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Congenital diaphragmatic hernia (CDH) is a congenital malformation in which the diaphragm and lungs are underdeveloped, leading to cardiorespiratory and other problems. This study aimed to explore professionals' views regarding prenatal counselling in CDH. A qualitative study was performed among healthcare professionals involved in the care of CDH patients in Radboud university medical center Amalia Children's Hospital. Semi-structured interviews were conducted until saturation was achieved. Transcripts were qualitatively analysed to gain insight into professionals' views regarding counselling. Eighteen professionals with various backgrounds were included. The professionals agreed that the first counselling session should be soon after diagnosis and additional sessions should be offered. Concerning counselling content, participants considered explanation of the diagnosis, prognosis, short- and long-term consequences, treatment options and practical aspects important. As for decision-making about possible termination of pregnancy, all professionals emphasised the importance of the parental role, but the preferred parental involvement varied. Regarding practical aspects, preferred counsellors were a neonatologist, obstetrician, paediatric surgeon and/or medical social worker. Participants emphasised that the counselling should be adjusted to parents' needs. This study gained insight into professionals' views regarding the timeline, content, decision-making process, and practical aspects of prenatal counselling in CDH. [ABSTRACT FROM AUTHOR]

Background: Mental disorders are burdensome and are associated with increased mortality. Mortality has been researched for various mental disorders, especially in countries with national registries, including the Nordic countries. Yet, knowledge gaps exist around national differences, while also relatively less studies compare mortality of those seeking help for mental disorders in specialized mental healthcare (SMH) by diagnosis. Additional insight into such mortality distributions for SMH users would be beneficial for both policy and research purposes. We aim to describe and compare the mortality in a population of SMH users with the mortality of the general population. Additionally, we aim to investigate mortality differences between sexes and major diagnosis categories: anxiety, depression, schizophrenia spectrum and other psychotic disorders, and bipolar disorder. Methods: Mortality and basic demographics were available for a population of N = 10,914 SMH users in the north of The Netherlands from 2010 until 2017. To estimate mortality over the adult lifespan, parametric Gompertz distributions were fitted on observed mortality using interval regression. Life years lost were computed by calculating the difference between integrals of the survival functions for the general population and the study sample, thus correcting for age. Survival for the general population was obtained from Statistics Netherlands (CBS). Results: SMH users were estimated to lose 9.5 life years (95% CI: 9.4–9.6). Every major diagnosis category was associated with a significant loss of life years, ranging from 7.2 (95% CI: 6.4–7.9) years for anxiety patients to 11.7 (95% CI: 11.0–12.5) years for bipolar disorder patients. Significant differences in mortality were observed between male SMH users and female SMH users, with men losing relatively more life years: 11.0 (95% CI: 10.9–11.2) versus 8.3 (95% CI: 8.2–8.4) respectively. This difference was also observed between sexes within every diagnosis, although the difference was insignificant for bipolar disorder. Conclusion: There were significant differences in mortality between SMH users and the general population. Substantial differences were observed between sexes and between diagnoses. Additional attention is required, and possibly specific interventions are needed to reduce the amount of life years lost by SMH users. [ABSTRACT FROM AUTHOR]

Background: Students' perspective on education is of crucial importance for its effectivity, but students' opinions are seldom acknowledged by teachers and designers. Student participation in the educational design process could be a suitable tool to better take students' preferences into account. However, for effective participatory design, it is necessary to know whether students have stable preferences for the design of their education. Changeability of preferences would require a more continuing design process allowing continuous adaptations. Aims: This longitudinal survey study aimed to determine the changeability over time of students' preferences for different aspects of a learning environment. Additionally, causes of possible changes in preferences are investigated. Sample: The participants were 1,335 high school students of five schools for secondary education in the Netherlands, joining this study during a period of 2 years. Method: Data about students' preferences were collected at three moments, using the Inventory of Perceived Study Environment Extended. Learning-related student characteristics, such as processing strategies and motivational orientations, were measured with the Inventory of Learning Styles. Additionally, data on learning performances were collected. Results: The results showed stability on preferences for almost all studied characteristics of the learning environment. Particularly remarkable was a drop in desirability for student autonomy. This was larger for students with a certificate-oriented motivation and smaller for self-regulated students. Additionally, poorly performing students had a larger decrease in preference for autonomy. Conclusions: The stability on most aspects supports that participatory design might result in fairly stable instructional designs, although caution is needed with respect to student autonomy. (Contains 3 figures and 5 tables.)

