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According to the Kunming-Montreal Global Biodiversity Framework, a "Whole-of-Society" approach is needed to initiate transitions to a nature-positive society. Many look at civil society to initiate and accelerate such transitions. In this article, we investigate strategies from Civil Society Actors (CSAs) to contribute to transformative change, with specific focus on Tiny Forests and Beach Clean-Ups in the Netherlands. Results show that CSAs have a clear Theory of Change to achieve their goals, and act upon that vision through assembling power and resources, developing policy-relevant environmental knowledge, mobilising public support and media coverage and initiating innovative sustainable practices. Adopting mosaic governance approaches, CSAs strategically position themselves in social and institutional networks, connecting professionals and citizens for political leverage. However, our findings show that the step from local impact towards transition remains a large one and the contribution of CSAs should be valued as emergent, co-produced and part of a broader transition movement. [ABSTRACT FROM AUTHOR]

This article provides insight into the motivation of young women to join the armed forces and to choose a career in the military. This insight explains why women are still underrepresented in the Netherlands armed forces and can optimize future recruitment programs. An online Dutch questionnaire was completed by 148 women (out of a total of 483 respondents). We analyzed the data of these young women in comparison to the men in this sample to better interpret the descriptive findings. Three research questions focus on whether young Dutch women are interested in the armed forces, how they perceive the Netherlands armed forces, and what their motivation is for choosing a career in the military. Women are very enthusiastic and interested in the armed forces. They know what they want, but they are not aware of the military's efforts to be an inclusive organization. Society's stereotypical thinking about the role of women and the image of the military may have led women to assume that the military environment is not such a good fit after all. Descriptive and injunctive norms, intrinsic motivating work aspects and the self-efficacy of young women appear to be important aspects in the motivation of young women and should be taken into consideration when designing new recruitment and communication strategies and promoting inclusiveness. Women also need more information about the different types of flexible contracts and career paths available within the armed forces. Female role models are important to inform, empower and win over women. The Netherlands armed forces should invest in the recruitment process and anticipate the interest, perception and motivation of young Dutch women to encourage them to apply and reduce stereotypical thinking. [ABSTRACT FROM AUTHOR]

The article offers information about the risks faced by food business operators in the Netherlands making medical claims for their products and the potential for fines under food law and the Dutch Medicines Act, based on the legal definitions of medicinal products and criteria of qualification of products.

Jaundice caused by hyperbilirubinaemia is a common phenomenon during the neonatal period. Population-based studies evaluating assessment, management, and incidence of jaundice and need for phototherapy among otherwise healthy neonates are scarce. We prospectively explored these aspects in a primary care setting via assessing care as usual during the control phase of a stepped wedge cluster randomised controlled trial. We conducted a prospective cohort study embedded in the Screening and TreAtment to Reduce Severe Hyperbilirubinaemia in Infants in Primary care (STARSHIP) Trial. Healthy neonates were included in seven primary care birth centres (PCBCs) in the Netherlands between July 2018 and March 2020. Neonates were eligible for inclusion if their gestational age was ≥ 35 weeks, they were admitted in a PCBC for at least 2 days during the first week of life, and if they did not previously receive phototherapy. Outcomes were the findings of visual assessment to detect jaundice, jaundice incidence and management, and the need for phototherapy treatment in the primary care setting. 860 neonates were included of whom 608 (71.9%) were visibly jaundiced at some point during admission in the PCBC, with 20 being 'very yellow'. Of the latter, four (20%) did not receive total serum bilirubin (TSB) quantification. TSB levels were not associated with the degree of visible jaundice (p = 0.416). Thirty-one neonates (3.6%) received phototherapy and none received an exchange transfusion. Five neonates did not receive phototherapy despite having a TSB level above phototherapy threshold. Jaundice is common in otherwise healthy neonates cared for in primary care. TSB quantification was not always performed in very jaundiced neonates, and not all neonates received phototherapy when indicated. Quality improvement initiatives are required, including alternative approaches to identifying potentially severe hyperbilirubinaemia. Trial registration: NL6997 (Dutch Trial Register; Old NTR ID 7187), registered 3 May 2018. [ABSTRACT FROM AUTHOR]

In 1927-1928 the Dutch architect Jan Buijs (1889--1961) built for the socialist co-operative "De Volharding" a stunning "glass house" in The Hague. The building was particularly remarkable for the revolutionary way in which Buijs interpreted his client's demand for a nighttime display of advertisements in the façades. At night De Volharding seemed transformed into a grand, luminous billboard. Although the building achieved an international reputation as a revolutionary example of the new architecture, its cubist-aesthetic appearance and its failure to conform to the tenets of the "New Objectivity" doomed it to oblivion during the 1930s. If we apply a view other than the polar, historical view of Dutch architecture, De Volharding and other buildings by Buijs appear to be, like the work of Dudok and Jan Wils, part of an independent trend that deserves to be studied in its own right. De Volharding was influenced by the art of De Stijl and by Russian constructivism, but the idea of incorporating light as Buijs did in this building originated with Paul Scheerbart and the expressionist circle around Bruno Taut, with whom Buijs was acquainted. The crystal world of his German friends fascinated Buijs; he was an ardent crystal collector who used sophisticated lighting to bring out the full beauty of his stones. In much the same way, De Volharding achieved its true significance by means of light. It became a beaconlight in the darkness, an example of an architecture of glass and light, and a symbol of the 1920s' optimistic expectations of the future society. [ABSTRACT FROM AUTHOR]

Water ferns of the genus Azolla and the filamentous cyanobacteria Nostoc azollae constitute a model symbiosis that enabled the colonization of the water surface with traits highly desirable for the development of more sustainable crops: their floating mats capture CO2 and fix N2 at high rates using light energy. Their mode of sexual reproduction is heterosporous. The regulation of the transition from the vegetative phase to the spore forming phase in ferns is largely unknown, yet a prerequisite for Azolla domestication, and of particular interest as ferns represent the sister lineage of seed plants. Sporocarps induced with far red light could be crossed so as to verify species attribution of strains from the Netherlands but not of the strain from the Anzali lagoon in Iran; the latter strain was assigned to a novel species cluster from South America. Red-dominated light suppresses the formation of dissemination stages in both gametophyte- and sporophyte-dominated lineages of plants, the response likely is a convergent ecological strategy to open fields. FR-responsive transcripts included those from MIKCC homologues of CMADS1 and miR319-controlled GAMYB transcription factors in the fern, transporters in N. azollae , and ycf2 in chloroplasts. Loci of conserved microRNA (miRNA) in the fern lineage included miR172, yet FR only induced miR529 and miR535, and reduced miR319 and miR159. Phylogenomic analyses of MIKCC TFs suggested that the control of flowering and flower organ specification may have originated from the diploid to haploid phase transition in the homosporous common ancestor of ferns and seed plants. [ABSTRACT FROM AUTHOR]

