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Purpose:The construct validity, test–retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated. Method:112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs). Results:For construct validity (N = 105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test–retest reliability coefficient was 0.96 (95% Confidence Interval 0.94–0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88–0.94) and small standard errors (SEM 5.6–7.2). Conclusion:The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change.Implications for RehabilitationThe Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS).Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS.The equivalence of scores from online, paper or interview administration is supported.A change score of ≥18 points on the scale of the AMSQ (on a scale 0–100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient. [ABSTRACT FROM AUTHOR]

This editorial introduction has twin purposes. The first is to make a wide audience aware of the new Dutch HRM Network. The second is to introduce a set of papers which make a contribution to the connections between HR policies/strategies and organizational performance. These purposes are linked by the fact that the papers come from the inaugural conference of the Network that was held in the Rotterdam School of Economics at Erasmus University at the end of 1999. [ABSTRACT FROM AUTHOR]

Objective: Aging societies will bring an increase in the number of long-term care patients with mental-physical multimorbidity (MPM). This paper aimed to describe the natural course of neuropsychiatric symptoms (NPS) in patients with MPM in the first 8 months after admission to a geronto-psychiatric nursing home (GP-NH) unit. Methods: Longitudinal cohort study among 63 patients with MPM no dementia living in 17 GP-NH units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, and brief neuropsychological testing, among which our primary outcome measure the Neuropsychiatric Inventory (NPI). Descriptive and bivariate analyses were conducted. Results: Our study showed a significant increase of the NPI total score (from 25.3 to 29.3, p = 0.045), and the total scores of a NPI hyperactivity cluster (from 9.7 to 11.8, p = 0.039), and a NPI mood/apathy cluster (from 7.7 to 10.1, p = 0.008). Just over 95% had any clinically relevant symptom at baseline and/or six months later, of which irritability was the most prevalent and persistent symptom and the symptom with the highest incidence. Hyperactivity was the most prevalent and persistent symptom cluster. Also, depression had a high persistence. Conclusions: Our results indicate the omnipresence of NPS of which most were found to be persistent. Therefore, we recommend to explore opportunities to reduce NPS in NH patients with MPM, such as creating a therapeutic milieu, educating the staff, and evaluating patient's psychotropic drug use. [ABSTRACT FROM AUTHOR]

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

This paper discusses the question of how to assess academic discourse on reflection from a dialogical point of view. The starting point of this research was Schön’s well-known ‘reflection-in-action’ model, which was expanded to include aspects of discursive analysis. A corpus of two sets of reflexive reports (26 in total) was analyzed along four analytical dimensions: self-reference, modality, meta-discourse and domains of reflection. These dimensions were subsequently subdivided into 13 variables. Statistical analysis of these variables resulted in the construction of five different modes of reflection, two of which highly correlate with an independent rating of perceived ‘good reflection’. This research gives evidence for the proposition that there are sensible patterns to be discovered in reflective writing, and that these patterns provide insights into the narrative styles used by the authors of reflection reports. [ABSTRACT FROM PUBLISHER]

Individuals with aphasia have more problems detecting small differences between speech sounds than larger ones. This paper reports how phonemic processing is impaired and how this is influenced by speechreading. A non-word discrimination task was carried out with 'audiovisual', 'auditory only' and 'visual only' stimulus display. Subjects had to decide whether two presented stimuli were the same. Six aphasic subjects with speech sound processing difficulties and 14 non-brain-damaged control subjects participated in this study. It was found that the aphasic subjects have difficulties in discriminating pairs of non-words, which are more profound for small differences. Differences in 'voicing' were least often detected and therefore seem most difficult to perceive. This implies different processing of the phonetic dimensions in speech sound perception. Performance improved when speechreading was possible. As this improvement is not based on differences in place of articulation only, theories of audiovisual processing need to be revised. [ABSTRACT FROM AUTHOR]

The production of reliable analytical data is dependent on a range of quality control procedures. One of the critical components of a robust quality assurance program is the ability to demonstrate the comparison of results achieved to a previously "benchmarked sample." The use of a validated internal reference sample with a similar matrix as that of samples routinely analyzed is the preferred option. However, due to cost considerations and the commercial availability of suitable reference material, this is often not possible. This paper describes our experience in establishing reference control sample of pine needles (spp. Pinus patula) in collaboration with Wageningen Evaluating Programmes for Analytical Laboratories (WEPAL) based at the Wageningen University in the Netherlands. The sample was analyzed for total concentrations of B, Fe, Cu, Zn, Mn, P, Ca, Mg, K, Na and N. The results achieved are presented in comparison to the consensus values achieved by the IPE (international Plant Analytical Exchange) program. The data was analyzed and the group statistics (mean, standard deviation and coefficients of variation) were determined for each element. In general the Standard Deviation values for the "intra laboratory" analyses were lower than the "inter laboratory" values achieved. The wide range of analytical methods considered in the "inter laboratory" comparison will most likely account for this difference. [ABSTRACT FROM AUTHOR]

To develop and explore underlying dimensions of the Self-Regulation Assessment (SeRA) and psychometric features of potential components. Further, to identify associations between the SeRA and disability-management self-efficacy, type of diagnosis, and type of rehabilitation. Based on a previously developed model of self-regulation, expert and patient opinions, and cognitive interviews, a list of 22 items on self-regulation (the SeRA) was constructed. The SeRA was included in a cross-sectional survey among a multi-diagnostic group of 563 former rehabilitation patients. Exploratory analyses were conducted. Respondents had a mean age of 56.5 (SD 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. Four components were found within the SeRA, labelled as "insight into own health condition," "insight into own capabilities," "apply self-regulation," and "organization of help." Cronbach's alpha was high (total scale: 0.93, subscales: range 0.85–0.89). Only scores on the first subscale showed a ceiling effect. Subscale three showed the highest correlation with a self-efficacy measure. Small differences in SeRA total scores (range 71.6–78.1) were found between different diagnostic groups. The SeRA is a new self-regulation measure with four subscales. Further research is needed to establish the validity and reliability of the SeRA. The Self-Regulation Assessment (SeRA) was developed to provide a comprehensive measurement of self-regulation among rehabilitation populations. The SeRA could potentially be used to identify persons with self-regulation problems at the start of rehabilitation treatment and measure outcomes of rehabilitation for self-regulation. The SeRA could potentially be used to help analyse outcomes of rehabilitation practice as well as evaluate interventions on self-regulation. [ABSTRACT FROM AUTHOR]

The communicative behavior of young children with significant cognitive and motor developmental delays is generally considered to be limited, idiosyncratic and non-intentional. At present, changes between and within children over time regarding their communicative behavior are hard to detect. This article describes an exploratory observational study that draws on data from the first data point of 38 children who are participating in a longitudinal project on the developmental trajectories of children with significant cognitive and motor developmental delays. The aims of this study were to (a) describe the participants' communicative behavior in detail with communication-related variables that reflect differences across individuals, (b) create summarizing variables and (c) explore whether subgroups of children can be detected. A self-developed coding scheme and descriptive statistics combined with correlational analyses were used, followed by a principal component analysis and visual inspection of the outcome of this analysis. The within-group differences related to communicative behavior was characterized using 16 variables. Based on these variables, three overarching components were formulated: communication proficiency, Expressions of Discomfort and Rejection and Differentiation According to Focus. All participating children were found to be unique in terms of their component scores and the relationship among their component scores. [ABSTRACT FROM AUTHOR]

