustration among healthcare professionals.Practical implications The paper works out the benefits and costs of managerial knowledge brokering. This allows to spell out practical implications for managers, nurses and clinicians who have to deal with managerial QI in healthcare organizations.Originality/value This paper fulfils an identified need to study managerial knowledge brokering practices as a means to implement managerial QI into healthcare organizations. By doing that, the article adds to the body of research on knowledge translation in healthcare. [ABSTRACT FROM AUTHOR]

Objective: To estimate the number of people in a prolonged disorder of consciousness (PDOC) who may need a formal best interests decision-making process to consider starting and/or continuing life-sustaining treatment each year in the population of a developed country. Method: Identification of studies on people with a PDOC giving information about incidence, and/or prevalence, and/or cause, and/or location of long-term care. Sources included systematic reviews, a new search of MEDLINE (April 2018), and a personal collection of papers. Validating information was sought from existing data on services. Results: There are few epidemiologically sound studies, most having bias and/or missing information. The best estimate of incidence of PDOC due to acute onset disease is 2.6/100,000/year; the best estimate of prevalence is between 2.0 and 5.0/100,000. There is evidence that prevalence in the Netherlands is about 10% of that in other countries. The commonest documented causes are cerebral hypoxia, stroke, traumatic brain injury, and tumours. There is some evidence suggesting that dementia is a common cause, but PDOC due to progressive disorders has not been studied systematically. Most people receive long-term care in nursing homes, but a significant proportion (10%–15%) may be cared for at home. Conclusion: Each year, about 5/100,000 people will enter a prolonged state of unconsciousness from acute onset and progressive brain damage; and at any one time, there may be 5/100,000 people in that state. However, the evidence is very limited in quality and quantity. The numbers may be greater. [ABSTRACT FROM AUTHOR]

In 2015 the discovery of meningeal (dural) lymphatics was announced to much fanfare. The journal Science named this the second most important discovery of the year! Yet, they had actually been well described two and a quarter centuries earlier, in Italy, England and Holland. However, there was controversy about their existence because of the difficulties in studying them, also addressed two and a quarter centuries earlier. Their study had generated a very large literature and they were "textbook" knowledge. The reasons for this neglect are discussed emphasizing the current scientific milieu and the changing modes of evaluating scientists. [ABSTRACT FROM AUTHOR]

In the context of globalising higher education (HE) policies, there is an increasing interest among scholars in detecting patterns of policy change, including the rate and magnitude of policy change and the direction of change (convergence or divergence) This paper adds to that literature by comparing the pattern of policy change and by providing theory-based explanations for HE policy change. The national quality assurance (QA) policies for universities in England and the Netherlands were compared (1985–2005) based on an analytical framework drawing on new institutionalism. Key findings were that both QA systems moved in the direction of an extrinsic QA orientation, but the differences between the two systems were larger in 2005 and in 1985. The degree of policy change in England was more incremental, the Dutch case showing rather radical change in 2002. These dissimilarities can be ascribed to the different policy change mechanism: bricolage and translation. [ABSTRACT FROM PUBLISHER]

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

Purpose The purpose of this paper is to describe service users’ perspectives on the difference between high secure long-stay forensic psychiatric services in the Netherlands and high secure forensic psychiatric care in England. These perspectives are relevant in considering the benefits of a similar long-stay service in England.Design/methodology/approach A current in-patient detained in a high secure hospital in England and other mental health service users and carers with experience in forensic-psychiatric settings were asked to watch a documentary on a Dutch high secure long-stay service. Then they were invited to make comparisons between this service and high secure care in England. These perspectives were gained in the context of their membership of the Service User Reference Group of an externally funded study on long-stay in forensic-psychiatric settings in England.Findings The small group of participants highlighted the importance of relational security, meaningful occupation, autonomy, positive therapeutic relationships with staff and a homely environment for those with lengthy admissions and perceived these to be better met in the Dutch service. These factors might contribute to improved quality of life that services should strive to achieve, especially for those with prolonged admissions.Practical implications Perspectives of service users with lived experience of long-stay in forensic settings are important in informing service developments. Lessons can be learnt from initiatives to improve the quality of life in long-stay services in other countries and consideration be given on how to best manage this unique group.Originality/value To the authors’ knowledge this is the first study asking service users about their view on forensic services in other countries. The findings suggest that service users have valuable contributions to make to aid service developments and should be involved in similar such exercises in the future. [ABSTRACT FROM AUTHOR]