Background: The match between students' perceptions of a learning environment and their preferences about its design influences students' learning behaviour and by consequence the effectiveness of education. Therefore, the students' perspective deserves a more prominent place in the educational design process. Having an adequate picture of the match between students' perceptions and preferences is needed for teachers/educational designers to account for students' perspectives while designing education. As perception-preference match is likely to differ between students, establishing correlates to it would provide valuable information. Students' perceptions are known to relate to several student characteristics; this study extends our understanding to its relations with perception-preference match. Purpose: This study aims to investigate the degree to which students' perceptions of lessons match with their preferences about different characteristics of modern education. Additionally, it is aimed to determine the most prominent relationships between perception-preference match and learning-related student characteristics. Sample: The sample consisted of 1146 10th-grade high school students (mean age = 16 years) from five secondary schools in the Netherlands. As data collection took place during normal school hours, the response rate was 100%, comprising all students that were at school on the day of data collection. Design and methods: To measure students' perceptions of the lessons and their preferences about its instructional design, students completed the Inventory of Perceived Study Environment Extended, being composed of eight scales about central characteristics of modern education. The Inventory of Learning Styles was administered to measure learning-related student characteristics: cognitive processing strategies, regulation strategies, motivational orientations, conceptions about learning and affective processing strategies. To answer the research questions, paired "t"-tests and multiple regression analyses were conducted. Results: Findings showed low perception-preference matches on fascinating contents, clarity of goals and student autonomy. Students preferred these characteristics being more represented in their lessons than they actually perceived them. Perception-preference match was predominantly related to students' motivation and affective state: a personally interested motivational orientation related to better perception-preference match, whereas motivation/concentration problems related to worse matches. These relations did not give indications about causality, but based on the literature a bidirectional relation is supposed. Conclusion: This study shows that students' perception-preference match gives clear indications for which aspects of lessons could be improved. As students consider almost all characteristics of modern education as desirable, meeting students' preferences could contribute to more effective education. Additionally, the perception-preference match relates to students' motivation and affective strategies. Improving education by accounting for the match between students' perceptions and preferences of education is likely to improve motivation as well as having a significant effect on the quality of education. (Contains 6 tables and 1 figure.)

Background: Teachers have limited insight in students' perspectives on education, although these perspectives influence quality of learning. As students' and teachers' perspectives differ considerably, there is a need for teachers to learn more about students' experiences and ideas about education. Participatory design might be a good strategy for taking student perspectives into account in instructional design. In areas outside education, the positive effects of participation have already been demonstrated. Purpose: The main goals of this exploratory study are to develop an approach--based on the principles of participatory design--for student participation in instructional design, and to evaluate how students and teachers experience the discussion about possible changes in the design and how they co-operate in designing lessons. Additionally, the study investigates whether the used approach is workable and suitable for use with a range of courses. Sample: The sample consisted of six teachers (of mathematics, economics and English) from two secondary schools in the Netherlands and their 10th-grade pre-university students (N = 139; average age 16 years). In each class, a small group of seven co-designing students was selected as a representative sample of their class. All other students in these classes (i.e. those not directly involved in participatory re-design) were also included, as evaluators of the proposed changes. Design and methods: A participatory design meeting was organised for each group separately. In all groups, the same approach for participatory design was used. The quality of the meeting and the agreement with the proposed changes were evaluated using open questions. The questions were answered individually by both teachers and co-designing students. The remaining students answered questions about their agreement with the proposed changes. The written answers were analysed using a coding scheme. Results: Findings suggest that both teachers and co-designing students were largely satisfied with the meeting. The atmosphere was experienced predominantly as comfortable and enough opportunities were provided to express thoughts and ideas. Teachers, additionally, stated that the usability of students' suggestions was good. The remaining students predominantly agreed on the proposed changes discussed. No differences were found between the evaluation scores of students of different courses. Conclusions: The main conclusion from this exploratory study is that participatory design appears suitable for use in education. The approach used for initiating and structuring the discussion between the teacher and his/her students was appropriate for designing lessons, according to all those involved. As this study suggests, the barriers to the inclusion of students in the instructional design process are not insurmountable, and there are compelling reasons for implementing participatory design in education. (Contains 4 tables and 1 figure.)

