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Purpose: Researchers who work in partnership with older adults in participatory studies often experience various advantages, but also complex ethical questions or even encounter obstacles during the research process. This paper aims to provide insights into the value of an intersectional lens in participatory research to understand how power plays out within a mixed research team of academic and community co-researchers. Design/methodology/approach: Four academic researchers reflected in a case-study approach in a dialogical way on two critical case examples with the most learning potential by written dialogical and via face-to-face meetings in duos or trios. This study used an intersectionality-informed analysis. Findings: This study shows that the intersectional lens helped the authors to understand the interactions of key players in the study and their different social locations. Intersections of age, gender, ethnicity/class and professional status stood out as categories in conflict. In hindsight, forms of privilege and oppression became more apparent. The authors also understood that they reproduced traditional power dynamics within the group of co-researchers and between academic and community co-researchers that did not match their mission for horizontal relations. This study showed that academics, although they wanted to work toward social inclusion and equality, were bystanders and people who reproduced power relations at several crucial moments. This was disempowering for certain older individuals and social groups and marginalized their voices and interests. Originality/value: Till now, not many scholars wrote in-depth about race- and age-related tensions in partnerships in participatory action research or related approaches, especially not about tensions in research with older people. [ABSTRACT FROM AUTHOR]

According to self-determination theory, individual well-being is universally dependent upon the satisfaction of three basic psychological needs: autonomy, competence and relatedness. This study set out to further elucidate the relationship between basic psychological need satisfaction (BPNS) and well-being across age by (i) more closely examining the age distribution of BPNS, and (ii) investigating whether BPNS is comparably associated with well-being across all ages, as predicted by the universality assumption, while taking into account variability in other demographic factors. A general population sample of Dutch speaking adults from The Netherlands and Belgium (N = 1709; Mage = 48.6 years, SD = 19.0, range 18–97) filled out a cross-sectional online or paper-and-pencil survey questionnaire, providing self-reports of BPNS and well-being, using the Basic Psychological Need Satisfaction and Frustration Scale and Mental Health Continuum-Short Form, respectively. Data analyses consisted of initial visual inspection using LOESS smoothed curve plotting, and subsequent model testing using multiple regression analyses. When correcting for other demographic factors, results showed a positive linear relationship between age and autonomy satisfaction, no significant relationship between age and competence satisfaction, and a slight positive cubic relationship between age and relatedness satisfaction (initial 'peak', followed by a slight decline and 'dip', and steady rise for later ages). All basic psychological needs factors were positively linked to well-being in all domains, with associations generally comparable between adults of different ages, thus lending support to the universality assumption of self-determination theory. Despite distinct age distributions, all three basic psychological needs seem important for maintaining a sense of well-being throughout life. [ABSTRACT FROM AUTHOR]

Background: Early detection and remediation of language disorders are important in helping children to establish appropriate communicative and social behaviour and acquire additional information about the world through the use of language. In the Netherlands, children with (a suspicion of) language disorders are referred to speech and hearing centres for multidisciplinary assessment. Reliable data are needed on the nature of language disorders, as well as the age and source of referral, and the effects of cultural and socioeconomic profiles of the population served in order to plan speech and language therapy service provision. Aims: To provide a detailed description of caseload characteristics of children referred with a possible language disorder by generating more understanding of factors that might influence early identification. Methods & Procedures: A database of 11,450 children was analysed consisting of data on children, aged 2–7 years (70% boys, 30% girls), visiting Dutch speech and hearing centres. The factors analysed were age of referral, ratio of boys to girls, mono‐ and bilingualism, nature of the language delay, and language profile of the children. Outcomes & Results: Results revealed an age bias in the referral of children with language disorders. On average, boys were referred 5 months earlier than girls, and monolingual children were referred 3 months earlier than bilingual children. In addition, bilingual children seemed to have more complex problems at referral than monolingual children. They more often had both a disorder in both receptive and expressive language, and a language disorder with additional (developmental) problems. Conclusions & Implications: This study revealed a bias in age of referral of young children with language disorders. The results implicate the need for objective language screening instruments and the need to increase the awareness of staff in primary child healthcare of red flags in language development of girls and multilingual children aiming at earlier identification of language disorders in these children. What this paper addsWhat is already known on the subjectIdentifying language disorders before children enter school can foster the initiation of early interventions before these problems interfere with formal education and behavioural adjustment. Information on caseload characteristics is important to plan speech and language therapy service provision. There are only a few studies on the caseload characteristics of children at first referral for language assessment.What this paper adds to existing knowledgeThis study provides a detailed description of the caseload characteristics of children referred to Dutch speech and hearing centres. The results reveal an age bias in referral: boys were referred earlier than girls, and monolingual children were revealed earlier than bilingual children. On top of that, bilingual children seemed to have more complex problems at referral.What are the potential or actual clinical implications of this work?This study indicates that it is important to be aware of bias in the age of referral of subgroups of children with language disorders. Solutions might be to implement a language screening instrument designed for use by non‐speech–language therapists, and training in early recognition of girls and multilingual children with (less complex) language disorders for health professionals in key positions in child healthcare. In addition, it might be worthwhile to assign speech and language therapists with diverse ethnic and language backgrounds and/or with experience with bilingual/cultural children in a regional mentoring function to support referral agents and parents. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: If women suffer from postpartum psychosis, treatment in a specialist facility like a psychiatric mother–baby unit is recommended and should focus on the maternal health, mother–baby outcomes and the care for the next of kin.The role of mental health nurses on a mother–baby unit is essential but challenging, given the complex problems and care needs of the patient, the baby and family members.To date, very little evidence about effective nursing interventions for patients with postpartum psychosis is available. What this paper adds to existing knowledge: This paper systematically describes nursing interventions and their rationale for patients with postpartum psychosis admitted to a specialized mother–baby unit.Given the limited scientific evidence for effective nursing interventions for patients with postpartum psychosis, knowledge was obtained from a best‐practice setting (i.e., a specialized mother–baby unit), thus providing a basis for the systematic development of nursing interventions to be tested on effectiveness in future studies. Implications for mental health nursing: Mental health nurses play an essential role in the multidisciplinary treatment team in providing information on the patient's personal functioning and her ability to take care for the baby, in order to determine the appropriate amount of guidance and protection, in order to prevent harm and promote recovery.To provide integrated and personalized nursing care, mental health nurses should tailor their interventions to the needs of the patient, the baby and the next of kin, adapted to the successive stages of treatment. Introduction: Postpartum psychosis is one of the severest psychiatric disorders to occur in the postpartum period. If it requires a woman's admission, a psychiatric mother–baby unit is recommended, where care will focus on the mother's health, the mother–baby dyad and their next of kin. To date, few studies have examined nursing interventions for patients with postpartum psychosis. Aim: Identifying nursing interventions used at a psychiatric mother–baby unit, when a patient is hospitalized with postpartum psychosis. Method: A qualitative design using thematic analysis. Data were collected using semi‐structured interviews (N = 13) with expert nurses working at such a unit. Results: The analysis identified three themes: (a) treatment of the mental disorder, which involves interventions to improve the mother's mental and physical well‐being; (b) care for the mother–baby dyad, which involves interventions intended to promote safe interactions between mother and baby; and (c) care for the partner, which involves interventions to improve the partner's well‐being. Discussion: Overall, within each of these themes, nurses described the urgency to tailor interventions to the needs of the patient, baby and partner. Implications to practice: Our comprehensive description of interventions can be used for the improvement of nursing care for patients hospitalized with postpartum psychosis. [ABSTRACT FROM AUTHOR]