Abstract: Introduction and objective: The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. Method: From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12‐week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT‐C; the proportion of screen‐negative patients given advice, and the proportion of screen‐positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet‐based counselling. Results: Thirty‐two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen‐negative patients were falsely classified. At baseline, 27% of screen‐negative patients were given advice, and 22.5% screen‐positive patients were not given advice. These proportions halved during the 12‐week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen‐positive patients not given advice (OR = 0.56; 95% CI, 0.31‐0.99; P < .05). Conclusion: Although the use of AUDIT‐C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives. [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]

Background: Lifestyle interventions targeting physical activity, sedentary time and dietary behaviours have the potential to initiate and support behavioural change and result in public health gain. Although men have often been reluctant to engage in such lifestyle programs, many are at high risk of several chronic conditions. We have developed an evidence and theory-based, gender sensitised, health and lifestyle program (European Fans in Training (EuroFIT)), which is designed to attract men through the loyalty they feel to the football club they support. This paper describes the study protocol to evaluate the effectiveness and cost-effectiveness of the EuroFIT program in supporting men to improve their level of physical activity and reduce sedentary behaviour over 12 months.Methods: The EuroFIT study is a pragmatic, two-arm, randomised controlled trial conducted in 15 football clubs in the Netherlands, Norway, Portugal and the UK (England). One-thousand men, aged 30 to 65 years, with a self-reported Body Mass Index (BMI) ≥27 kg/m(2) will be recruited and individually randomised. The primary outcomes are objectively-assessed changes in total physical activity (steps per day) and total sedentary time (minutes per day) at 12 months after baseline assessment. Secondary outcomes are weight, BMI, waist circumference, resting systolic and diastolic blood pressure, cardio-metabolic blood biomarkers, food intake, self-reported physical activity and sedentary time, wellbeing, self-esteem, vitality and quality of life. Cost-effectiveness will be assessed and a process evaluation conducted. The EuroFIT program will be delivered over 12 weekly, 90-minute sessions that combine classroom discussion with graded physical activity in the setting of the football club. Classroom sessions provide participants with a toolbox of behaviour change techniques to initiate and sustain long-term lifestyle changes. The coaches will receive two days of training to enable them to create a positive social environment that supports men in engaging in sustained behaviour change.Discussion: The EuroFIT trial will provide evidence on the effectiveness and cost-effectiveness of the EuroFIT program delivered by football clubs to their male fans, and will offer insight into factors associated with success in making sustained changes to physical activity, sedentary behaviour, and secondary outcomes, such as diet.Trial Registration: Isrctn: 81935608 . Registered 16 June 2015. [ABSTRACT FROM AUTHOR]

• We develop a framework for analysing the role of Science Policy Interfaces in Flood Risk Governance. • We apply this framework to England, France and the Netherlands using policy analysis and stakeholder interviews. • SPIs help diversify FRM; increase their connectivity, facilitate decentralisation of FRM and foster inter-country learning. • SPIs can steer FRG, either along existing pathways, or towards new and potentially transformative change. • SPIs are an underexposed factor explaining dynamics in flood risk governance which merits more systematic empirical study. In the face of increasing threats from flooding, there are growing calls to strengthen and improve arrangements of flood risk governance (FRG). This endeavour requires an appreciation of the multitude of factors stabilising and driving governance dynamics. So-called catalyst flood events, policy champions and advocacy coalitions have tended to dominate this study to date, whilst the potential role played by Science Policy Interfaces (SPIs) has been somewhat neglected and often approached in a reductionist and fragmented way. This paper addresses this gap by drawing from in-depth policy analysis and stakeholder interviews conducted within England, France and the Netherlands under the auspices of the EU-FP7 STAR-FLOOD project. The analysis reveals four prominent ways in which SPIs shape FRG, by i) facilitating the diversification of Flood Risk Management (FRM) strategies; ii) increasing their connectivity, iii) facilitating a decentralisation of FRM and iv) fostering inter-country learning. It identifies different roles of specific interfaces (structures) and interfacing mechanisms (processes) in shaping governance dynamics. This way, the analysis reveals various 'entry points' through which SPIs can steer FRG, either along existing pathways, or towards new and potentially transformative change. The study shows that SPIs are a hitherto underexposed factor explaining dynamics in flood risk governance which merits additional systematic empirical study. [ABSTRACT FROM AUTHOR]