FindMyApps is a web-based selection-tool and errorless learning training program to help people with mild dementia/Mild Cognitive Impairment (MCI) and caregivers find user-friendly apps. In preparation of a definitive trial, the impact and feasibility of the FindMyApps intervention on self-management and engagement in meaningful activities, including social participation, was explored. An exploratory pilot randomised controlled trial (trial registration approval number: NL7210) with pre/post measurements was conducted with community-dwelling people with mild dementia/MCI and their caregivers (n = 59) in the Netherlands. Dyads in the experimental group (n = 28) received training to use the tablet and FindMyApps, and the errorless learning method was taught to their caregivers. Control group dyads (n = 31) received a tablet (without FindMyApps), instructions on tablet-use and links to dementia-friendly apps. Validated instruments were used to assess person with dementia's self-management, meaningful activities and social participation, caregiver's sense of competence and both their quality of life. No statistical significant group differences on the outcomes were found. Small to moderate effect-sizes in favour of the FindMyApps group were found for self-management and social participation. Caregivers tended to have more positive care experiences. Subgroup analyses showed that people older than 70 benefitted more from FindMyApps regarding self-management and higher educated people benefitted more regarding social participation. FindMyApps is feasible for the target group and may have potential to improve self-management and social participation. For a future definitive effectiveness trial a larger sample size is recommended, as well as taking into account the possible impact of education and age. The FindMyApps program is feasible for people with dementia/MCI and may have potential to improve their self-management and social participation. Informal caregivers may develop a more positive care experience when utilizing FindMyApps to find suitable apps for self-management and social participation for the person with dementia/MCI. [ABSTRACT FROM AUTHOR]

(1) To estimate the proportion of Dutch wheelchair users with spinal cord injury (SCI) who meet different SCI exercise guidelines; (2) to evaluate which demographic and lesion characteristics are associated with meeting these guidelines; (3) whether meeting these guidelines is associated with physical fitness and health. Based on the PASIPD questionnaire items, participants were allocated to meeting two SCI aerobic exercise guidelines, which differ in exercise load. Differences in personal, lesion, fitness, and health characteristics between groups were tested with a one-way ANOVA. Multiple regression analyses were performed to evaluate if meeting guidelines was associated with better fitness and health. Statistical significance was accepted at p < 0.05. Of the 358 included participants, 63.1% met at least one aerobic exercise guideline. Being female, older age, having tetraplegia, and lower educational level were associated with a lower likelihood to meet the aerobic exercise guidelines. Meeting aerobic exercise guidelines showed a positive association with all respiratory and exercise capacity parameters. Limited associations were found between meeting exercise guidelines and health. Meeting exercise guidelines was associated with better respiratory functions and exercise capacity with additional fitness and some body composition benefits in higher exercise activity levels. Meeting SCI exercise guidelines are associated with better respiratory functions and exercise capacity with additional fitness and body composition benefits when higher exercising at higher activity levels, emphasizing the value and importance of regular exercise in individuals with SCI. [ABSTRACT FROM AUTHOR]

To determine which items regarding prosthesis use were considered most important by adults with major unilateral upper limb absence (ULA) and to develop a patient-reported outcome measure to assess the preferred usage features of upper limb prostheses: PUF-ULP. Based on a qualitative meta-synthesis combined with input from patients and clinicians a graphical diagram of 79 items related to prosthesis use was developed. Adults with ULA (N = 358; mean age = 55.4 ± 16.5 years; 52.0% male/40.8% female/7.3% unknown) selected their top-10 of most important items from this diagram. This study is registered in the Netherlands Trial Register: NL7682. Most selected items were "wearing comfort" (54.0% of cases), "grabbing, picking up, and holding" (34.3%), and "weight" (31.4%). All subpopulations (i.e. age, sex, origin of ULA, level of ULA, and prosthesis type), except multi-grip myoelectric hand prosthesis users (MHP), selected "wearing comfort" most. Nine items were included in the PUF-ULP: "wearing comfort," "functionality," "independence," "work, hobby, and household," "user-friendly," "life-like appearance," "phantom limb pain," "overuse complaints," and "reliability." All prosthesis users, except MHP-users, considered wearing comfort most important, which might be of interest for future research and industry. The PUF-ULP can be used to reflect the match between users and their prostheses. All persons with upper limb absence, except multi-grip myoelectric hand prosthesis users, considered "wearing comfort" most important regarding prosthesis use, which highlights that prosthesis wearing comfort deserves more attention in future research to increase the value placed by the user on their upper limb prosthesis. Regarding prosthesis use, men considered "ease of control" more important compared to the overall population, while women considered "independence," "household," "life-like appearance," "overuse complaints," and "anonymity" more important. Persons with a mono- or multi-grip myoelectric upper limb prosthesis rated function-related items as more important compared to the overall population, while persons with a passive/cosmetic prosthesis rated comfort-related and appearance-related items as more important. The newly developed measurement tool, also called the PUF-ULP, provides a single score that represents the match between the user and their upper limb prosthesis. [ABSTRACT FROM AUTHOR]

Non-binary and genderqueer (NBGQ) individuals do not identify with a binary gender identity. Some but not all NBGQ individuals identify as transgender, and it is currently unclear on which aspects of mental and sexual well-being NBGQ and binary transgender individuals may differ. To compare NBGQ, binary transgender and cisgender individuals on variables related to mental well-being, sexual well-being, and sexual self-concept discrepancies. We conducted an online questionnaire study in 125 transgender men, 72 transgender women, 78 NBGQ individuals, 98 cisgender men, and 107 cisgender women. For most variables, NBGQ individuals did not differ from binary transgender individuals. These two groups differed only on gender dysphoria and transgender specific body image worries, which were both lower in the NBGQ group. Compared to the cisgender group, NBGQ individuals scored higher on gender dysphoria, actual/ought sexual self-concept discrepancies, and actual/ideal sexual self-concept discrepancies, and lower on general life satisfaction and sexual esteem related to body perception. These results offer a first quantitative analysis of sexual well-being in NBGQ individuals, and highlight that – while both groups face unique challenges – NBGQ individuals encounter similar difficulties concerning mental and sexual well-being as binary transgender individuals. [ABSTRACT FROM AUTHOR]

To examine the effects of web-based SUpport PRogram (SUPR) for communication partners (CPs) of persons with hearing loss (PHLs) in a HA dispensing setting. Cluster randomised controlled trial (cRCT) with two arms (SUPR: Booklet, online videos; care as usual: no support) plus process evaluation. Measurements: baseline, and immediately-, six, and 12 months post-intervention. Outcomes: Significant Other Scale for Hearing Disability (SOS-HEAR), International Outcome Inventory for HAs/Alternative Interventions for Significant Others (IOI-HA/AI-SO). Process evaluation: dose-received, satisfaction, and benefit. The cRCT included 73 (SUPR) and 57 (care as usual) CPs. In the process evaluation study, 41 CPs (SUPR) participated. There were no significant effects of SUPR for third-party disability (SOS-HEAR), the proxy report (IOI-HA-SO item "use"), and third-party disability (IOI-HA-SO items "satisfaction", and "quality of life"). SUPR-videos were watched by 15-22% of the CPs. SUPR materials were rated as moderately beneficial and useful. Low baseline disability (floor effect) and low intervention dose-received may explain the findings. Directly targeting CPs rather than via their PHLs and providing intervention materials specifically for CPs may improve their engagement and contribute to SUPR's value supplementary to standard HA care. [ABSTRACT FROM AUTHOR]