Background: Perception by workers of their health problems as work-related is possibly associated with sickness absence (SA). The aim of this study was to to study the relationship between perceived work-relatedness of health problems and SA among workers who visit their GP, taking the influence of other potential determinants into account and to study the influence of these determinants on SA. Design and setting prospective cohort study in 32 Dutch GP practices.Methods: A secondary analysis of RCT data among workers, aged 18-63 years, who visited their GP. We measured self-reported SA days in 12 months and high SA (>20 days in 12 months) and compared workers who perceived work-relatedness (WR+) with workers who did not (WR-). With multivariable linear and logistic regression models, we analyzed the influence of age, gender, experienced health, chronic illness, prior SA, number of GP consultations and perceived work ability.Results: We analyzed data of 209 workers, 31% perceived work-relatedness. Geometric mean of SA days was 1.6 (95% CI: 0.9-3.0) for WR+- workers and 1.2 (95% CI: 0.8-1.8) for WR- workers (P = 0.42). Incidence of high SA was 21.5 and 13.3%, respectively (odds ratio 1.79; 95% CI: 0.84-3.84). SA was positively associated with chronic illness, prior SA, low perceived work ability and age over 50.Conclusions: Perceived work-relatedness was not associated with SA. SA was associated with chronic illness, prior SA, low perceived work ability and age over 50. [ABSTRACT FROM AUTHOR]

Contemporary societies are rapidly changing demographically and culturally. This raises new challenges regarding support for and engagement in nature conservation. Our paper discusses differences and similarities between young adult non-immigrants and immigrants in how they understand and value nature, based on group interviews and a survey conducted among young adults of Turkish, Chinese and non-immigrant Dutch backgrounds. We show that how people perceive nature differs between ethnic groups, even though the immigrants included spent (most of) their youth in the Netherlands. Non-immigrants used most strict boundaries to qualify green areas as nature, while especially Chinese immigrants expressed a more inclusive idea of nature. Turkish immigrants articulated most often ecocentric and religious reasons to conserve nature, while Chinese immigrants stood out as mentioning most often anthropocentric reasons. Traditional cultural representations of nature partly seemed to echo in people's perceptions of nature. Support for nature conservation was high among the respondents; however, this hardly translated into engagement in nature conservation. [ABSTRACT FROM AUTHOR]

Legitimacy of environmental management and policies is an important topic in environmental research. Based on the notion of ‘regimes of justification’, we aim to analyse the dynamics in argumentations used to legitimize and de-legitimize Dutch nature conservation practices. Contrary to prior studies, we demonstrate how actors in two locations where environmental disputes arose showed little willingness to switch between arguments in order to reach a compromise. Instead, some actors constructed incompatibilities between arguments in order to delegitimize competing actors. Especially in the visioning phase, institutional actors emphasized technical efficiency, planning and global environmentalism, and arguments related to emotional accounts, inspiration and locality were de-legitimized. In the discussion, we argue that it is not the formal or informal inclusion of the actors in the process, but the construction of the legitimacy of their arguments that determines the inclusiveness and outcome of the process. [ABSTRACT FROM AUTHOR]

Objective: To test the effectiveness of a social network intervention (SNI) to improve children's healthy drinking behaviours.Design: A three-arm cluster randomised control trial design was used. In the SNI, a subset of children were selected and trained as 'influence agents' to promote water consumption-as an alternative to sugar-sweetened beverages (SSB)-among their peers. In the active control condition, all children were simultaneously exposed to the benefits of water consumption. The control condition received no intervention.Setting: Eleven schools in the Netherlands.Participants: Four hundred and fifty-one children (Mage = 10·74, SDage = 0·97; 50·8 % girls).Results: Structural path models showed that children exposed to the SNI consumed 0·20 less SSB per day compared to those in the control condition (β = 0·25, P = 0·035). There was a trend showing that children exposed to the SNI consumed 0·17 less SSB per day than those in the active control condition (β = 0·20, P = 0·061). No differences were found between conditions for water consumption. However, the moderation effects of descriptive norms (β = -0·12, P = 0·028) and injunctive norms (β = 0·11-0·14, both P = 0·050) indicated that norms are more strongly linked to water consumption in the SNI condition compared to the active control and control conditions.Conclusions: These findings suggest that a SNI promoting healthy drinking behaviours may prevent children from consuming more SSB. Moreover, for water consumption, the prevailing social norms in the context play an important role in mitigating the effectiveness of the SNI. [ABSTRACT FROM AUTHOR]

Agrobiodiversity has been decreasing substantially in Europe. Social scientific research in this area has paid limited attention to how citizens value agrobiodiversity and its decline, and how these valuations can be influenced. We explore the influence of different arguments for enhancing agro-biodiversity, delivered via short movies, on attitudes and behaviour of students, environmental professionals and people interested in nature conservation in the Netherlands. We conclude that information provision does not influence attitudes. However, it does influence values assigned to agrobiodiversity, but not always in the ways we hypothesized. Information about the intrinsic value of agrobiodiversity has the most effects on values assigned to agrobiodiversity. Among students, women and people with a low emotional attachment with agricultural landscapes ('place identity' and 'place dependence'), emphasizing the instrumental value of agrobiodiversity has a counter-intuitive effect. It does not influence the importance of this value but instead reinforces the intrinsic value they assign to agrobiodiversity. The latter finding is at odds with the instrumental biodiversity discourse in science and policy, which, under headings such as ecosystem services and natural capital, aims to mobilize support for nature conservation by emphasizing its instrumental, functional and economic values. Emphasizing the intrinsic value of agrobiodiversity seems more effective. [ABSTRACT FROM AUTHOR]

Background: Older patients (≥65 years old) experience high rates of adverse outcomes after an emergency department (ED) visit. Reliable tools to predict adverse outcomes in this population are lacking. This manuscript comprises a study protocol for the Risk Stratification in the Emergency Department in Acutely Ill Older Patients (RISE UP) study that aims to identify predictors of adverse outcome (including triage- and risk stratification scores) and intends to design a feasible prediction model for older patients that can be used in the ED.Methods: The RISE UP study is a prospective observational multicentre cohort study in older (≥65 years of age) ED patients treated by internists or gastroenterologists in Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. After obtaining informed consent, patients characteristics, vital signs, functional status and routine laboratory tests will be retrieved. In addition, disease perception questionnaires will be filled out by patients or their caregivers and clinical impression questionnaires by nurses and physicians. Moreover, both arterial and venous blood samples will be taken in order to determine additional biomarkers. The discriminatory value of triage- and risk stratification scores, clinical impression scores and laboratory tests will be evaluated. Univariable logistic regression will be used to identify predictors of adverse outcomes. With these data we intend to develop a clinical prediction model for 30-day mortality using multivariable logistic regression. This model will be validated in an external cohort. Our primary endpoint is 30-day all-cause mortality. The secondary (composite) endpoint consist of 30-day mortality, length of hospital stay, admission to intensive- or medium care units, readmission and loss of independent living. Patients will be followed up for at least 30 days and, if possible, for one year.Discussion: In this study, we will retrieve a broad range of data concerning adverse outcomes in older patients visiting the ED with medical problems. We intend to develop a clinical tool for identification of older patients at risk of adverse outcomes that is feasible for use in the ED, in order to improve clinical decision making and medical care.Trial Registration: Retrospectively registered on clinicaltrials.gov ( NCT02946398 ; 9/20/2016). [ABSTRACT FROM AUTHOR]