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

Understanding the development of behavioral and mental health issues among adolescents, particularly those from immigrant families, is a key area of concern. Many prior studies have focused on the role of societal (country-of-destination) language skills, but we know less about the role played by the use of the heritage language in families. We examined this latter relationship with a focus on changes in heritage language use and internalizing and externalizing problems, and how family relations moderate this relationship. We used the first two waves (2010/2011 and 2011/2012) of the Children of Immigrants Longitudinal Survey in Four European Countries (CILS4EU) data collected from Germany (n = 1614; Mage = 14.8 years, 50% female), the Netherlands (n = 1203; Mage = 14.7 years, 54% female), Sweden (n = 1794; Mage = 14.2 years, 53% female), and England (n = 1359; Mage = 14.6 years, 50% female). Our results suggest that increased use of heritage language is associated with fewer externalizing problems only in families with greater family cohesion and parental warmth (in Germany and the U.K.) and with fewer internalizing problems only in families with higher parental monitoring (in the Netherlands and Sweden). Good family relations are thus an important precondition for increased heritage language use to lead to improved behavioral and mental health for children of immigrants. [ABSTRACT FROM AUTHOR]

Objectives: People living with dementia can feel hesitant disclosing their diagnosis to social networks, partly due to stigma. Little attention has been paid to the measurement of disclosure decisions and stigma, and few standardised stigma tools have been validated in languages other than English. We investigated the psychometric properties of Dutch translations of three stigma measures, and explored the stigma experiences of Dutch and English people living with dementia as well as patterns and predictors of comfort with disclosure. Methods: Community-dwelling adults living with dementia in the Netherlands (n = 40) and England (n = 40) completed either the English versions or the Dutch translations of the Comfort with Disclosure scale and three stigma measures (Stigma Impact, Stigma Stress, and Secrecy Scale). We established the psychometric properties of the stigma measures and conducted correlation and regression analyses. Results: Internal consistency was good to excellent for all measures in the Dutch sample. Small but significant differences were found between the Dutch and English samples on the total score of the Stigma Impact Scale and its subscale social isolation. Age was negatively associated with comfort disclosing to family, and desire for secrecy was negatively associated with comfort disclosing to both family and friends. Conclusions: The psychometric properties of the Dutch scales were satisfactory. Many people living with dementia would feel comfortable disclosing their diagnosis to family and friends, but stigma experiences can greatly affect this decision. Cross-cultural differences in stigma experiences in persons with dementia require further investigation. [ABSTRACT FROM AUTHOR]

This paper re-examines the role of the school share of separated families with new data, new countries, and a broader set of outcomes. Past studies in the US have shown that the share of students from separated families has a negative effect on students' test scores. Using data on 16,468 students and their parents in 471 secondary schools in England, Germany, the Netherlands and Sweden, multilevel models were estimated to assess the effects of the demographic composition of schools on student outcomes while simultaneously exploring the role of school disadvantages and school-level social capital. Findings showed that students had lower reading test scores, displayed poorer behavior in school, and had more problem behaviors outside of school, when a larger share of the students in school came from separated families. The associations were to some extent explained by associated school disadvantages but social capital at the school level did not explain the associations. The adverse effects of the school context on behavior inside and outside of school were stronger for girls than for boys but the effects on reading were similar. There were also country differences, the most noteworthy being that context effects as well as gender differences therein were absent in Sweden. • Students have lower reading scores and more problem behavior if a school has a larger share of students from separated families. • The association mostly remains present when controlling for a broad set of characteristics at the school, family, and student level. • Part of the association is explained by school disadvantages but social capital effects at the school level do not explain the association. • In three countries, associations with the school share of separated parents were stronger for girls than for boys. • Boys on average have more problem behaviors than girls but this gender gap disappears in schools with large shares of separated parents. • The associations were strongest in England and Germany, weaker in the Netherlands, and absent in Sweden. [ABSTRACT FROM AUTHOR]

The VAR has introduced a new element to football. Before, a decision to award a penalty kick could not be reversed. The player taking the penalty could take it relatively quickly after the referee called the foul. After the introduction of the VAR, every penalty kick decision is replayed by the VAR and also quite often reviewed on-field. As a consequence, time between the initial decision by the referee and the actual penalty kick has increased substantially. We examined the influence of the time-interval duration between the foul and the actual penalty kick on the conversion probability using a logit model. Also, we assessed the consequences of a VAR intervention, if any. We used data on all 2888 penalties awarded in top leagues in England, Spain, Germany, Italy, the Netherlands, and the UEFA Champions League, over the course of five seasons (2015/2016–2019/2020). We found that the duration between the foul and the moment the penalty is taken does not impact the conversion probability. However, whether or not the VAR intervenes with the referee's decision has a negative effect on the conversion probability of penalty kicks. Football teams and coaches should incorporate this element of uncertainty in training. [ABSTRACT FROM AUTHOR]