Loneliness is seen as an important problem, contributing to serious health problems. As a baseline measurement for the evaluation of a community project aimed at reducing loneliness in Rotterdam, loneliness was measured, as well as potential correlates. This article describes models of social and emotional loneliness among older adults. This study was conducted among 3,821 randomly selected community dwelling citizens of 65 years and older. Loneliness was measured by using the Jong-Gierveld loneliness questionnaire/scale. As potential correlates demographic, health and psychological and social variables were included. Data were subjected to multiple hierarchically regression analysis. Emotional loneliness was reported by 60% and social loneliness by 47% of the sample. Women were more emotionally lonely than men , while men reported more social loneliness than women. Emotional social support and quality of life were strongest in predicting emotional loneliness and social capital in the neighbourhood, companionship and instrumental support were strongest predictors for social loneliness. Demographic variables predicted variability in emotional loneliness. The strength of the correlates differed between the two dimensions of loneliness. In the design of interventions to prevent and reduce loneliness among older adults, strategies should be developed aimed at the specific dimensions of loneliness. [ABSTRACT FROM AUTHOR]

Existing physical activity interventions do not reach a considerable proportion of physically disabled people. This study assessed feasibility and short-term effects of Activity Coach+, a community-based intervention especially targeting this hard-to-reach population. Feasibility was determined by reach, dropouts, and compliance with the protocol. Physical activity was measured with the Activ8 accelerometer and the adapted SQUASH questionnaire. Health outcomes were assessed by body composition, blood pressure, hand grip force, 10-metre walk test, 6-minute walk test, and the Berg Balance Scale. The RAND-36, Exercise Self-Efficacy Scale, Fatigue Severity Scale, and IMPACT-S were administered. Measurements were performed at baseline and after 2 and 4 months. Changes over time were analysed by Friedman tests. Twenty-nine participants enrolled during the first 4 months, of whom two dropped out. Intervention components were employed in 86–100% of the participants. Physical activity did not change after the implementation of Activity Coach+. Body mass index (p = 0.006), diastolic blood pressure (p = 0.032), walking ability (p = 0.002), exercise capacity (p = 0.013), balance (p = 0.014), and vitality (p = 0.049) changed over time. Activity Coach + is feasible in a community setting. Indications for effectivity of Activity Coach + in hard-to-reach people with a physical disability were found. Activity Coach + was able to reach physically disabled people living in community, a population that is assumed hard-to-reach. Activity Coach + was feasible in a population of persons with a physical disability that was heterogeneous with respect to age and (severity of) disability. The current study provides the first indications for the beneficial health effects of Activity Coach + in hard-to-reach people with a physical disability. [ABSTRACT FROM AUTHOR]

We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items 'hitting', pushing', 'biting' and 'kicking' of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on 'screaming' and 'making strange noises'. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63–2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23–12.98). Very frequent PA was only associated with apathy (odds ratio (OR)=1.93, 95% CI: 1.04–3.61). Correlates of very frequent vocalizations were age (OR = 0.97, 95% CI: 0.951–0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR = 1.56, 95% CI: 1.08–2.26), antiepileptic drug use (OR = 2.75, 95% CI: 1.34–5.68) and euphoria (OR = 2.01, 95% CI: 1.22–3.31). Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life. [ABSTRACT FROM AUTHOR]

Persons with profound intellectual disability (PID) are mostly not able to use assistive technology (AT) independently. Caregivers play an important mediating role in implementing AT in the daily life of persons with PID. Both first-order barriers, extrinsic to caregivers, and second-order barriers, intrinsic to caregivers, influence the attitudes and behaviors of caregivers with regard to AT-use. It could be asked if increased knowledge on and experience with AT may impact the effect of first- and second-order barriers. This study investigated how knowledge and experience influence the professional caregivers' beliefs about which factors may impact the AT use in persons with PID and their intentions to use AT for persons with PID. A questionnaire on the experienced limitations and successes in using AT was developed. The questionnaire was send to professionals working with or responsible for persons with PID in various countries in Europe. In total the answers of 195 respondents were included in this study. This study's results demonstrate that AT is used for various reasons in persons with PID, mostly to support communication and interaction or for fun or relaxation. Based on the answers of the respondents can be concluded that both experience and knowledge of caregivers seem to influence first- and second-order barriers. Besides, a possibility to overcome the second-order barriers is to provide professionals with possibilities to increase their knowledge and experience. AT for persons with PID is mostly used for communication and interaction or for fun and relaxation. Professional caregivers belief that AT-use may positively influence various aspects in the life of persons with PID, especially communication and interaction, active engagement and participation in activities, and self-esteem of the person. Caregivers need to have sufficient experience in order to rate the barriers of AT-use as less limited in the group of persons with PID. In order to overcome the barriers experienced in implementing AT in persons with PID, knowledge of caregivers is essential. [ABSTRACT FROM AUTHOR]

Employment of young adults with chronic physical conditions entering the labor market after finishing post-secondary education remains behind compared to typically developing peers. The aim of this study is to evaluate changes in their paid employment levels after following a vocational rehabilitation intervention ('At Work'). Participants aged between 16 and 27 years (n = 90) were recruited via rehabilitation physicians and a jobcoach agency and participated in a vocational rehabilitation program. Cochran's Q and McNemar tests served to test the development of intervention participants' paid employment over time. Chi-square tests were used to compare intervention participants' paid employment level with national reference data selected on age and having a self-reported chronic physical condition. Paid employment level of the intervention cohort significantly increased from 10.0% at baseline to 42.4% at 2-years follow-up (p < 0.001). At 2-years follow-up, their employment rates approached the employment rates of national reference data (42.4% versus 52.9%, p = 0.17). Starting from a disadvantaged position, the paid employment rate of the intervention cohort substantially increased over time, approaching the employment rate of reference data. 'At Work' seems to be appropriate for supporting this specific group who face obstacles to enter the labor market, to find competitive employment. 'At Work' is a vocational rehabilitation intervention for young adults with chronic physical conditions who experience problems with finding and maintaining competitive employment after finishing post-secondary education. The 'At Work' intervention entails a combination of group sessions and individual coaching sessions based on the supported employment methodology. Paid employment rates of the intervention cohort substantially increased on the short- and long term, and approached employment rates of reference data of persons with chronic physical conditions. The 'At Work' intervention seems appropriate to support young adults with chronic physical conditions who experience barriers for work participation, to enter the labor market and find competitive and sustainable employment. [ABSTRACT FROM AUTHOR]