Research has shown the importance of students' perceptions of a learning environment and the existence of discrepancies between students' and teachers' perceptions. Participatory design could be a helpful strategy to reduce such discrepancies and eventually improve the design of learning environments, as it has proven to be effective to optimize design in other domains. The current study investigated the desirability and feasibility of possible use of participatory design in education. Students and teachers in secondary education were interviewed about their opinions on the idea of participatory design of a learning environment. Both students and teachers displayed predominantly positive opinions towards possibly engaging in participatory design, supporting its desirability and feasibility. Practical suggestions for implementation are included. (Contains 2 tables. Coding scheme: description of response categories to interview questions is appended.)

Educational designers often develop a "powerful learning environment" that is subsequently implemented by teachers. Due to a lack of cooperation with teachers they may receive limited feedback on the quality of their design and the way it is implemented. This study focuses on teachers' perceptions of a Dutch innovative learning environment called the "Second Phase", as well as their desires and their dis/satisfaction with this environment. The results show that teachers are reserved about student autonomy and productive learning. Perceptions and desires are related to their individual approaches to teaching. The findings provide useful feedback for designers and a starting point to intensify their cooperation with teachers.

In order to reach the main aims of modern education, powerful learning environments are designed. The characteristics of the design of PLEs are expected to have positive effects on student learning. Additionally, teachers' conceptions of learning and teaching do influence the implementation of a PLE. Moreover, students' perceptions of a learning environment affect their subsequent learning behaviour and the quality of the learning outcomes. The different perspectives of educational designers, teachers, and students are summarized in the Combination-of-perspectives (COOP) model. Combining these perspectives by mutual exchange of conceptions and perceptions is expected to have positive effects on the power of PLEs.

Background: Psychological distress is highly prevalent among patients with metastatic colorectal cancer. Aims: To perform an economic evaluation of a combined screening and treatment program targeting psychological distress in patients with metastatic colorectal cancer in comparison with usual care. Design: Societal costs were collected alongside a cluster randomized controlled trial for 48 weeks. A total of 349 participants were included. Setting: Participants were recruited from oncology departments at 16 participating hospitals in the Netherlands. Methods: Outcome measures were the Hospital Anxiety and Depression Scale and quality-adjusted life-years. Missing data were imputed using multiple imputation. Uncertainty was estimated using bootstrapping. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated to show uncertainty surrounding the cost-effectiveness estimates. Sensitivity analyses were performed to check robustness of results. Results: Between treatment arms, no significant differences were found in Hospital Anxiety and Depression Scale score (mean difference: –0.058; 95% confidence interval: –0.13 to 0.011), quality-adjusted life-years (mean difference: 0.042; 95% confidence interval: –0.015 to 0.099), and societal costs (mean difference: –1152; 95% confidence interval: –5058 to 2214). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 0.64 and 0.74 at willingness-to-pay values of €0 and €10,000 per point improvement on the Hospital Anxiety and Depression Scale, respectively. The probability that the intervention was cost-effective compared to usual care for quality-adjusted life-years was 0.64 and 0.79 at willingness-to-pay values of €0 and €20,000 per quality-adjusted life-year, respectively. Conclusion: The intervention is dominant over usual care, primarily due to lower costs in the intervention group. However, there were no statistically significant differences in clinical effects and the uptake of the intervention was quite low. Therefore, widespread implementation cannot be recommended. [ABSTRACT FROM AUTHOR]

