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Introduction: Observational data are increasingly seen as a valuable source for integrated care research. Especially since the growing availability of routinely collected data and quasi-experimental methods. The aim of this paper is to describe the potentials and challenges when using observational data for integrated maternity care research, based on our experience from developing and working with the Data-InfrAstructure for ParEnts and childRen (DIAPER). Methods and Results: We provide a description of DIAPER, which is a linked datainfrastructure on the individual level based on maternity care claims data, quality and utilization of maternity care and data from municipal registries, covering the life course from preconception to adulthood. We then discuss potentials and practical applications of DIAPER such as to evaluate alternative payment models for integrated maternity care, to set the policy agenda regarding postpartum care, to provide insights into value of care and into provider variation, and to evaluate (policy) interventions designed to promote and support integrated maternity care. This is relevant for several stakeholders: policy makers, payers, providers and clients/patients. Based on experiences with DIAPER, we identify remaining challenges: missing data sources (especially self-reported outcomes), suboptimal quality of data, privacy concerns and potential biases introduced during data linkage, and describe how these challenges were tackled within the applications of DIAPER. Conclusions: With DIAPER we demonstrated that using observational data can be of added value for integrated care research, but also that challenges remain. It is essential to keep exploring and developing the possibilities of observational data and continue the discussions in the scientific community. Learning from each other's successes and failures will be critical. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to improve the general operationalization of an “active patient,” by examining the specific activities and skills expected of active patients. Design/methodology/approach – Expected activities and necessary skills were studied through a qualitative case study into the development and use of an assistive technology (i.e. web site) aimed at stimulating active patient-ship. Interviews, observations and document analysis were used to capture and explore designers’ inscribing practices and their consequences regarding expected competences and activities of patients using the web site. Findings – Designers inscribed two “co-design roles” that active patients were expected to perform on the web site (co-designing their own healthcare and co-designing the healthcare of peers), for which at least eight different competencies were needed. The absence of skills or facilities to apply these skills resulted in incomplete use, a different use than intended by designers and non-use of the web site. Practical implications – Technological choices and inscribing processes determine who is able or facilitated to become active and who is not. Due to inscribed co-design roles, it also influences the extent to which already active peers are able to perform health-related activities. Different users with different conditions should be taken into account in the design as specific group characteristics can influence level of individual activity. Originality/value – This study is, as far as the authors know, the first that examines the “active patient” concept by studying an assistive technology and using scripting literature, resulting in an improved understanding of what it means to become “active” in terms of skills and activities. [ABSTRACT FROM AUTHOR]

Maximum permissible concentrations for chemical elements in soils (MPCs) of Russia, Germany, Canada, the Netherlands and the USA are compared. In Russia, general sanitary, water-transferred and translocation MPCs are created; in Germany, general sanitary and translocation, and in the Netherlands, the USA and Canada, general sanitary. It is found that the Russian MPCs for total contents of chemical elements are adequate for Mn and V, American, for Co, Cu, and Pb; Dutch, for Pb and Zn; Canadian, for Ba, Co, Ni, Pb, V, and Zn, and German, for Cr, Ni, and Pb by taking into account the typical levels of elements in the background soils across the world. The methodologically closest Russian and Dutch standard rates of total contents of chemical elements are compared in this paper with the typical levels for background Retisols gleic, Phaeozems, and Chernozems in the center of Western Siberia. It is established that use of the Dutch MPCs for the soils under study gives fewer cases of false Pb pollution, but in all the soils under consideration the Dutch MPCs for Ba is exceeded. False pollution by total Zn is observed in the top-soil; by Cr, Cu and V, in subsoil horizons of Retisols gleic as well as by Cr, Ni and V, in most samples of Phaeozems and Chernozems. It is concluded that for the soils under consideration the utilization of Russian MPCs gives fewer cases of false pollution by V. But in the background Retisols gleic, Russian MPCs for Mn and Pb accumulated in the biogeochemical barrier in the top-soil horizons are exceeded. Russian MPCs for metal mobile fraction are the most correct for Co, Cr, Cu, Ni and Pb. The MPCs for mobile fraction of biogenic Mn and Zn are underestimated. Background levels (mg/kg in subindex) of total concentration (mobile fraction extracted by acetate-ammonium buffer) are proposed for Ba404–515, Co12–19(0.001–0.23), Cr143–188(0.001–0.72), Cu32–41(0.01–0.72), Mn423–874(0.09–64), Ni30–62(0.003–1.3), Pb18–27(0.003–0.87), V112–170 иZn55–104(0.004–0.42) in Retisols gleic on Tobol Upland, Phaeozems on Ishym Upland, and Chernozems in the Trans-Ural region. [ABSTRACT FROM AUTHOR]