Learning to use an exoskeleton is time consuming and diverse between users. Knowledge about trainability of exoskeleton skills is relevant for planning and expectation management. The objective was to assess predictors of exoskeleton skill performance during and after exoskeleton training. Twenty-four participants with a motor complete spinal cord injury were given 24 training sessions in 8 weeks. Nine potential predictors were identified: lesion level, age, gender, age at injury, time since injury, BMI, sport, active lifestyle, and anxiety. Univariate and multivariate linear regression analyses were performed to examine predictors of skill performance after 2, 4, 6, and 8 weeks. Twenty participants completed the training. Univariate analysis revealed that positive predictors were: low lesion level and more active lifestyle after 2 weeks, whereas low age at injury, low BMI, and more active lifestyle were positive predictors after 6 weeks. Multivariate regression model explained 65% of the performance after 2 weeks (predictors: lesion level, anxiety, active lifestyle) and 66% after 6 weeks (predictors: BMI, active lifestyle, age). Lesion level was a predictor during the first 4 weeks, but did not influence participants' final skill level. BMI, age, and active lifestyle were predictors toward the end of the training period. With the help of wearable exoskeletons people with a complete spinal cord injury can regain their standing and walking mobility. Learning to use an exoskeleton is time consuming and the number of training sessions required to walk independently differs greatly between users. This study shows that lesion level was an important predictor of exoskeleton motor learning in the first 4 weeks of training. BMI, age, and active lifestyle were predictors of exoskeleton skill performance toward the end of the 8 week training period. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the implementation of a physical activity counseling program in rehabilitation and to study heterogeneity in received counseling and investigate its association with changes in patients' physical activity outcomes. This prospective cohort study was conducted in 18 rehabilitation institutions. Data were collected using surveys completed by professionals (n= ±70) and patients (n = 1719). Implementation was evaluated using different process outcomes: reach, dosage, satisfaction, maintenance. Patients' physical activity outcomes included changes in total minutes/week of physical activity. Latent class analyses were conducted to identify profiles of received counseling characteristics and multilevel models were used to investigate associations with physical activity outcomes. 5873 Patients were provided with motivational interviewing-based counseling after rehabilitation. Professionals and patients were positive about the program. Sixteen institutions (89%) formally agreed to continue the program. The four identified profiles of counseling characteristics illustrate a large variation in received counseling among patients. No substantial differences in physical activity outcomes were found between profiles. After a three-year program period, the physical activity counseling centers were sustainably implemented in Dutch rehabilitation care. This study illustrated an innovative approach to assess heterogeneity in implementation outcomes (e.g., counseling profiles) in relation to program outcomes (e.g., physical activity). Physical activity counseling after rehabilitation is important to support people with disabilities in making the step from rehabilitation-based physical activities to community-based physical activities. Establishing "Physical Activity Counseling Centers" is a promising "disability-overarching" strategy to promote physical activity after rehabilitation. Although the actual received counseling (dosage) varied among patients, this did not coincide with large differences in physical activity outcomes. The training in Motivational Interviewing, the financial incentives, and the advisory support were considered as important or essential ingredients for a successful implementation of the counseling program in rehabilitation practice. [ABSTRACT FROM AUTHOR]

Purpose: To compare family and functional outcome in infants at very high risk of cerebral palsy, after receiving the family centred programme "Coping with and Caring for infants with special needs (COPCA)" or typical infant physiotherapy. Materials and methods: Forty-three infants at very high risk were included before 9 months corrected age and randomly assigned to one year COPCA (n = 23) or typical infant physiotherapy (n = 20). Family and infant outcome were assessed before and during the intervention. Physiotherapy intervention sessions were analysed quantitatively for process analysis. Outcome was evaluated with non-parametric tests and linear mixed-effect models. Results: Between-group comparisons revealed no differences in family and infant outcomes. Within-group analysis showed that family's quality of life improved over time in the COPCA-group. Family empowerment was positively associated with intervention elements, including "caregiver coaching." Conclusions: One year of COPCA or typical infant physiotherapy resulted in similar family and functional outcomes. Yet, specific intervention elements, e.g., coaching, may increase empowerment of families of very high risk infants and may influence quality of life, which emphasizes the importance of family centred services. One year of the family centred programme "Coping with and a Caring for infants with special needs" compared with typical infant physiotherapy resulted in similar family outcome and similar functional outcome for the infants at very high risk for cerebral palsy. Specific contents of intervention, such as caregiver coaching, are associated with more family empowerment and increased quality of life. Emphasis on family needs is important in early intervention for infants at very high risk for cerebral palsy. [ABSTRACT FROM AUTHOR]

Purpose: With the growing attention in pediatric rehabilitation services for supporting self-management, the need increases for more shared understanding of the concept. The aim of this study was to explore parent activation, associated factors of- and underlying perceptions on parental self-management of parents of children with chronic conditions. Materials and methods: Using a mixed-methods strategy, first variations in self-management behaviors, motivation and perceived autonomy support were assessed with a cross-sectional survey among parents of children with chronic conditions (N = 239). Statistical analysis involved descriptive statistics and univariate analysis of variance. The survey was followed by 18 in-depth interviews with parents. Thematic analysis was used to recognize relevant topics in the qualitative data. Results: In the survey most parents reported being active self-managers. Nevertheless, only one third persisted in self-management when under stress. Autonomous motivation was strongly associated with parental self-management. In the interviews, parents mentioned attuning with professionals and finding balance as important aspects of self-management. To facilitate self-management, professionals were expected to have expert knowledge, be engaged and empathic. Conclusion: From the perspective of parents, self-management should be viewed as a collaborative effort in which they are supported by professionals, rather than having to manage it "by themselves". To facilitate self-management, parents expect professionals to have expert knowledge and additionally show interpersonal competences as openness, engagement and empathy. Motivating parents may facilitate their level of self-management regarding the care for their child with a chronic disorder. Good communication and collaboration with professionals appear to be key aspects of parental self-management. Parents expect pediatric rehabilitation teams to tune their services to the needs, desires and expectations of parents to support them in "self-managing" the care for their child. [ABSTRACT FROM AUTHOR]

Aim: To review definitions and elements of interventions in studies, which used the word "functional" to describe their intervention for children with cerebral palsy (CP), and to determine whether definitions and elements are similar to criteria of functional therapy described in the Dutch Guidelines. Methods: Systematic review of intervention studies, which used the word "functional" to describe interventions for children with CP. We described criteria of functional therapy that were used to describe the intervention, and whether criteria were described similarly to the descriptions used in the Dutch Guidelines. Results: Of the 27 included studies, criteria "based on the activities/participation level of the ICF-CY", "goal-directed" and "context-specific" were referred to the most (40–59.3%). Descriptions of these criteria were less comparable to the suggested definition (43.8–69.2%). The remaining three criteria ("active involvement", "task-specific", and "focused on functionality instead of normality") were referred to less frequently (18.5–33.3%). The descriptions reported for these criteria were, however, the most comparable with the suggested definitions (80–100%). Conclusions: The included studies, in general have not used criteria of functional therapy. Future studies have to describe the elements of interventions in detail. Moreover, it is important to reach consensus on the definition and elements of functional therapy. [ABSTRACT FROM AUTHOR]

Research on the longitudinal impact of using the internet as an information source on patients' beliefs and medication adherence is scarce. Chronic patients (N = 107) from six hospitals were surveyed to longitudinally explore their online information seeking behavior throughout treatment (i.e., before the consultation about their newly prescribed medication in the initiation phase and after six months in the implementation phase) and how this affects their medication beliefs (concerns and necessity) and medication adherence after three weeks (T1) and six months (T2). Most patients (79%) used the internet. Patients who used the internet before the consultation reported to have more concerns about their medication at T1 and T2 compared to those who did not. Moreover, patients who used the internet throughout treatment valued their concerns higher than the necessity after six months (T2). Patients who used the internet after the consultation reported to be more non-adherent after three weeks (T1) compared to those who did not. Because of the longitudinal nature of this study, we were able to pinpoint in which treatment phase patients' online information seeking behavior is particular relevant in affecting patients' beliefs and medication adherence. [ABSTRACT FROM AUTHOR]