Research on attitudes of the general public toward nature conservation often focuses on values, beliefs, or value orientations as separate cognitions. This article argues for a more holistic approach that integrates various attitudinal components into comprehensive frameworks or “images of nature.” Based on qualitative studies in the Netherlands, five ideal types of images of nature were derived: the wilderness image, the autonomy image, the inclusive image, the aesthetic image, and the functional image, all with different implications for natural resource management. Some images focus on either individualistic or holistic interpretations of the intrinsic value of nature, while others focus more on beautiful landscapes or utilitarian functions. Integrating the pluralism of cognitions into images of nature may help managers to understand conflicts based on diverging opinions on local nature conservation practices. In participatory processes, images of nature may function as sensitizing concepts to facilitate discussions between experts and the general public. [ABSTRACT FROM AUTHOR]

The article presents reprint of the article "Design Management Education at the Delft University of Technology," by Jan Buijs which appeared in the vol. 18 no. 3 issue of "Design Management Review." The study presents the philosophy of Delft University in the Netherlands to incorporate teaching with the dilemmas of decision-making in corporations. The university offers teaching programs including integrated product design, design for interaction and strategic product design.

Participatory planning is becoming increasingly integral to governance. Numerous planning innovations are developed which aim to increase democratic legitimacy and improve decision making. This paper critically reflects on a typical Dutch innovation: the area committee. Based on two individual case studies, we investigate whether area committees realise democratic legitimacy in existing planning practices. Analytically, we focus on four democratic goods: inclusiveness, popular control, considered judgement and transparency. Based on the interdependencies between area committees and government structures we discuss the potential and dilemmas for the area committee to contribute to the democratic legitimacy of environmental policy and rural development. [ABSTRACT FROM AUTHOR]

Studies on immigrants' recreational use of greenspace have tended to focus on ethnic groups as homogeneous entities. In a qualitative study based on group interviews, this article focuses on the cultural diversity among and within ethnic groups. We used an identity perspective to study outdoor recreation of young Dutch adults with Chinese, Turkish, or nonimmigrant backgrounds. Results show that primarily personal identities, age, and ethnicity inform recreational behavior. The multiplicity of peoples' identities results in more heterogeneity between and within ethnic groups, as well as more homogeneity between immigrants and nonimmigrants, than commonly described. When immigrants are considered as a homogeneous group that underparticipates in outdoor recreation, individual immigrants who frequently participate in outdoor recreation are overlooked. Furthermore, we show that acculturation does not progress at the same rate among all ethnic groups, and that ethnic identity may be sustained among second and subsequent generations through certain recreational activities. [ABSTRACT FROM PUBLISHER]

Objective: Wound risk-stratified analyses are clinically relevant as they can assist in identifying hard-to-heal wounds. The aim of the study is to develop risk categories for wound healing based on a limited number of reliably recordable clinical data. Method: This retrospective study used observational data. The primary outcome measure was wound healing at the end of treatment and the secondary outcome measure was the time to wound healing. A stratification model using regression analyses was developed to assign the patients to risk categories for wound healing and the time-to-heal. Results: The study cohort comprised of 540 patients. The most common wound diagnoses were diabetic ulcers, wounds in irradiated areas and wound dehiscence after surgery. Average wound duration before starting treatment at the wound centre was 11.7 months. Healing was achieved in 382 (71%) wounds, after an average treatment time of 4.4 months. A total of four risk categories for wound healing were developed by combining wound diagnosis (favourable versus unfavourable) and duration (<3 months versus >3 months). These risk categories demonstrated healing percentages ranging from 69–97% (p=0.0004) and mean time-to-healing varying from 2.7–5.9 months (p=0.01). Conclusion: Using two clinical wound variables, diagnosis and duration, stratification categories were identified with significant associations with wound healing outcomes. Longer wound duration and unfavourable diagnoses, when combined into unfavourable risk categories, were associated with a lower percentage of wound healing and a longer treatment time until healing. [ABSTRACT FROM AUTHOR]

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Objectives: To investigate cooperation between occupational physicians (OPs) and general practitioners (GPs).Methods: Literature review; structured interviews; questionnaires sent to randomised samples of OPs (n = 232) and GPs (n = 243).Results: Actual cooperation is poor. However, more than 80% of both groups responded that they want to improve their cooperation, aiming at better quality of care. Obstacles identified by OPs include insufficient knowledge among GPs about occupational health services (OHSs) (57%) and their patients' working conditions (52%). OPs also consider that GPs suspect them of serving employers more than employees (44%) and of verifying reasons of absence, with information from GPs (34%). Responses from GPs confirm these two suspicions (48%, response 58%), adding obstacles like commercialisation of OHS, lack of financial incentives, etc. Both groups are unanimous about prerequisites for improvement, especially guaranteeing the professional autonomy of OPs (OPs 86%, GPs 76%).Conclusion: As a first step to overcome obstacles to cooperation, OPs must clarify their position to GP colleagues. Initiatives have been taken after presenting this study. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to evaluate the effects of the Dutch “Skills for Life” programme on students’ health behaviours, bullying behaviour and suicidal ideation. Design/methodology/approach – The effectiveness of the “Skills for Life” programme on health behaviour outcomes was evaluated at three points in time in using a cluster randomized controlled study design with a follow-up of 20 months. In total, 27 schools and 1,394 students were included. Findings – The programme was judged to be well implemented in just under half of cases. The outcome results for the experimental group (EG) compared with controls present a complex picture at the three different time points used for evaluation. There was a clearly positive effect on levels of alcohol consumption and a clearly negative effect on smoking across time. There was a mixed picture over time for suicide ideation and for bullying including sexual bullying (although the prevalence rates for bullying were low and thus results should be treated with caution). There were generally more positive impacts on students with lower educational levels including less suicidal ideation and less bullying. Research limitations/implications – Limitations were the dropping out of several schools during the study and the low level of fidelity of the curriculum. Social emotional learning (SEL) programs can be part of a health promoting school framework but should be more tailored to disadvantaged school populations. Originality/value – The findings indicate that students with a less optimal starting position, when it comes to health related behaviours, benefit most from a SEL programme. This indicates that schools with disadvantaged school populations could benefit most from a Health Promoting School approach. [ABSTRACT FROM AUTHOR]

Product innovation is the focal point of the Delft Design School in the Netherlands. During its more than thirty years of existence different models of the product innovation process were and are used for education and for research. This paper will describe the development of these models. The first models tried to describe the product innovation process in a logical linear order, but recently this logical order has come under discussion. The most recent models try to show the more chaotic character of the product innovation processes in real corporate life. Although this chaotic model better reflects the product innovation practice, for educational purposes it seems to be less useful than the original logical ones. For our teaching we propose the two versions (logic and chaos) of our innovation model as two sides of one coin. This innovation coin is without proper value with one side left blank. [ABSTRACT FROM AUTHOR]