Background. To date, there has been no attempt to describe or compare physical therapy as practiced globally, nor any evidence that an international data set exists to support this effort. It is known that research evidence can be used in strategic and tactical ways, especially within the highly politicized context of the policy arena. The International Private Practitioners Association recognized the potential value a global evidence base could have in influencing policy and supporting professional development in a number of countries, yet it lacked a mechanism to achieve these aims. Objectives. The purposes of this study were: (1) to identify and test an international data set, definitions, and means of data collection and (2) to establish views in relation to the value of international collaborations. Design. A mixed, prospective design was used in the study. Method. Phase 1 (2006-2007) involved the development of a data set, definitions, and Web-based and paper-based data collection options involving 98 physical therapists from 68 physical therapy practices in 7 countries. Phase 2 (2008-2009) involved testing of the data set in 34 practices involving 3,195 patient episodes and included physical therapist feedback of experience, local relevance of the data set, and value of international collaborations. Results. Testing confirmed the relevance and reliability of the data set and definitions and a preference for Web-based data collection (74.0%). Physical therapist feedback supported these findings. Most respondents (60.0%-100.0%) reported the value of further international collaborations for their profession nationally or internationally. Limitations. Although a true international collaboration, the limited sample size should be recognized. Conclusions. It is possible to develop an agreed-upon international data set and means of data collection. Testing appears to support its acceptability and relevance for use in practice. Participants highly valued the opportunity to undertake international collaborations that may benefit their profession nationally and internationally. Further testing and use of the data set are advocated before final validation is sought. [ABSTRACT FROM AUTHOR]

There is an increasing amount of research that investigates the needs and wishes of people with aphasia and their relatives with regards to improving the accessibility of communication with healthcare professionals (HCP). An important way to improve this is by training HCP to use supportive conversation techniques and tools. This study aimed to inform the development of such a training, by adding to previous findings in the literature regarding the experiences, needs and wishes of people with aphasia and their relatives. We were interested in their experiences with the accessibility of communication and support from HCP and how they believed this can be improved. An exploratory qualitative research design was chosen. Data was collected through qualitative semi-structured interviews with 20 people with aphasia and 12 relatives. The time post stroke ranged from 3 months to 41 years. Four themes described the data. According to people with aphasia and relatives (1) information transfer in healthcare settings and (2) the use of supported conversation techniques by HCP are inadequate, (3) there is a lack of shared decision-making in healthcare settings, and (4) support, guidance, counseling and education is mainly targeted at the person with aphasia. People with aphasia and relatives reported a variety of positive and negative experiences in all themes. Even though guidelines and interventions have been developed to improve healthcare for people with aphasia and their relatives, we found that people still encounter substantial challenges in access to- and provision of information, shared decision-making, support and communication with HCP. The findings in this study provide some important recommendations for improvement, including the improvement of transfer of information, shared decision-making and individual support for the relatives. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to a report of activities of daily living in the aged population.

Following the paradigm shift to recovery in the Anglophone world, recovery is also gaining momentum in drug policy and practice in Flanders (Belgium) and the Netherlands. Since the meaning of recovery is being debated internationally, broadening the assessment of how the recovery framework is applied in policy discourse and how it is implemented in various international contexts is imperative. This comparative policy analysis aims to assess similarities and differences in addiction recovery vision, implementation, and evaluation in Flanders and the Netherlands. The thematic analysis draws upon a triangulation of different data collection methods: a focus group (n = 14) and interviews (n = 21) with key figures in the addictions field, followed by analyses of relevant policy documents (n = 9). Our findings show that a holistic vision of addiction recovery is endorsed in both countries. Although differences in policy development occurred (i.e. centrally driven in Flanders versus 'bottom-up' in the Netherlands), similar challenges emerged concerning recovery-oriented addiction policies. While policymakers in Flanders and the addiction sector in the Netherlands strongly proclaim recovery, structural implementation, dedicated funding, and systematic evaluation of recovery-oriented policies are lacking. This study suggests that systematic inclusion of experts by experience and aligning government and practice level funding and policies are crucial. [ABSTRACT FROM AUTHOR]