Learning English as a foreign language (FL) is mandatory for children with developmental language disorders (DLD) in elementary education in the Netherlands. Because of their difficulties in acquiring their first language, learning an FL at school can be challenging. To date, almost no literature on children with DLD and FL learning exists. The aim of this study is to investigate the relationship between language proficiency in Dutch of monolingual and multilingual children with DLD and learning English as an FL. A cross-sectional study was conducted in four special education schools for children with DLD. Thirty-five sixth graders (mean age 12;3 years) participated in this study. Twenty-two children were monolingual, and 13 children were multilingual. Correlation analyses between scores on standardised Dutch language tests and a standardised test for English proficiency were performed. Because the English proficiency test partly relies on reading skills, scores on a Dutch word decoding test were included in the analyses. Results show that the children with DLD performed poorly on the FL proficiency test when compared to typically developing children. Significant positive relationships were found between Dutch and English language skills of children with DLD, with no significant differences in FL proficiency between the monolingual and multilingual groups. Possibly, children with DLD cannot achieve acceptable proficiency levels of English as an FL, because of poor word decoding skills and impaired morphosyntactic skills in Dutch. Future research should focus on oral English proficiency of the children, because the English proficiency test only uses written and auditory presented tasks. [ABSTRACT FROM AUTHOR]

Objective: Ethnic minorities in the Netherlands experience worse (mental) health than Dutch natives. So far, socioeconomic factors, discrimination, and the migration process have been identified as underlying factors, neglecting the potential role of health-related behaviours. This study investigates the mediating effect of lack of physical activity, smoking and alcohol consumption on ethnic inequalities in (mental) health in the Netherlands. Design: Data from a municipal health survey (2012) in the four largest cities in the Netherlands, including 15,633 Dutch natives, 1,297 Surinamese, 850 Turks and 779 Moroccans were analysed. Mediation analyses were performed on the associations between ethnicity and psychological distress (range 10-50) and self-rated health (range 1-5). Results: Being from an ethnic minority was associated with higher distress and poorer self-rated health, especially for Turks (higher distress 4.69, 95%CI 4.22-5.16; poorer health 0.35, 95%CI 0.30-0.40). Moroccans and Turks were the least physically active, Turks smoked the most, and Dutch natives drank the most. Lack of physical activity partially mediated the association between Turks (6% respectively 11%) and Moroccans (13% respectively 9%) for psychological distress and self-rated health. Smoking played a mediating role (3%) in Turks. Conclusion: Lower physical activity and smoking more cigarettes partly explained ethnic health inequalities in the Netherlands. The current findings suggest that intervening and facilitating certain ethnic groups in engaging in health behaviours could contribute to improving their health and reduce ethnic health inequalities. [ABSTRACT FROM AUTHOR]

Introduction: It is known that music may enhance emotional well-being which may have a positive effect on sleep. The goal of the present study was to examine whether a specific type of music, rapping and singing (Rap & Sing Music Therapy (Rap&SingMT)) could serve as a motivating engagement strategy to improve sleep in adolescents. Methods: Fifty-two adolescents received Rap&SingMT, 45 min, once a week, during four months in a group school setting. Twenty-three adolescents in the control group received a program of various mental activities - but no music. Actigraphy assessed six sleep variables: sleep time, sleep efficiency, sleep episodes, snooze time, onset latency and wake percentage. Sleep assessments took place at baseline and after four months (post-testing). Results: A repeated-measures multivariate analysis of variance failed to demonstrate a significant effect of Rap&SingMT on "overall" sleep. However, a decline in total sleep time over a period of four months was less in the Rap&SingMT group than in the control group. Discussion: Despite the fact that the participants did not suffer from sleep disturbances, a seasonal change over the experimental period of four months appeared to have less impact on total sleep time in the Rap&SingMT group. These findings will be addressed in more detail. [ABSTRACT FROM AUTHOR]

The stigma associated with a diagnosis of mental illness is well known yet has not reduced significantly in recent years. Health professionals, including nurses, have been found to share similar negative attitudes towards people with labelled with mental illness as the general public. The low uptake of mental health nursing as a career option reflects these stigmatised views and is generally regarded as one of the least popular areas of in which to establish a nursing career. The aim of the current project was to examine nursing students' attitudes towards the concept of mental illness and mental health nursing across four European countries (Ireland, Finland, Norway and the Netherlands), and Australia, using the Opening Minds Scale and the Mental Health Nurse Education survey. The surveys were distributed to students prior to the commencement of the mental health theory component. Attitudes towards mental health nursing were generally favourable. Differences in opinion were evident in attitudes towards mental illness as a construct; with students from Australia and Ireland tending to have more positive attitudes than students from Finland, Norway and the Netherlands. The future quality of mental health services is dependent on attracting sufficient nurses with the desire, knowledge and attitudes to work in mental health settings. Understanding attitudes towards mental illness and mental health nursing is essential to achieving this aim. [ABSTRACT FROM AUTHOR]

The standardized Mensendieck test (SMT) was developed to quantify posture, movement, gait, and respiration. In the hands of an experienced therapist, the SMT is proven to be a reliable tool. It is unclear whether posture, movement, gait, and respiration are related to the degree of functional disability in patients with chronic pain. The objective of this study was to assess the reliability and convergent validity of the SMT in a heterogeneous sample of 50 patients with chronic pain. Methods: Internal consistency was determined by Cronbach’s α and interrater reliability by the intraclass correlation coefficient (ICC). Convergent validity was assessed by determining the Spearman rank correlation coefficient between the movement quality measured in the SMT and functional limitation measured on the disability rating index (DRI). Results: The internal consistency was Cronbach’s α 0.91. Substantial reliability was found for the items: movement (ICC = 0.68), gait (ICC = 0.69), sitting posture (ICC = 0.63), and respiration (ICC = 0.64). Insufficient reliability was found for standing posture (ICC = 0.23). A moderate correlation was found between average test score SMT and the DRI (r = −0.37) and respiration and DRI (r = −0.45). Discussion: The SMT is a reasonably reliable tool to assess movement, gait, sitting posture, and respiration. None of the items in the domain standing posture has sufficient reliability. A thorough study of this domain should be considered. The results show little evidence for convergent validity. Several items of the SMT correlated moderately with functional limitation with the DRI. These items were global movement, hip flexion, pelvis rotation, and all respiration items. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the validity and efficacy of a transient noise reduction algorithm (TNR) in cochlear implant processing and the interaction of TNR with a continuous noise reduction algorithm (CNR). Design: We studied the effects of TNR and CNR on the perception of realistic sound samples with transients, using subjective ratings of annoyance, a speech-in-noise test and a noise tolerance test. Study sample: Participants were 16 experienced cochlear implant recipients wearing an Advanced Bionics Naida Q70 processor. Results: CI users rated sounds with transients as moderately annoying. Annoyance was slightly, but significantly reduced by TNR. Transients caused a large decrease in speech intelligibility in noise and a moderate decrease in noise tolerance, measured on the Acceptable Noise Level test. The TNR had no significant effect on noise tolerance or on speech intelligibility in noise. The combined application of TNR and CNR did not result in interactions. Conclusions: The TNR algorithm was effective in reducing annoyance from transient sounds, but was not able to prevent a decreasing effect of transients on speech understanding in noise and noise tolerance. TNR did not reduce the beneficial effect of CNR on speech intelligibility in noise, but no cumulated improvement was found either. [ABSTRACT FROM AUTHOR]