This article contributes to the theoretical understanding of institutions as fundamental in shaping the demand for migrant labour by investigating labour market regulation as possible explanation for cross-country differences in labour market segmentation and the presence of migrant workers. It compares the adult social care sector in England and the Netherlands with important cross-country differences in the reliance on migrant labour amid similar cost saving policies and marketization drives. The analysis draws on data collected between 2009 and 2019 and consisting of sectoral survey data, policy documents, interviews with relevant actors, and the observations of trade union and care workers' meetings. The findings highlight the importance of path-dependent features of the national industrial relations systems in explaining observed differences but also how the specific nature of the regulatory outcomes depends on unions' strategies and power. [ABSTRACT FROM AUTHOR]

Introduction: This integrative review aimed to understand the impact of nursing on the health outcomes of people with opioid use disorder (OUD). Methods: Whittemore and Knafl's (2005) integrative review methodology guided the review process. The authors searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and OVID databases for peer‐reviewed, English language articles describing nursing care for people receiving medications for OUD. The literature search followed the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines. Results: A total of 773 articles were identified through the database searches after duplicates were removed; 15 articles met inclusion criteria and were included in the final review from the United States, Canada, Ireland, England, and the Netherlands. Two themes emerged: (1) The effect of nurse‐led care on patient outcomes and (2) Nursing roles and the environment of care. Studies emphasized the aspects of nursing care that promote patient‐centeredness and patient satisfaction. Conclusions: The importance of the registered nurse in providing quality care for people receiving medications for OUD is clear from the literature reviewed. The studies in the review highlighted important aspects of the registered nurses' role in affecting outcomes for people receiving medications for OUD including communication and care coordination. Clinical relevance: This review highlights the need for role delineation and further development of nurse‐sensitive indicators in the OUD treatment setting. [ABSTRACT FROM AUTHOR]

Objective: To examine cross-national differences in gestational age over time in the U.S. and across three wealthy countries in 2020 as well as examine patterns of birth timing by hour of the day in home and spontaneous vaginal hospital births in the three countries. Methods: We did a comparative cohort analysis with data on gestational age and the timing of birth from the United States, England and the Netherlands, comparing hospital and home births. For overall gestational age comparisons, we drew on national birth cohorts from the U.S. (1990, 2014 & 2020), the Netherlands (2014 & 2020) and England (2020). Birth timing data was drawn from national data from the U.S. (2014 & 2020), the Netherlands (2014) and from a large representative sample from England (2008–10). We compared timing of births by hour of the day in hospital and home births in all three countries. Results: The U.S. overall mean gestational age distribution, based on last menstrual period, decreased by more than half a week between 1990 (39.1 weeks) and 2020 (38.5 weeks). The 2020 U.S. gestational age distribution (76% births prior to 40 weeks) was distinct from England (60%) and the Netherlands (56%). The gestational age distribution and timing of home births was comparable in the three countries. Home births peaked in early morning between 2:00 am and 5:00 am. In England and the Netherlands, hospital spontaneous vaginal births showed a generally similar timing pattern to home births. In the U.S., the pattern was reversed with a prolonged peak of spontaneous vaginal hospital births between 8:00 am to 5:00 pm. Conclusions: The findings suggest organizational priorities can potentially disturb natural patterns of gestation and birth timing with a potential to improve U.S. perinatal outcomes with organizational models that more closely resemble those of England and the Netherlands. [ABSTRACT FROM AUTHOR]

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The Comprehensive Assessment of Psychopathic Personality Symptom Rating Scale (CAPP SRS) is a relatively new measure of psychopathic personality disorder (PPD) based on the CAPP concept map of psychopathy. To investigate the CAPP SRS, we identified the most plausible formal test structure for the test using the framework proposed by Slaney and Maraun, identified an appropriate quantitative characterization of that test structure, and then statistically evaluated it based on analysis of CAPP SRS data collected from a multisite sample of 314 adult male correctional offenders and secure hospital patients in Scotland and England. Overall, the CAPP SRS survived falsification when observed test data were compared to expectations based on the unidimensional monotone latent variable or UMLV model of Holland and Rosenbaum. CAPP SRS composite scores calculated consistent with the UMLV model had good measurement precision and good external validity with respect to scores on an established test of PPD. The findings provide provisional support for the test validity of the CAPP SRS and highlight the importance of theory-driven evaluations of test validity. [ABSTRACT FROM AUTHOR]

