Search

Background: Research on cognitive effects of educational games in general shows promising results. However, there are large variations in learning outcomes between individual educational games. Research on the design process and different design elements of educational games has led to some interesting directions, but some design aspects remain unclear. Objectives: We examined how an educational game designed on the basis of intrinsic integration theory, based on a strong alignment between game and learning goals, supports the learning of Newtonian mechanics. Methods: This study applied a mixed‐methods approach (N = 223). A pre‐ and post‐test design was used to examine possible learning and transfer effects fostered by playing the educational game, Newton's Race. To examine how players played the game, log data for each player were digitally recorded during gameplay. Results and Conclusions: Our findings demonstrated a significant positive learning effect of Newton's Race (p = 0.003, d = 0.201). This can be explained through the acquired log data. Log data show that players' gameplay mostly matched expected learning during the game, with physically correct game settings occurring more and more as gameplay progressed. The ability to transfer learned knowledge to other situations was shown to be limited to situations closely resembling the game environment. Implications: Similarly, designed intrinsically integrated games on different (physics) subjects could also foster learning in a relative short time. To foster transfer to other situations we propose embedding the game within other instructional activities. Lay Description: What is already known about this topic?: Research on cognitive effects of educational games in general shows promising results.There are large variations in learning outcomes between individual educational games.Some design aspects remain unclear on the design process and different design elements of educational games.Attempting to integrate learning with gameplay, without affecting the enjoyability of the game, is not easily achieved. What this paper adds?: The current study fits within the research body that emphasizes the importance of aligning gameplay with learning in educational games (i.e., intrinsic integration).Evidence for intrinsic integration as a key element in the design process, found by examining players' log data.A better understanding of how an intrinsically integrated game supports the learning of Newtonian mechanics. Implications for practice and/or policy: Similarly, designed intrinsically integrated games on different (physics) subjects could also foster learning in a relative short time.To foster transfer to other situations we propose embedding the game within other instructional activities. [ABSTRACT FROM AUTHOR]

Introduction: Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. Methods: We performed a cluster‐randomized, stepped‐wedge study to explore the effect of the the implementation of a new nursing evidence‐based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47‐item questionnaire with a score range of 0–100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. Results: At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL‐dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. Conclusion: Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence‐based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL‐dependent patients. [ABSTRACT FROM AUTHOR]

Background: Because the cause of increasing rates of postpartum hemorrhage (PPH) and manual placental removal (MROP) is still unknown, we described trends in PPH, MROP, and childbirth interventions and examined factors associated with changes in rates of PPH and MROP. Methods: This nationwide cohort study used national perinatal registry data from 2000 to 2014 (n = 2,332,005). We included births of women who gave birth to a term singleton child in obstetrician‐led care or midwife‐led care. Multivariable logistic regression analyses were used to examine associations between characteristics and interventions, and PPH ≥ 1000 mL and MROP. Results: PPH rates increased from 4.3% to 6.6% in obstetrician‐led care and from 2.5% to 4.8% in midwife‐led care. MROP rates increased from 2.4% to 3.4% and from 1.0% to 1.4%, respectively. A rising trend was found for rates of induction and augmentation of labor, pain medication, and cesarean section, while rates of episiotomy and assisted vaginal birth declined. Adjustments for characteristics and childbirth interventions did not result in large changes in the trends of PPH and MROP. After adjustments for childbirth interventions, in obstetrician‐led care, the odds ratio (OR) of PPH in 2014 compared with the reference year 2000 changed from 1.66 (95% CI 1.57–1.76) to 1.64 (1.55–1.73) among nulliparous women and from 1.56 (1.47–1.66) to 1.52 (1.44–1.62) among multiparous women. For MROP, the ORs changed from 1.51 (1.38–1.64) to 1.36 (1.25–1.49) and from 1.56 (1.42–1.71) to 1.45 (1.33–1.59), respectively. Conclusions: Rising PPH trends were not associated with changes in population characteristics and rising childbirth intervention rates. The rising MROP was to some extent associated with rising intervention rates. [ABSTRACT FROM AUTHOR]

Introduction: Patients living with obesity often experience weight stigma in healthcare settings, which has worrying consequences for their healthcare experiences. This cross‐sectional study aimed to: (1) provide an overview of stigmatising experiences in healthcare settings reported by adults living with varying classes of obesity, (2) identify associations among patient characteristics and perceived weight stigma and (3) investigate the association between perceived weight stigma and person‐centred care (PCC). Methods: Dutch adults living with obesity classes I (body mass index [BMI]: 30 to <35 kg/m2; n = 426), II (BMI: 35 to <40 kg/m2; n = 124) and III (BMI: ≥40 kg/m2; n = 40) completed measures of perceived weight stigma in healthcare settings and PCC. Descriptive, correlational and multivariate analyses were conducted. Results: Of patients living with classes I, II and III obesity, 41%, 59% and 80%, respectively reported experiences of weight stigma in healthcare settings. Younger age, greater obesity severity and the presence of chronic illnesses were associated with greater perceived weight stigma. Greater perceived weight stigma was associated with lower PCC. Conclusion: The results of this study emphasise the significant role of weight stigma in the healthcare experiences of patients living with obesity. Reducing weight stigma is expected to improve PCC and the overall quality of care for these patients. Minimising weight stigma will require efforts across various healthcare domains, including increasing awareness among healthcare professionals about sensitive communication in weight‐related discussions. Patient Contribution: Our sample consisted of patients living with obesity. Additionally, patients were involved in the pilot testing and refinement of the PCC instrument. [ABSTRACT FROM AUTHOR]

Aim: This study examines the prevalence of the professional use of social media platforms by independent DHs in the Netherlands and assesses the associated personal and demographic factors. Methods: In this exploratory, observational, cross‐sectional study, independent DHs who were members of the Dutch Dental Hygienist Association (Nederlandse Vereniging voor Mondhygiënisten: NVM) were included. Data were collected from the DH practices' websites. Statistics included frequency distributions, percentages, chi‐square tests for the relationship between the parameters, and multiple logistic regression for the associations between social media use and the personal and demographic factors. Results: A total of 830 independent DHs from 670 different practices were included in the study. Of these DHs, 34.4% had a link to a social media platform on their website. DHs with practices in the west or south of the Netherlands were more likely to use Facebook (p = 0.035 and p = 0.002, respectively) than those in the east or north. The likelihood of DHs with 4 years of training using Facebook was 1.910 greater than those with 2 years of training (p = 0.002). Furthermore, DHs who graduated in Utrecht were more likely to use Instagram (p < 0.001). Conclusion: Over a third of the independent DHs in the Netherlands used social media for professional purposes. DHs who trained in Utrecht for 4 years and who had a practice in the west or south of the Netherlands were more likely to use social media for professional purposes. [ABSTRACT FROM AUTHOR]

Objectives: Translating the Oral Health Assessment Tool (OHAT) into Dutch and assessing the inter‐rater reliability among community nurses. Methods: The original version of the OHAT was translated following the five stages of the 'Guidelines for the Process of Cross‐Cultural Adaptation'. After a forward and backward translation, consensus on the pre‐final version was obtained in an expert panel discussion. This version was pre‐tested on its comprehensibility among 31 nurses and hereafter finalized. Then, inter‐rater reliability of the OHAT‐NL was determined by two trained nurses during oral assessments of 37 care‐dependent community‐dwelling older people. Intraclass correlation coefficient (ICC) and the Cohen's kappa statistic for individual items were estimated. Results: Feedback from nurses in the pre‐test did lead to minor changes of the OHAT‐NL. Inter‐rater reliability was good (ICC 0.79; 95% CI 0.63–0.89) on the total score. Agreement on item level ranged from fair to very good, the kappa ranged from 0.36–0.89. Conclusions: OHAT is now available in Dutch having good inter‐rater reliability among trained community nurses. Future research can further validate the OHAT‐NL and develop intervention according to total OHAT‐NL scores. [ABSTRACT FROM AUTHOR]