Background: Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs. Aim: The aim of the present study was to compare the cost-effectiveness between a biodegradable and a titanium system in Maxillofacial surgery. Materials and Methods: This multicenter RCT was performed in the Netherlands from December 2006 to July 2009. Included were 230 patients who underwent a bilateral sagittal split osteotomy (BSSO), a Le Fort-I osteotomy, or a bi-maxillary osteotomy and those treated for fractures of the mandible, maxilla, or zygoma. The patients were randomly assigned to a titanium group (KLS Martin) or to a biodegradable group (Inion CPS). Costs were assessed from a societal perspective. Health outcomes in the incremental cost-effectiveness ratio (ICER) were bone healing (8 weeks) and plate removal (2 years). Results: In 25 out of the 117 patients who were randomized to the biodegradable group, the maxillofacial surgeon made the decision to switch to the titanium system intra-operatively. This resulted in an Intention-To-Treat (ITT-)analysis and a Treatment-Received (TR-) analysis. Both analyses indicated that operations performed with titanium plates and screws had better health outcomes. In the TR-analysis the costs were lower in the biodegradable group, in the ITT-analysis costs were lower in the titanium group. Conclusion and Discussion: The difference in costs between the ITT and the TR analyses can be explained by the intra-operative switches: In the TR-analysis the switches were analysed in the titanium group. In the ITT-analysis they were analysed in the biodegradable group. Considering the cost-effectiveness the titanium system is preferable to the biodegradable system in the regular treatment spectrum of mandibular, Le Fort-I, and zygomatic fractures, and BSSO’s, Le Fort-I osteotomies and bimaxillary osteotomies. Trial Registration: Controlled-Trials.com [ABSTRACT FROM AUTHOR]

Many school health promotion curricula address a single health behavior, without paying attention to potential learning effects in associated behavioral domains. We developed an innovative curriculum about smoking and safe sex that also focused on promoting students' transfer of knowledge, skills and attitudes to other domains. In a quasi-experimental study involving 1107 students (Grades 7 and 8) in the Netherlands, the curriculum was compared with regular lessons about smoking and safe sex. The central research questions were to what extent the transfer-oriented curriculum: (i) had effects on psychosocial determinants and behaviors in the domains of smoking and safe sex, (ii) had effects on determinants and behaviors in three domains about which no lessons were taught (consumption of alcohol, fruit and breakfast). Multi-level analyses showed that the answer to both questions is positive. The results indicate that a transfer approach may have surplus value over the classic domain-specific approach and warrant further elaboration in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND: Vending machines account for food sales and revenue in schools. We examined 3 strategies for promoting the sale of lower-calorie food products from vending machines in high schools in the Netherlands. METHODS: A school-based randomized controlled trial was conducted in 13 experimental schools and 15 control schools. Three strategies were tested within each experimental school: increasing the availability of lower-calorie products in vending machines, labeling products, and reducing the price of lower-calorie products. The experimental schools introduced the strategies in 3 consecutive phases, with phase 3 incorporating all 3 strategies. The control schools remained the same. The sales volumes from the vending machines were registered. Products were grouped into (1) extra foods containing empty calories, for example, candies and potato chips, (2) nutrient-rich basic foods, and (3) beverages. They were also divided into favorable, moderately unfavorable, and unfavorable products. RESULTS: Total sales volumes for experimental and control schools did not differ significantly for the extra and beverage products. Proportionally, the higher availability of lower-calorie extra products in the experimental schools led to higher sales of moderately unfavorable extra products than in the control schools, and to higher sales of favorable extra products in experimental schools where students have to stay during breaks. Together, availability, labeling, and price reduction raised the proportional sales of favorable beverages. CONCLUSION: Results indicate that when the availability of lower-calorie foods is increased and is also combined with labeling and reduced prices, students make healthier choices without buying more or fewer products from school vending machines. Changes to school vending machines help to create a healthy school environment. [ABSTRACT FROM AUTHOR]

The main objective was to investigate whether low-molecular-weight fraction of edible mushroom shiitake extract (Lentinus edodes) possesses caries-preventive properties. The study was designed as a double-blind, three-leg, cross-over, randomized, controlled clinical trial carried out on two series of volunteers at the University of Gothenburg, and the Academic Centre for Dentistry Amsterdam. Volunteers rinsed twice daily with a solution containing low-molecular-weight fraction of edible mushroom, placebo (negative control without active ingredients), or Meridol (positive control, AmF-SnF2) for two weeks, with a two-week washout period between each rinsing period. Changes in the acidogenicity of dental plaque before and after a sucrose challenge, shifts in microbial composition, and plaque scores were determined. Frequent rinses with shiitake reduced themetabolic activity of dental plaque. No reduction of plaque scores and no inhibition of the production of organic acids in plaque was found. Minor differences inmicrobial composition between test sessions were found. To conclude, the results indicate that shiitake extract has anticariogenic potential, but not to the same extent as the positive control. [ABSTRACT FROM AUTHOR]

Considering the tolerant and gay-friendly image of the Netherlands, antigay violence is a remarkably grave problem. By combining a broad survey of Amsterdam youth with in-depth interviews with smaller groups and individual attackers and reviewing recent cases, we conclude that traditional norms of gender and sexuality present in broader society form the breeding ground of the violence. The gay-friendly narrative that dominates discussions on citizenship in the Netherlands – opposing the liberal ‘Dutch’ to the Muslim ‘Other’ – coexists next to traditional norms of gender and sexuality, thereby not challenging the roots of homonegativity. Even perpetrators duplicate the prevailing gay-tolerant rhetoric of Dutch society, but do not refrain from all sorts of violence as soon as they are confronted with aspects of it that collide with traditional norms of gender and sexuality. Peer pressure and the fear of seduction often function as triggers of the violence. However, these situational factors can only be understood in a larger macro-sociological framework, showing the necessity of a multilevel approach in coming towards a comprehensive understanding of antigay violence. [ABSTRACT FROM AUTHOR]