Objective: ClearVoice is a single-microphone noise reduction algorithm in Advanced Bionics cochlear implant(CI) systems with the aim to improve performance in background noise. The present study investigated a hypothesised increased effect of ClearVoice if combined with a structural increase of maximum comfort stimulation levels (M-levels) in the CI fitting. Design: We tested performance with ClearVoice (Medium) in four conditions, defined by combined settings of ClearVoice off/on and with/without 5% increase of M-levels. The main outcome measures were the Acceptable Noise Level (ANL) and the speech reception threshold in continuous background noise (SRTn). Study sample: Participants were 16 experienced cochlear implant recipients with Advanced Bionics implants and a Naida Q70 processor. Results: The ANL significantly improved by using either ClearVoice or an increase of M-levels. Combining both settings gave the largest improvement in ANL. For the SRTn, we found a small, but significant interaction between ClearVoice and an increase of M-levels, implying that ClearVoice improved speech understanding slightly, but only if combined with a 5% increase of M-levels. Conclusions: Optimal profit from ClearVoice is obtained if combined with a structural 5% increase of M-levels. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a Dutch online speech-in-noise screening test (in Dutch: “Kinderhoortest”) in normal-hearing school-age children. Sub-aims were to study test–retest reliability, and the effects of presentation type and age on test results.Design: An observational cross-sectional study at school. Speech reception thresholds (SRTs) were obtained through the online test in a training condition, and two test conditions: on a desktop computer and smartphone. The order of the test conditions was counterbalanced.Study sample: Ninety-four children participated (5–12 years), of which 75 children were normal-hearing (≤25 dB HL at 0.5 kHz, ≤20 dB HL at 1–4 kHz).Results: There was a significant effect for test order for the two test conditions (first or second test), but not for presentation type (desktop computer or smartphone) (repeated measures analyses,F(1,75) = 12.48,p < 0.001;F(1,75) = 0.01,p = 0.982). SRT significantly improved by age year (first test: 0.25 dB SNR, 95% CI: –0.43 to –0.08,p = 0.004. Second test: 0.29 dB SNR, 95% CI: –0.46 to –0.11;p = 0.002).Conclusions: The online test shows potential for routine-hearing screening of school-age children, and can be presented on either a desktop computer or smartphone. The test should be evaluated further in order to establish sensitivity and specificity for hearing loss in children. [ABSTRACT FROM PUBLISHER]

Aim: To compare fine motor performance of 3-year-old children with visual impairment with peers having normal vision, to provide reference scores for 3-year-old children with visual impairment on the ManuVis, and to assess inter-rater reliability.Method: 26 children with visual impairment (mean age: 3 years 7 months (SD 3 months); 17 boys) and 28 children with normal vision (mean age: 3 years 7 months (SD 4 months); 14 boys) participated in the study. The ManuVis age band for 3-year-old children comprised two one-handed tasks, two two-handed tasks, and a pre-writing task.Results: Children with visual impairment needed more time on all tasks (p< .01) and performed the pre-writing task less accurately than children with normal vision (p< .001). Children aged 42–47 months performed significantly faster on two tasks and had better total scores than children aged 36–41 months (p< .05). Inter-rater reliability was excellent (Intra-class Correlation Coefficient = 0.96–0.99).Conclusions: The ManuVis age band for 3-year-old children is appropriate to assess fine motor skills, and is sensitive to differences between children with visual impairment and normal vision and between half-year age groups. Reference scores are provided for 3-year-old children with visual impairment to identify delayed fine motor development. [ABSTRACT FROM PUBLISHER]

The aim of the present investigation was to evaluate the effect of visual feedback on rating voice quality severity level and the reliability of voice quality judgment by inexperienced listeners. For this purpose two training programs were created, each lasting 2 hours. In total 37 undergraduate speech–language therapy students participated in the study and were divided into a visual plus auditory-perceptual feedback group (V + AF), an auditory-perceptual feedback group (AF), and a control group with no feedback (NF). All listeners completed two rating sessions judging overall severity labeled as grade (G), roughness (R), and breathiness (B). The judged voice samples contained the concatenation of continuous speech and sustained phonation. No significant rater reliability changes were found in the pre- and posttest between the three groups in every GRB-parameter (allp > 0.05). There was a training effect seen in the significant improvement of rater reliability for roughness within the NF and AF groups (allp < 0.05), and for breathiness within the V + AF group (p < 0.01). The rating of the severity level of roughness changed significantly after the training in the AF and V + AF groups (p < 0.01), and the breathiness severity level changed significantly after the training in the V + AF group (p < 0.01). The training of V + AF and AF may only minimally influence the reliability in the judgment of voice quality but showed significant influence on rating the severity level of GRB parameters. Therefore, the use of both visual and auditory anchors while rating as well as longer training sessions may be required to draw a firm conclusion. [ABSTRACT FROM PUBLISHER]

Background:Progress tests (PT) are used to assess students on topics from all medical disciplines. Progress testing is usually one of the assessment methods of the cognitive domain. There is limited knowledge on how positioning of the PT in a program of assessment (PoA) influences students’ PT scores, use of PT feedback and perceived learning value. Methods:We compared PT total scores and use of a PT test feedback (ProF) system in two medical courses, where the PT is either used as a summative assessment or embedded in a comprehensive PoA and used formatively. In addition, an interview study was used to explore the students’ perception on use of PT feedback and perceived learning value. Results:PT total scores were higher, with considerable effect sizes (ESs) and students made more use of ProF when the PT was embedded in a comprehensive PoA. Analysis of feedback in the portfolio stimulated students to look for patterns in PT results, link the PT to other assessment results, follow-up on learning objectives, and integrate the PT in their learning for the entire PoA. Conclusions:Embedding the PT in an assessment program designed according to the principles of programmatic assessment positively affects PT total scores, use of PT feedback, and perceived learning value. [ABSTRACT FROM PUBLISHER]

We examined the extent to which individual relationships with mother and father, social support from partner, and quality of the relationship with the partner, are related to work orientation and work ethic. Survey data were obtained from 3841 respondents from the Netherlands Kinship Panel Study (wave 2). The results showed that, overall, people with a more positive relationship with their parents had a more positive work orientation and a stronger work ethic. A positive relationship with the father had a greater influence on these work aspects than a positive relationship with the mother, particularly for men. Partner support and the quality of the partner relationship partially mediated the association between the relationship with one's parents and work orientation only for women. There were no significant relationships between partner support or the quality of the partner relationship, and work ethic. Research on the relationship with parents and work-related variables is discussed. [ABSTRACT FROM AUTHOR]