Purpose: Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach: The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings: Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications: These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value: The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders. [ABSTRACT FROM AUTHOR]

Childhood aggression and its resulting consequences inflict a huge burden on affected children, their relatives, teachers, peers and society as a whole. Aggression during childhood rarely occurs in isolation and is correlated with other symptoms of childhood psychopathology. In this paper, we aim to describe and improve the understanding of the co-occurrence of aggression with other forms of childhood psychopathology. We focus on the co-occurrence of aggression and other childhood behavioural and emotional problems, including other externalising problems, attention problems and anxiety-depression. The data were brought together within the EU-ACTION (Aggression in Children: unravelling gene-environment interplay to inform Treatment and InterventiON strategies) project. We analysed the co-occurrence of aggression and other childhood behavioural and emotional problems as a function of the child’s age (ages 3 through 16 years), gender, the person rating the behaviour (father, mother or self) and assessment instrument. The data came from six large population-based European cohort studies from the Netherlands (2x), the UK, Finland and Sweden (2x). Multiple assessment instruments, including the Child Behaviour Checklist (CBCL), the Strengths and Difficulties Questionnaire (SDQ) and Multidimensional Peer Nomination Inventory (MPNI), were used. There was a good representation of boys and girls in each age category, with data for 30,523 3- to 4-year-olds (49.5% boys), 20,958 5- to 6-year-olds (49.6% boys), 18,291 7- to 8-year-olds (49.0% boys), 27,218 9- to 10-year-olds (49.4% boys), 18,543 12- to 13-year-olds (48.9% boys) and 10,088 15- to 16-year-olds (46.6% boys). We replicated the well-established gender differences in average aggression scores at most ages for parental ratings. The gender differences decreased with age and were not present for self-reports. Aggression co-occurred with the majority of other behavioural and social problems, from both externalising and internalising domains. At each age, the co-occurrence was particularly prevalent for aggression and oppositional and ADHD-related problems, with correlations of around 0.5 in general. Aggression also showed substantial associations with anxiety-depression and other internalizing symptoms (correlations around 0.4). Co-occurrence for self-reported problems was somewhat higher than for parental reports, but we found neither rater differences, nor differences across assessment instruments in co-occurrence patterns. There were large similarities in co-occurrence patterns across the different European countries. Finally, co-occurrence was generally stable across age and sex, and if any change was observed, it indicated stronger correlations when children grew older. We present an online tool to visualise these associations as a function of rater, gender, instrument and cohort. In addition, we present a description of the full EU-ACTION projects, its first results and the future perspectives. [ABSTRACT FROM AUTHOR]

Background: The incidence of human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is increasing in high income countries. HPV-associated OPC generally presents as an invasive disease, often with lymph node involvement, in relatively young patients with minimal or no history of smoking and alcohol consumption. Knowledge on HPV-associated OPC among primary care professionals is essential for disease recognition and early start of treatment. Aim: To examine the knowledge on HPV-associated OPC among GPs in the Netherlands. Design & setting: A cross-sectional postal survey among GPs in the Netherlands. Method: A 12-item questionnaire was sent to 900 randomly selected general practices. Outcome measures included awareness of the link between HPV and OPC, epidemiological trends, and patient characteristics. Data were statistically analysed for sex, years after graduation, and self-rated knowledge of OPC. Results: A total of 207 GPs participated in this study. Seventy-two per cent recognised HPV as a risk factor for OPC and 76.3% were aware of the increasing incidence rate of HPV-associated OPC. In contrast, 35.7% of participants knew that patients with HPV-associated OPC are more often male, and just over half (53.6%) of the participants were aware of the younger age of these patients. Conclusion: More than one-quarter of GPs in the Netherlands are unaware of HPV as a causative factor for OPC. Furthermore, there is a gap in knowledge on characteristics of patients with HPV-associated OPC. Further training on these topics could improve disease recognition and, ultimately, patient survival. [ABSTRACT FROM AUTHOR]

The Eyberg Child Behavior Inventory (ECBI) is one of the most widely used and well-validated parent rating scales for children’s disruptive behavior. This screening instrument is a short, targetted and easy to implement inventory with good psychometric properties and is normed for different countries, among which the United States, Spain, Sweden and Norway. The ECBI has been successfully used for research and clinical purposes, in several countries including The Netherlands. To date, Dutch studies have relied on Scandinavian or US norm scores. However, this may be problematic because of cross-cultural differences in the degree to which certain behaviors are seen as problematic by parents. The main goal of this paper therefore was to obtain norm scores for The Netherlands among 6462 Dutch children aged 4 to 8 years (Mage = 6.37 years; SD = 1.32; 50.6% boys). In line with previous research, we found small differences on the mean sum scores across children of different ages (intensity scale) and gender (intensity and problem scale). Therefore, Dutch norm scores were provided age- and gender specific. Our results showed that disruptive behavior of children in the most rural areas was reported as occurring less frequently and was seen as less problematic by parents compared to the disruptive behavior of children in less rural areas. Finally, we found that Dutch norm scores on the ECBI were significantly lower than US norm scores, and significantly higher on the intensity scale (but not the problem scale) than Norwegian and Swedish norm scores. [ABSTRACT FROM AUTHOR]

Summary: The FRAX tool has been calibrated to the entire Dutch population, using nationwide (hip) fracture incidence rates and mortality statistics from the Netherlands. Data used for the Dutch model are described in this paper. Introduction: Risk communication and decision making about whether or not to treat with anti-osteoporotic drugs with the use of T-scores are often unclear for patients. The recently developed FRAX models use easily obtainable clinical risk factors to estimate an individual's 10-year probability of a major osteoporotic fracture and hip fracture that is useful for risk communication and subsequent decision making in clinical practice. As of July 1, 2010, the tool has been calibrated to the total Dutch population. This paper describes the data used to develop the current Dutch FRAX model and illustrates its features compared to other countries. Methods: Age- and sex-stratified hip fracture incidence rates (LMR database) and mortality rates (Dutch national mortality statistics) for 2004 and 2005 were extracted from Dutch nationwide databases (patients aged 50+ years). For other major fractures, Dutch incidence rates were imputed, using Swedish ratios for hip to osteoporotic fracture (upper arm, wrist, hip, and clinically symptomatic vertebral) probabilities (age- and gender-stratified). The FRAX tool takes into account age, sex, body mass index (BMI), presence of clinical risk factors, and bone mineral density (BMD). Results: Fracture incidence rates increased with increasing age: for hip fracture, incidence rates were lowest among Dutch patients aged 50-54 years (per 10,000 inhabitants: 2.3 for men, 2.1 for women) and highest among the oldest subjects (95-99 years; 169 of 10,000 for men, 267 of 10,000 for women). Ten-year probability of hip or major osteoporotic fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age, and a decreased BMD T-score. Parental hip fracture accounted for the greatest increase in 10-year fracture probability. Conclusion: The Dutch FRAX tool is the first fracture prediction model that has been calibrated to the total Dutch population, using nationwide incidence rates for hip fracture and mortality rates. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Dutch FRAX tool a good candidate for implementation into clinical practice. [ABSTRACT FROM AUTHOR]

This article enquires about why some countries have specialised their further education provision more than others, focusing on three types of specialisation: by subject, by geographical area and by age group. The article proposes an analytical framework to understand the drivers for further education provider specialisation, based on four variables: inputs to the further education system, regulatory framework, demand and supporting clusters. It then applies this framework to review the experience of Germany, New Zealand and the Netherlands in recent years. Drawing on this review, the last section of the paper provides some lessons for England and issues for further debate. It is concluded that the model proposed helps to explain the evolution of provider specialisation in the countries covered and that the UK's current specialisation profile suggests that greater efforts should be made to increase geographical specialisation, whereas action in stimulating further specialisation by subject and age group should be subject to caveats. [ABSTRACT FROM AUTHOR]