Background: This study aims to report on the design of a model to determine the cost-effectiveness of prevention and treatment of early psychosis (PsyMod) and to estimate ten-year cost-effectiveness and budget impact of interventions targeting individuals with ultra-high risk (UHR) of developing psychosis or with first episode psychosis (FEP).Methods: PsyMod was built in parallel with the development of a new standard of care for treatment of early psychosis in the Netherlands. PsyMod is a state-transition cohort simulation model and considers six health states, namely ultra-high risk of psychosis (UHR), FEP, post-FEP, no-UHR, recovery/remission, and death. Results are expressed as total healthcare costs, QALYs, incremental cost-effectiveness ratio (ICER), and budget impact.Results: PsyMod was used to extrapolate budget impact and cost-effectiveness of cognitive behavioural therapy for preventing FEP for individuals at UHR of psychosis (CBTuhr) compared to care as usual. CBTuhr resulted in a per-patient increase of 0.06 QALYs and a per patient cost reduction of €654 (dominant ICER) with a reduction in 5-year healthcare costs of €1,002,166.Conclusions: PsyMod can be used to examine cost-effectiveness and budget impact of interventions targeting prevention and treatment of FEP and is freely available for academic purposes upon request by the authors. [ABSTRACT FROM AUTHOR]

Objective: Obesity is highly prevalent in patients with rheumatoid arthritis (RA), with likely impact on weight-bearing foot joints. We explored the associations between body mass index (BMI) and measures of foot health in patients with RA and foot complaints.Method: We examined patients with RA presenting for their first custom-made therapeutic footwear or foot orthoses. Domains of foot health comprised: foot pain, foot-related activity limitations, forefoot plantar pressure, foot synovitis, and foot deformity. In regression analyses, BMI was the independent variable and foot health domains were the dependent variables.Results: The cohort at baseline comprised 230 patients [mean ± sd age 58 ± 13 years, 80% female, mean ± sd disease duration 10 ± 9 years, and median (interquartile range) BMI 26.7 (23.5-30.1) kg/m2]. Small to modest statistically significant associations were found in the majority of the measures studied between a higher BMI and more foot pain, more foot-related activity limitations, higher in-shoe measured forefoot plantar pressure, and the presence of foot synovitis. No relationships were found between BMI and barefoot measured forefoot plantar pressure or foot deformity.Conclusion: BMI is negatively associated with foot health in patients with RA. Although the clinical relevance of our findings for an individual patient is not immediately obvious, future research should consider BMI as a potential therapeutic target to improve foot health. [ABSTRACT FROM AUTHOR]

Background: In patients with rheumatoid arthritis (RA), both high and low forefoot plantar pressures have been reported. Better understanding of pathology in the forefoot associated with altered pressure distribution in patients with RA could help to better formulate and specify goals for treatment with foot orthoses or therapeutic footwear.Objectives: To investigate the association of plantar pressure with disease activity and deformity in the forefoot in patients with rheumatoid arthritis and forefoot symptoms.Methods: A cross sectional study, using data of 172 patients with rheumatoid arthritis and forefoot symptoms, was conducted. Peak pressure (PP) and pressure time integral (PTI) in the forefoot were measured with a pressure platform. Forefoot deformity was assessed using the Platto score. Forefoot disease activity was defined as swelling and/or pain assessed by palpation of the metatarsophalangeal joints. The forefoot was divided in a medial, central and lateral region, in which the following conditions could be present: 1) no pathology, 2) disease activity, 3) deformity or 4) disease activity and deformity. A multilevel analysis was performed using condition per forefoot region as independent variable and PP or PTI in the corresponding region as dependent variable.Results: Statistically significant higher plantar pressures were found in forefoot regions with deformities (RR 1.2, CI 1.1-1.3, P<0.0001), compared to forefoot regions without forefoot pathology. No significant differences in plantar pressures were found when solely forefoot disease activity was present in forefoot regions.Significance: Forefoot deformities are related to higher plantar pressures measured in the corresponding forefoot regions. The absence of an association between local disease activity and plantar pressure might be explained by the low prevalence of metatarsophalangeal joint pain or swelling. Future research with sensitive imaging measures to detect disease activity is recommended to reveal the effect of forefoot disease activity on plantar pressure. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery. It is important to prevent the negative side effects of delirium by identifying high-risk patients before surgery. Koster and colleagues designed a risk model to identify patients with an increased risk of postoperative delirium after cardiac surgery. Aim: The aim of this study was to validate the risk model for delirium and further improve the risk model. Methods: A delirium risk checklist containing predictors associated with postoperative delirium was used during the preoperative outpatient screening in 329 patients. The delirium observation screening scale was used preoperatively and postoperatively to assess delirium. Results: Compared with the model of Koster and colleagues age greater than 70 years and a history of delirium were confirmed as statistically significant predictors of postoperative delirium, while cognitive impairment and alcohol abuse were almost significant factors. The European system for cardiac operative risk evaluation (EuroSCORE), comorbidity and type of surgery could not predict a postoperative delirium again. The area under the curve of this model was 0.79 (95% confidence interval (CI) 0.73–0.86; P<0.001). Based on the data of this study the model was improved with the following independent predictors of postoperative delirium: age, more than one comorbidity, history of delirium and a lower standardised mini mental state examination score as with an area under the curve of 0.79 (95% CI 0.73–0.85; P<0.001). Conclusion: The risk model could not be fully validated. It is difficult to validate a risk model over time; there are different circumstances such as the increased focus on the prevention of delirium. [ABSTRACT FROM AUTHOR]