Although workforce aging is among the major challenges facing developed countries, organizational communication about this issue has received little scholarly attention. Drawing on a content analysis of corporate media, we reconstruct how Dutch organizations (N = 50) framed older workers’ employability during the period 2006–2013 in diagnostic (problem-definitions) and prognostic (solution-definitions) terms, and we trace the influence of corporate media types and organizational characteristics on these frames. Results reveal that organizations frequently highlight problems on the macrolevel (societal) and the mesolevel (organizational), while most solutions are located on the microlevel (individual). Using multilevel modelling, we found support for the expectation that the issue is more strongly problematized in internal compared to external corporate media, and that problems related to individual older employees are most pronounced in public sector organizations’ communication. Our findings highlight diverse ways in which organizations can communicatively address factors that hamper older workers’ employability. [ABSTRACT FROM PUBLISHER]

Objective: To assess the degree of fatigue in children and youth after traumatic and non-traumatic brain injury (TBI and NTBI) and related factors. Method: Follow-up study including patients with a hospital-based diagnosis of acquired brain injury (ABI), aged 4–20 years at onset and their parents. Parents and children (dependent on age) completed the Paediatric Quality of Life Inventory™ Multidimensional Fatigue Scale (PedsQL™ MFS), which measures general fatigue (GF), sleep/rest fatigue (SRF) and cognitive fatigue (CF). Additional assessments included the Child & Family Follow-up Survey (CFFS) and PedsQL™ 4.0 General Core Scales and sociodemographic and disease characteristics. Results: Eighty-eight parents completed the PedsQL™ MFS 24–30 months after diagnosis, with 49/88 patients (56%) completing the child version. The median age of the patients was 11 years (interquartile range [IQR] = 7). There were 69 patients with TBI (16% moderate/severe TBI) and 19 patients with NTBI (16% moderate/severe NTBI). The median parent-reported and child-reported PedsQL™ MFS Total Scale Scores were 76.5 (SD = 16.4) and 78.5 (12.9), respectively (Spearmanr= 0.450,p= 0.001). Apart from NTBI, increasing age and a single-parent household were significantly associated with more fatigue according to the parent-reported PedsQL™ MFS Total Score (and/or one or more sub-scale scores). Conclusion: Two years after onset, in particular, the parent-reported fatigue after NTBI was considerable. Moreover, older children and children from a single-parent household were found to have higher fatigue levels. [ABSTRACT FROM PUBLISHER]

In cremation rituals in the Netherlands, music plays an important role. However, what exactly this role is remains unclear. In the literature on cremation rituals, music has received little attention up to now. A computational analysis of music played during cremations and a subsequent comparison of the results of this analysis with results of the analysis of two other playlists containing popular music shows that the crematorium playlist differs significantly from the other two playlists. The music played at cremations does indeed have specific properties, properties that correspond to notions typically expected at cremations, making it suitable for the occasion. Theories of the relation between musical properties and emotions indicate that the music played as part of cremation rituals can be qualified as serene, solemn and tender. Here, we provide computational evidence that this is indeed the case. [ABSTRACT FROM AUTHOR]

In sports, fast and accurate execution of movements is required. It has been shown that implicitly learned movements might be less vulnerable than explicitly learned movements to stressful and fast changing circumstances that exist at the elite sports level. The present study provides insight in explicit and implicit motor learning in youth soccer players with different expertise levels. Twenty-seven youth elite soccer players and 25 non-elite soccer players (aged 10–12) performed a serial reaction time task (SRTT). In the SRTT, one of the sequences must be learned explicitly, the other was implicitly learned. No main effect of group was found for implicit and explicit learning on mean reaction time (MRT) and accuracy. However, for MRT, an interaction was found between learning condition, learning phase and group. Analyses showed no group effects for the explicit learning condition, but youth elite soccer players showed better learning in the implicit learning condition. In particular, during implicit motor learning youth elite soccer showed faster MRTs in the early learning phase and earlier reached asymptote performance in terms of MRT. Present findings may be important for sports because children with superior implicit learning abilities in early learning phases may be able to learn more (durable) motor skills in a shorter time period as compared to other children. [ABSTRACT FROM PUBLISHER]

Background:Portfolios are used as tools to coach and assess students in the workplace. This study sought to evaluate the content validity of portfolios as reflected in their capacity to adequately assess achieved competences of medical students during clerkships. Methods: We reviewed 120 workplace portfolios at three medical universities (Belgium and the Netherlands). To validate their content, we developed a Validity Inventory for Portfolio Assessment (VIPA) based on the CanMEDS roles. Two raters evaluated each portfolio and indicated for each VIPA item whether the portfolio provided sufficient information to enable satisfactory assessment of the item. We ran a descriptive analysis on the validation data and computed Cohen’s Kappa to investigate interrater agreement. Results:The portfolios adequately covered the items pertaining to the communicator (90%) and professional (87%) roles. Coverage of the medical expert, collaborator, scholar and manager roles ranged between 75% and 85%. The health advocate role, covering 59%, was clearly less well represented. This role also exhibited little interrater agreement (Kappa < 0.4). Conclusions:This study lends further credence to the evidence that portfolios can indeed adequately assess the different CanMEDS roles during clerkships, the health advocate role, which was less well represented in the portfolio content, excepted. [ABSTRACT FROM PUBLISHER]

Objective: The Dutch digits-in-noise test (NL DIN) and the American-English version (US DIN) are speech-in-noise tests for diagnostic and clinical usage. The present study investigated differences between NL DIN and US DIN speech reception thresholds (SRTs) for a group of native Dutch-speaking listeners. Design: In experiment 1, a repeated-measures design was used to compare SRTs for the NL DIN and US DIN in steady-state noise and interrupted noise for monaural, diotic, and dichotic listening conditions. In experiment 2, a subset of these conditions with additional speech material (i.e. US DIN triplets without inter-digit coarticulation/prosody) was used. Study sample: Experiment 1 was conducted with 16 normal-hearing Dutch students. Experiment 2 was conducted with nine different students. Results: No significant differences between SRTs measured with the NL DIN and US DIN were found in steady-state noise. In interrupted noise the US DIN SRTs were significantly better in monaural and diotic listening conditions. Experiment 2 demonstrated that these better SRTs cannot be explained by the combined effect of inter-digit coarticulation and prosody in the American-English triplets. Conclusions: The NL DIN and US DIN are highly comparable and valuable tests for measuring auditory speech recognition abilities. These tests promote across-language comparisons of results. [ABSTRACT FROM AUTHOR]

Purpose:The purpose of this study is to investigate how aspects of a teaching performance evaluation system may affect faculty’s teaching performance improvement as perceived by residents over time. Methods:Prospective multicenter cohort study conducted in The Netherlands between 1 September 2008 and 1 February 2013. Nine hundred and one residents and 1068 faculty of 65 teaching programs in 16 hospitals were invited to annually (self-) evaluate teaching performance using the validated, specialty-specific System for Evaluation of Teaching Qualities (SETQ). We used multivariable adjusted generalized estimating equations to analyze the effects of (i) residents’ numerical feedback, (ii) narrative feedback, and (iii) faculty’s participation in self-evaluation on residents’ perception of faculty’s teaching performance improvement. Results:The average response rate over three years was 69% for faculty and 81% for residents. Higher numerical feedback scores were associated with residents rating faculty as having improved their teaching performance one year following the first measurement (regression coefficient,b: 0.077; 95% CI: 0.002–0.151;p = 0.045), but not after the second wave of receiving feedback and evaluating improvement. Receiving more suggestions for improvement was associated with improved teaching performance in subsequent years. Conclusions: Evaluation systems on clinical teaching performance appear helpful in enhancing teaching performance in residency training programs. High performing teachers also appear to improve in the perception of the residents. [ABSTRACT FROM PUBLISHER]