The Liverpool Care Pathway for the Dying Patient (LCP) was a prominent set of guidance in the late 2000s and early 2010s within palliative and end‐of‐life care. Developed in England to improve the care of dying patients, it was later adopted in 20 counties. After a public scandal, it was removed from practice in England but remains in other locations, including the Netherlands. Drawing on two sets of ethnographic data, from England and the Netherlands, we consider the ways in which the LCP was engaged with as a form of standardisation aimed at improving practice, how it was deployed in relation to other forms of knowledge, and the political and moral statements that are being made through the (selective) use of it. Looking into the use of the LCP shows that, while the LCP attempts to standardise some of the values associated with palliative care, there are significant differences between how these standardised values are then enacted in different institutional and national contexts and by different individual care professionals. We conclude that the LCP was used to impart moral values, establish protocols of care, and demonstrate professionalism, showing the multiplicity of the use of standards in healthcare practice. [ABSTRACT FROM AUTHOR]

Since the publication of study results on adverse events to health care in OECD countries, the importance of the national quality improvement strategies has been recognised. To examine how these strategies have been shaped in different jurisdictions, we carried out this study. We conducted a web-based comparative study of international practices. We first defined seven key health care and services quality management functions. We then drew on the experience of authors to make a reasoned selection of 13 countries or states across the world. We determined the distance that separates each of these functions from a country's Ministry of Health (MoH); and examined whether these functions are concentrated in a single organisation or dispersed across several organisations. Afterwards, we correlated our results with the quality level of these countries based on the OECD's health care indicators. Overall, Netherlands, Québec (Canada), Korea, Germany, England (UK), and the United States had at least 50% of their quality management functions controlled by self-regulated organisations. The Market Concentration Index ranged from 937 for the United States to 6800 for Russia. Graphical representation has shown us two health system models. Our results also clearly showed that countries had a better quality of care most often when they belong to model 1 of our taxonomy. These findings will help countries design and implement large-scale health care and services quality strategies for better and safer health care and services., (© 2023 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

The motivation for this article was the main finding of an earlier study, which concludes that choice‐driven education systems—in the study represented by England and Sweden—are particularly beneficial for immigrants in that they provide them with many opportunities to pursue their generally high educational ambitions. We extend this analysis by including two countries with performance‐driven education systems: Germany and the Netherlands. Our study specifically aims to explore whether it is true that choice‐driven systems are more beneficial for immigrants or whether immigrants can also succeed in more stratified and selective education systems. Using longitudinal data from the Children of Immigrants Longitudinal Survey in Four European Countries (CILS4EU), we show that there are no differences in (gross) transition rates between immigrants and natives in Germany, the Netherlands, and Sweden, but immigrants' optimistic choices are more pronounced in England. However, these differences diminish once we account for achievement and students' socioeconomic background in the analyses. Regarding the underlying mechanisms, we find that educational aspirations have an (equally) strong, universal impact, while anticipated discrimination plays a minor role. [ABSTRACT FROM AUTHOR]

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

Objective: Due to cardiovascular safety concerns, the European Medicines Agency (EMA) recommended new contraindications and changes to product information for diclofenac across Europe in 2013. This study aims to measure their impact among targeted populations. Method: Quarterly interrupted time series regression (ITS) analyses of diclofenac initiation among cohorts with contraindications (congestive cardiac failure [CHF], ischaemic heart disease [IHD], peripheral arterial disease [PAD], cerebrovascular disease [CVD]) and cautions (hypertension, hyperlipidaemia, diabetes) from Denmark, the Netherlands, England and Scotland. Results: The regulatory action was associated with significant immediate absolute reductions in diclofenac initiation in all countries for IHD (Denmark −0.08%, 95%CI −0.13, −0.03; England −0.09%, 95%CI −0.13 to −0.06%; the Netherlands −1.84%, 95%CI −2.51 to −1.17%; Scotland −0.34%, 95%CI −0.38 to −0.30%), PAD and hyperlipidaemia, the Netherlands, England and Scotland for hypertension and diabetes, and England and Scotland for CHF and CVD. Post‐intervention there was a significant negative trend in diclofenac initiation in the Netherlands for IHD (−0.12%, 95%CI −0.19 to −0.04), PAD (−0.13%, 95%CI −0.22 to −0.05), hypertension, hyperlipidaemia and diabetes, and in Scotland for CHF (−0.01%, 95%CI −0.02 to −0.007%), IHD (−0.017, 95%CI −0.02, −0.01%), PAD and hypertension. In England, diclofenac initiation rates fell less steeply. In Denmark changes were more strongly associated with the earlier EMA 2012 regulatory action. Conclusion: Although significant reductions in diclofenac initiation occurred, patients with contraindications continued to be prescribed diclofenac, the extent of which varied by country and target condition. Understanding reasons for such variation may help to guide the design or dissemination of future safety warnings. [ABSTRACT FROM AUTHOR]