Background: Survival data that are applicable to the current population of adults with congenital heart disease (CHD) are not available.Objectives: Using an alternative survival analysis with age as the primary time scale, we assessed the contemporary survival of adult patients with CHD.Methods: Survival was assessed using prospective data of the national registry of adult patients with CHD of the Netherlands. Survival was stratified by severity and lesion, and compared with a standardised general population.Results: Mean age at inclusion was 37 years, and 49% of the study population was male. During a cumulative prospective follow-up of 90, 270 patient-years in 14, 327 patients, 535 deaths occurred. Median survival was 53.4 (95% CI 49.9 to 60.7), 75.4 (95% CI 72.9 to 79.1) and 84.1 (95% CI 81.9 to 87.0) years for patients with severe, moderate and mild lesions, respectively. Survival of most patients with mild lesions did not differ from the general population, while, as expected, survival of patients with severe and moderate lesions was substantially lower (<0.001).Conclusions: The present study gives insight in the contemporary survival of adults with CHD. This may aid patient counselling, timing of interventions and future research. [ABSTRACT FROM AUTHOR]

Background: Dietary fat quality may influence skeletal muscle lipid processing and fat accumulation, thereby modulating insulin sensitivity. Objective: The objective was to examine the acute effects of meals with various fatty acid (FA) compositions on skeletal muscle FA processing and postprandial insulin sensitivity in obese, insulin-resistant men. Design: In a single-blind, randomized, crossover study, 10 insulin-resistant men consumed 3 high-fat mixed meals (2.6 MJ), which were high in SFAs, MUFAs, or PUFAs. Fasting and postprandial skeletal muscle FA processing was examined by measuring differ-ences in arteriovenous concentrations across the forearm muscle. |:H2]Palmitate was infused intravenously to label endogenous tri-acylglycerol and FFAs in the circulation, and [U-13C]palmitate was added to the meal to label chylomicron-triacylglycerol. Skeletal muscle biopsy samples were taken to assess intramuscular lipid metabolism and gene expression. Results: Insulin and glucose responses (AUC) after the SFA meal were significantly higher than those after the PUFA meal (P = 0.006 and 0.033, respectively). Uptake of triacylglycerol-derived FAs was lower in the postprandial phase after the PUFA meal than after the other meals ( AUC60_24o; P = 0.02). The fractional synthetic rate of the tri-acylglycerol, diacylglycerol, and phospholipid pool was higher after the MUFA meal than after the SFA meal. PUFA induced less transcrip-tional downregulation of oxidative pathways than did the other meals. Conclusion: PUFAs reduced triacylglycerol-derived skeletal muscle FA uptake, which was accompanied by higher postprandial insulin sensitivity, a more transcriptional oxidative phenotype. and altered intra-myocellular lipid partitioning and may therefore be protective against the development of insulin resistance. This trial was registered at clin-icaltrials.gov as NCT01466816. [ABSTRACT FROM AUTHOR]