Little is known about the epidemiology of sepsis in the Netherlands. In addition, information regarding the ability of emergency medical services (EMS) personnel to recognize sepsis is lacking. The aim of this study is to determine epidemiological characteristics of sepsis and the recognition of sepsis by EMS personnel in an urban area in the Netherlands. We conducted a retrospective cohort study using transport information from EMS Amsterdam and admission diagnoses at the emergency department gathered through discharge data from two academic hospitals in Amsterdam for the year 2012. A total of 253 patients with sepsis were evaluated, of which 131 were transported by ambulance. The in-hospital mortality rate of the total population was 21% and a mean length of hospital stay was of 13.5 days. Sixty-seven patients (26.5%) were admitted to the intensive care unit. Almost half of the patients were assigned to the internal medicine ward (117; 46.2%). The most common site of infection was the urinary tract (30%).E. coliwas the most frequent cause of infections. EMS staff recognized 18/131 (13.7%) transported patients with (severe) sepsis or septic shock. In 52 cases (39.7%) sepsis went unrecognized, probably due to an incomplete primary survey. In 60 cases (45.8%) sepsis went unrecognized, although enough systemic inflammatory response syndrome criteria were present at initial presentation. Recognition of sepsis by EMS staff in the Netherlands is low, probably due to a lack of awareness of the syndrome and infrequent measurement of temperature and respiratory rate. As early initiation of treatment is crucial, the EMS staff, general practitioners, and other specialties could benefit from more education on this critical illness. [ABSTRACT FROM PUBLISHER]

Purpose: Medical students receive feedback during clerkships from many different sources: attendings, residents, paramedics, other clerks and even patients. Not all feedback providers have similar impact on learning. One characteristic that is believed to have impact is their credibility to the recipient. This study investigates the effects of feedback provider credibility on medical student satisfaction, self-efficacy and performance with a trained skill. Methods: A single-blind randomized controlled between-subjects design was used, with feedback provider credibility (high–low) as independent variable and examination of hearing abilities as the task. First year medical students’ (n = 68) satisfaction, self-efficacy and performance were the dependent variables and were measured both directly after the intervention and after a three-week delay. Results: Credibility did not significantly affect immediate or delayed self-efficacy. Students receiving feedback from a high-credibility source were more satisfied with the feedback. They did not perform significantly better immediately after the feedback intervention, but did so three weeks after the intervention. High credibility was associated with a perception of a negative feedback message and an unsocial feedback provider. Conclusions: Feedback provider credibility impacts satisfaction with feedback and delayed performance. If feedback is not effective in clinical settings, feedback providers may reconsider their credibility. [ABSTRACT FROM PUBLISHER]

Objective:Reporting guidelines call for descriptions of control group support in equal detail as for interventions. However, how to assess the active content (behaviour change techniques (BCTs)) of treatment-as-usual (TAU) delivered to control groups in trials remains unclear. The objective of this study is to pre-test a method of assessing TAU in a multicentre cost-effectiveness trial of an HIV-treatment adherence intervention. Design:HIV-nurses (N = 21) completed a semi-structured open-ended questionnaire enquiring about TAU adherence counselling. Two coders independently coded BCTs. Main outcome measures:Completeness and clarity of nurse responses, inter-coder reliabilities and the type of BCTs reported were examined. Results:The clarity and completeness of nurse responses were adequate. Twenty-three of the 26 identified BCTs could be reliably coded (meanκ = .79; mean agreement rate = 96%) and three BCTs scored belowκ = .60. Total number of BCTs reported per nurse ranged between 7 and 19 (M = 13.86, SD = 3.35). Conclusions:This study suggests that the TAU open-ended questionnaire is a feasible and reliable tool to capture active content of support provided to control participants in a multicentre adherence intervention trial. Considerable variability in the number of BCTs provided to control patients was observed, illustrating the importance of reliably collecting and accurately reporting control group support. [ABSTRACT FROM PUBLISHER]

We examined whether differences in adult attachment representations could be predicted from early and later maternal sensitivity, controlling for early and later assessments of attachment. In this longitudinal study on 190 adoptees, attachment at 23 years was measured with the Attachment Script Assessment. Maternal sensitivity was observed in infancy and at seven and 14 years. Attachment was also measured in infancy and at 14 years. Higher maternal sensitivity in infancy predicted more secure attachment in infancy and more secure attachment representations in young adulthood. Higher maternal sensitivity in middle childhood also predicted more secure attachment representations in young adulthood. There was no continuity of attachment from infancy to young adulthood, but attachment in adolescence and young adulthood were significantly related. Even in genetically unrelated families, maternal sensitivity in early and middle childhood predicts attachment representations in young adults, confirming the importance of sensitive parenting for human development. [ABSTRACT FROM PUBLISHER]

Background: Postgraduate medical education training programs strive to prepare their trainees optimally for independent practice. Several studies have shown, however, that new consultants feel inadequately prepared for practice, and that this increases the risk of stress and burnout. Aim: To analyze across specialties for which tasks and themes new consultants feel inadequately prepared. And, to identify themes that need improved attention in postgraduate medical education programs or after registration. Methods: 330 New consultants from all hospital specialities with accredited training programs who completed their training in the north-eastern educational region of The Netherlands between 2004 and 2010 received a questionnaire which was based on a previously validated generic task inventory. Results: 143 respondents (43%) returned the questionnaire. They felt excellently prepared for 40 tasks, well prepared for 25 tasks, marginally sufficiently prepared for 18 tasks and insufficiently prepared for 8 tasks. Preparedness scores were lowest for tasks concerning management administration and leadership, research, end-of-life care, and patient safety-related communication. Surgical specialists felt better prepared for practice than medical specialists, which could not be explained by differences in general self-efficacy. Conclusion: Although new consultants felt well prepared for medical tasks, the scores of more generic tasks indicate that the alignment between the different phases of the medical education continuum and independent practice needs improvement. [ABSTRACT FROM AUTHOR]

Strategies to promote implementation of school-based health promotion (HP) programmes should be designed to suit determinants of implementation and continuation. This study explored determinants of completeness of teachers' implementation of a healthy diet promotion programme and of their intention to continue the programme. Strategies for promoting complete and continued implementation of school-based HP programmes should be designed to suit such determinants. Teacher logbooks were used to assess completeness. Additionally, the teachers completed questionnaires before and after implementation on user-, programme-, context- and dissemination strategy-related determinants and their intention to continue the programme in the next school year. Non-parametric tests and logistic regressions were used to assess baseline-posttest changes in determinants and differences in determinants between teachers with levels of completeness and of intention to continue the programme. Variability in teachers' completeness of using the programme was best predicted by their perception of ‘relative advantage’ and ‘compatibility’ of the intervention programme. Teachers' intention to continue could be explained by ‘perceived personal benefits’, their perception of ‘programme outcome feasibility’ and on ‘subjective norm from students’. Our explorative study indicates that HP professionals should target various user-, programme- and context-related determinants in their implementation strategy to improve completeness of programme implementation and continuation. Close collaboration with the users and members of the target group during the programme development phase is essential. [ABSTRACT FROM PUBLISHER]