Summary: We analyzed 12-month compliance for all ten oral osteoporosis drugs in the Netherlands by medication possession ratio (MPR ≥ 80%) in 105,506 patients, and persistence in 8,626 starters indicated high MPR (91%), low persistence (43%), and no restart in 78% of the stoppers after 18 months. Introduction: We studied compliance and persistence for all available oral osteoporosis medications on a national scale in the Netherlands. Methods: We analyzed the IMS Health's longitudinal prescription database, which represents 73% of all pharmacies in the Netherlands. Twelve-month compliance was measured by medication possession ratio (MPR) in a cross-sectional cohort of 105,506 patients who received at least three prescriptions. Twelve-month persistence (no gap in refills for >6 months) was measured in all 8,626 consecutive patients starting therapy, with a further follow-up in non-persistent patients during an additional 18 months for evaluation of switching, restart, or definitive stopping oral medication. Multivariate logistic regression analysis was used to analyze the odds ratios (ORs) with 95% confidence intervals (CI) of characteristics of non-persistence. Results: MPR of ≥80% was found in 91% of patients. Persistence was 43% (range, 29-52%). Persistence was related to age >60 years (ORs, 1.41 to 1.64), pharmacy outside very dense urban area (ORs, 1.39 to 1.44), additional use of calcium and/or vitamin D supplementation (OR, 1.26 and CI, 1.13, 1.39) and use of glucocorticoids (OR, 0.65 and CI, 0.59, 0.72) or cardiovascular medication (OR, 0.88 and CI, 0.79, 0.97). Of non-persistent patients, 22% restarted within 18 months with oral osteoporosis drugs. Conclusions: One-year compliance for all available oral osteoporosis medications was high, but 1-year persistence was low. Most stoppers did not restart or switch during an additional 18-month follow-up. These data indicate a major failure to adequately treat patients at high risk for fractures in daily practice. [ABSTRACT FROM AUTHOR]

Q fever is a zoonosis caused by the bacterium Coxiella burnetii. One of the largest reported outbreaks of Q fever in humans occurred in the Netherlands starting in 2007; epidemiologic investigations identified small ruminants as the source. To determine the genetic background of C. burnetii in domestic ruminants responsible for the human Q fever outbreak, we genotyped 126 C. burnetii--positive samples from ruminants by using a 10-loci multilocus variable-number tandem-repeat analyses panel and compared them with internationally known genotypes. One unique genotype predominated in dairy goat herds and 1 sheep herd in the human Q fever outbreak area in the south of the Netherlands. On the basis of 4 loci, this genotype is similar to a human genotype from the Netherlands. This finding strengthens the probability that this genotype of C. burnetii is responsible for the human Q fever epidemic in the Netherlands. [ABSTRACT FROM AUTHOR]

In this article we address the question how differences in organizational contexts influence the consolidation of governance capacity and thus the sustainability of successful governance reforms. We analyze the outcomes (in terms of consolidation of governance capacity) of two change trajectories in the Dutch public domain in rather different institutional contexts. The first case is a bilateral planning process between Flanders and the Netherlands in which a new way of collaborative decision-making for the Schelde estuary was established. After decades of stalemate negotiations, the governments of Flanders and the Netherlands decided to initiate a collaborative governance process with a variety of public, private and societal actors which was intended to result in an integral (broadly supported) vision on the future of the estuary. The second case assessed is a program in the Dutch ministry of Housing, Spatial Planning and the Environment (VROM), intended to get more interaction between policy-makers and citizens as well as to improve citizen orientation with the organization. A variety of projects were launched to experiment with new ways of working and to enhance the openness of the policy process with regard to environmental policy. [ABSTRACT FROM AUTHOR]

The position of Muslims in the Netherlands and government policies regarding Muslims have been influenced not only by the attacks of 9/11, but even more by the murder of the film-maker Theo van Gogh on 2 November 2004. The brutal murder activated serious political problems and perceptions that were already present; it caused authorities to panic, it was the starting point of a series of arson attacks and threats, and many Muslims experienced a feeling of exclusion. The background to these developments can partly be traced back to the socio-economic, cultural and political positions of Muslims in the Netherlands and to the perceptions that Muslims cherish regarding religion and the West. The prevailing perceptions are subject to political struggle between Muslim democrats and Muslim radicals. The development of this struggle calls for a new understanding of the attraction exerted by radicalism and extremism on a small number of Muslim youngsters in Western Europe. This radicalism shows a complicated relation with the religious orthodoxy that is usually called 'Salafism'. A closer study reveals that Salafism manifests itself in three movements, intensively competing for domination and the recruitment of Muslim youngsters. The two non-violent varieties of Salafism claim to build a threshold against radicalism, whereas others depict it as a stepping-stone towards radicalisation. These perceptions influence policies against terrorism and especially against the spread of radicalism. [ABSTRACT FROM AUTHOR]

Background: Jejunal feeding is preferred instead of gastric feeding in patients who are intolerant to gastric feeding or at risk of aspiration. However, the impact of gastric feeding compared with that of jejunal feeding on postprandial circulating plasma glucose and amino acid concentrations and the associated endocrine response in vivo in humans remains largely unexplored. Objective: We compared the impact of administering enteral nutrition as either gastric feeding or jejunal feeding on endocrine responses in vivo in humans. Design: In a randomized, crossover study design, 12 healthy young men (mean ± SD age: 21 ± 2 y) received continuous enteral nutrition that contained noncoagulating proteins for 12 h via a na-sogastric tube or a nasojejunal tube placed 3CMK) cm distal to the ligament of Treitz. Blood samples were collected during the 12-h postprandial period to assess the rise in plasma glucose, amino acid, and gastrointestinal hormone concentrations. Results: No differences were observed in the postprandial rise in circulating plasma amino acid and glucose concentrations between regimens. Jejunal feeding resulted in higher peak plasma insulin concentrations than did gastric feeding (392 ± 53 compared with 326 ± 54 pmol/L, respectively; P < 0.05). The postprandial rise in plasma cholecystokinin, peptide YY (PYY), glucagon-like peptide 1 (GLP-1), and glucagon-like peptide 2 (GLP-2) concentrations was greater after jejunal feeding than after gastric feeding, with higher peak concentrations and a greater postprandial incremental AUC for GLP-1 and cholecystokinin (all P < 0.05). Plasma ghrelin concentrations did not differ between regimens. Conclusions: Enteral nutrition with gastric or jejunal feeding in healthy young men results in similar postprandial plasma amino acid and glucose concentrations. However, the endocrine response differs substantially, with higher peak plasma cholecystokinin, PYY, GLP-1, and GLP-2 concentrations being attained after jejunal feeding. This effect may result in an improved anabolic response, greater insulin sensitivity, and an improved intestinotropic effect. Nevertheless, it may also lead to delayed gastric emptying. This trial was registered at trialregister.nl as NTR2801. [ABSTRACT FROM AUTHOR]

Background: Arginine plays a role in many different pathways in multiple cell types. Consequently, a shortage of arginine, caused by pathologic conditions such as cancer or injury, has the potential to disturb many cellular and organ functions. Glutamine is the ultimate source for de novo synthesis of arginine in humans via the intestinal-renal axis. Therefore, we hypothesized that parenteral glutamine supplementation may stimulate the interorgan pathway of arginine production. Objectives: The objectives were to quantify arginine production from its precursor glutamine and to establish the contribution of the kidneys to de novo synthesis of arginine in patients receiving intravenous supplementation of glutamine dipeptide during major abdominal surgery. Design: Whole-body and renal metabolism of glutamine, citrulline, and arginine was assessed by stable isotope techniques in 7 patients receiving a perioperative supplement of intravenous alanyl-glutamine (0.5 g ⋅ kg-1 ⋅ d-1). Results: Plasma glutamine, citrulline, and arginine concentrations increased significantly in patients receiving intravenous glutamine dipeptide. At whole-body level, 91% of total citrulline turnover was derived from glutamine, whereas 49% of whole-body citrulline turnover was used for de novo synthesis of arginine. The kidneys were responsible for 75% of whole-body arginine production from citrulline. Conclusions: Glutamine and citrulline are important sources for de novo arginine synthesis. The kidneys are the main production site for endogenous arginine. After comparison of these results with previous similar studies, our data suggest that an intravenous glutamine supplement doubles renal arginine production from citrulline. This trial was registered at www.trialregister.nl as NTR2914. [ABSTRACT FROM AUTHOR]