Objectives: For older people who worry about their memory, their general practitioner (GP) is often the first healthcare professional they turn to. This study aims to increase knowledge of GPs' daily practice on diagnostic strategies for patients who present themselves with memory complaints and/or worries about dementia for the first time in general practice and to explore associations of patients' characteristics with these strategies. Method: Retrospective observational study using electronic patient records from patients presenting with memory complaints between 2012 and 2019. The patient records are derived from a Dutch primary care registration network. The decision on diagnostic strategy was extracted and categorized as (1) wait and see, (2) diagnostic testing in primary care, or (3) referral. Patient characteristics (gender, age, general practice, level of comorbidities, chronic polypharmacy, and the number of consultations on memory complaints), fear of developing dementia, and information on why the first consultation on memory complaints was scheduled were extracted. Results: A total of 228 patients were included. Most patients were cared for within primary care, either for further primary care diagnostics (56.1%) or because a wait‐and‐see strategy was pursued (14.9%). One‐third (28.9%) of patients were referred. Differences between diagnostic strategies in patient characteristics, fear of developing dementia, or reason for first consultation between these diagnostic strategies were not found, nor were these variables predictive of referral. Conclusion: Most Dutch patients with memory complaints and/or worries about dementia who seek help from their GP for the first time are cared for in the primary care setting for the following 6 months. The lack of association between included patient characteristics and diagnostic strategies highlights the complexity of the decision‐making process on diagnostic testing for dementia in general practice. Key points: Most Dutch patients who seek help for memory complaints from their general practitioner (GP) for the first time are not referred for specialized diagnostic testing, which underlines the crucial and gatekeeper role GPs play in the management and care for this patient group.Previous qualitative research indicates that GPs consider patient characteristics important in decisions on diagnostic trajectories for memory complaints. Retrospective data from the studied electronic patient records, however, indicates that patient characteristics such as age and comorbidity do not differ between diagnostic strategies nor are they predictive for referrals.Further unraveling of the complex decision‐making process for diagnostic testing for dementia is needed to facilitate timely dementia diagnoses. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, antenatal cardiotocography (aCTG), used to assess fetal well‐being, is performed in obstetrician‐led care. To improve continuity of care, an innovation project was designed wherein primary care midwives perform aCTGs for specific indications. The aim of this study was to examine the satisfaction and experiences of pregnant women who received an aCTG in primary midwife‐led care and explore which factors were associated with high satisfaction. Methods: Data were collected through a self‐administered questionnaire based on the Consumer Quality Index. The primary outcome was general satisfaction on a 10‐point scale, with a score above nine indicating participants were "highly satisfied". Results: In total, 1227 women were included in the analysis. The study showed a mean general satisfaction score of 9.2. Most women were highly satisfied with receiving an aCTG in primary midwife‐led care (77.4%). On the Consumer Quality Index, the mean satisfaction level varied from 3.98 (SD ± 0.11) for the subscale "client satisfaction" to 3.87 (SD ± 0.32) for the subscale "information provision" on a 4‐point scale. Women at between 33 and 36 weeks' gestation were more likely to be highly satisfied (adjusted OR [aOR] = 3.35). Compared with a completely comfortable position during the aCTG, a mostly comfortable or somewhat comfortable level had decreased odds of being associated with a ranking of highly satisfied (aOR 0.24 and 0.19, respectively). Conclusions: This study shows that pregnant women are satisfied with having an aCTG in midwife‐led care. Providing aCTG in midwife‐led care can increase access to continuity of care. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether and which diseases co‐occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients. Materials and Methods: A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio‐economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self‐reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used. Results: Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co‐occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30–1.43; multimorbidity = 1.18; 95% CI: 1.11–1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%). Conclusions: This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co‐occurring in certain groups of individuals. [ABSTRACT FROM AUTHOR]

Background: Sensitive responsiveness is an important aspect in affect‐regulation of people with severe to profound intellectual disabilities. Aim: This randomized controlled trial evaluated the Attune & Stimulate‐checklist, a tool for detecting subtle and idiosyncratic communicative behaviours and responding adequately. Methods: Effects on the sensitive responsiveness of professional caregivers and the arousal and valence of adults with severe to profound intellectual disabilities were investigated. Video recordings of 102 interactions were analysed with several observation instruments. Results: Although no significant effect was found on the checklist‐suggestions of responsive behaviours (d = 0.33, p =.052), the intervention increased caregivers' sensitive responsive and affective behaviour (d = 0.94 – 1.10, p <.001) and clients' optimal arousal (d = 0.48, p =.019) and interactive engagement (d = 0.40 – 0.48, p =.018 ‐.050). Conclusion: This low‐intensity intervention had a medium to large immediate effect on the interaction. Future research should investigate medium‐ and long‐term effects. [ABSTRACT FROM AUTHOR]

Purpose: For postoperative vaginal brachytherapy (POVBT), the diversity of applicators complicates the creation of a generalized auto‐segmentation model, and creating models for each applicator seems difficult due to the large amount of data required. We construct an auto‐segmentation model of POVBT using small data via domain‐adversarial neural networks (DANNs). Methods: CT images were obtained postoperatively from 90 patients with gynaecological cancer who underwent vaginal brachytherapy, including 60 and 30 treated with applicators A and X, respectively. A basal model was devised using data from the patients treated with applicator A; next, a DANN model was constructed using these same 60 patients as well as 10 of those treated with applicator X through transfer learning techniques. The remaining 20 patients treated with applicator X comprised the validation set. The model's performance was assessed using objective metrics and manual clinical evaluation. Results: The DANN model outperformed the basal model on both objective metrics and subjective evaluation (p<0.05 for all). The median DSC and 95HD values were 0.97 and 3.68 mm in the DANN model versus 0.94 and 5.61 mm in the basal model, respectively. Multi‐centre subjective evaluation by three clinicians showed that 99%, 98%, and 81% of CT slices contoured by the DANN model were acceptable versus only 73%, 77%, and 57% of those contoured by the basal model. One clinician deemed the DANN model comparable to manual delineation. Conclusion: DANNs provides a realistic approach for the wide application of automatic segmentation of POVBT and can potentially be used to construct auto‐segmentation models from small datasets. [ABSTRACT FROM AUTHOR]

Introduction: Over the past years, mapping and ablation techniques for the treatment of ventricular tachycardia (VT) have evolved rapidly. High Density (HD) substrate mapping is now routine and pre‐procedural imaging is increasingly used. The additional value of these techniques for long‐term VT‐free survival is not clear. Methods: We compared baseline and procedural characteristics, procedural success, safety and outcome of mapping and ablation of ventricular tachycardia in patients with ischemic heart disease between two groups. (1) Low Density (LD) group: VT mapping and ablation with a 4 mm single tip catheter (2) HD group: HD substrate mapping with the Pentaray (Biosense Webster, USA) or HD Grid (Abbott, USA) catheter and ablation with a 4 mm single tip catheter. Results: VT ablation was performed in 133 patients (71 patients in LD group and 62 patients in HD group). The median follow‐up was 5.0 years in LD group and 2.0 years in HD group. One‐, two‐, and five‐year VT recurrence rates were 47%, 56%, and 65% in the LD group versus 39%, 50%, and 55% in the HD group (log‐rank test for VT recurrence p =.70). One‐, two‐, and five‐year ICD shock recurrence rates were 14%, 18%, and 24% in the LD group versus 8%, 15%, and 19% in the HD group (log‐rank test for ICD‐shock p =.79). All‐cause mortality, cardiac (non‐arrhythmic), and arrhythmic death, were similar in both groups. Severe procedural complications (tamponade, stroke, or procedural death) occurred in four patients (5%, 1 vascular, 3 tamponade) in the LD group versus two patients (3%, both tamponade) in the HD group (NS). In univariate and multivariable analysis, only a higher LVEF was significantly associated with VT‐free survival. HD mapping was not significantly associated with VT‐free survival. Anterior infarct location and age were significantly associated with ICD recurrent shock in both univariate and multivariable analyses. Conclusions: In patients with ischemic cardiomyopathy, a HD substrate mapping, and ablation strategy did not lead to higher VT‐free survival and shock‐free survival compared to a single tip mapping and ablation strategy. In this study, only LVF is an independent predictor for VT recurrence. Anterior infarct location and age predict recurrent ICD shocks. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess associations between socio‐demographic characteristics and dental costs of children living in Amsterdam. Having incurred dental costs was an indicator for having visited the dentist. Having incurred low or high dental costs may indicate the type of dental care provided (periodic examination, preventive care or restorative treatment). Methods: This study followed a cross‐sectional, observational design. The research population contained all children up until 17 years living in Amsterdam in 2016. Dental costs from all Dutch healthcare insurance companies were obtained via Vektis, and socio‐demographic data were obtained from Statistics Netherlands (CBS). The study population was stratified into age groups: 0–4 and 5–17 years. Dental costs were classified as no dental costs (0 euros), low dental costs (>0 to <100 euros) or high dental costs (≥100 euros). Univariable and multivariable logistic regression analyses were performed to study the distribution of dental costs and associations with socio‐demographic child and parent variables. Results: In the population of 142 289 children, 44 887 (31.5%) incurred no dental costs, 32 463 (22.8%) incurred low dental costs and 64 939 (45.6%) incurred high dental costs. Among children of 0–4 years, a much larger proportion (70.2%) incurred no dental costs, compared to those of 5–17 years (15.8%). In both age groups, migration background (adjusted Odds Ratio (aOR) range 1.23–1.98), low(er) household income (aOR range 0.45–0.93), low(er) parental educational level (aOR range 0.51–0.87) and living in a single‐parent household (aOR range 0.89–0.91) were strongly associated with incurring high (vs. low) dental costs. Furthermore, in 5‐17‐year‐old children, a lower level of secondary or vocational education (aOR range 1.12–1.17) and living in households receiving social benefits (aOR 1.23) were associated with incurring high dental costs. Conclusions: Among children living in Amsterdam in 2016, one in three children did not visit a dentist. For children that did visit a dentist, those with a migration background, low parental educational level and from a low household income were more likely to incur high dental costs, which could be indicative for additional restorative treatment. Hence, patterns of oral healthcare consumption, specified by type of dental care over time, and their association with oral health status, are targets for future research. [ABSTRACT FROM AUTHOR]