The authors examine cross-national variation in the ethnic gradient in aspirations among 14-year-olds in England, Germany, the Netherlands and Sweden by using data from the Children of Immigrants Longitudinal Survey in Four European Countries, collected in 2009/2010. Results show that most ethnic minority groups are more likely to have university aspirations than ethnic majority youth. The most consistent minority advantage is found in England and Sweden, consistent with the interpretation that the ample scope for choice in progression through these school systems allows high ambitions of minorities to play out well. However, minority advantage of some groups is also present in the Netherlands and Germany, where transitions are more heavily conditional on previous performance. The pattern for immigrant generational status varies across countries and ethnic origins. There is no consistent empirical evidence indicating that aspiration differences between ethnic minority and majority youth will diminish due to assimilation processes across the generations. [ABSTRACT FROM AUTHOR]

Background: In the regulation of healthcare, the subject of patient and family involvement figures increasingly prominently on the agenda. However, the literature on involving patients and families in regulation is still in its infancy. A systematic analysis of how patient and family involvement in regulation is accomplished across different health systems is lacking. We provide such an overview by mapping and classifying methods of patient and family involvement in regulatory practice in four countries; Norway, England, the Netherlands, and Australia. We thus provide a knowledge base that enables discussions about possible types of involvement, and advantages and difficulties of involvement encountered in practice.Methods: The research design was a multiple case study of patient and family involvement in regulation in four countries. The authors collected 1) academic literature if available and 2) documents of regulators that describe user involvement. Based on the data collected, the authors from each country completed a pre-agreed template to describe the involvement methods. The following information was extracted and included where available: 1) Method of involvement, 2) Type of regulatory activity, 3) Purpose of involvement, 4) Who is involved and 5) Lessons learnt.Results: Our mapping of involvement strategies showed a range of methods being used in regulation, which we classified into four categories: individual proactive, individual reactive, collective proactive, and collective reactive methods. Reported advantages included: increased quality of regulation, increased legitimacy, perceived justice for those affected, and empowerment. Difficulties were also reported concerning: how to incorporate the input of users in decisions, the fact that not all users want to be involved, time and costs required, organizational procedures standing in the way of involvement, and dealing with emotions.Conclusions: Our mapping of user involvement strategies establishes a broad variety of ways to involve patients and families. The four categories can serve as inspiration to regulators in healthcare. The paper shows that stimulating involvement in regulation is a challenging and complex task. The fact that regulators are experimenting with different methods can be viewed positively in this regard. [ABSTRACT FROM AUTHOR]

Such an overview, or business model (BM), has been published for the Netherlands, where POCTs are frequently used. This paper therefore aims to identify the BM applying to POCT integration at general practices (GPs) in England, and to compare it with the existing Dutch BM. [Extracted from the article]