Copyright of Études Inuit Studies is the property of Centre interuniversitaire d'etudes et de recherches autochtones (CIERA) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Rheumatic diseases are a major cause of permanent work disability. In the process of occupational rehabilitation several health professionals may have a role.Objective: To assess the quality and quantity of communication and cooperation between Dutch rheumatologists and occupational physicians.Methods: A postal survey among 187 Dutch rheumatologists.Results: 153/187 rheumatologists (82%) returned the questionnaire. They considered reducing pain and fatigue to be their major responsibility in the process of occupational rehabilitation, followed by improving work participation (68/153 (44%)) and quality of work (55/153 (36%)). Although 112/153 (73%) of the rheumatologists judged the communication and cooperation with occupational physicians as reasonable to good, 119/153 (78%) of them were willing to improve the collaboration. Perceived bottlenecks mentioned were a lack of clarity about the occupational physician's position and activities, and the absence of practice guidelines. The most important prerequisites for improvement were found to be guarantees about the occupational physician's professional independence and more clarity about the competence of the occupational physicians and how they used the information provided.Conclusion: Dutch rheumatologists are willing to improve cooperation and communication with occupational physicians. The perceived lack of clarity about their mutual tasks appears to be a major obstacle. Thus the development of a joint education programme and a guideline for occupational rehabilitation in rheumatic diseases may be appropriate first steps towards improvement. [ABSTRACT FROM AUTHOR]

Background:  Brown rats (Rattus norvegicus) may carry pathogens that can be a risk for public health. Brown rats in the Netherlands were tested for the zoonotic pathogens Leptospira spp. and Seoul hantavirus (SEOV), in order to obtain insight in their prevalence. Methods and results:  Cross-sectional studies were performed at four locations from 2011 to 2015. The rats were tested for Leptospira spp. using real-time PCR and/or culture resulting in a prevalence ranging between 33-57%. Testing for SEOV was done through an adapted human Seoul hantavirus ELISA and real-time RT-PCR. Although at several locations the ELISA indicated presence of SEOV antibodies, none could be confirmed by focus reduction neutralization testing. Conclusion:  The results indicate a widespread presence of Leptospira spp. in brown rats in the Netherlands, including areas with a low leptospirosis incidence in humans. No evidence for circulation of SEOV was found in this study. [ABSTRACT FROM AUTHOR]

Background: Cancer patients report that they lack support from healthcare providers when it comes to returning to or maintaining employment. In the education of general practitioners (GPs) in the Netherlands, there is little attention given to discussing work participation with patients. The aim of this pilot study was to evaluate a newly developed education program for GPs in training that focuses on discussing work participation with cancer patients. Methods: Two groups of in total twenty-one GPs in training participated in the education program. GPs were educated about the importance of discussing work participation with patients, work-related problems cancer patients can experience, and advice they can give to support cancer patients regarding work issues. In this pilot study using a mixed-method design, participants evaluated the program in two self-developed questionnaires and in a focus group discussion. Results: Seventeen participating GPs (81%) indicated that the education program was suitable for implementation in the education curriculum. Eleven participants (52%) reported that they had never discussed work participation with cancer patients before. Directly after the education program, eighteen participants (86%) reported that they planned to discuss work participation more often with their patients. Four months after the program, 67% indicated they had applied their new knowledge and skills in practice by discussing work participation and by referring cancer patients to occupational health professionals or online resources. According to the GPs in training, integrating the topic of work participation into other education for GPs in training and focusing on a broader group of patients could improve the impact of the education program. Conclusions: According to the results of this pilot study, the newly developed education program increased the awareness of GPs in training on the importance of discussing work participation with cancer patients. Future studies should focus on whether cancer patients experience more support from their GPs for maintaining and returning to employment after their GP has participated in the training program. [ABSTRACT FROM AUTHOR]

Introduction: In the Netherlands, most emergency department (ED) patients are referred by a general practitioner (GP) or a hospital specialist. Early risk stratification during telephone referral could allow the physician to assess the severity of the patients' illness in the prehospital setting. We aim to assess the discriminatory value of the acute internal medicine (AIM) physicians' clinical intuition based on telephone referral of ED patients to predict short-term adverse outcomes, and to investigate on which information their predictions are based. Methods: In this prospective study, we included adult ED patients who were referred for internal medicine by a GP or a hospital specialist. Primary outcomes were hospital admission and triage category according to the Manchester Triage System (MTS). Secondary outcome was 31-day mortality. The discriminatory performance of the clinical intuition was assessed using an area under the receiver operating characteristics curve (AUC). To identify which information is important to predict adverse outcomes, we performed univariate regression analysis. Agreement between predicted and observed MTS triage category was assessed using intraclass and Spearman's correlation. Results: We included 333 patients, of whom 172 (51.7%) were referred by a GP, 146 (43.8%) by a hospital specialist, and 12 (3.6%) by another health professional. The AIM physician's clinical intuition showed good discriminatory performance regarding hospital admission (AUC 0.72, 95% CI: 0.66–0.78) and 31-day mortality (AUC 0.73, 95% CI: 0.64–0.81). Univariate regression analysis showed that age ≥65 years and a sense of alarm were significant predictors. The predicted and observed triage category were similar in 45.2%, but in 92.5% the prediction did not deviate by more than one category. Intraclass and Spearman's correlation showed fair agreement between predicted and observed triage category (ICC 0.48, Spearman's 0.29). Conclusion: Clinical intuition based on relevant information during a telephone referral can be used to accurately predict short-term outcomes, allowing for early risk stratification in the prehospital setting and managing ED patient flow more effectively. [ABSTRACT FROM AUTHOR]