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole. [ABSTRACT FROM AUTHOR]

Background: A pragmatic, stepped wedge trial design can be an appealing design to evaluate complex interventions in real-life settings. However, there are certain pitfalls that need to be considered. This paper reports on the experiences and lessons learned from the conduct of a cluster randomized, stepped wedge trial evaluating the effect of the Hospital Elder Life Program (HELP) in a Dutch hospital setting to prevent older patients from developing delirium.Methods: We evaluated our trial which was conducted in eight departments in two hospitals in hospitalized patients aged 70 years or older who were at risk for delirium by reflecting on the assumptions that we had and on what we intended to accomplish when we started, as compared to what we actually realized in the different phases of our study. Lessons learned on the design, the timeline, the enrollment of eligible patients and the use of routinely collected data are provided accompanied by recommendations to address challenges.Results: The start of the trial was delayed which caused subsequent time schedule problems. The requirement for individual informed consent for a quality improvement project made the inclusion more prone to selection bias. Most units experienced major difficulties in including patients, leading to excluding two of the eight units from participation. This resulted in failing to include a similar number of patients in the control condition versus the intervention condition. Data on outcomes routinely collected in the electronic patient records were not accessible during the study, and appeared to be often missing during analyses.Conclusions: The stepped wedge, cluster randomized trial poses specific risks in the design and execution of research in real-life settings of which researchers should be aware to prevent negative consequences impacting the validity of their results. Valid conclusions on the effectiveness of the HELP in the Dutch hospital setting are hampered by the limited quantity and quality of routine clinical data in our pragmatic trial. Executing a stepped wedge design in a daily practice setting using routinely collected data requires specific attention to ethical review, flexibility, a spacious time schedule, the availability of substantial capacity in the research team and early checks on the data availability and quality.Trial Registration: Netherlands Trial Register, identifier: NTR3842 . Registered on 24 January 2013. [ABSTRACT FROM AUTHOR]

Introduction:Elderly alcohol dependent patients can be discriminated based on the age of onset of alcohol use. This is relevant for their clinical problem presentation and for the course of treatment. Materials and methods:In this paper, problems of elderly patients are presented at intake in an addiction treatment center, based on the most recent, almost nationwide applied intake instrument in The Netherlands: the MATE. Prevalences are analyzed for substance use, psychiatric and somatic co-morbidity, level and severity of dependence, limitations in daily functioning, craving, and perceived levels of depression, anxiety and stress. Among a total of 1942 alcohol dependent patients, four subpopulations were compared in the analyses: adults (24–55 years), elderly patients (≥ 55 years) with early (early-onset alcohol dependence (EOAD), < 25 years), middle (medium-onset alcohol dependence (MOAD), 25–45 years) and late (late-onset alcohol dependence (LOAD),  > 45 years) onset alcohol dependence. Results:Results show that LOAD has less problem severity in almost all assessment areas than adults. They do however use 3.5 times more often medication for physical illnesses, and suffer more often from confusion and somatic diseases. LOAD is not different from EOAD and MOAD. Conclusion:The results show that LOAD in a relatively short time period developed an alcohol dependence and alcohol related problems that are similar to that of their peers who used alcohol for a much longer time. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders (CMD) are highly prevalent among sick-listed precarious workers and often lead to long-term sickness-absence, work disability and unemployment. This study aimed to identify predictors of a longer time until return to work (RTW) and prolonged duration of sickness absence in sick-listed precarious workers with CMD. Methods: We conducted a secondary Cox regression analysis using existing data from two Dutch randomized controlled trials and one cohort study among sick-listed precarious workers with CMD (N = 681). Age, gender, baseline employment status, study allocation, severity of psychological symptoms and RTW self-efficacy were evaluated for their predictive value on time until sustainable (≥ 28 days) RTW and duration of sickness absence during 12-month follow-up. In this study, time until sustainable RTW and duration of sickness absence are distinct dependent variables, because they are not mutually exclusive. Results: Age above 50 years (HR 0.57, 95% CI 0.39–0.82), severe psychological symptoms (HR 0.64, 95% CI 0.43–0.93), unemployment (HR 0.19 95% CI 0.11–0.33) and loss of employment contract during sickness absence (HR 0.25, 95% CI 0.14–0.47) were predictive of a longer time until RTW. Male gender (HR 0.77, 95% CI 0.62–0.97), severe psychological symptoms (HR 0.64, 95% CI 0.46–0.87), unemployment (HR 0.47, 95% CI 0.27–0.84) and loss of employment contract (HR 0.48, 95% CI 0.26–0.90) predicted a prolonged duration of sickness absence. Conclusions: Unemployment at the moment of sick-listing, loss of employment contract during sickness absence, and severe psychological symptoms are predictors of both a longer time until RTW and prolonged duration of sickness absence among sick-listed precarious workers with CMD. This knowledge assists occupational health and mental health professionals in the early identification of workers at risk of long-term sickness absence, enabling them to arrange targeted occupational rehabilitation support and mental health care. Trial registration: The included randomized controlled trials were prospectively registered in the Dutch national trial register under NTR4190 (September 27, 2013) and NTR3563 (August 7, 2012). [ABSTRACT FROM AUTHOR]

Background: Approximately 20 % of children and adolescents who have sustained mild traumatic brain injuries may experience long-term consequences, including cognitive problems, post-traumatic stress symptoms and reduced load-bearing capacity. The underestimation and belated recognition of these long-term consequences may lead to chronic and disruptive problems, such as participation problems in school and in social relationships. The aim of this study is to examine the level of activities and participation of children and adolescents up to 6 months after a mild traumatic brain injury and to identify possible outcome predictors. Another aim is to investigate the effectiveness of an early psychoeducational intervention and compare the results with those obtained with usual care.Methods/design: This paper presents the Brains Ahead! study design, a randomised controlled trial nested within a multicentre, longitudinal, prospective cohort study. The eligible participants include children and adolescents between 6 and 18 years of age who have experienced a mild traumatic brain injury within the last 2 weeks. The cohort study will include 500 children and adolescents with a mild traumatic brain injury and their caregivers. A subset of 140 participants and their caregivers will be included in the randomised controlled trial. Participants in the randomised controlled trial will be randomly assigned to either the psychoeducational intervention group or the usual care control group. The psychoeducational intervention involves one face-to-face contact and one phone contact with the interventionist, during which the consequences of mild traumatic brain injury and advice for coping with these consequences to prevent long-term problems will be discussed. Information will be provided both verbally and in a booklet. The primary outcome domain is activities and participation, which will be evaluated using the Child and Adolescent Scale of Participation. Participants are evaluated 2 weeks, 3 months and 6 months after the mild traumatic brain injury.Discussion: The results of this study will provide insight into which children with mild traumatic brain injury are at risk for long-term participation problems and may benefit from a psychoeducational intervention.Trial Registration: Netherlands Trial Register identifier NTR5153 . Registered on 17 Apr 2015. [ABSTRACT FROM AUTHOR]

