Search

Because of the improvement-oriented nature of peer-feedback activities, students have to deal with errors (e.g., spelling and argumentation errors) when providing and processing peer-feedback on writing assignments. Despite the central role of errors in feedback activities, it is uncertain how students deal with errors and whether the dealing with errors is affected by interpersonal perceptions. Therefore, this study explores (1) whether cognitive sub-phases are distinguishable during the process of dealing with errors and (2) the extent to which dealing with errors is affected by interpersonal perceptions. Six dyads of Dutch 11th grade students provided and processed peer-feedback on argumentative texts while thinking-aloud, and they reflected on the processes in a post-interview. The think-aloud utterances and interviews were analyzed with a mixed-methods design, using quantitative content analyses, and qualitative thematic analyses. The dealing with errors during peer-feedback provision displayed two patterns: error identification either occurred simultaneously with the decoding and often any evaluation-related thoughts lacked, or error-identification occurred as a result of an interpreting/evaluating phase. Also during peer-feedback processing, two main patterns were observable: students either knew immediately whether they agreed with feedback, or they first had to study the feedback more thoroughly. Additionally, interpersonal perceptions seemed to affect most students implicitly during feedback provision, and most students explicitly during feedback processing. As such, this study provides empirical evidence for the existence of cognitive sub-phases in the process of dealing with errors during peer-feedback activities, and portrays how these activities may be affected by interpersonal perceptions.

This research examined the preference for identity-first language (IFL) versus person-first language (PFL) among 215 respondents (M[subscript age] = 30.24 years, SD = 9.92) from the Dutch autism community. We found that a stronger identification with the autism community and a later age of diagnosis predicted a stronger IFL preference and a weaker PFL preference. Both effects were mediated by the perceived consequences (justice to identity, prejudice reduction) of PFL. Participants' own explanations were in line with these statistical analyses but also provided nuance to the IFL-PFL debate. Our results are consistent with the Social Identity Approach (Reicher et al., 2010) and Identity Uncertainty Theory (Hogg, 2007) and demonstrate the value of a social psychological approach to study disability language preferences.

This longitudinal study (three waves across a school year) investigated the links between children's motivations to respond without prejudice and their ethnic outgroup attitudes at the between-person level (means and changes over time) and the within-person level (time-specific fluctuations). Participants were 945 ethnic majority students (M[subscript ageW1] = 9.86 years, SD = 1.21; 471 girls) from 51 grade 3-6 classrooms in the Netherlands. Children reported (increasingly) more positive outgroup attitudes when their internal motivation was structurally high (between-person effects) and temporarily high (within-person effect), and less positive attitudes when their external motivation was structurally and temporarily high. The between-person effects were independent of the ethnic composition and the antiprejudice climate of the classroom. These findings may help in developing interventions aimed at reducing prejudice in late childhood.

The ethnic classroom composition and classmates' ethnic attitudes can affect how students experience their classroom social environment (CSE). Following the imbalance of power thesis and prior research on ethnic attitudes, this cross-sectional study examined if ethnic classroom composition (i.e., proportion of in-group and Herfindahl Index) and classmates' explicitly and implicitly measured ethnic attitudes predicted secondary school students' (M[subscript age] = 13.31 years; 58.1% female) classroom belonging, popularity and likability, classroom cohesion and conflict in mixed classes in the Netherlands. Differences between non-ethnic Dutch (n = 248) versus ethnic Dutch students (n = 141) were examined as well. Ethnic Dutch students report an overall more negative CSE than their non-ethnic Dutch classmates. Multilevel analyses indicated that a higher proportion of in-group peers affected non-ethnic Dutch students' popularity and likability negatively. Moreover, classmates' explicitly measured ethnic attitudes were predictive of student popularity while classmates' implicitly measured ethnic attitudes were predictive of student likability. Finally, classmates implicitly measured ethnic attitudes moderated the effect of proportion in-group peers on students' shared experience of classroom belonging. These results show that promoting classroom diversity is not enough to create a positive CSE for all students. Classmates' ethnic attitudes are also important to consider.