Objectives: To develop a patient's attitude questionnaire regarding prevention in oral health for use internationally. Methods: Using a mixed methods approach, a questionnaire was developed and refined as part of ADVOCATE (Added Value for Oral Care) study, involving partners in six countries: Netherlands, Hungary, Denmark, Ireland, Germany, and the UK. A literature review explored the history of oral healthcare delivery systems to develop a template for each of the six ADVOCATE countries. A systematic review identified the perceived barriers and facilitators to preventive oral healthcare and underpinned a topic guide and established the patient questionnaire domains. Focus groups in each ADVOCATE country developed the first version of the questionnaire. Patient and Public Involvement and Engagement (PPIE) in each ADVOCATE country tested the questionnaire and led to further refinement. The questionnaire was produced in five languages. Content validity and reproducibility used principal component analysis (PCA) and exploratory factor analysis (EFA) refined the questionnaire. Results: The literature review aided an understanding of each country's oral healthcare system, and the findings from the 25 studies identified in the systematic review found the main barriers/facilitators to preventive oral healthcare were cost, knowledge (preventive treatments and advice), and a patient awareness and adherence to preventive advice/treatments. Interviews and focus groups with 148 participants in the ADVOCATE study identified receiving the appropriate level of care/feeling valued, cost, level of motivation/priority, not feeling informed, knowledge, and skill mix as the main barriers/facilitators. Fifty‐three PPIE members refined the questionnaire. The pilot questionnaire was tested with 160 participants. Non‐essential or highly correlated variables were then removed, leaving 38 items, covering 6 domains (cost, advice received, advice wanted, message delivery, motivation, knowledge, and responsibility) within the questionnaire. A second pilot test‐run was undertaken with 185 participants. The test‐re‐test reliability demonstrated strong consistency of responses between the two time points (kappa range 0.3–0.7, most p <.0011), which culminated with a final version of the Patient Attitudes to Prevention in Oral Health Questionnaire (PAPOH) questionnaire. Conclusions: This mixed‐methods approach enabled the development of a multi‐language attitudinal questionnaire for use with patients (PAPOH) to compare attitudes to oral disease prevention internationally. [ABSTRACT FROM AUTHOR]

In this introduction to the special issue, Adaptive Tools for Resilient Bones: Biostatistical Approaches to Past Physical Activity in Osteoarchaeology, we discuss the outcome of the workshop held in Leiden (the Netherlands; November 18–19, 2021). We review statistical approaches to entheseal changes and present a series of new contributions to this field. These research, commentary, and review articles present different statistical approaches to entheseal changes and reflect the current state of research in the field. [ABSTRACT FROM AUTHOR]

Purpose: The Viking Speech Scale is used to classify speech performance in children with cerebral palsy (CP). A Dutch‐language version (VSS‐NL) has recently become available. This study aimed to determine the reliability and validity of the VSS‐NL and the association with motor type of CP, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Communication Function Classification System (CFCS). Methods: A total of 90 children with CP, recruited throughout the Netherlands, took part in the study. VSS‐NL classifications by speech and language therapists unfamiliar (SLT1) and familiar (SLT2) with the child, parents and physicians were compared. Convergent and discriminant validity were determined with the Intelligibility in Context Scale‐Dutch (ICS‐NL) and the Computer Based Instrument for Low Motor Language Testing (C‐BiLLT). Inter‐ and intrarater reliability were determined by weighted Kappa (ƙw). Validity and associations between VSS‐NL and GMFCS, MACS and CFCS were determined with Spearman's coefficient. Association between VSS‐NL and motor type of CP was determined with Fisher's exact test. Results: Interrater reliability was excellent between SLT1‐SLT2 (ƙw = 0.93, 95% confidence interval [CI] 0.87–0.99), good between SLT1‐parent (ƙw = 0.71, 95% CI 0.60–0.83), SLT1‐physician (ƙw = 0.70, 95% CI 0.58–0.81), SLT2‐parent (ƙw = 0.71, 95% CI 0.57–0.84), SLT2‐physician (ƙw = 0.73, 95% CI 0.62–0.85) and parent‐physician (ƙ = 0.72, 95% CI 0.60–0.85). Intrarater reliability was excellent for SLTs familiar and unfamiliar to the child (ƙw = 1.00, 95% CI 1.00–1.00), and very good for physicians (ƙw = 0.89, 95% CI 0.75–1.00) and parents (ƙw = 0.72, 95% CI 0.62–1.00). Convergent validity was very strong (r = −0.81, p < 0.001) and discriminant validity moderate (r = −0.56, p < 0.001). Association with motor type of CP was significant (χ2 = 27.558, p < 0.001) and strong with GMFCS (r = 0.62, p < 0.001), MACS (r = 0.63, p < 0.01) and CFCS (r = 0.69, p < 0.001). Conclusion: The VSS‐NL is a reliable and valid system to classify speech performance in children with cerebral palsy. Classifications can be performed by SLTs, parents and physicians. [ABSTRACT FROM AUTHOR]

For the public employment services of many Member countries of the Organisation for Economic Co‐operation and Development, the importance of using profiling tools for job seekers is increasing rapidly in importance. With this trend, there is also widening concern about the risks of an over reliance on such tools. Part of the concern lies with a lack of transparency concerning how such tools work. This article aims to address this by offering a detailed investigation of the Work Profiler – the instrument used in the Netherlands by the Institute for Employee Benefits (Uitvoeringsinstituut Werknemersverzekeringen – UWV) to predict re‐employment success and provide a diagnosis of key factors hindering job seekers' return to work. Professionals use these insights to deepen their understanding of the situation of job seekers and decide together with job seekers how to support their return to work. UWV decided to maintain and revise the Work Profiler through a large‐scale study involving a sample of 53,238 people. Work Profiler 1.0 was developed in 2007–2010 and has been in use on a regional basis since 2011 and nationwide since 2015. This article explains how the new tool (version 2.0; implemented in 2018) works and, most importantly, demonstrates the choices made to ensure that it functions well and is used effectively by professionals. These latter two aspects are rarely discussed in the literature. [ABSTRACT FROM AUTHOR]

Effective monitoring of national circular economy policies requires consistent, national databases of material flows and environmental impacts. Yet, databases and indicators developed so far are scattered and inconsistent. To tackle this problem, Statistics Netherlands (CBS) developed a material flow monitor (MFM) that integrates existing statistics using principles of the System of Environmental Economic Accounting (SEEA). The MFM is the physical counterpart of the Dutch supply and use tables (SUT) of the National Accounts and is also referred to as physical SUT (P‐SUT). The P‐SUT captures national resource extraction, product imports and exports, product flows between economic sectors, as well as emissions and waste streams resulting from economic activities. Our work illustrates how a statistical office can use and enrich its formal statistical data to compose an MFM consistent with the National Accounts and how indicators can be extracted with a case study on the bio‐based economy. We contribute a clear step‐by‐step description of the method and the used datasets. This supports the development of MFMs by other statistical offices and researchers, thereby enabling consistent and comparable circular economy monitoring. [ABSTRACT FROM AUTHOR]