The Tropospheric Ozone Lidar Network (TOLNet) was used to validate retrievals of ozone (O 3) profiles in the troposphere from the TROPOspheric Monitoring Instrument (TROPOMI) ultraviolet (UV), Cross-track Infrared Sounder (CrIS) infrared (IR), and a combined UV + IR wavelength retrieval from TROPOMI/CrIS. Observations from six separate ground-based lidar systems and various locations of ozonesondes distributed throughout North America and in the Netherlands were used to quantify systematic bias and random errors for each satellite retrieval. Furthermore, TOLNet data were used to intercompare idealized UV, IR, and UV + IR convolved lidar profiles of O 3 in the troposphere during case studies representative of high-O 3 events. This study shows that the improved sensitivity and vertical resolution in UV + IR retrievals in the middle- and upper-troposphere resulted in tropospheric degree of freedom (DOF) values ∼ 33 % higher compared to UV- and IR-only retrievals. The increased DOFs in the UV + IR retrievals allowed for improved reproduction of mid- and upper-tropospheric O 3 enhancements and, to a lesser degree, near-surface pollution enhancements compared to single-wavelength satellite products. The validation of O 3 profiles in the troposphere retrieved with the UV-only, IR-only, and UV + IR Tikhonov regularised Ozone Profile retrievAl with SCIATRAN (TOPAS) algorithm developed at the Institute for Environmental Physics, University of Bremen, demonstrated the utility of using TOLNet as a satellite evaluation data set. TOPAS UV-only, IR-only, and UV + IR wavelength retrievals had systematic biases, quantified with normalized mean bias, throughout the troposphere of 11.2 ppb (22.1 %), -1.7 ppb (-0.3 %), and 3.5 ppb (7.8 %), respectively, which meet the tropospheric systematic bias requirements defined by the science teams for the TROPOMI and CrIS sensors. The primary drivers of systematic bias were determined to be solar zenith angle, surface albedo, and cloud fraction. Random errors, representative of uncertainty in the retrievals and quantified by root mean squared errors (RMSEs), were large for all three retrievals, with UV-only, IR-only, and UV + IR wavelength retrievals having RMSEs throughout the troposphere of 17.4 ppb (19.8 % of mean tropospheric column values), 10.5 ppb (12.6 % of mean tropospheric column values), and 14.0 ppb (14.6 % of mean tropospheric column values), respectively. TOPAS UV-only profiles did not meet the uncertainty requirements defined for TROPOMI for the troposphere; however, CrIS IR-only retrievals did meet the uncertainty requirements defined by this mission. The larger random errors reflect the challenge of retrieving daily O 3 profiles due to the limited sensitivity and vertical resolution of these retrievals in the troposphere. Tropospheric systematic biases and random error were lower in IR-only and combined UV + IR retrievals compared to UV-only products due to the increased sensitivity in the troposphere allowing the retrievals to deviate further from the a priori profiles. Observations from TOLNet demonstrated that the performance of the three satellite products varied by season and altitude in the troposphere. TOLNet was shown to result in similar validation statistics compared to ozonesonde data, which are a commonly used satellite evaluation data source, demonstrating that TOLNet is a sufficient source of satellite O 3 profile validation data in the troposphere, which is critical as this data source is the primary product identified for the tropospheric O 3 validation of the recently launched Tropospheric Emissions: Monitoring of Pollution (TEMPO) mission. [ABSTRACT FROM AUTHOR]

Currently, there is a growing interest in transforming wastewater treatment plants (WWTPs) into resource recovery plants. Microorganisms in aerobic granular sludge produce extracellular polymeric substances (EPS), which are considered sustainable resources to be extracted and can be used in diverse applications. Exploring applications in other high-value materials, such as adhesives, will not only enhance the valorization potential of the EPS but also promote resource recovery. This study aimed to characterize a water-soluble fraction extracted from the EPS collected at the demonstration plant in the Netherlands based on its chemical composition (amino acids, sugar, and fatty acids) and propose a proof-of-concept for its use as an adhesive. This fraction comprises a mixture of biomolecules, such as proteins (26.6 ± 0.3%), sugars (21.8 ± 0.2%), and fatty acids (0.9%). The water-soluble fraction exhibited shear strength reaching 36-51 kPa across a pH range of 2-10 without additional chemical treatment, suggesting a potential application as an adhesive. The findings from this study provide insights into the concept of resource recovery and the valorization of excess sludge at WWTPs. [ABSTRACT FROM AUTHOR]

An increasing number of schools obtained a Healthy School certificate, yet little is known about factors, characteristics, and processes, i.e. conditions, influencing the effectiveness of the Healthy School program. Therefore, a mixed methods evaluation study will be conducted on three levels: the student, the school, and the region. The research questions are focused on: 1) conditions for student outcomes, 2) conditions for implementation in schools, and 3) conditions for regional support. For the evaluation, the school and region are considered complex adaptive systems. Conditions for intended outcomes on student lifestyle, health, and academic achievement will be examined using a combination of existing datasets including school codes. Based on student outcomes, best and worst performing schools will be selected for predominantly qualitative analysis to further explain differences. To get insight into conditions for implementation in schools and regional support in nine regions, the degree of implementation will be determined with a questionnaire to select schools for predominantly qualitative analysis. Combined, this study will not only provide insight into the current situation on the three levels, but also explain differences between regions, schools, and students. Consequently, it will be possible to provide concrete advice to strengthen implementation of the Healthy School program. [ABSTRACT FROM AUTHOR]

At the beginning of 2020, the large and unforeseen inflow of COVID-19 patients had a deep impact on the healthcare operations of Dutch hospitals. From a patient flow logistics perspective, each hospital handled the situation largely in its own particular and improvised way. Nevertheless, some hospitals appeared to be more effective in their dealing with this sudden demand for extra care than others. This prompted a study into the factors which hindered and facilitated effective operations during this period. We provide an overview of actions and measures for organizing and managing the inflow, throughput and outflow of COVID-19 patients within Dutch hospitals from various types of departments in a large number of hospitals in The Netherlands, based on interviews with nine experts and twelve hospital managers. Ten actions or measures have been identified, which have been divided into the following three dimensions: Streamlining of the underlying in- and external processes, reducing unnecessary or undesirable inflow of patients and increasing or making more adequate use of the available (human) capacity. The main lessons learned are the importance of integral tuning in the care process, giving up habits and self-interest, good information provision and the middle manager as a linking pin. [ABSTRACT FROM AUTHOR]

Sown field margins can improve the conservation of biodiversity in rural areas and can contribute to the aesthetics of rural landscapes, thereby potentially increasing public support for agri-environmental measures. However, these two functions do not necessarily coincide. This raises the question whether field margins that are appreciated for their contribution to landscape aesthetics also deliver on the conservation of biodiversity. We conducted choice experiments with different groups of citizens and collected biodiversity data in the Netherlands, to investigate if the number of colors and vegetation cover in field margins increased respondents' appreciation for them, and how these visual cues correlated with taxonomic diversity and abundance of plants and invertebrates in those field margins. Using manipulated photos, we also assessed whether the presence of colorful field margins in a range of different rural landscapes increased respondents' appreciation of those landscapes. Respondents preferred colorful margins with high vegetation cover and showed a preference for green rural landscapes with colorful field margins. The presence of colorful field margins increased landscape aesthetics most in the least appreciated landscapes. The number of colors correlated positively with the diversity of sown and spontaneous plant species, and overall invertebrate abundance and abundance of predatory invertebrates, but was not related to invertebrate diversity. Our results show for the first time that colorful field margins support both public appreciation and diversity of plants and abundance of ground-dwelling invertebrates, with potential advantages to farmers in terms of natural pest control, at least in intensively used agricultural landscapes. However, management practices to maintain a high number of colors over time may be detrimental for invertebrate diversity. To optimize the different functions, we recommend that field margin layouts should consist of a perennial part that is allowed to develop over time, in combination with a part that is managed for its colorfulness. [ABSTRACT FROM AUTHOR]