Background: Ventricular systolic and diastolic function, as measured by echocardiography, are diminished in patients with a systemic right ventricle (RV). As the clinical implications of these finding remained unknown, we aimed to identify echocardiographic parameters of systolic and diastolic ventricular function that are independent determinants of the clinical condition in these patients. Methods: Forty-six adult patients (61% male; mean age 33 [range 18-69] years) with a systemic RV underwent echocardiography to assess qualitative and quantitative systolic and diastolic function of the systemic RV and the subpulmonary left ventricle (LV). Uni- and multivariate linear regression analyses were performed to identify independent echocardiographic determinants for NYHA class, maximal exercise capacity (V'O) and NT-proBNP levels. Results: We found qualitative assessment of RV and LV function to be significantly associated with NYHA class (RV: β= 0.26; P = 0.05 and LV: β= 0.82; P < 0.01), V'O (RV: β=−10.4; P < 0.05 and LV: β=−18.4; P < 0.05) and NT-proBNP levels (RV: β= 0.58; P < 0.01 and LV: β= 1.40; P < 0.001). Tricuspid annulus plane systolic excursion (TAPSE) was significantly associated with NYHA class (β=−0.92; P = 0.001), V'O (β= 18.5; P = 0.05), and serum NT-proBNP levels (β=−1.00; P < 0.05). Associations between quantitative parameters of systolic subpulmonary LV function and clinical parameters were less distinct. We found no associations between RV and LV diastolic function and clinical parameters. Conclusions: Qualitative function of the systemic RV and the subpulmonary LV, and TAPSE, are determinants of clinical condition in patients with a systemic RV. These patients' clinical condition could not be determined by echocardiographically measured diastolic RV function, and systolic and diastolic LV function. (Echocardiography 2010;27:1247-1255) [ABSTRACT FROM AUTHOR]

The article presents information on a study which compared the effect of newborn hearing screening against distraction hearing screening, carried out at nine months of age, on development, spoken communication and quality of life. It references the replacement of distraction hearing screening with newborn hearing screening in all 65 regions in the Netherlands between 2002 and 2006. Study population were children born in the Netherlands between 2003 and 2005. Main outcome measures included performance, such as education, spoken and signed communication, general and language development, and quality of life. A detailed discussion on the research findings is offered.

Background/Objectives:Acrylamide, a probable human carcinogen, was detected in various heat-treated foods such as French fries and potato crisps. Recently, positive associations have been found between dietary acrylamide intakes, as estimated with a food frequency questionnaire using an acrylamide database, and cancer risk in some epidemiological studies. As acrylamide levels vary considerably within the same type of foods, a validation study was performed to investigate whether use of an acrylamide food database containing calculated mean acrylamide content, based on extensive sampling and chemical analysis of Dutch foods (several samples per food), can classify subjects with respect to true acrylamide intake.Subjects/Methods:We used the data from a 24-h duplicate diet study. The acrylamide content of 39 Dutch 24-h duplicate diets collected in 2004 was estimated using the mean acrylamide levels of foods available from the database and the menu list, on which the participants of the duplicate diet study had listed the amounts of individual foods and drinks in household units. Next, the acrylamide content of the total duplicate diets was analytically measured and correlated to the estimated acrylamide contents.Results:The Spearman's correlation coefficient between chemically determined acrylamide content and the calculated acrylamide content of the duplicate diets was 0.82 (P<0.001).Conclusions:This study indicates that it is possible to classify subjects with respect to acrylamide intake if mean instead of actual content of each food is applied. The database can therefore be applied in epidemiological studies on acrylamide intake and cancer risk, such as the Netherlands Cohort Study on Diet and Cancer. [ABSTRACT FROM AUTHOR]

The securitization crisis that started in mid-2007 has demonstrated that we are indeed living in a "global financial village" and are all subject to the vagaries of financialization. Nevertheless, the fallout from the credit crisis has not been homogeneous across space. That some localities were hit harder than others suggests that there are distinct geographies of financialization. Combining insights from the "varieties of capitalism" literature with those from the literature on "financialization studies," the article offers a first take on what may explain these different geographies on the basis of an informal comparison of the trajectories of financialization and their political repercussions in the United States, Germany, and the Netherlands. The article ends with some reflections on how economic geography could be enriched by combining comparative studies on institutionalism and financialization, while its distinct research focus-detailed spatial analysis endowed with a well-developed sensitivity for geographic variegation—may help overcome the methodological nationalism of much comparative institutionalism. [ABSTRACT FROM AUTHOR]