Purpose: Increasing age, high quadriceps strength, and low hamstring muscle strength are associated with hamstring strain injury in soccer. The authors investigated the age-related variation in maximal hamstring and quadriceps strength in male elite soccer players from under-13 (U-13) to the senior level. Methods: A total of 125 elite soccer players were included from a Danish professional soccer club and associated youth academy (first tier; U-13, n = 19; U-14, n = 16; U-15, n = 19; U-17, n = 24; U-19, n = 17; and senior, n = 30). Maximal voluntary isometric force was assessed for the hamstrings at 15° knee joint angle and for the quadriceps at 60° knee joint angle (0° = full extension) using an external-fixated handheld dynamometer. Hamstring-to-quadriceps strength (H:Q) ratio and hamstring and quadriceps maximal voluntary isometric force levels were compared across age groups (U-13 to senior). Results: Senior players showed 18% to 26% lower H:Q ratio compared with all younger age groups (P ≤.026). Specific H:Q ratios (mean [95% confidence interval]) were as follows: senior, 0.45 (0.42–0.48); U-19, 0.61 (0.55–0.66); U-17, 0.56 (0.51–0.60); U-15, 0.59 (0.54–0.64); U-14, 0.54 (0.50–0.59); and U-13, 0.57 (0.51–0.62). Hamstring strength increased from U-13 to U-19 with a significant drop from U-19 to the senior level (P =.048), whereas quadriceps strength increased gradually from U-13 to senior level. Conclusion: Elite senior soccer players demonstrate lower H:Q ratio compared with youth players, which is driven by lower hamstring strength at the senior level compared with the U-19 level combined with a higher quadriceps strength. This discrepancy in hamstring and quadriceps strength capacity may place senior-level players at increased risk of hamstring muscle strain injuries. [ABSTRACT FROM AUTHOR]

Aim: To describe a Delphi study regarding practice variation in needs assessment by Dutch home care nurses, to define practice variation in home care nursing and explore which factors may have a role in this needs assessment. Design: A Delphi study was conducted with the participation of home care representatives. Method: A Delphi questionnaire was developed, preceded by literature research and an expert meeting. The Delphi study took place between December 2020 and February 2021. The goal was to achieve a consensus level of at least 70%. Results: After three rounds, 32 experts reached a consensus about definitions regarding variation in needs assessment, warranted and unwarranted variation. In total, 59 factors were determined related to (1) the client and health, (2) the clients' context, (3) nurses and (4) the nurses' context. Thirty‐four factors scored warranted of influence and 18 (of 34) were client related. Most of the factors that scored unwarranted influencing needs assessment (17 of 26) were related to the home care nurses' context. Conclusion: Having a consensus about the definition of practice variation in needs assessment and possible influencing factors support the professionals to discuss and improve the unity and quality of their decision‐making process in home care. This may contribute to more righteous care for clients in need of home care. Impact: Since 2015, home care nurses in the Netherlands are responsible for determining the amount, type and duration of care for clients in need of home care. This so‐called needs assessment legitimizes the payment by health insurers. Signals of practice variation in needs assessment are heard in home care field. Although practice variation may be justified, it can lead to over or underuse of care, which may affect clients' outcomes. If we can identify influencing factors and find patterns that contribute to practice variation, we might gain a better understanding of the process and improve home care. Patient or public contribution: In this study, there was no patient or public involvement. Client representatives were included in this research as experts in the home care field, and they participated in three rounds of the Delphi study. They contributed by sharing their expert opinion on the definitions presented and the factors possibly influencing needs assessment. [ABSTRACT FROM AUTHOR]

To investigate the cross-national relevance of community health promotion, this paper compared community variation in alcohol use and risk and protective factors for adolescents in Australia (State of Victoria, 2009) and the Netherlands (2007/2008). Multi-level analyses examined community variation in heavy episodic (binge) alcohol use [≥5 drinks in a session ≥once in the prior fortnight (>63 ml of ethanol)] and associations with predictors. Representative community samples of adolescents (12–17 years) were recruited. The participants were 7812 students from 36 Australian communities and 15 082 adolescents from 124 Dutch communities. Predictors included adolescent reports of family, school, peer and neighbourhood environments and community predictors (rural, disadvantage). The overall prevalence of alcohol use prevalence was similar in both nations. Australia had higher use at younger ages and no difference between genders. In the Netherlands older adolescents and males used alcohol at significantly higher rates. Although individual predictors were mostly similar, binge drinking was more strongly associated with poor family management, friends' use of drugs and community disorganization in Australia. Significant community variation in adolescent heavy alcohol use was observed in both countries, but was higher in the Netherlands [inter class correlation 6.1%, (95% CI: 4.5–8.3%)] than Australia (ICC 2.4%, 1.3–4.5%). Youth from rural areas drank at a higher level, especially in the Netherlands. Targeting community level adolescent alcohol use appears feasible in both countries. Although behavioural patterns and risk and protective influences are similar in the Netherlands and Australia, important differences should be taken into account in tailoring community interventions. [ABSTRACT FROM AUTHOR]

Background Numerous papers have been published on the medium- and long-term results of hemiarthroplasties (HAs) after femoral neck fracture in the elderly. We were not aware of any articles that describe the outcome of HA until the patient dies. Methods Between 1975 and 1989, 307 bipolar hemiarthroplasties were performed in 302 consecutive patients with a displaced femoral neck facture. Patients with osteoarthritis of the hip, rheumatoid arthritis (RA), or senile dementia were not included in the study. All patients were followed annually until they died or until they needed a revision operation. Results The mortality rate was 28% after 1 year, and 63% after 5 years. The last patient who did not need a revision operation died in October 2010. Revision operations for aseptic loosening, protrusion, or both had to be performed in 34 patients (16%). A difference in reoperation rate was observed between patients less than 75 years of age (38%) and those who were older (6%). Interpretation Apart from age below 75 years, male sex appeared to be predictive of a revision operation. HA is a safe and relatively inexpensive treatment for patients over 75 years of age with a displaced femoral neck fracture. [ABSTRACT FROM AUTHOR]

The current paper investigated age-related differences in the relations of psychological contract breach with work outcomes over time. Based on affective events theory, we expected job satisfaction to mediate the longitudinal relationship of contract breach with changes in job performance. Moreover, based on socio-emotional selectivity theory, it was predicted that reactions to contract breach on job satisfaction and job performance would be stronger among younger workers than older workers. This two-wave panel study among 240 employees investigated interactions of age with psychological contract breach in relation to changes in job satisfaction and job performance over time. Moderated structural equation modeling showed that job satisfaction partially mediated the longitudinal relationships between contract breach and job performance. Moreover, the analyses supported socio-emotional selectivity theory; older workers reacted less intensely to psychological contract breach towards job satisfaction and job performance, indicating a general decreased responsiveness of older workers towards the psychological contract. It is concluded that age plays an important role in how contract breaches relate to changes in work outcomes over time. [ABSTRACT FROM AUTHOR]

Objective This paper examines the relationship between the amount of bicycle use and the number of single-bicycle crashes (ie, only one cyclist involved) in Dutch municipalities. Previous research has focused on crashes between bicycles and motor vehicles; however, most cyclists admitted to hospital are victims of single-bicycle crashes. Methods This correlational study used three data sets which included data relating to single-bicycle crashes and kilometres travelled by bicycle. Negative binomial regression was used to compare the amount of bicycling with the number of injuries incurred in single-bicycle crashes in Dutch municipalities. Results The likelihood of single-bicycle crashes varied inversely with the level of bicycle use. The exponent for the change in the number of single-bicycle crashes in response to changes in bicycle volumes was <1 in all analyses (ie, the increase in the number of single-bicycle crashes in a given municipality is proportionally less than the increase in the number of bicycle kilometres travelled by its inhabitants). The value was reduced in analyses of single-bicycle crashes with more severe injuries. Conclusions Cyclists are less likely to be involved in a severe single-bicycle crash in municipalities with a high amount of cycling. Given the large numbers of patients admitted to hospital as a result of single-bicycle crashes, it is important to include the risks of these in road safety and health effect evaluations, and to take into account the non-linearity of the relationship between single-bicycle crashes and bicycle use if road safety measures are to affect the level of bicycle use. [ABSTRACT FROM AUTHOR]