Purpose. We aimed to evaluate the potential for implementing exercise interventions for patients with breast cancer in the Netherlands, based on findings of the Dutch randomized controlled trials in this population. Methods. We evaluated the implementation of four Dutch exercise trials retrospectively, using the five dimensions of the RE-AIM framework: Reach (exercise participation rate), Effectiveness for physical fitness, fatigue, quality of life, and physical function, Adoption (e.g., satisfaction of physical therapists guiding the exercise intervention), Implementation (cost-effectiveness and exercise adherence correlates thereof), and Maintenance (maintenance of exercise levels by individual patients and sustainability of exercise delivery at organization level). Thereby, we reflect on these results using (international) literature to gain better insight in overall barriers, facilitators, and opportunities for further implementation of exercise interventions. Results. Participation rates of 44–52% not only indicated acceptable Reach in the context of a trial but also indicated room for improvement. Effectiveness of exercise during and after treatment was demonstrated in most trials showing benefits for aerobic fitness, physical fatigue, quality of life and physical function, and high patient satisfaction. Adoption of the exercise interventions by physical therapists was adequate (satisfaction score: 7.5 out of 10). Evaluation of Implementation indicated adequate adherence to supervised exercise, inconsistent findings on potential correlates of adherence, and promising results on cost-effectiveness. Currently, reimbursement for exercise programs is lacking. Maintenance of intervention effects at the patient level was limited and inconsistent. Maintenance of intervention availability at the organizational level was facilitated by an extensive network of specially trained physical therapists, but better communication and collaboration between different healthcare professionals are desired. Conclusions. Improved implementation could particularly be achieved by increasing reach and improved focus on exercise maintenance on both the patient and organizational level. [ABSTRACT FROM AUTHOR]

Landscape heritage is frequently contested as perspectives on heritage and landscape may vary across stakeholders. The present article makes a novel contribution by examining pathways to landscape heritage contestation. We propose a distinction between (a) heritage as object in matterscape, being the physical landscape out-there, (b) heritage as meaning in mindscape, being the landscape as experienced by a subject, and (c) heritage as political act in powerscape, being the landscape as rules that organise behaviour. Contestation, then, might originate in matterscape, mindscape, or powerscape. We illustrate these pathways to contestation upon analyses of semi-structured interviews among stakeholders of Schokland, The Netherlands, a World Heritage site. Findings reveal contestation about matterscape pertaining to the issue whether a water system leads to wet spots on adjacent agricultural land, about mindscape pertaining to the beauty of new nature developed around Schokland, and powerscape pertaining to the rules associated with the World Heritage status. [ABSTRACT FROM AUTHOR]

The authors discuss the content of the Hague Conference on the role for occupational health in primary health care. They provide the strategy outlined in the conference to integrate occupational and primary health care which include training healthcare workers to recognize work-related illnesses, connecting its healthcare centres and services under local primary care networks, and development of occupational guidelines.

Three decades after the end of the Cold War, the United States still deploys about 100 nuclear weapons in Europe under NATO's nuclear sharing policy. Two of the hosting states, Germany and the Netherlands, are now debating the prospective withdrawal of these weapons from their territory. This article presents the findings of a recent public opinion poll in the two countries, where German and the Dutch citizens expressed their views on the US withdrawal. Given the changing political landscape in these two countries, public support for these policies is a pertinent aspect of the political decisions over the future of US nuclear weapons in Europe. [ABSTRACT FROM AUTHOR]

This article deals with the role of government in encouraging the decline of radical movements. The question posed is: “Which story can the government tell to encourage the decline of radical groups and the disengagement of their members?” The article makes use of the survey of factors promoting decline and disengagement drawn up by Demant, Slootman, Buijs (†) and Tillie in 2008, as well as the factor “official policy strategies” based on concepts taken from discourse analysis, adapted to counterterrorism and deradicalization strategies by De Graaf in 2009. The article will therefore not address the different practical measures in this field, but focus instead on the perception of these official measures by the radicals. It will illustrate this with two case studies: the deradicalization of South Moluccan youths in the 1970s and of jihadist radicals after 2001, both in the Netherlands. [ABSTRACT FROM AUTHOR]

Copyright of Sociologie is the property of Amsterdam University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study examines the use of natural environments for recreation among immigrants and factors that led to changes in their use of natural environments between home and host countries. The data were collected through individual interviews with 13 Latino and 13 Chinese immigrants in the U.S., 15 Ukrainian and 11 Vietnamese immigrants in Poland, 9 Moroccan immigrants in the Netherlands and 9 Turkish immigrants in Germany. The findings show that changes in the use of natural environments for recreation are related to different types of nature in home and host countries, access-related issues, quality of natural environments, work focus among immigrants, transportation problems, cultural differences, lack of knowledge of opportunities, life stage and ageing. Based on the findings, we develop a model that outlines different types of interaction with natural environments among immigrants following their settlement in the host countries. [ABSTRACT FROM PUBLISHER]

Background: Overweight among adolescents remains a serious concern worldwide and can have major health consequences in later life, such as cardiovascular diseases and cancer. Still, 33% of secondary school adolescents in the Netherlands consume sugar-sweetened beverages daily and over 26% do not consume water every day. The Dutch Healthy School program was developed to support schools in stimulating healthier lifestyles by focusing on health education, school environments, identifying students' health problems, and school policy. We examined the variation between secondary schools regarding the daily consumption of water and sugar-sweetened beverages and whether this variation can be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population. Methods: We performed a cross-sectional multilevel study. We used data from the national Youth Health Monitor of 2019 on secondary schools (grades 8 and 10, age range about 12 to 18 years) of seven Public Health Services and combined these with information regarding Healthy School certification and general school- and school population characteristics. Our outcomes were daily consumption of water and sugar-sweetened beverages. In total, data from 51,901 adolescents from 191 schools were analysed. We calculated the intraclass correlation to examine the variation between schools regarding our outcomes. Thereafter, we examined whether we could explain this variation by the included characteristics. Results: The school-level explained 4.53% of the variation in the consumption of water and 2.33% of the variation in the consumption of sugar-sweetened beverages. This small variation in water and sugar-sweetened consumption could not be explained by Healthy School certification, yet some general school- and school population characteristics did: the proportion of the school population with at least one parent with high educational attainment, the educational track of the adolescents, urbanicity (only for water consumption) and school type (only for sugar-sweetened beverages consumption). Conclusions: The low percentages of explained variation indicate that school-level characteristics in general (including Healthy School certification) do not matter substantially for the daily consumption of water and sugar-sweetened beverages. Future research should examine whether school health promotion can contribute to healthier lifestyles, and if so, under which level of implementation and school conditions. [ABSTRACT FROM AUTHOR]