Background: Sex differences in clinical outcomes have been observed for patients with type 2 diabetes mellitus (T2DM). These could be related to sex disparities in treatment. Objectives: To determine whether there are sex disparities in medication prescribing amongst patients with T2DM. Methods: A cohort study was conducted using the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) database, which includes data from primary care patients with T2DM from the north of the Netherlands. Data on demographics, physical examinations, laboratory measurements and prescribing were extracted. A set of validated prescribing quality indicators assessing the prevalence, start, intensification and safety of glucose‐, lipid‐, blood pressure‐ and albuminuria‐lowering medication was applied for the calendar year 2019. Univariate logistic regression analyses were conducted. Results: We included 10,456 patients (47% females). Females were less often treated with metformin (81.7% vs. 86.5%; OR 0.70, 95% CI 0.61–0.80), and were less often prescribed a renin‐angiotensin‐aldosterone inhibitor (RAAS‐i) when treated with multiple blood pressure‐lowering medicines (81.9% vs. 89.3%; OR 0.55, 95% CI 0.46–0.64) or when having albuminuria (74.7% vs. 82.1%; OR 0.64, 95% CI 0.49–0.85) than males. Statin treatment was less frequently started (19.7% vs. 24.7%; OR 0.75, 95% CI 0.58–0.96) and prescribed (58.7% vs. 63.9%; OR 0.80, 95% CI 0.73–0.89) in females. There were no differences in starting and intensifying glucose‐, blood pressure‐ and albuminuria‐lowering medication. Conclusions: Sex disparities in medication prescribing amongst T2DM patients were seen, including less starting with statins and potential undertreatment with RAAS‐i in females. Such disparities may partly explain higher excess risks for cardiovascular and renal complications associated with diabetes observed in females. [ABSTRACT FROM AUTHOR]

Background: Thirst is one of the most intense and distressing symptoms experienced by patients in the intensive care unit (ICU), and no validated measurement tools exist. Validating a thirst measurement tool for the ICU population could be a first step in gaining a better understanding of thirst in ICU patients and aid the development and implementation of strategies regarding the prevention and control of thirst. Aim: The objective of this study was to determine the validity and reliability of the "Thirst distress scale for patients with heart failure (TDS‐HF)" in measuring thirst distress in adult ICU patients. Methods: Content validity was established by an expert panel consisting of ICU nurses, intensivists and five ICU patients. Concurrent validity, known‐groups validity and internal consistency were determined in a consecutive sample of 56 awake and oriented ICU patients with a median age of 70 years (IQR: 57‐74). Results: Content validity of the TDS‐HF in the ICU population was low, with item‐content validity indexes between 0.25 and 0.75. Concurrent validity was high as Spearman's correlation between TDS‐HF and the numeric rating score (0‐10) for thirst distress was 0.71. Internal consistency was high (Cronbach's alpha 0.78). When comparing groups, only higher blood urea nitrogen was significantly related to higher scores on the TDS‐HF (P =.003). Conclusion: The TDS‐HF has high concurrent validity and reliability in measuring thirst distress in ICU patients. Nevertheless, questions remain regarding the applicability and content validity of the scale, which should be further explored before the TDS‐HF can be used in the ICU. Relevance for clinical practice: The TDS‐HF can be used to explore thirst distress and to evaluate interventions. Individual items of the scale can be used to explore the nature of thirst distress in individual patients. [ABSTRACT FROM AUTHOR]

Background: CenteringPregnancy (CP), a model of group antenatal care, was implemented in 2012 in the Netherlands to improve perinatal health; CP is associated with improved pregnancy outcomes. However, motivating women to participate in CP can be difficult. As such, we explored the characteristics associated with CP uptake and attendance and then investigated whether participation differs between health care facilities. In addition, we examined the reasons why women may decline participation and the reasons for higher or lower attendance rates. Methods: Data from a stepped‐wedge cluster randomized controlled trial were used. Univariate and multivariate logistic regression models were used to determine associations among women's health behavior, sociodemographic and psychosocial characteristics, health care facilities, and participation and attendance in CP. Results: A total of 2562 women were included in the study, and the average participation rate was 31.6% per health care facility (range of 10%‐53%). Nulliparous women, women <26 years old or >30 years old, and women reporting average or high levels of stress were more likely to participate in CP. Participation was less likely for women who had stopped smoking before prenatal intake, or who scored below average on lifestyle/pregnancy knowledge. For those participating in CP, 87% attended seven or more out of the 10 sessions, and no significant differences were found in women's characteristics when compared for higher or lower attendance rates. After the initial uptake, group attendance rates remained high. Conclusion: A more comprehensive understanding of the variation in participation rate between health care facilities is required, in order to develop effective strategies to improve the recruitment of women, especially those with less knowledge and understanding of health issues and smoking habits. [ABSTRACT FROM AUTHOR]

Background: Third‐trimester routine ultrasounds are increasingly offered to monitor fetal growth. In addition to limited evidence for its clinical effectiveness, little is known about its importance for pregnancy‐specific anxiety and mother‐to‐infant bonding. Methods: 1275 low‐risk women participated in a Dutch nationwide pragmatic cluster‐randomized trial and answered questionnaires on pregnancy‐specific anxiety (PRAQ‐R) and prenatal mother‐to‐infant bonding (MAAS) before and after a third‐trimester routine ultrasound was offered to the intervention group. Linear mixed model regression analyses were performed to examine the effect of offering a third‐trimester routine ultrasound on pregnancy‐specific anxiety and mother‐to‐infant bonding. In addition, we examined whether the effect depended on maternal background characteristics and level of satisfaction with the ultrasound procedure. Results: We found no effect of offering a third‐trimester routine ultrasound on pregnancy‐specific anxiety and mother‐to‐infant bonding. However, interaction analyses showed that women with high levels of depressive symptoms at baseline and women who were very satisfied with the ultrasound procedure benefited somewhat more from offering a third‐trimester routine ultrasound in terms of mother‐to‐infant bonding compared with women with low or no depressive symptoms, or less satisfied women. Conclusions: The relationship between offering a third‐trimester routine ultrasound with pregnancy‐specific anxiety and mother‐to‐infant bonding is limited. A beneficial effect only applies to some subgroups of women. This implies that, in terms of psychological outcomes, there are no counterarguments to implementing a third‐trimester routine ultrasound. Strong evidence for offering all pregnant women a third‐trimester routine ultrasound for psychological reasons, however, is lacking. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether mindfulness‐based childbirth and parenting (MBCP) or enhanced care as usual (ECAU) for expectant couples decreases fear of childbirth (FOC) and nonurgent obstetric interventions during labor and improves newborn outcomes. Design: Randomized controlled trial. Setting: Midwifery settings, the Netherlands, April 2014‐July 2017. Population: Pregnant women with high FOC (n = 141) and partners. Methods: Allocation to MBCP or ECAU. Hierarchical multilevel and intention‐to‐treat (ITT) and per‐protocol (PP) analyses. Main outcome measures: Primary: pre‐/postintervention FOC, labor anxiety disorder, labor pain (catastrophizing and acceptance), and preferences for nonurgent obstetric interventions. Secondary: rates of epidural analgesia (EA), self‐requested cesarean birth (sCB), unmedicated childbirth, and 1‐ and 5‐minute newborn's Apgar scores. Results: MBCP was significantly superior to ECAU in decreasing FOC, catastrophizing of labor pain, preference for nonurgent obstetric interventions, and increasing acceptance of labor pain. MBCP participants were 36% less likely to undergo EA (RR 0.64, 95% CI [0.43‐0.96]), 51% less likely to undergo sCB (RR 0.49, 95% CI [0.36‐0.67]), and twice as likely to have unmedicated childbirth relative to ECAU (RR 2.00, 95% CI [1.23‐3.20]). Newborn's 1‐minute Apgar scores were higher in MBCP (DM −0.39, 95% CI [−0.74 to −0.03]). After correction for multiple testing, results remained significant in ITT and PP analyses, except EA in ITT analyses and 1‐minute Apgar. Conclusions: MBCP for pregnant couples reduces mothers' fear of childbirth, nonurgent obstetric interventions during childbirth and may improve childbirth outcomes. MBCP adapted for pregnant women with high FOC and their partners appears an acceptable and effective intervention for midwifery care. [ABSTRACT FROM AUTHOR]