This paper has contributed to confirming the link between education and health in developed countries. The analysis is based on 11 European Union countries. We estimate country-specific health functions, where the dependent variable is self-reported health status and the education attainment is one of the main inputs. All eight waves (1994–2001) of the European Community Household Panel are deployed. A random effects ordered probit is estimated in order to control, to a given extent, for unobserved heterogeneity. Explanatory variables are both time invariant (education attainment and gender) and time varying (gross wages, hours of work, age and living alone). Results confirm the positive impact of secondary education on health in most cases and tertiary education in all cases, even after controlling for other inputs in the health function and taking unobserved heterogeneity into account. Secondary education has an impact on health in all countries in the sample except for The Netherlands and UK. The effect does not differ between secondary and tertiary education in France, Ireland and Greece. The correlation between education and health is interpreted in different but complementary ways by diverse approaches and we may not disentangle the precise mechanism that connects health with education from our results. Anyway, it seems clear that better coordination is needed between education and health policies to effectively improve health literacy. Other relevant results from our study are that women register poorer health than men, age contributes to worsening health status and wages contribute positively to health. [ABSTRACT FROM AUTHOR]

Background: Studies revealed unidirectional associations between frailty and medication‐related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi‐directional association between frailty and the risk of MRPs in community‐dwelling older adults in five European countries. Methods: Participants were 1785 older adults in the population‐based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one‐year follow‐up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross‐lagged panel modeling was used to assess bi‐directional associations. Results: The unidirectional association between frailty at baseline and the risk of MRPs at follow‐up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow‐up shows similar trends. The bi‐directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow‐up than reversed path (Wald test for comparing lagged effects: p < 0.05). Conclusion: This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways. [ABSTRACT FROM AUTHOR]

Aim. To measure how nurses' work engagement developed during the first three COVID-19 waves and to compare this with the data collected just before the outbreak. Background. The shortage of nurses is a threat to population health. COVID-19 posed nurses with personal and professional challenges that affected their work engagement. Insights into how the pandemic affected their work engagement may help hospitals retain and recruit nurses in the future. Methods. A single centre prospective survey study was conducted using the UWES-9. Results. In total, 1,697 nurses (90.5% female, mean age 41 years) completed four assessments. Each assessment showed a significant decrease in work engagement compared with that before COVID-19. Work engagement stabilized in the last two assessments. Conclusion. Work engagement decreased significantly compared with that in March 2020, just before the outbreak. Although the decrease stabilized from the 8th month to the 16th month, it did not return to pre-COVID-19 levels. Whether this stabilization was the beginning of a recovery in work engagement or reflected a permanent decline needs to be established. Implications for nursing management. Nurse leaders should facilitate nurses' self-regulation processes and encourage them to develop resources in order to maintain work engagement at a high level. [ABSTRACT FROM AUTHOR]

Background: Although risk factors for differences in SARS-CoV-2 infections between migrant and non-migrant populations in high income countries have been identified, their relative contributions to these SARS-CoV-2 infections, which could aid in the preparation for future viral pandemics, remain unknown. We investigated the relative contributions of pre-pandemic factors and intra-pandemic activities to differential SARS-CoV-2 infections in the Netherlands by migration background (Dutch, African Surinamese, South-Asian Surinamese, Ghanaians, Turkish, and Moroccan origin). Methods: We utilized pre-pandemic (2011–2015) and intra-pandemic (2020–2021) data from the HELIUS cohort, linked to SARS-CoV-2 PCR test results from Public Health Service of Amsterdam (GGD Amsterdam). Pre-pandemic factors included socio-demographic, medical, and lifestyle factors. Intra-pandemic activities included COVID-19 risk aggravating and mitigating activities such as physical distancing, use of face masks, and other similar activities. We calculated prevalence ratios (PRs) in the HELIUS population that was merged with GGD Amsterdam PCR test data using robust Poisson regression (SARS-CoV-2 PCR test result as outcome, migration background as predictor). We then obtained the distribution of migrant and non-migrant populations in Amsterdam as of January 2021 from Statistics Netherlands. The migrant populations included people who have migrated themselves as well as their offspring. We used PRs and the population distributions to calculate population attributable fractions (PAFs) using the standard formula. We used age and sex adjusted models to introduce pre-pandemic factors and intra-pandemic activities, noting the relative changes in PAFs. Results: From 20,359 eligible HELIUS participants, 8,595 were linked to GGD Amsterdam PCR test data and included in the study. Pre-pandemic socio-demographic factors (especially education, occupation, and household size) resulted in the largest changes in PAFs when introduced in age and sex adjusted models (up to 45%), followed by pre-pandemic lifestyle factors (up to 23%, especially alcohol consumption). Intra-pandemic activities resulted in the least changes in PAFs when introduced in age and sex adjusted models (up to 16%). Conclusion: Interventions that target pre-pandemic socio-economic status and other drivers of health inequalities between migrant and non-migrant populations are urgently needed at present to better prevent infection disparities in future viral pandemics. [ABSTRACT FROM AUTHOR]

Simple Summary: Up to 50% of patients diagnosed with advanced melanoma develop brain metastases during the course of their disease. The prognosis of melanoma patients is heavily affected by the presence of brain metastases. Unfortunately, there is a lack of data on prognostic factors for these patients. Many of these patients are treated with immune checkpoint inhibitors. Therefore, the aim of our study was to identify prognostic factors in melanoma patients with brain metastases treated with immune checkpoint inhibitors. In a population of 1278 advanced melanoma patients, we found that serum lactate dehydrogenase levels were the strongest clinical parameter associated with survival. This information is useful for both doctors and patients to provide more insight into patients' prognoses. The efficacy of immune checkpoint inhibitors (ICIs) in patients with advanced melanoma that develop brain metastases (BM) remains unpredictable. In this study, we aimed to identify prognostic factors in patients with melanoma BM who are treated with ICIs. Data from advanced melanoma patients with BM treated with ICIs in any line between 2013 and 2020 were obtained from the Dutch Melanoma Treatment Registry. Patients were included from the time of the treatment of BM with ICIs. Survival tree analysis was performed with clinicopathological parameters as potential classifiers and overall survival (OS) as the response variable. In total, 1278 patients were included. Most patients were treated with ipilimumab–nivolumab combination therapy (45%). The survival tree analysis resulted in 31 subgroups. The median OS ranged from 2.7 months to 35.7 months. The strongest clinical parameter associated with survival in advanced melanoma patients with BM was the serum lactate dehydrogenase (LDH) level. Patients with elevated LDH levels and symptomatic BM had the worst prognosis. The clinicopathological classifiers identified in this study can contribute to optimizing clinical studies and can aid doctors in giving an indication of the patients' survival based on their baseline and disease characteristics. [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]