Acrylamide is a probable human carcinogen that was detected in several heat-treated foods, such as French fries and crisps, in 2002. Prospective studies are needed on acrylamide and human cancer risk. We prospectively investigated the association between acrylamide and gastrointestinal cancer risk. In 1986, 120,852 men and women (aged 55-69 y) were included in the Netherlands Cohort Study on diet and cancer. At baseline, a random subcohort of 5000 participants was selected for a case- cohort approach. Acrylamide intake was assessed with a FFQ at baseline and was based on acrylamide analyses in relevant Dutch foods. After 13.3 y of follow-up, 2190, 563, 349, and 216 cases of colorectal, gastric, pancreatic, and esophageal cancer, respectively, were available for analysis. The daily acrylamide intake of the subcohort was (mean ± SD) 21.7 ± 12.1μg. A 10-μg/d increment of acrylamide intake was associated with multivariable-adlusted Cox proportional hazard rate ratios (HR) (95% Cl) of 1.00 (0.96-1.06), 1.02 (0.94-1.10), 1.06 (0.96-1.17), and 0.96 (0.85-1.09) for colorectal, gastric, pancreatic, and esophageal cancer, respectively. For former or never-smokers, the corresponding HR were: 1.03(0.94-1 .12), 1.09 (0.98-1.22), 1.07 (0.93-1.241, and 0.92 (0.76-1.11). There were some significantly increased risks within subgroups stratified by obesity, nonoccupational physical activity, and age, factors that were a priori selected based on their capacity to modify cytochrome P4502E1 activity. Overall, acrylamide intake was not associated with colorectal, gastric, pancreatic, and esophageal cancer risk, but some subgroups deserve further attention. [ABSTRACT FROM AUTHOR]

Studies the extent to which the accessibility of cities, in particular public transport, is a recognizable element of the policy drive to vitalize cities in the Netherlands. Intersection of the government's policy packages, Accessibility of Cities and Vitalization of Cities: Urban Accessibility; Privatization and decentralization of public transport.

Schizophrenia Spectrum Disorder (SSD) is characterized by its chronic, episodic nature. The clear definition of such episodes is essential for various clinical and research purposes. Most current definitions of episodes in SSD are based on either hospitalizations or on symptom scales. Both have drawbacks; symptom scales are measured infrequently, while hospitalization rates are often affected by policy. This study presents an approach for defining episodes in healthcare data that does not suffer such drawbacks. Healthcare use of 13,155 SSD patients in the Northern Netherlands with up to 12 years of follow-up was available. Patient-level structural changes in the trend of healthcare use costs were determined using Exponentially Weighted Moving Average (EWMA) control charts. Control charts restart with updated parameters after a detected structural change. Episodes were defined using these structural changes. The resulting episodes were validated by investigating their association with the Global Assessment of Functioning (GAF) scale. The mean number of episodes was 0.61 (sd: 0.60) per patient per year. For the sub-group without hospitalizations this was 0.51 (sd: 0.71). Average episode duration of the sub-group (147 days, sd: 309.4) was similar to that of the full sample (150 days, sd: 305.5). A significant inverse association was identified between GAF scores and the episode-state indicator. The repeated application of EWMA control charts based on healthcare-intensity is a feasible and promising tool for quantifying patient-level healthcare episodes. The validation using GAF scores indicates that our episode indicator is associated with lower levels of global functioning. Results for individuals without hospitalizations indicate that the method is robust with regard to changes in healthcare policy. • We present a method for defining episodes in time series data of chronic diseases. • It applies to various observed outcomes, e.g. symptoms, resource use, or lab tests. • The method supports disease modeling, clinical evaluation, and health care policy. • A case study of schizophrenia results in 0.61 episodes per patient per year. • The healthcare use episodes were associated with lower levels of functioning. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to estimate the total economic and health related burden of breast cancer in the Netherlands.Methods: Data on incidence, prevalence, mortality and survival were extracted from the Dutch National Cancer Registry and were used to calculate the economic and health related burden of breast cancer for overall, DCIS (stage 0), early- (stage I), locally advanced- (stage II-III) and metastatic- (stage IV) breast cancer by age groups and by year (if applicable).Results: The overall incidence of breast cancer increased from 103.4 up to 153.2 per 100,000 women between 1990 and 2014. The increase was driven by DCIS and early breast cancer as the incidence of locally advanced and metastatic breast cancer remained stable. Between 1990 and 2014, ten-year overall survival rates increased from 87% to 93% for early breast cancer, 41% to 62% for locally advanced- and from 6% to 9% for metastatic disease. Annually, breast cancer in the Netherlands is responsible for approximately 3100 deaths, 26,000 life years lost, 65,000 Disability Adjusted Life Years (DALYs) and an economic burden of €1.27 billion.Conclusions: This study provides a comprehensive assessment of the burden of breast cancer and subsequent trends over time in the Netherlands. [ABSTRACT FROM AUTHOR]