In communities with an increased prevalence of hereditary deafness, social, and linguistic adaptations are found in response. Aulbers (1959) describes a high prevalence of deafness in a fishing village on the Dutch coast: Katwijk aan Zee. This article aims to assess the current prevalence of deafness in Katwijk, as well as the current sign language situation there. To this end, data were collected from various sources, including governmental studies on public health, archives, a genealogical database and interviews with deaf inhabitants of Katwijk. The various types of data confirm the presence of a higher prevalence of deafness in Katwijk that continues to date. Linguistic and anthropological research is needed to establish to what extent this has affected the experience and position of deaf people and their sign language usage in Katwijk. [ABSTRACT FROM AUTHOR]

This study focused on the degree of report bias in assessing autistic traits. Both parents of 124 preschoolers completed the Social Communication Questionnaire and the Autism-spectrum Quotient. Acceptable agreement existed between mother and father reports of children's mean scores of autistic traits, but interrater reliability for rank-order correlations was only fair. No evidence was found for report bias regarding parent-offspring autistic traits. However, adult autistic ratings were strongly biased: spouse-ratings were higher than self-ratings, correlations were only fair when both parents reported about the same person, and resemblance was higher for reports from the same person than for spouses' separate self-reports. It is advisable to involve multiple informants when assessing autistic traits, and to use procedural and/or statistical remedies to control for report bias. [ABSTRACT FROM AUTHOR]

The objective of the present study was to investigate the relationship between total and subtypes of bacterial fermented food intake (dairy products, cheese, vegetables and meat) and mortality due to all causes, total cancer and CVD. From the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort, 34 409 Dutch men and women, aged 20–70 years who were free from CVD or cancer at baseline, were included. Baseline intakes of total and subtypes of fermented foods were measured with a validated FFQ. Data on the incidence and causes of death were obtained from the national mortality register. Cox proportional hazards models were used to analyse mortality in relation to the quartiles of fermented food intake. After a mean follow-up of 15 (sd 2·5) years, 2436 deaths occurred (1216 from cancer and 727 from CVD). After adjustment for age, sex, total energy intake, physical activity, education level, hypertension, smoking habit, BMI, and intakes of fruit, vegetables and alcohol, total fermented food intake was not found to be associated with mortality due to all causes (hazard ratio upper v. lowest quartile (HRQ4 v. Q1) 1·00, 95 % CI 0·88, 1·13), cancer (HRQ4 v. Q1 1·02, 95 % CI 0·86, 1·21) or CVD (HRQ4 v. Q1 1·04, 95 % CI 0·83, 1·30). Bacterial fermented foods mainly consisted of fermented dairy foods (78 %) and cheese (16 %). None of the subtypes of fermented foods was consistently related to mortality, except for cheese which was moderately inversely associated with CVD mortality, and particularly stroke mortality (HRQ4 v. Q1 0·59, 95 % CI 0·38, 0·92, Ptrend= 0·046). In conclusion, the present study provides no strong evidence that intake of fermented foods, particularly fermented dairy foods, is associated with mortality. [ABSTRACT FROM PUBLISHER]