Background: Patients over 70 years old represent a substantial proportion of the COVID‐19 ICU population and their mortality rates are high. The aim of this study is to describe the outcomes of patients ≥70 years old admitted to Dutch ICUs with COVID‐19, compared to patients ≥70 years old admitted to the ICU for bacterial and other viral pneumonias, with adjustments for age, comorbidities, severity of illness, and ICU occupancy rate. Methods: Retrospective cohort study including patients ≥70 years old admitted to Dutch ICUs, comparing patients admitted with COVID‐19 from March 1st 2020 to January 1st 2022 with patients ≥70 years old admitted because of a bacterial and other viral pneumonia, both divided in a historical (i.e., January 1st 2017 to January 1st 2020) and current cohort (i.e., March 1st 2020 to January 1st 2022). Primary outcome is hospital mortality. Results: 11,525 unique patients ≥70 years old admitted to Dutch ICUs were included; 5094 with COVID‐19, 5334 with a bacterial pneumonia, and 1312 with another viral pneumonia. ICU‐mortality and in‐hospital mortality rates of the patients ≥70 years old admitted with COVID‐19 were 39.7% and 47.6% respectively. ICU‐ and hospital mortality rates of the patients who were admitted in the same or in an historical time period with a bacterial pneumonia or other viral pneumonias were considerably lower (19.5% and 28.6% for patients with a bacterial pneumonia in the historical cohort and 19.1% and 28.8% in the same period, for the patients with other viral pneumonias 20.7% and 28.9%, and 22.7% and 31.8% respectively, all p < 0.001). Differences persisted after correction for several clinical characteristics and ICU occupancy rate. Conclusions: In ICU‐patients ≥70 years old, COVID‐19 is more severe compared to bacterial or viral pneumonia. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. Objective: Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0–34.9 kg/m2), class II (BMI 35.0–39.9 kg/m2), and class III (BMI >40.0 kg/m2)) amongst older nursing home residents in European countries. Methods: We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD‐10, and care dependency. Descriptive and logistic regression analyses were performed. Results: Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p =.006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p <.05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p <.05). Conclusions: This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. Implications for practice: The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents. [ABSTRACT FROM AUTHOR]

Objectives Life experiences that are complex, sustained, and intense, such as active participation in music and speaking multiple languages, have been suggested to contribute to maintaining or improving cognitive performance and mental health. The current study focuses on whether lifetime musical and multilingual experiences differentially relate to cognition and well-being in older adults, and tests whether there is a cumulative effect of both experiences. Methods A total of 11,335 older adults from the population-based Lifelines Cohort Study completed a musical and multilingual background and experience questionnaire. Latent class analysis was used to categorize individuals into subgroups according to their various musical and multilingual experiences resulting in a (1) nonmusical, low-multilingual group; (2) nonmusical, high-multilingual group; (3) musical, low-multilingual group; and (4) musical high-multilingual group. To determine whether the groups differed in terms of cognition or emotional affect, differences in Ruff Figural Fluency Test (RFFT) and Positive and Negative Affect Schedule scores were investigated by means of multinomial logistic regression analysis. Results Having high-multilingual, and not musical, experience was related to better RFFT performance compared to no experience, but not to more positive affect. Having both musical and high-multilingual experiences is related to better RFFT performance and more positive affect in advanced age compared to having only one experience or none. Importantly, these results were found independently of age, level of education, and socioeconomic status. Discussion Musical and multilingual experiences are related to healthy aging, especially when combined, which supports the suggestion that a broader spectrum of lifetime experiences relates to cognitive reserve. [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 evaluate the effect of incorporating calcium advice into early pregnancy counseling on calcium intake during pregnancy in the Netherlands. A multicenter prospective before-after cohort study was conducted introducing risk-based care including calculating individual pre-eclampsia risk. Part of the intervention was to incorporate calcium advice into routine counseling. We calculated individual daily calcium intake and adequacy of calcium intake (≥1,000 mg/day) at 16, 24 and 34 weeks of pregnancy. We performed a multiple logistic regression adjusting for covariates to identify any differences in the risk of inadequate calcium intake between RC and CAC. In regular care (RC, 2013–2015, n=2,477) 60% had inadequate calcium intake, compared to 49% during calcium advice care (CAC, 2017–2018, n=774) (aOR 0.75, 95% CI 0.64–0.88). Specific calcium supplements were used by 2% and 29% in RC and CAC, respectively (OR 25.1, 95% CI 17.8–36.0). Determinants of an inadequate calcium intake were lower age (aOR per additional year 0.96, 95% CI: 0.94–0.98), nulliparity (aOR 1.22, 95% CI: 1.03–1.45) and non-Caucasian origin (aOR 1.83, 95% CI 1.09–3.09). In CAC, risk of inadequate intake decreased with increasing predicted pre-eclampsia risk, which was a trend reversal compared to RC. Incorporating calcium advice into early pregnancy counseling was shown to lead to a decrease in the risk of inadequate calcium intake during pregnancy, but still inadequate intake in half of the women suggesting the need for further study on improving implementation. Awareness of individual increased PE risk had positive effect on calcium intake. [ABSTRACT FROM AUTHOR]

Background: Worldwide, the majority of total hip arthroplasties (THAs) placed in patients <55 years are uncemented. However, little is known about the preferred method of fixation in revision hip arthroplasty in young patients. The aim of this study was to assess potential differences in the method of fixation used between primary and revision THA in young patients using data from the Dutch Arthroplasty Register. Methods: All primary THA placed in patients younger than 55 years, registered in the LROI between 2007 and 2019 were included n = 28,516). Kaplan-Meier survival analyses were used to estimate the survival of primary THA by method of fixation. Additionally, survival of revision procedures that changed or did not change in method of fixation were estimated. McNemar's test was used to assess differences in the proportion of cemented and uncemented fixation between primary and revision THA. Results: In all acetabular revisions, the use of cemented fixation increased statistically significant with 39% (95% CI, 34–45, p < 0.001) from 23% in primary THA to 62% in revision procedures. In all femoral revisions, the increase of cemented fixation was also statistically significant with 25% (95% CI, 19–31, p < 0.001), from 11% in primary THA to 36% in revision surgery. For both revised acetabular and femoral components, we found no statistically significant difference in the 5-year survival between revision procedures that changed or did not change in method of fixation. Conclusions: There was a significant change towards cemented fixation between primary and revision THA in young patients in the Netherlands, which was especially pronounced in acetabular revisions. No significant difference in short-term survival was found between revision procedures that changed or did not change in method of fixation. Long-term follow-up data are needed to evaluate the effect of this change in fixation method on the outcome of revision procedures in young patients. [ABSTRACT FROM AUTHOR]

The Western homicide drop is a known fact, but the reasons behind the drop have so far mainly focused on macro explanations. In this study, we argue that to understand the homicide drop, it is necessary to first explore whether the drop is general or specific. We do this by examining the subtypes of homicide together with perpetrator and victim demographic characteristics. This study seeks to describe the nature and scope of homicidal violence in the period 1992–2016 in the Netherlands, disaggregating by subtype of homicide, and perpetrator and victim gender constellation and age. In doing so, we make use of the Dutch Homicide Monitor. Findings show that the Dutch homicide drop is significantly related to homicides resulting from disputes and robberies and intimate partner homicides. The gender constellation and age distribution in all homicide types are further explored. This study highlights the importance of disaggregating data by subtype in unravelling the homicide drop. [ABSTRACT FROM AUTHOR]

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

To date, virtually no studies have examined toddlers' non‐response in developmental tasks. This study investigates data from 3667 toddlers to address (1) whether two aspects of non‐response (completion and engagement) are separable, (2) how stable these aspects are from ages two to three, (3) how non‐response relates to background characteristics, and (4) whether non‐response at ages two and three predicts early academic skills at age six. Structural equation modelling shows that completion and engagement are separable constructs, relatively stable across age, and related to several background characteristics. Especially engagement predicts later academic performance. Results show that non‐response in behavioural tasks in toddlers is not random, increasing the likelihood of sampling bias and lack of generalizability in developmental studies. [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]