Abstract: Background: A significant number of asymptomatic newborns infected with congenital cytomegalovirus (CMV) will present with permanent childhood hearing impairment (PCHI) during early childhood. Objectives: To investigate the role of congenital CMV infection in causing PCHI in the Netherlands, and assess the efficacy of two different hearing screening strategies and the developmental outcome following each strategy. Study design: We included 192 children with PCHI at the age of 3–5 years, who were offered hearing screening in their first year of life. Dried blood spots from 171 children were available for CMV detection using real-time PCR. The results of eight previously tested samples were also available. Clinical baseline characteristics were collected from medical records and the Child Development Inventory was used to investigate the developmental outcome. Results: The rate of congenital CMV among the 179 children was 8% (14/179) and 23% (9/39) among children with profound PCHI. Two of eight CMV-positive children with PCHI at the age of 3–5 years had passed the newborn hearing screening (NHS) test. Developmental outcome measures showed a significantly greater delay in language comprehension in children with both PCHI and congenital CMV infection (the largest in symptomatic children) than in the children with PCHI without congenital CMV infection. Conclusions: Congenital CMV infection is important in the etiology of PCHI. Universal NHS is not a guarantee of normal hearing and development in childhood for children with congenital CMV infection. This is a problem which might be solved by universal congenital CMV screening. [Copyright &y& Elsevier]

Abstract: There are relatively few institutions that have developed clinical data warehouses, containing patient data from the point of care. Because of the various care practices, data types and definitions, and the perceived incompleteness of clinical information systems, the development of a clinical data warehouse is a challenge. In order to deal with managerial and clinical information needs, as well as educational and research aims that are important in the setting of a university hospital, Erasmus Medical Center Rotterdam, The Netherlands, developed a data warehouse incrementally. In this paper we report on the in-house development of an integral part of the data warehouse specifically for the intensive care units (ICU-DWH). It was modeled using Atos Origin Metadata Frame method. The paper describes the methodology, the development process and the content of the ICU-DWH, and discusses the need for (clinical) data warehouses in intensive care. [Copyright &y& Elsevier]

OBJECTIVE. The aim of this study was to test the hypothesis that screening for scoliosis is effective in reducing the need for surgical treatment. METHODS. The study was a case-control study. A total of 125 consecutive patients who were treated surgically for idiopathic scoliosis between January 2001 and October 2004 and who were born on or after January 1, 1984, were invited; 108 agreed to participate. A total of 216 control subjects were selected randomly and anonymously, matched with respect to age and gender. For 279. adolescents, exact screening exposure and outcomes could be analyzed. Case subjects were recruited from 4 university and 6 nonuniversity Dutch hospitals; control subjects were recruited from all 37 municipal health services in the Netherlands. RESULTS. Screen-detected patients received diagnoses at a significantly younger age than did otherwise-detected patients (10.8 ± vs 13.4 ± 1.7 years). In total, 32.8% of the surgically treated patients had been screened between 11 and 14 years of age, compared with 43.4% of the control subjects. The odds ratio for being exposed to screening was 0.64. In total, 28% of the patients were diagnosed as having scoliosis before 11 years of age. CONCLUSIONS. Our results showed no evidence that: screening for scoliosis reduced the need for surgery. Abolishing screening seems justified, especially because the effectiveness of early treatment with bracing is still strongly debated. A randomized, controlled trial on the effectiveness of treating patients with idiopathic scoliosis with bracing is urgently needed. [ABSTRACT FROM AUTHOR]