Aim To elucidate the relationship between serum selenium levels and the risk of mortality and new-onset heart failure (HF) in the general adult population. Methods and results Selenium was measured in a Dutch cohort and a retrospective analysis of prospectively assessed data was performed. Main outcome measures were all-cause mortality and incidence of new-onset HF separately, and combined as a composite endpoint. Serum selenium was measured in 5973 subjects and mean selenium concentration was 84.6 (±19.5) µg/L. Mean age was 53.6 (±12.1) years and 3103 subjects (52%) were female. Median follow-up was 8.4 years. Selenium levels associated positively with female sex, higher total cholesterol and glucose concentrations, and associated negatively with incidence of anaemia, iron deficiency, current smoking, increased C-reactive protein levels, and higher body mass index. Univariate analysis on all subjects showed no association of continuous selenium concentrations, per 10 µg/L increase, with the composite endpoint (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.06, p = 0.407). However, significant interaction with smoking status was observed. In non-smoking subjects (n = 4288), continuous selenium concentrations were independently associated with reduced mortality risk (HR 0.87, 95% CI 0.79-0.96, p = 0.005), lower risk of new-onset HF (HR 0.82, 95% CI 0.69-0.96, p = 0.017), as well as reduced risk of the composite endpoint (HR 0.86, 95% CI 0.79-0.94, p = 0.001). In smoking subjects, no associations were found. Conclusion Serum selenium was independently associated with multiple indicators of the metabolic syndrome. In addition, high selenium levels were independently associated with reduced mortality and new-onset HF in non-smokers. Well-powered interventional studies are necessary to evaluate the potential benefit of repleting selenium, especially in non-smoking subjects. [ABSTRACT FROM AUTHOR]

Nowadays, students often practice problem‐solving skills in online learning environments with the help of examples and problems. This requires them to self‐regulate their learning. It is questionable how novices self‐regulate their learning from examples and problems and whether they need support. The present study investigated the open questions (1) to what extent students' (novices) task selections align with instructional design principles and (2) whether informing them about these principles would improve their task selections, learning outcomes, and motivation. Higher education students (N = 150) learned a problem‐solving procedure by fixed sequences of examples and problems (FS‐condition), or by self‐regulated learning (SRL). The SRL participants selected tasks from a database, varying in format, complexity, and cover story, either with (ISRL‐condition) or without (SRL‐condition) watching a video detailing the instructional design principles. Students' task‐selection patterns in both SRL conditions largely corresponded to the principles, although tasks were built up in complexity more often in the ISRL‐condition than in the SRL‐condition. Moreover, there was still room for improvement in students' task selections after solving practice problems. The video instruction helped students to better apply certain principles, but did not enhance learning and motivation. Finally, there were no test performance or motivational differences among conditions. Although these findings might suggest it is relatively 'safe' to allow students to independently start learning new problems‐solving tasks using examples and problems, caution is warranted: It is unclear whether these findings generalize to other student populations, as the students participating in this study have had some experience with similar tasks or learning with examples. Moreover, as there was still room for improvement in students' task selections, follow‐up research should investigate how we can further improve self‐regulated learning from examples and practice problems. Lay Description: What is (not) known about the subject matter: Learning new problem‐solving skills online with examples and problems is becoming more commonInstructional design principles (IDP) detail how to sequence tasks to optimize learning and motivationIt is unclear whether students spontaneously adhere to IDP when they select learning tasksNot much is known about how to support students to make better task selections What is the contribution of this paper: Students received a fixed task sequence (FS‐condition) or selected tasks themselves (SRL)Prior to SRL, SRL‐students watched a video about IDP (ISRL‐condition) or not (SRL‐condition)Results showed that (I)SRL‐students' task‐selections matched quite well with IDPThere were no differences among the FS and (I)SRL conditions in performance or motivation What are the implications of the findings: Students were quite capable of self‐regulating their learning from examples and problemsSRL was even as effective, efficient, and motivating as a fixed task sequenceWatching a video on IDP affected students' task‐selections, but did not enhance learning and motivationFuture research should examine how to further support SRL from examples and problems [ABSTRACT FROM AUTHOR]

Background and aims: Ibogaine is an indole alkaloid used in rituals of the African Bwiti tribe. It is also used in non‐medical settings to treat addiction. However, ibogaine has been linked to several deaths, mainly due to cardiac events called torsades des pointes preceded by QTc prolongation as well as other safety concerns. This study aimed to evaluate the cardiac, cerebellar and psychomimetic safety of ibogaine in patients with opioid use disorder. Design A descriptive open‐label observational study. Setting: Department of psychiatry in a university medical center, the Netherlands. Participants: Patients with opioid use disorder (n = 14) on opioid maintenance treatment with a lasting wish for abstinence, who failed to reach abstinence with standard care. Intervention and measurements: After conversion to morphine‐sulphate, a single dose of ibogaine‐HCl 10 mg/kg was administered and patients were monitored at regular intervals for at least 24 hours assessing QTc, blood pressure and heart rate, scale for the assessment and rating of ataxia (SARA) to assess cerebellar side effects and the delirium observation scale (DOS) to assess psychomimetic effects. Findings The maximum QTc (Fridericia) prolongation was on average 95ms (range 29‐146ms). Fifty percent of subjects reached a QTc of over 500ms during the observation period. In six out 14 subjects prolongation above 450ms lasted beyond 24 hours after ingestion of ibogaine. No torsades des pointes were observed. Severe transient ataxia with inability to walk without support was seen in all patients. Withdrawal and psychomimetic effects were mostly well‐tolerated and manageable (11/14 did not return to morphine within 24 hours, DOS scores remained below threshold). Conclusions: This open‐label observational study found that ibogaine treatment of patients with opioid use disorder can induce a clinically relevant but reversible QTc prolongation, bradycardia, and severe ataxia. [ABSTRACT FROM AUTHOR]

Objectives: Obsessive‐compulsive disorder (OCD) is a debilitating psychiatric disorder, often complicated with comorbidities. Social phobia (SP) is the most frequent co‐occurring anxiety disorder in OCD, associated with increased clinical severity. However, no study had examined the relevance of interpersonal processes in this comorbidity, which are at the core of SP. This study characterized the clinical (i.e., symptom profile, age of onset, chronicity, and comorbidity), vulnerability (i.e., childhood trauma, negative life events), and interpersonal (attachment style, expressed emotion, and social support) correlates of comorbid SP in a large sample of OCD patients. Methods: We analysed the data of 382 OCD patients participating in the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. We examined the correlates of SP in OCD using self‐report questionnaires and structured clinical interviews. In addition, data of 312 non‐OCD SP patients were drawn from the Netherlands Study of Depression and Anxiety (NESDA), to compare the age of onset of SP between groups. Descriptive univariate analyses were followed by backward stepwise logistic regression analyses. Results: Social phobia was present among approximately 20% of OCD patients. Social phobia in OCD was associated with increased depression severity and decreased ratings of secure attachment style. Among OCD patients, SP had a significantly earlier age onset as compared to SP in non‐OCD patients. Conclusion: Social phobia in OCD might render a vulnerable clinical picture, characterized with early onset of SP symptoms, insecure attachment style, and increased depressive symptoms. Future studies should use prospective designs to better understand the nature of comorbid SP in OCD. Practitioner points: Approximately one fifth of OCD patients were diagnosed with comorbid social phobia in a large representative clinical sample.OCD patients with comorbid social phobia presented with a vulnerable clinical picture, characterized with increased depression severity and decreased ratings of secure attachment style.Social phobia in OCD was associated with an earlier AOO as compared to the AOO of social phobia without OCD.The findings are limited by a cross‐sectional design; thus, causality could not be assessed.Research is needed to further examine the mechanisms of comorbid social phobia in OCD. [ABSTRACT FROM AUTHOR]

Background: To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim: This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods: Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results: Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion: The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution: European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey. [ABSTRACT FROM AUTHOR]