Background: Despite the growing body of research concerning affective relationships between teachers and ethnic minority students, very little is known about student-teacher relationship (STR) quality for religious minority students. Many Islamic schools have a mixed workforce consisting of both Muslim and non-Muslim teachers. This means that the quality of religiously congruent and religiously incongruent STRs can be directly compared. Aims: We investigated whether the quality of the STR experienced by Dutch Islamic school students depended on the religious background of their teacher (Muslim vs. non-Muslim). We also examined the role of teachers' implicitly measured attitudes towards Muslims as a possible explanation for differences in relationship quality. Sample: Participants were 707 students (56.9% female) from 35 classes (Grade 3-6) (M[subscript age] = 10.02 years, SD = 1.25) and their 35 teachers (85.7% female; M[subscript age] = 32.94 years, SD = 6.37). Methods: Students reported on the quality of the relationship with their teacher (closeness, conflict, and negative expectations), and teachers' implicit attitude towards Muslims (vs. non-Muslims) was measured with an Implicit Association Test. Results: Students reported relatively high levels of closeness and low levels of conflict and negative expectations for both Muslim and non-Muslim teachers. Conflict was slightly higher in religiously incongruent STRs, but only when teachers' implicitly measured attitude towards Muslims (vs. non-Muslims) was included in our model. Conclusion: Results of this study indicate that religious incongruence does not play a major role in STR quality in Islamic primary education.

In the current study, a Dutch whole school Positive Education Programme (PEP) was investigated. PEP is a bottom-up programme, aimed at shifting teacher's attention from solely focusing on learning outcomes towards a more comprehensive approach that takes the wellbeing and engagement of students during classes into account. PEP was investigated through a clustered quasi-experimental trial. Four primary schools, 639 pupils, were included, of which two were allocated to PEP. Multilevel analyses showed no significant differences on any of the outcomes. However, the data indicated a trend towards more engagement in the intervention schools (p = 0.09). Also, at post-measurement, the proportion of sufficiently engaged students was significantly higher in the intervention schools. Although it seems too premature to draw conclusions regarding the effectiveness of such a whole school approach, the findings on engagement are promising and have the potential to engender a wide range of other beneficial outcomes.

Background: Many studies have shown that school belonging is crucial for students' school adjustment, but the construct has been operationalized in different ways. Moreover, most research has focused on adolescents and not compared its antecedents for ethnic minority versus majority students. Aims: Based on Goodenow and Grady's (1993) seminal paper, we examined classroom identification as a central aspect of school belonging in minority and majority preadolescents, and predicted it from relationships with peers and teachers, taking into account classroom ethnic composition and perceived multicultural teaching. Sample: Participants were 485 grade 4-6 students from 39 classrooms in Dutch primary schools. Of these children, 68 had a Turkish background, 72 had a Moroccan background, and 345 had a native Dutch background. Methods: Participants completed questionnaires at two waves (4.5 months apart). We used self-reports to measure classroom identification at both waves, and student-teacher relationship closeness and conflict, multicultural teaching, and peer friendship and rejection at Wave 1. We conducted multilevel analyses to predict classroom identification at Wave 2, while controlling for classroom identification at Wave 1. Results: Children of all ethnicities reported more classroom identification over time if they were less rejected by their peers and had more co-ethnic classmates. For minority children, both closeness and conflict with the teacher predicted less identification, but the effect of conflict appeared to result from their ethnic underrepresentation in the classroom. Conclusions: Negative peer relationships can undermine classroom identification, and the student-teacher relationship has special significance for ethnic minority students.