Background This is a study of the epidemiology of acute and chronic episodes of care (EoCs) in the Transition Project in three countries. We studied the duration of EoCs for acute and chronic health problems and the relationship of incidence to prevalence rates for these EoCs. Method The Transition Project databases collect data on all elements of the doctor-patient encounter in family medicine. Family doctors code these elements using the International Classification of Primary Care.We used the data from three practice populations to study the duration of EoCs and the ratio of incidence to prevalence for common health problems. Results We found that chronic health problems tended to have proportionately longer duration EoCs, as expected, but also a lower incidence to prevalence rate ratio than acute health problems. Thus, the incidence to prevalence index could be used to define a chronic condition as one with a low ratio, below a defined threshold. Conclusions Chronic health problems tend to have longer duration EoCs, proportionately, across populations. This result is expected, but we found important similarities and differences which make defining a problem as chronic on the basis of time rather difficult. The ratio of incidence to prevalence rates has potential to categorise health problems into acute or chronic categories, at different ratio thresholds (such as 20, 30 or 50%). It seems to perform well in this study of three family practice populations, and is proposed to the scientific community for further evaluation. [ABSTRACT FROM AUTHOR]

Introduction Beside (cost-)effectiveness, the feasibility of an intervention is important for successful implementation in daily practice. This study concerns the process evaluation of a newly developed participatory return-to-work (RTW) program for workers without an employment contract, sick-listed due to musculoskeletal disorders. The program consisted of a stepwise process, guided by an independent RTW coordinator, aimed at making a consensus-based RTW plan with the possibility of a temporary (therapeutic) workplace. The aims of this study were to describe the reach and extent of implementation of the new program, the satisfaction and experiences of all stakeholders, and the perceived barriers and facilitators for implementation of the program in daily practice. Methods Temporary agency workers and unemployed workers, sick-listed for 2-8 weeks due to musculoskeletal disorders were eligible for this study. Data were collected from the workers; their insurance physicians and labour experts at the Dutch Social Security Agency; RTW coordinators; and case managers from participating vocational rehabilitation agencies. Data collection took place using professionals' reports, standardized matrices, questionnaires at baseline and at 3-month follow-up, and group interviews with the professionals. Results Of the 79 workers who were allocated to the participatory RTW program group, 72 workers actually started with the intervention. Overall, implementation of the program was performed according to protocol. However, offering of suitable temporary workplaces was delayed with 44.5 days. Results showed satisfaction with the RTW coordinator among the workers and three quarters of the labour experts experienced a minor or major contribution of the presence of the RTW coordinator. Several barriers for implementation were identified, such as the administrative time-investment, unclear information about the program, no timely offering of temporary (therapeutic) workplaces, and the need for additional support in case of complex health problems. Conclusions This study indicates overall feasibility for implementation of the participatory RTW program in daily practice. However, to overcome important barriers, more attention should be paid to improve timely offering of suitable temporary workplaces, to describe more clearly the program goals and the professional's roles, and to offer additional support for workers suffering from complex multi-causal health problems. Trial registration NTR1047. [ABSTRACT FROM AUTHOR]

Objective: After introducing a new descriptive recording system for congenital craniofacial abnormalities in The Netherlands, common oral clefts are highlighted. Design: Prospective observational study. Setting: Fifteen cleft palate teams, united in the Dutch Association for Cleft Palate and Craniofacial Anomalies, registered patients from 1997 to 2006. Patients: All unoperated patients with a common oral cleft were included. Main Outcome Measures: Detailed information and birth prevalence rates of cleft lip/alveolus, cleft lip/alveolus and palate, and cleft palate were provided, relating referral age, gender, family history, additional congenital abnormalities, and syndrome diagnoses to these three categories. Results: This study included 3512 patients, resulting in an overall prevalence of 16.6 per 10,000 live births. Patients showed a cleft lip/alveolus (28%), a cleft lip/alveolus and palate (39%), or a cleft palate (33%).The three categories exhibited very heterogeneous cleft types. Mean referral age was 5.8 months (median 3 weeks). Birth weight was the lowest in cleft palate patients (3238 g; p <.001 to .009). Cleft palate patients showed less positive family history concerning congenital anomalies (23%, p<.001 to .013), but more syndrome diagnoses were established in this category (24%, p<.001). Ten percent of all cleft patients showed additional abnormalities of the head and neck area, and 13% displayed congenital anomalies of other systems. Conclusions: This new recording method allows adequate description of common oral clefts. Many cleft types exist within these three categories and should be differentiated, because they originate from different time frames and/ or cell biological mechanisms during embryogenesis. [ABSTRACT FROM AUTHOR]