Patient‐reported outcome measures (PROMs) for chronic wounds mainly focus on specific types of wounds. Our team developed the WOUND‐Q for use with all types of wounds in any anatomic location. We conducted 60 concept elicitation interviews with patients in Canada, Denmark, the Netherlands, and the United States. Analysis identified concepts of interest to patients and scales were formed and refined through cognitive interviews with 20 patients and input from 26 wound care experts. Scales were translated into Danish and Dutch. An international field‐test study collected data from 881 patients (1020 assessments) with chronic wounds. Rasch measurement theory (RMT) analysis was used to refine the scales and examine psychometric properties. RMT analysis supported the reliability and validity of 13 WOUND‐Q scales that measure wound characteristics (assessment, discharge, and smell), health‐related quality of life (life impact, psychological, sleep impact, and social), experience of care (information, home care nurses, medical team, and office staff), and wound treatment (dressing and suction device). The WOUND‐Q can be used to measure outcomes in research and clinical practice from the perspective of patients with any type of wound. [ABSTRACT FROM AUTHOR]

This article builds on the argument that research on the link between HRM and performance benefits from investigating how HR practices are envisioned by managers (in terms of underlying philosophies), and how they are perceived by employees (in terms of psychological climates). Our study focuses on the effects of a strengths-based HR philosophy assuming that employee performance can be maximized through leveraging individual strengths. This philosophy relates to a strengths-based psychological climate, that is, employee perceptions of the opportunities they get to identify, develop, and use their strengths. We hypothesized that a strengths-based psychological climate positively influences employees' positive affect, which in turn enhances their in-role and extra-role performance. In our study, 442 respondents working in 39 departments of eight Dutch and Belgian organizations gave ratings on the strength-based psychological climate of their organization, and indicated their level of work-related positive affect, in-role performance, and extra-role performance. Results of multilevel hierarchical regression analyses supported our hypotheses by indicating that strengths-based psychological climate was positively linked to in-role and extra-role performance, and that this link was mediated by positive affect. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This study aimed to investigate children's potential for reasoning by analogy utilizing a newly‐developed computerized dynamic test, and the potential differential influence of executive functions (cognitive flexibility, attention, and planning) on static and dynamic measures of analogical reasoning. Participants included 64 children (mean age = 7.55). The study employed a two‐session experimental test‐training‐test design. Based on randomized blocking, half of the children received a graduated prompts training between pre‐test and post‐test, and the other half did not. Trained children improved more than control children in both their accuracy scores and number of accurately applied transformations from pre‐test to post‐test. It was further found that cognitive flexibility, attention and planning, is associated with successful solving of analogies. Training children in analogical reasoning seemed to reduce the effect of executive functions. It was also found that that children who were more cognitively flexible needed more prompts during the training. Lay Description: What is already known about this topic: Analogical reasoning is of great importance to scholastic performance and everyday learning.Computerized dynamic tests are promising for measuring children's potential for analogical reasoning.Executive functions have been found to influence analogical reasoning performance.Dynamic testing compensates for the influence of executive functions What this paper adds: A newly developed computerized dynamic test of analogical reasoning can detect individualized learning paths and instructional needs of children of various ability levels.Training children in analogical reasoning as part of a computerized dynamic test seems to reduce the effect of executive functioning.Children's instructional needs are related to cognitive flexibility. Implications for practice and/or policy: Computerized dynamic testing of analogical reasoning is a useful instrument for identification purposes.These tests provide information about children's problem‐solving behaviour, and the type and number of instructions they need when solving new tasks, offering insights relevant for individualized education plans.Individual differences in children's (improvements in) analogical reasoning seem to be related to their executive functioning. [ABSTRACT FROM AUTHOR]

Aim: When glycaemic control for people with type 2 diabetes is not achieved with metformin and sulfonylurea alone, adding another oral anti‐diabetes drug, such as a sodium–glucose co‐transporter 2 (SGLT2) or dipeptidyl peptidase‐4 (DPP‐4) inhibitor, is an alternative to starting insulin. The aim of this study is to determine the cost‐effectiveness of dapagliflozin (an SGLT2 inhibitor) compared with DPP‐4 inhibitors when added to metformin and sulfonylurea in people with type 2 diabetes in the Netherlands. Methods: A cost–utility analysis is performed using the Cardiff diabetes model, a fixed‐time increment stochastic simulation model informed by 'United Kingdom Prospective Diabetes Study 68' risk equations. The base‐case analysis uses a 40‐year time horizon, a Dutch societal perspective and differential discounting (4% for costs, 1.5% for effects). Inputs are obtained from the literature and Dutch price lists. Univariate and probabilistic sensitivity analysis are performed. Results: Dapagliflozin is dominant compared with DPP‐4 inhibitors, resulting in a €990 cost saving and a 0.28 quality‐adjusted life year gain over 40 years. Cost savings are associated mainly with treatment costs and a reduced incidence of micro‐ and macrovascular complications, among others nephropathy, myocardial infarction and stroke. Results are robust to changes in input parameters. Conclusions: Dapagliflozin is a cost‐saving alternative to DPP‐4 inhibitors when added to metformin and sulfonylurea. The incidence of micro‐ and macrovascular complications is lower for people treated with dapagliflozin. Uncertainty around this outcome is low. [ABSTRACT FROM AUTHOR]

In a multisource field study, we examine the relationship between employee perceptions of high-commitment human resource management ( HRM), task proficiency, work engagement, and organizational commitment. Based on conservation of resources ( COR) theory, we first propose that work engagement mediates the relationship between high-commitment HRM and organizational commitment. Second, we propose a mediated moderation model in which employees' task proficiency moderates the relationship between high-commitment HRM and work engagement, which in turn affects organizational commitment. Results indicate that the relationship between high-commitment HRM and organizational commitment was fully mediated by work engagement. Results also supported the mediated moderation model. A significant indirect effect was found from high-commitment HRM to commitment via engagement for low task proficiency, but not for high task proficiency. Implications and directions for future research are discussed. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Line managers are today seen as increasingly important in effectively implementing HRM practices. Based on the Ability-Motivation-Opportunity (AMO) theory, we predict that line managers' performance in this regard will depend on their ability to apply HRM practices, and that their motivation and the opportunity provided will enhance this effect. Through a survey of 174 line managers and 1,065 of their direct subordinates in two organizations, we found ability to be the best predictor of a line manager's HRM performance. Motivation did not moderate the effect of ability on performance as predicted, and our results suggest this relationship needs further attention. Opportunity did enhance the effect of ability on HRM implementation effectiveness. Therefore, HRM departments should aim to enhance line managers' abilities and provide adequate opportunities for them to carry out the expected HRM duties. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

It has been widely acknowledged in debates about nationalism and ethnicity that identity categories used for classifying people along the lines of culture, race, and ethnicity help to enact, that is, bring into being, the collective identities they name. However, we know little about how categories acquire their performative powers. The contribution of this paper is twofold: first, it proposes a conceptual framework based on concepts and insights from science and technology studies for investigating the performative powers of statistical identity categories and possibly also other domains. Second, it demonstrates, through an empirical study of two examples from Estonian and Dutch official population statistics, that statistical identity categories enact more than the groups to which they refer. We argue that they also enact national identities and notions of national belonging of majoritarian groups in the host countries. Therefore, statistical identity categories can be used as analytical lenses to study nationalism and processes of nation‐building. [ABSTRACT FROM AUTHOR]

FourSight theory contends that individuals show preferences for the mental operations rooted in the creative process. The four fundamental preferences measured by FourSight are Clarifiers, Ideators, Developers, and Implementers. The present study examined the extent to which certain occupations reflect a proclivity for these four creative‐process preferences. Guided by Holland's theory of vocational choice, hypothesized relationships were formulated for the link between FourSight theory and 17 occupations. For example, it was predicted that those who work in finance would show a significant bias toward the Clarifier preference. Of the 17 hypothesized relationships between FourSight and occupation, statistical analysis of the FourSight preferences for 20,784 individuals showed support for 12 predictions and partial support for two of the hypothesized relationships. These findings clearly demonstrate that particular occupations engage specific creative‐process preferences. Future investigations might wish to examine the degree to which the interaction between work and creative‐thinking preferences predicts creative performance, satisfaction, stress, and turnover. [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]