Policy PointsStrategically purchasing health care has been and continues to be a popular policy idea around the world.Key asymmetries in information, market power, political power, and financial power hinder the effective implementation of strategic purchasing.Strategic purchasing has consistently failed to live up to its promises for these reasons. Future strategies based on strategic purchasing should tailor their expectations to its real effectiveness. Context: Strategic purchasing of health care has been a popular policy idea around the world for decades, with advocates claiming that it can lead to improved quality, patient satisfaction, efficiency, accountability, and even population health. In this article, we report the results of an inquiry into the implementation and effects of strategic purchasing. Methods: We conducted three in‐depth case studies of England, the Netherlands, and the United States. We reviewed definitions of purchasing, including its slow acquisition of adjectives such as strategic, and settled on a definition of purchasing that distinguishes it from the mere use of contracts to regulate stable interorganizational relationships. The case studies review the career of strategic purchasing in three different systems where its installation and use have been a policy priority for years. Findings: No existing health care system has effective strategic purchasing because of four key asymmetries: market power asymmetry, information asymmetry, financial asymmetry, and political power asymmetry. Conclusions: Further investment in policies that are premised on the effectiveness of strategic purchasing, or efforts to promote it, may not be worthwhile. Instead, policymakers may need to focus on the real sources of power in a health care system. Policy for systems with existing purchasing relationships should take into account the asymmetries, ways to work with them, and the constraints that they create. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate the occurrence rates of clinical events and their associations with comfort in dying nursing home residents with and without dementia.Methods: Epidemiological after-death survey was performed in nationwide representative samples of 322 nursing homes in Belgium, Finland, Italy, the Netherlands, Poland, and England. Nursing staff reported clinical events and assessed comfort. The nursing staff or physician assessed the presence of dementia; severity was determined using two highly discriminatory staff-reported instruments.Results: The sample comprised 401 residents with advanced dementia, 377 with other stages of dementia, and 419 without dementia (N = 1197). Across the three groups, pneumonia occurred in 24 to 27% of residents. Febrile episodes (unrelated to pneumonia) occurred in 39% of residents with advanced dementia, 34% in residents with other stages of dementia and 28% in residents without dementia (P = .03). Intake problems occurred in 74% of residents with advanced dementia, 55% in residents with other stages of dementia, and 48% in residents without dementia (P < .001). Overall, these three clinical events were inversely associated with comfort. Less comfort was observed in all resident groups who had pneumonia (advanced dementia, P = .04; other stages of dementia, P = .04; without dementia, P < .001). Among residents with intake problems, less comfort was observed only in those with other stages of dementia (P < .001) and without dementia (P = .003), while the presence and severity of dementia moderated this association (P = .03). Developing "other clinical events" was not associated with comfort.Conclusions: Discomfort was observed in dying residents who developed major clinical events, especially pneumonia, which was not specific to advanced dementia. It is crucial to identify and address the clinical events potentially associated with discomfort in dying residents with and without dementia. [ABSTRACT FROM AUTHOR]

Background/objectives: Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death. Design and setting: In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents' death. Measurements: Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis. Results: Nurses' response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9–27.2) in the Netherlands, 25.2% (18.3–33.6) in Belgium, 29.3% (16.9–45.8) in England, 33.7% (26.2–42.2) in Finland, 64.6% (52.0–75.4) in Italy and 79.1% (71.2–85.3) in Poland (p < 0.001). Opioid underuse was 57.2% (33.0–78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9–63.8) for pain and 37.4% (19.4–59.6) for both symptoms (p = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20–0.54) when pain was assessed. Conclusion: Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders. [ABSTRACT FROM AUTHOR]

Objective: In patients with velocardiofacial syndrome (VCFS), medial displacement of the internal carotid arteries (ICAs) may increase the risk of vascular injury during the surgical correction of velopharyngeal dysfunction (VPD). Some surgeons advocate the use of vascular imaging studies prior to surgery. Nevertheless, the role of preoperative imaging is still controversial. This study aimed to review the current practice of the UK cleft units and also examine our own practice at the Evelina London Children's Hospital in relation to children with VCFS undergoing speech surgery over the previous 7 years. Design: A questionnaire was sent to all UK cleft surgeons to enquire about the management and use of preoperative vascular imaging in patients with VPD and VCFS. A retrospective study was also conducted of the unit's 7-year series of patients with VPD and VCFS. Results: Thirty-four completed questionnaires were returned (response rate 100%). Most UK surgeons (73.5%) do not regularly order preoperative vascular imaging for patients with VCFS although some reportedly would consider it if a posterior pharyngeal wall pulsation was visible. In our unit, between 2013 and 2019, a total of 40 patients affected by VCFS have been assessed for VPD. A magnetic resonance angiography (MRA) was performed for 23 patients. Medial deviation of the ICAs was identified in 7 (30%) patients. Conclusions: The results of the national survey showed no consensus on routine use of preoperative vascular imaging. Our retrospective study showed a 30% prevalence of medialized ICAs in our patient cohort. In these patients, the MRA findings influenced the choice of speech surgery. [ABSTRACT FROM AUTHOR]