Purpose The decision whether to disclose mental illness at work can have important positive and negative consequences for sustainable employment and well-being. The aim of the study is (1) to examine workers' expectations of outcomes of mental illness disclosure in the workplace and to evaluate their expectations regarding which factors are of influence on these outcomes, (2) to identify distinct subgroups of workers, and (3) to characterize these subgroups in terms of personal, sociodemographic, and work-related characteristics. Methods In this cross-sectional survey study, a sample of 1224 Dutch workers was used. Latent Class Analysis (LCA) was used to identify classes of workers based on expected workplace mental illness outcomes. A three-step approach LCA was chosen to investigate whether the classes differed in characteristics. Results The majority of workers expected predominantly positive outcomes of workplace mental illness disclosure (e.g., being able to be one's authentic self; 82.4%), even though they simultaneously expected disclosure to lead to advancement-related discrimination (e.g., lower chances of contract renewal; or getting a promotion; 68.4% and 57%, respectively). Six distinct subgroups of workers were identified based on expected workplace mental illness disclosure outcomes: two positive classes (50.1%), two negative classes (33.3%), and two classes who indicated not to know what the outcomes would be (16.7%). Significant differences between the classes were found on personal experience, work-related association with mental illness, gender, educational level, and workplace atmosphere. Conclusion The disclosure process is complex, as most workers were optimistic (i.e., expected generally positive outcomes) whilst simultaneously expecting workplace discrimination. Subgroup differences in expectations regarding workplace mental illness disclosure outcomes were found. [ABSTRACT FROM AUTHOR]

There is a lack of evidence to guide district nurses in using nurse‐sensitive patient outcomes as it is unclear how these outcomes are currently used in daily district nursing practice. Therefore, we aimed to explore (1) which nurse‐sensitive patient outcomes are measured and how these outcomes are measured, (2) how district nurses use the outcomes to learn from and improve current practice and (3) the barriers and facilitators to using outcomes in current district nursing practice. An exploratory cross‐sectional survey study was conducted. The survey was distributed online among nurses working for various district nursing care organisations across the Netherlands. The responses from 132 nurses were analysed, demonstrating that different instruments or questionnaires are available and used in district nursing care as outcome measures. The nurse‐sensitive patient outcomes most often measured with validated instruments are pain using the Numeric Rating Scale or Visual Analogue Scale, delirium using the Delirium Observation Scale, weight loss using the Short Nutritional Assessment Questionnaire and caregiver burden using the Caregiver Strain Index or a Dutch equivalent. Falls and client satisfaction with delivered care are most often measured using unvalidated outcome measures. The other nurse‐sensitive outcomes are measured in different ways. Outcomes are measured, reported and fed back to the nursing team multiple times and in various ways to learn from and improve current practice. In general, nurses have a positive attitude towards using nurse‐sensitive outcomes in practice, but there is a lack of facilitation to support them. Because insight into how nurses can and should be supported is still lacking, exploring their needs in further research is desirable. Additionally, due to the high variation in the utilisation of outcomes in current practice, it is recommended to create more uniformity by developing (inter)national guidelines on using nurse‐sensitive patient outcomes in district nursing care. [ABSTRACT FROM AUTHOR]

More positive outcome expectations and illness perceptions are associated with better outcomes for patients with several osteoarthritic orthopedic conditions. However, it is unknown whether these factors also influence outcomes of non-operative treatment for first carpometacarpal osteoarthritis (CMC-1 OA). Therefore, we assess the role of pre-treatment outcome expectations and illness perceptions in reports of pain and hand function 3 months after non-operative treatment for CMC-1 OA. We conducted a cohort study with 219 patients treated non-operatively for CMC-1 OA between September 2017 and October 2018. Patients were included in the study if they completed measures of pain and hand function, illness perceptions (scale: 0–10), and expectations (scale: 3–27) as part of routine outcome measurements. Pain and hand function were measured before treatment and 3 months after starting treatment using the Dutch version of the Michigan Hand Outcomes Questionnaire. Multivariable linear regression analysis was used to assess the influence of outcome expectations and illness perceptions on pain and hand function. Both positive outcome expectations (B = 0.64; 95% CI [0.1–1.2]) and a better illness understanding (an illness perception subdomain; B = 1.53; 95% CI [0.2–2.9]) at baseline were associated with less pain at 3 months. For hand function, similar estimates were found. We found that positive outcome expectations and a better illness understanding, were associated with a better outcome of non-operative treatment for CMC-1 OA. Non-operative treatment can often be successful for patients with arthritis of the thumb. Outcome expectations and illness perceptions are associated with pain and hand function 3 months after non-operative treatment for thumb base osteoarthritis. Improving the outcome expectations and illness perceptions of patients through better education could improve the outcome of non-operative treatment. [ABSTRACT FROM AUTHOR]

Background: While consumption of alcohol does not often begin until early adolescence, young children are highly capable of internalizing normative information through observational learning. We used a longitudinal multiple‐informant family study to examine the impact of exposure to mothers' and fathers' drinking on young children's normative perceptions of who drinks alcohol. Methods: Three hundred twenty‐nine children (4 to 6 years old at baseline [Mage 4.78 (SD = 0.725)], 51% girls) completed the Dutch electronic appropriate beverage task [eABT] where they attributed alcoholic beverages to a variety of persons depicted in an illustrated scenario. Their parents completed an online survey that included information on alcohol use and exposure. Results: Children more frequently exposed to their mothers' drinking provided females shown in the eABT illustrations with alcohol significantly more often than children less frequently exposed to mothers' drinking. There was no effect of mother's exposure on providing males in the eABT with alcoholic beverages. Similarly, children more frequently exposed to their fathers' drinking provided fathers with alcoholic beverages significantly more often than children less frequently exposed to their fathers' drinking. There was no effect of father's exposure on providing the females with alcoholic beverages, nor was there an effect of father's exposure on providing "other males" with alcohol. These patterns held after adjusting for age and sex. Conclusions: This study demonstrates that there are gender‐specific effects of exposure to parents' (particularly mothers') drinking on young children's perceptions of person‐specific drinking norms. The findings provide unique evidence in a young population group of effects on an understudied dimension of alcohol‐related perceptions with implications for future drinking behavior. [ABSTRACT FROM AUTHOR]

This paper is the first to apply prospect theory to societal health-related decision making. In particular, we allow for utility curvature, equity weighting, sign-dependence, and loss aversion in choices concerning quality of life of other people. We find substantial inequity aversion, both for gains and losses, which can be attributed to both diminishing marginal utility and differential weighting of better-off and worse-off. There are also clear framing effects, which violate expected utility. Moreover, we observe loss aversion, indicating that subjects give more weight to one group's loss than another group's gain of the same absolute magnitude. We also elicited some information on the effect of the age of the studied group. The amount of inequity aversion is to some extent influenced by the age of the considered patients. In particular, more inequity aversion is observed for gains of older people than gains of younger people. [ABSTRACT FROM AUTHOR]

Purpose: How old are young people when they start having sex? Although this question is important for educators and policymakers, its answer can easily mislead due to methodology that does not take into account age-censoring and generational trends. This study investigated whether 1-year birth-year cohorts can be jointly modeled by Cox proportional hazards regression to estimate sexual debut ages and to investigate age trends for different sexual behaviors. Method: We used pooled data from three Dutch periodic population-based surveys, for which 33,377 participants, born between 1980 and 2004, completed an online questionnaire. Results: Cox proportional hazards regression is appropriate if hazard changes over birth years appear proportionally similar among ages. The Dutch data shows such hazard changes for petting, oral sex, and sexual intercourse, but not for masturbation, French kissing, or manual sex. For sexual intercourse, the Cox model estimates can be interpreted as an approximate linear increase of 1 month in the median sexual debut age per birth-year cohort, resulting in an estimated debut age of 18.17 years in the current (2020) generation of Dutch adolescents. Conclusion: If the assumptions are met, we recommend using the Cox regression modeling approach to estimate how old young people are when they start having sex, since this method yields precise and current debut ages by pooling information across birth-year cohorts without arbitrarily combining them in multiple-year groups. The age of first intercourse is increasing, so continuous sexuality education throughout high school is advisable, in addition to early sexuality education. [ABSTRACT FROM AUTHOR]