Introduction: In response to a relatively high perinatal mortality rate in The Netherlands, the Dutch Health Ministry recommended changes to maternity care, opening a pathway toward more integrated woman‐centered services. Because of its potential to positively influence risk factors for adverse pregnancy outcomes, CenteringPregnancy (CP) group prenatal care was implemented. Methods: We performed a retrospective cohort study (n = 2318) and survey on women's experiences (n = 222) in eight primary care midwifery practices to investigate outcome differences between CP and traditional individual prenatal care. Data from the period 2011‐2013 were analyzed. Results: Primiparous and multiparous CP women attended more prenatal care visits compared with women who received individual care (adjusted odds ratio [aOR] 1.23 [95% confidence interval [CI] 1.18‐1.29] and 1.29 [1.21‐1.36]). Fewer primiparous CP women used pain relief during labor (0.56 [0.43‐0.73]), and they initiated breastfeeding more often (1.74 [1.15‐2.62]). Women participating in CP were more likely to feel that their wishes with respect to medication use (69.1% vs 54.4%, P = 0.039), physical activities (72.8% vs 52.5%, P = 0.008), and relaxation exercises (67.9% vs 35.6%, P ≤ 0.001) were listened to by care providers. They also felt more supported to actively participate in their care (89.6% vs 68.5%, P = 0.001) and felt more able to voice opinions about care (92.7% vs 73.9%, P = 0.002). Conclusions: The CP model is a good approach aligning with Dutch policy calling for women‐centered care and responding to the needs of pregnant women. This study supports CP scale‐up in The Netherlands and adds to the pool of international knowledge about CP implementation. [ABSTRACT FROM AUTHOR]

Background: Late language emergence is a risk indicator for developmental language disorder. Parent‐implemented early language intervention programmes (parent programmes) have been shown to have positive effects on children's receptive and expressive language skills. However, long‐term effectiveness has rarely been studied. Additionally, little is known about which strategies parents learn to use after participating in parent programmes and whether this affects their child's language development. Aims: To evaluate medium‐ and long‐term effectiveness (1 and 2 years after inclusion) of a low‐dosage parent programme in a sample of late talkers (LTs) with an expressive language delay. Specifically, we investigated which strategies the parents learned to use in interaction with their child and which strategies were associated with child language growth over time. Methods & Procedures: This quasi‐experimental study with a longitudinal design included 24‐month‐old LTs. After the pre‐test, parents of children in the intervention group received a parent programme (n = 30), while parents of children in the comparison group received care as usual (n = 30). Children's language development was assessed using standardized language tests at pre‐test and two follow‐up tests at 36 and 48 months of age. Change in parental communicative behaviour was measured by a parent–child interaction observation measure, at pre‐test and follow‐up at 36 months of age. Outcomes & Results: At 36 months old, children in the parent programme group showed a significantly higher growth in expressive vocabulary than children in the comparison group. However, differences between the groups were not seen in the long‐term, at the 48‐month follow‐up. In contrast to parents in the comparison group, parents in the parent programme group changed their communicative behaviour positively in two domains: Interaction and Pressure on the child. However, no changes in the domains of Language Stimulation and Responsiveness were observed. Children's growth in expressive vocabulary and expressive syntax was associated with a decrease in the domain of Pressure. Conclusions & Implications: At 4 years of age, the majority of children in both groups achieved expressive vocabulary scores within the normal range. However, the mean score for expressive syntax in both groups remained below that of their peers, and 29% of the children still had expressive language scores below the mean range. Ongoing monitoring of LTs' language development is necessary in order to make decisions regarding the timing and nature of intervention. [ABSTRACT FROM AUTHOR]

This study investigated the effect of a touch‐typing course on the spelling and narrative‐writing skills on the computer of elementary school students. Data of 207 students in Grades 4, 5, and 6 were analysed using a pretest–posttest design. Students in the experimental group (n = 154) followed a touch‐typing course, and those in the control group (n = 53) did not. The experimental group showed more progress in typing, spelling, and narrative‐writing skills on the computer than the control group. It can be concluded that the touch‐typing course had a positive effect, not only on typing skills but also on spelling and narrative‐writing skills on the computer. Lay Description: What is known Typing skills are important for the quality of the typewritten text output.In touch‐typing with automaticity of transcription, workting‐memory load is decreased.Studies on the effect of a touch‐typing course are rare. What this paper adds This study investigated the effect of a touch‐typing course on spelling and narrative writing.We used a design with an experimental (with typing‐course) and a control group (no course)The experimental group showed more improvement in typing, spelling and narrative writing. Implications for practitioners It is important for the quality of student's text output to learn how to touch‐typeTouch‐typing can be learned in a teacher-directed course, containing 15 training sessions of 1.5 hours eachPractice of 20 minutes a day is necessary [ABSTRACT FROM AUTHOR]

Task solving processes and changes in these processes have long been expected to provide valuable information about children's performance in school. This article used electronic tangibles (concrete materials that can be physically manipulated) and a dynamic testing format (pretest, training, and posttest) to investigate children's task solving processes and changes in these processes as a result of training. We also evaluated the value of process information for the prediction of school results. Participants were N = 253 children with a mean age of 7.8 years. Half of them received a graduated prompts training; the other half received repeated practice only. Three process measures were used: grouping behaviour, verbalized strategies, and completion time. Different measures showed different effects of training, with verbalized strategies showing the largest difference on the posttest between trained and untrained children. Although process measures were related to performance on our dynamic task and to math and reading performance in school, the amount of help provided during training provided the most predictive value to school results. We concluded that children's task solving processes provide valuable information, but the interpretation requires more research. Lay Description: What is already known about this topic: Dynamic testing provides information on a child's ability to learn.Solving process information provides indications for intervention.Computerized testing can be of great help in recording process information. What this paper adds: Process‐oriented dynamic testing provides explanatory information beyond traditional tests.The use of a tangible user interface (TUI) console uncovers valuable information on solving processes.Process measures are related to series completion performance, math, and reading.Need for instruction is the best predictor of math and reading ability.Implications for practice and/or policy: A framework for interpreting process information is necessary in dynamic testing.Process‐oriented dynamic testing may be more suitable to inform education.TUIs provide a more natural testing environment. [ABSTRACT FROM AUTHOR]

This study assessed if staff members of two juvenile justice institutions in the Netherlands were able to motivate parents to participate in a programme of Family‐centred Care. For research purposes, parents were considered to participate if they (a) attended the family meeting, (b) visited their son during regular visiting hours, and (c) participated in measurements. Study participants were the parents of 139 short‐term detained male adolescents. The family meeting was attended by 47% of the parents, most adolescents (74.1%) were visited at least once by their parents, and 42% of the parents participated in measurements. Several factors influenced the parental participation rate variables, although effect sizes were small. The more parenting problems parents faced, the less likely they were to attend the family meeting. Parents with a job visited their son more often than unemployed parents. Finally, a longer stay of the adolescent and Dutch ethnicity predicted more parental participation in measurements. Our study showed that parental participation is feasible. However, the participation rates in the two years after the first steps of implementation were eligible for improvement. More implementation experience where staff could fully benefit from training and coaching in family‐centred work could substantially increase parental participation rates. [ABSTRACT FROM AUTHOR]

Background: Most young carer studies on parentification, resilience and coping concentrated on child carers up to age 18 years, whereas the group of young adult caregivers (18–24 years) has been neglected. In our study, we focused on these young adult caregivers, who are in a life phase in which young people usually are distancing themselves from their families and are striving for autonomy and freedom. Aim: To explore young adult carers' perceptions of parentification, resilience and coping compared to young adult noncarers. Design: Cross‐sectional. Methods: In 2014/2015, data were collected on 297 healthcare students from a school for vocational education and a university in the Netherlands. A fully structured questionnaire was used. Young adult carers were compared with young adult noncarers on parentification, resilience and coping. Results: Fifty‐six students identified themselves as a carer: 40 vocational education students and 16 university students. Carers scored significantly higher than noncarers on three out of six parentification dimensions. No differences were found for resilience and problem‐focused coping behaviour, whereas results for emotion‐focused coping demonstrated a higher score for the carers compared to the noncarers. Conclusion: Although it is important to take care of the needs of all young carers, special attention should be given to those who are at the start of their adult lives, undergoing extensive changes and taking major decisions on study and career issues. Home‐care professionals and school counsellors should be able to recognise this group and their needs and activate support from specialised services and significant others. [ABSTRACT FROM AUTHOR]