This study compares the five-level EuroQol five-dimension questionnaire (EQ-5D-5L) crosswalks and the 5L value sets for England, the Netherlands, and Spain and explores the implication of using one or the other for the results of cost-utility analyses. Data from two randomized controlled trials in depression and diabetes were used. Utility value distributions were compared, and mean differences in utility values between the EQ-5D-5L crosswalk and the 5L value set were described by country. Quality-adjusted life years (QALYs) were calculated using the area-under-the-curve method. Incremental cost-effectiveness ratios (ICERs) were calculated, and uncertainty around ICERs was estimated using bootstrapping and graphically shown in cost-effectiveness acceptability curves. For all countries investigated, utility value distributions differed between the EQ-5D-5L crosswalk and 5L value set. In both case studies, mean utility values were lower for the EQ-5D-5L crosswalk compared with the 5L value set in England and Spain, but higher in the Netherlands. However, these differences in utility values did not translate into relevant differences across utility estimation methods in incremental QALYs and the interventions' probability of cost-effectiveness. Thus, our results suggest that EQ-5D-5L crosswalks and 5L value sets can be used interchangeably in patients affected by mild or moderate conditions. Further research is needed to establish whether these findings are generalizable to economic evaluations among severely ill patients. [ABSTRACT FROM AUTHOR]

Background: For years, the benefits of septoplasty have been questioned. Due to the scarce and inconclusive literature, several National Health Service (NHS) Clinical Commissioning Groups in England decided to add septal surgery to their list of restricted procedures with low clinical value. Recently, evidence was obtained that septoplasty is actually more effective than non-surgical management for nasal obstruction in adults with a deviated septum. However, the relation between costs and effects of septoplasty remains unknown.Methods: We conducted an economic evaluation alongside an open, multicenter, pragmatic randomized controlled trial in two tertiary and 16 secondary referral hospitals in the Netherlands. Adults with nasal obstruction and a deviated septum were randomized to (1) septoplasty with or without concurrent turbinate surgery or (2) non-surgical management consisting of (a combination of) medical treatment and watchful waiting. Analyses were performed on an intention-to-treat basis. Single imputation nested in the bootstrap percentile method (using 5000 bootstrap replications) was performed to assess the effect of missing data. After 12 and 24 months, we assessed the incremental costs per quality-adjusted life year (QALY) gained from a healthcare and a societal perspective.Results: A total of 203 adults were randomly assigned to septoplasty (N = 102) or non-surgical management (N = 101). After 12 months, the mean cost difference between septoplasty and non-surgical management using a healthcare or societal perspective was €1181 (95%CI €1038 to €1323) or €2192 per patient (95%CI €1714 to €2670), respectively. The mean QALY difference was 0.03 per patient (95%CI - 0.01 to 0.07). Incremental costs per QALY gained from a healthcare or societal perspective were €41,763 or €77,525, respectively. After 24 months, the mean cost difference between the two groups using a healthcare or societal perspective decreased to €936 (95%CI €719 to €1153) or €1671 per patient (95%CI €952 to €2390), respectively. The mean QALY difference increased to 0.05 per patient (95%CI - 0.03 to 0.14). Incremental costs per QALY gained from a healthcare or societal perspective became €17,374 or €31,024, respectively. Analyses of imputed data did not alter our findings.Conclusions: Depending on the selected perspective, cost-effectiveness threshold, and time horizon, septoplasty has the potential to be cost-effective. Despite considerable uncertainty, septoplasty seems to be cost-effective from a healthcare perspective, after 24 months against a threshold of €20,000 per QALY. From a societal perspective, septoplasty is not yet cost-effective after 24 months, but it comes closer to the cost-effectiveness threshold as time passes by.Trial Registration: Nederlands Trial Register, NTR3868 (https://www.trialregister.nl/trial/3698). Prospectively registered on February 21, 2013. [ABSTRACT FROM AUTHOR]

The consensus in the academic literature is that energy efficiency is associated with transaction value premiums, but it is not clear to what extent property appraisers take account of this. We decompose external appraisals of rental housing by international valuation firms in England and the Netherlands in two waves, keeping the samples of valued homes constant between these years. We find a notable change in the behavior of external property appraisers. In England, energy performance does not impact assessed values in 2012, while estimation results for 2015 show a significant discount in assessed values for D-, E- and F- relative to C-labeled dwellings. For the Netherlands, we do not observe a significant relationship between energy efficiency and assessed values in 2010, but in 2015 we find that more energy efficiency leads to higher external valuations. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the association between registered nurses' (referred to as "nurses" for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers. Background: The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps. Design: Cross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries. Methods: The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist. Results: When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant. Conclusion: Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care. Relevance to clinical practice: Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients. [ABSTRACT FROM AUTHOR]

Purpose: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross‐national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. Design: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. Findings: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one‐factor model, which confirmed that across countries the seven survey items measure a common factor of physician‐nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician–nurse relations. Conclusions: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse‐reported relations with physicians, which strongly varied across countries. Clinical Relevance: Better nurse‐reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse‐perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses. [ABSTRACT FROM AUTHOR]