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In this study, Weiss's (1973) theorizing about the sources of emotional and social loneliness is elaborated - with notions about the asymmetric gratifications derived from marriage, about the conflicting loyalties that result from remarriage, and about selection into marriage - in order to reach an understanding of gender differences in loneliness, both in and outside of marriage. First and subsequent marriages are considered, as well as marital disruptions and never marrying. The data (N = 3737) are from the 1992 Dutch survey on older adults' living arrangements and social networks (NESTOR-LSN). Marital-history differences emerge, not only for emotional loneliness, but also (and contrary to Weiss's theoretical conceptualizations) for social loneliness. The marital-history differences in emotional and social loneliness are greater among men than women. For men, the marriage bond appears not only to be more central to emotional well-being than is the case for women but also to play a pivotal role in their involvement with others. Marital history offers the best explanation for differences in emotional loneliness among men, but social embeddedness characteristics also account for differences in emotional loneliness among women. Apparently, whereas men are more likely to find an intimate attachment in marriage, women also find protection from emotional loneliness in other close ties. The marital-history differences in social loneliness are largely mediated by social embeddedness characteristics, partly in different ways for men and women. Involvement in activities outside the home serves as the context for sociability for men, whereas parenthood plays a more important role in women's social engagements.

Textbook outcome (TO) is a composite outcome measure covering the surgical care process in a single outcome measure. TO has an advantage over single outcome parameters with low event rates, which have less discriminating impact to detect differences between hospitals. This study aimed to assess factors associated with TO, and evaluate hospital and network variation after case-mix correction in TO rates for liver surgery. This was a population-based retrospective study of all patients who underwent liver resection for malignancy in the Netherlands in 2019 and 2020. TO was defined as absence of severe postoperative complications, mortality, prolonged length of hospital stay, and readmission, and obtaining adequate resection margins. Multivariable logistic regression was used for case-mix adjustment. 2376 patients were included. TO was accomplished in 1380 (80%) patients with colorectal liver metastases, in 192 (76%) patients with other liver metastases, in 183 (74%) patients with hepatocellular carcinoma and 86 (51%) patients with biliary cancers. Factors associated with lower TO rates for CRLM included ASA score ≥3 (aOR 0.70, CI 0.51–0.95 p = 0.02), extrahepatic disease (aOR 0.64, CI 0.44–0.95, p = 0.02), tumour size >55 mm on preoperative imaging (aOR 0.56, CI 0.34–0.94, p = 0.02), Charlson Comorbidity Index ≥2 (aOR 0.73, CI 0.54–0.98, p = 0.04), and major liver resection (aOR 0.50, CI 0.36–0.69, p < 0.001). After case-mix correction, no significant hospital or oncological network variation was observed. TO differs between indications for liver resection and can be used to assess between hospital and network differences. [ABSTRACT FROM AUTHOR]

Ampullary cancer is rare and as a result epidemiological data are scarce. The aim of this population-based study was to determine the trends in incidence, treatment and overall survival (OS) in patients with ampullary adenocarcinoma in the Netherlands between 1989 and 2016. Patients diagnosed with ampullary adenocarcinoma were identified from the Netherlands Cancer Registry. Incidence rates were age-adjusted to the European standard population. Trends in treatment and OS were studied over (7 years) period of diagnosis, using Kaplan-Meier and Cox regression analyses for OS and stratified by the presence of metastatic disease. In total, 3840 patients with ampullary adenocarcinoma were diagnosed of whom, 55.0% were male and 87.1% had non-metastatic disease. The incidence increased from 0.59 per 100,000 in 1989–1995 to 0.68 per 100,000in 2010–2016. In non-metastatic disease, the resection rate increased from 49.5% in 1989–1995 to 63.9% in 2010–2016 (p < 0.001). The rate of adjuvant therapy increased from 3.1% to 7.9%. In non-metastatic disease, five-year OS (95% CI) increased from 19.8% (16.9–22.8) in 1989–1995 to 29.1% (26.0–31.2) in 2010–2016 (logrank p < 0.001). In patients with metastatic disease, median OS did not significantly improve (from 4.4 months (3.6–5.0) to 5.9 months (4.7–7.1); logrank p = 0.06). Cancer treatment was an independent prognostic factor for OS among all patients. Both incidence and OS of ampullary cancer increased from 1989 to 2016 which is most likely related to the observed increased resection rates and use of adjuvant therapy. • Over time, the incidence of ampullary cancer in the Netherlands increased. • Resection was 50% of non-metastatic disease in 1989–1995 and 64% in 2010–2016. • Five-year overall survival increased from 20% to 29% in non-metastatic disease. • Treatment choices and overall survival in metastatic disease were similar over time. [ABSTRACT FROM AUTHOR]

The financial position of older adults in the Netherlands is a heterogeneous one. Gender, living arrangement and age are among the most important determinants of household income levels, as has been illustrated with macro level data. However, the interconnectedness of current characteristics of older males and females with life-course experiences in the field of labour market participation and partner relationships, is hypothesized to be of crucial importance to explain the differences in financial opportunities and resources older adults are confronted with. To investigate the financial position of older men and women, data from the NESTOR 'Living Arrangement and Social Network' programme, based on 4494 face-to-face interviews, have been used. [ABSTRACT FROM AUTHOR]

B Background: b The 2016 Dutch national guidelines on handling of a removed gallbladder for cholelithiasis proposes a selective histopathologic policy (Sel-HP) rather than routine policy (Rout-HP). B Materials and Methods: b Surgeons who were engaged in gallbladder surgery in the Netherlands and were involved in local hospitals' gallbladder protocols completed a questionnaire study regarding gallbladder policy, between December 2017 and May 2018. Of the 39 hospitals who had a Rout- HP, 36 were open to a transition to a Sel-HP although some expressed the need for more evidence on safety or novel guidelines. [Extracted from the article]