Although parental problems and poor parenting are commonly associated with adolescents' admission to secure residential care, few studies examined these parental characteristics. This study aims to identify parental problems and strengths and their association with parenting styles for 64 of these parents. We assessed perspectives of both adolescents and their parent figures shortly after admission. Parents often report high levels of psychopathology for both mothers and fathers, respectively, including depression (54.7% and 39.1%), anxiety (29.7% and 12.5%), substance dependence (14.1% and 26.6%), antisocial behaviour (1.6% and 21.1%), and psychosis (11.0% and 9.4%). Parents also report high parenting stress specifically related to the behaviour of their child. In contrast to our expectations, most parents experience a high quality of life. Living in a 1‐parent family, being unemployed and having debts are most frequently mentioned risk factor combinations. We found limited support for the hypothesis that parents with more risk and less protective factors show poorer parenting. Parents with more psychopathology and parenting stress do show poorer parenting than parents without these problems. Based on our findings, we describe several implications for engaging and supporting parents of adolescents in secure residential care. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effectiveness of advance care planning (ACP) in frail older adults. Design: Cluster randomized controlled trial. Setting: Residential care homes in the Netherlands (N=16). Participants: Care home residents and community‐dwelling adults receiving home care (N=201; n=101 intervention; n=100 control). Participants were 75 years and older, frail, and capable of consenting to participation. Intervention: Adjusted Respecting Choices ACP program. Measurements: The primary outcome was change in patient activation (Patient Activation Measure, PAM‐13) between baseline and 12‐month follow‐up. Secondary outcomes included change in quality of life (SF‐12), advance directive (AD) completion, and surrogate decision‐maker appointment. Use of medical care in the 12 months after inclusion was also assessed. Multilevel analyses were performed, controlling for clustering effects and differences in demographics. Results: Seventy‐seven intervention participants and 83 controls completed the follow‐up assessment. There were no statistically significant differences between the intervention (–0.26±11.2) and control group (–1.43±10.6) in change scores of the PAM (p=.43) or the SF‐12. Of intervention group participants, 93% completed an AD, and 94% appointed a decision‐maker. Of control participants, 34% completed an AD, and 67% appointed a decision‐maker (p<.001). No differences in the use of medical care were found. Conclusions: ACP did not increase levels of patient activation or quality of life but did increase completion of ADs and appointment of surrogate decision‐makers. It did not affect use of medical care. [ABSTRACT FROM AUTHOR]

The question remains whether wound swabs yield similar culture results to the traditional gold standard, biopsies. Swabs are not invasive and easy to perform. However, they are believed to capture microorganisms from the surface rather than microorganisms that have invaded tissue. Several studies compared swabs and biopsies using different populations and sampling methods, complicating the ability to draw conclusions for clinical practice. This study aimed to compare swab and biopsy in clinical practice, by including a variety of wounds and using standard sampling and culture procedures. Swabs (Levine technique) and biopsies were taken for microbiological culture in a standardized manner from the same location of one wound for each patient. Statistical analyses were performed to determine overall agreement, and observed agreement and kappa for specific microorganisms. A variety of wounds of 180 patients from different healthcare facilities in The Netherlands were included. Skin flora was more frequently cultured from swabs, resulting in similar recovery rates when excluding skin flora (1.34 vs 1.35). Swabs were able to identify all microorganisms cultured from biopsies in 131 wounds (72.8%) wounds. Most frequently identified organisms were Staphylococcus aureus, Pseudomonas aeruginosa, and beta‐haemolytic streptococci species. Observed agreement and kappa for these organisms varied between 87.2 and 97.8% and 0.73 and 0.85, respectively. This study demonstrates that swabs and biopsies tend to yield the same culture results when taken from the same location. For frequently occurring microorganisms, agreement between the two methods was even higher. Therefore, there seems to be no direct need for invasive biopsy in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Background and Purpose: Physiotherapy (PT) and occupational therapy (OT) are key professions providing treatment for the arm after stroke; however, knowledge about the content of these treatments is scant. Detailed data are needed to replicate interventions, evaluate their effective components, and evaluate PT and OT practice. This paper describes PT and OT treatment for the severely affected arm in terms of duration, content according to components and categories of the International Classification of Human Functioning, Disability and Health, and to analyze differences between professions. Methods: Design: This is a retrospective analysis of randomized trial data. Participants: 46 patients after stroke with poor arm motor control recruited from inpatient neurological units from three rehabilitation centers in the Netherlands. Procedure: PTs and OTs recorded duration and content of arm treatment interventions for 8 weeks using a bespoke treatment schedule with 15 International Classification of Human Functioning, Disability and Health categories. Results: PTs and OTs spent on average 4–7 min per treatment session (30 min) on arm treatment. OTs spent significantly more time providing arm treatment and treatment at the activities level than PTs. PTs spent 79% of their arm treatment time on body functions, OTs 41%. OTs spent significantly more time on “moving around using transportation,” “self care,” and “household tasks” categories. Conclusions: Patients after stroke with a severely affected arm and an unfavorable prognosis for arm motor recovery receive little arm‐oriented PT and OT. Therapists spent most arm treatment time on body functions. There was a considerable overlap in the content of PT and OT in 12 of the 15 categories. Results can be generalized only to patients with poor arm motor control and may not represent practice in other countries. [ABSTRACT FROM AUTHOR]

Background Patient-reported outcome measures ( PROMs) are increasingly used to establish the value of health care. In order to reflect value, PROMs should measure outcomes that matter to patients. However, patients are not always involved in the development of PROMs. This study therefore aimed to investigate whether PROMs, which were developed without patient involvement, are relevant to patients and whether the level of importance allocated towards aspects of these PROMs varies between patient groups. Methods All patients from 20 Dutch hospitals undergoing hip or knee surgery in 2014 were invited to a PROMs survey. Participants were asked to rate the importance of each of the items in the HOOS-Physical Function Short form or the KOOS-Physical Function Short form, the EQ-5D and the NRS pain. Results Most outcomes were considered important. However, 77.7% of hip surgery patients rated being able to run as unimportant. Being able to kneel (32.7%) or squat (39.6%) was not important to a considerable minority of knee surgery patients. Pain, especially during rest, was considered very important by both hip (68.2%) and knee (66.5%) surgery patients. Patients who were older, male, experienced overall bad health and psychological health considered many items from the PROMs less important than other patients. Discussion Patients differ in what they consider important. Health-care professionals should explore patients' preferences and discuss which treatment options best fit patients' preferences. Additionally, if PROMs are used in performance measurement, further research is needed to look at whether and how variation in patient preferences can be taken into account. [ABSTRACT FROM AUTHOR]

Background Rinsing with the combined use of an oxygenating-agent (OA) and chlorhexidine (CHX) in addition to mechanical oral hygiene could improve and/or maintain good gingival health over a long period. Methods This study had an examiner-blinded, randomized, six-group parallel design consisting of two-phases: a 3-week treatment phase and a subsequent 12-month experimental phase. A total of 267 subjects in good general health (≥18 years), without periodontitis, with at least five teeth per quadrant, and with moderate to advanced gingivitis were enrolled. A 3-week treatment phase was initiated to improve gingival health. Subjects were assigned to one of the six groups: two basic oral hygiene groups (Control I & II), one professional oral hygiene instruction group (OHI), one professional prophylaxis group (PP), an OA&CHX rinse group and a group receiving a combination of all regimens (COMBI group), being OHI + PP + OA&CHX. Dental plaque, gingival bleeding and staining assessments were performed at the start of the treatment phase, at baseline and at 4, 7, 10, and 12 months. Results There was a significant reduction in dental plaque-scores for the OA&CHX and COMBI-group (0.51 [SD = 0.37], 0.38 [SD = 0.33] respectively) and a significant reduction in gingivitis scores for the OA&CHX and COMBI group (6.9% [SD = 14.0], 13.4% [SD = 13.4] respectively) from the start of the treatment phase to baseline. No clinically relevant changes were observed for the other four groups. After baseline, bleeding and plaque-scores increased back to a non-significant level between groups, and this level remained throughout the study. Conclusion OA&CHX and COMBI-group showed a clinically relevant improvement after the treatment phase in terms of dental plaque and gingival bleeding levels. At the 4-month clinical assessment, there was no longer a significant difference between groups. [ABSTRACT FROM AUTHOR]