Background: Assisted human reproduction (AHR) treatment is not regulated in Ireland although it has been practiced since 1987. Thus, Ireland is one of the only European countries without any form of AHR specific regulation. This literature review research aimed to provide a comprehensive and comparative overview of AHR regulation and any associated literature to compare Ireland and other developed countries. Methods: Systematic searches were conducted in several databases (Google Scholar, Web of Science, MEDLINE, SCOPUS and official government websites) utilising search strings in relation to AHR legislation for each country under review. A final review of 155 research articles were eligible after screening related to legislation in each country for inclusion. The findings were synthesised and summarised by legislation in each country. Results: Different countries offer different levels of ART and IVF provision and services in terms of the type of services allowed, financial support, age, sex and eligibility of recipients. The UK's oversight legislation combined with the Netherlands financial legislation section provides as being most effective hybrid model of best practice for adoption in Ireland. Conclusions: This research concluded that there is no AHR legislation in any country that can be described as all-encompassing in terms of the services allowed, financial support and age of recipients. It was concluded that significant changes need to be made to the Irish draft legislation which is in limbo with the government for the last 3 years in order to meet Irish patient needs. Plain language summary: Ireland is one of the only European countries without any form of assisted human reproduction specific regulation. This research aimed to review of assisted human reproduction regulations to compare Ireland with other developed countries. There is no assisted reproduction legislation in any country that can be described as perfect. The UK's legislation combined with the Netherlands financial legislation section is concluded as being most effective hybrid model of best practice for adoption in Ireland. It was concluded that significant changes need to be made to the Irish draft legislation which is in limbo with the government for the last 3 years. [ABSTRACT FROM AUTHOR]

Introduction: To the best of our knowledge, there is a lack of reliable, validated, and standardized (Dutch) measuring instruments to document visual speech perception in a structured way. This study aimed to: (1) evaluate the effects of age, gender, and the used word list on visual speech perception examined by a first version of the Dutch Test for (Audio-)Visual Speech Perception on word level (TAUVIS-words) and (2) assess the internal reliability of the TAUVIS-words. Methods: Thirty-nine normal-hearing adults divided into the following 3 age categories were included: (1) younger adults, age 18–39 years; (2) middle-aged adults, age 40–59 years; and (3) older adults, age >60 years. The TAUVIS-words consist of 4 word lists, i.e., 2 monosyllabic word lists (MS 1 and MS 2) and 2 polysyllabic word lists (PS 1 and PS 2). A first exploration of the effects of age, gender, and test stimuli (i.e., the used word list) on visual speech perception was conducted using the TAUVIS-words. A mixed-design analysis of variance (ANOVA) was conducted to analyze the results statistically. Lastly, the internal reliability of the TAUVIS-words was assessed by calculating the Chronbach α. Results: The results revealed a significant effect of the used list. More specifically, the score for MS 1 was significantly better compared to that for PS 2, and the score for PS 1 was significantly better compared to that for PS 2. Furthermore, a significant main effect of gender was found. Women scored significantly better compared to men. The effect of age was not significant. The TAUVIS-word lists were found to have good internal reliability. Conclusion: This study was a first exploration of the effects of age, gender, and test stimuli on visual speech perception using the TAUVIS-words. Further research is necessary to optimize and validate the TAUVIS-words, making use of a larger study sample. [ABSTRACT FROM AUTHOR]

Aim: The aim of this qualitative study is to understand the research priorities of Dutch children with juvenile idiopathic arthritis (JIA) as well as researching how children can be involved. Background: Several health research agendas have successfully been developed with adults but rarely with children. Children are still seldom recognized as possessing credible knowledge about their own body and life. This research project with focus group discussions and interviews with children with juvenile idiopathic arthritis (JIA) was an innovative addition to a nationwide prioritization of research questions of patients with JIA, their carers and health care professionals, based on the James Lind Alliance (JLA) methodology. Results: Children with JIA appreciated being invited to give their opinion on JIA research prioritization as knowledgeable actors. They have clear views on what topics need most attention. They want more insight on how to medically and socially treat JIA so that they can better fulfil their aspirations at school, later in work and with their relationships. Conclusion: We have identified the Top 5 research priorities for children with JIA. Most priorities are unique and differ from the priorities of the adolescents and young adults, parents and healthcare professionals in the main JLA priority setting exercise. Ultimately, two of the children's priorities were included in the final JLA Top 10. [ABSTRACT FROM AUTHOR]

Few instruments have been developed that measure impairments in reciprocity, a defining feature of autism. We introduce a new test assessing the quality of reciprocal behaviour: the interactive drawing test (IDT). Children and adolescents (n = 49) with and without high functioning autism spectrum disorders (HFASD) were invited to collaborate with an experimenter in making a joint drawing. Within both groups the performance on collaborative reciprocity improved with age. However, compared to the control group, HFASD participants showed less collaborative and more basic reciprocal behaviour and preferred to draw their own objects. They were less tolerant of the experimenter's input as well. Performance on the IDT was independent of estimated verbal IQ. Reciprocal behaviour in self-initiated objects corresponded with more parental reported autistic traits, while reciprocal behaviour in other-initiated objects corresponded with less autistic traits. The findings of this study suggest that IDT is a promising instrument to assess reciprocity. [ABSTRACT FROM AUTHOR]

Abstract: Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981–2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology. [Copyright &y& Elsevier]

Background after hospitalisation for cardiac disease, older patients are at high risk of readmission and death. Objective the cardiac care bridge (CCB) transitional care programme evaluated the impact of combining case management, disease management and home-based cardiac rehabilitation (CR) on hospital readmission and mortality. Design single-blind, randomised clinical trial. Setting the trial was conducted in six hospitals in the Netherlands between June 2017 and March 2020. Community-based nurses and physical therapists continued care post-discharge. Subjects cardiac patients ≥ 70 years were eligible if they were at high risk of functional loss or if they had had an unplanned hospital admission in the previous 6 months. Methods the intervention group received a comprehensive geriatric assessment-based integrated care plan, a face-to-face handover with the community nurse before discharge and follow-up home visits. The community nurse collaborated with a pharmacist and participants received home-based CR from a physical therapist. The primary composite outcome was first all-cause unplanned readmission or mortality at 6 months. Results in total, 306 participants were included. Mean age was 82.4 (standard deviation 6.3), 58% had heart failure and 92% were acutely hospitalised. 67% of the intervention key-elements were delivered. The composite outcome incidence was 54.2% (83/153) in the intervention group and 47.7% (73/153) in the control group (risk differences 6.5% [95% confidence intervals, CI −4.7 to 18%], risk ratios 1.14 [95% CI 0.91–1.42], P  = 0.253). The study was discontinued prematurely due to implementation activities in usual care. Conclusion in high-risk older cardiac patients, the CCB programme did not reduce hospital readmission or mortality within 6 months. Trial registration Netherlands Trial Register 6,316, https://www.trialregister.nl/trial/6169 [ABSTRACT FROM AUTHOR]