Ethnic minority adolescents receive not only less formal mental health services than their ethnic majority peers but also less school-based mental health services. Little is known about the extent to which adolescents indicate their teachers help them with their mental health problems. The aim of the current study was to investigate ethnic differences in teacher-provided informal help for adolescents' internalizing problems, and whether these could be explained by differences in teacher-reported internalizing problems and teacher-adolescent relationship quality. A sample of adolescents at risk of internalizing problems and their teachers participated in the study (n = 229). Adolescents originated from four ethnic groups in the Netherlands: three ethnic minority groups (Surinamese Dutch, Turkish Dutch, Moroccan Dutch) and the ethnic majority (native Dutch). Results showed that only Moroccan Dutch adolescents reported considerably less informal help from their teachers for their internalizing problems than native Dutch adolescents, whereas Turkish Dutch and Surinamese Dutch adolescents were not found to differ from native Dutch adolescents. Teacher-student relationship quality and teacher-reported internalizing problems could not explain the differences in informal help between Moroccan Dutch and Dutch adolescents. Teachers reported significantly higher levels of conflict in their relationships with Moroccan Dutch than native Dutch adolescents, and for Moroccan Dutch adolescents, higher levels of conflict were associated with lower levels of informal help by the teacher.

In the Netherlands, all schools are required to develop a wellbeing and social safeness policy. Despite this legislation, there is currently no adequate instrument available to measure the wellbeing and social safeness. Therefore, the present study investigates the psychometric properties of the Wellbeing and Social Safeness Questionnaire (WSSQ). The WSSQ is a Dutch online questionnaire and was filled in by 1468 students (grade 5-8, age 8-12) from 14 Dutch primary schools. Exploratory and confirmatory factory analysis showed an adequate fit for a two factor structure consisting of (1) School-Related Wellbeing and Social Safeness, and (2) Generic Wellbeing. Adequate reliability and construct validity were demonstrated for both factors. Conceptually, it was found that school-related social safeness and wellbeing are not empirically separate factors, however, generic wellbeing may deserve separate consideration. The initial psychometric properties of the WSSQ are promising. This online instrument could potentially be used as a screening tool for teachers to measure social safeness and wellbeing of students.

This research examined the preference for identity-first language (IFL) versus person-first language (PFL) among 215 respondents (Mage = 30.24 years, SD = 9.92) from the Dutch autism community. We found that a stronger identification with the autism community and a later age of diagnosis predicted a stronger IFL preference and a weaker PFL preference. Both effects were mediated by the perceived consequences (justice to identity, prejudice reduction) of PFL. Participants' own explanations were in line with these statistical analyses but also provided nuance to the IFL-PFL debate. Our results are consistent with the Social Identity Approach (Reicher et al., 2010) and Identity Uncertainty Theory (Hogg, 2007) and demonstrate the value of a social psychological approach to study disability language preferences. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on a process and impact evaluation of the Positief Educatief Programma (Positive Education Programme (PEP)), a whole school approach to supporting children's well-being and creating a positive school climate in primary schools in the Netherlands. PEP adopts a competence skill enhancement approach with a focus on developing children's positive emotions and strengths. Design/methodology/approach: A process and impact evaluation was performed within the context of two schools piloting the programme. Employing questionnaires and interviews, the evaluation sought to examine the implementation of PEP, participants' experiences with key components and the programme impact of PEP. Findings: The findings reveal largely positive attitudes towards PEP. Staff and parents were positive about the core components of PEP. Results from standardised questionnaires provide preliminary evidence about the positive impact of PEP on children's self-reported well-being and problem behaviour, teachers' awareness of children's strengths and overall school climate. The provision of practical strategies and activity-based resources was considered essential to the ongoing implementation of PEP. Research limitations/implications: This study reports on findings from two implementation schools and therefore lacks generalisability. Further research using more robust research methods exploring the effectiveness of PEP when compared with "business as usual" is needed. Originality/value: School frameworks aimed at creating a positive school climate and promoting well-being at the whole school level have not been carried out in the Netherlands to date. The results from this study provide a unique insight into the implementation and perceived impact of a whole school framework in the context of two primary schools.

This longitudinal study (three waves across a school year) investigated the links between children's motivations to respond without prejudice and their ethnic outgroup attitudes at the between-person level (means and changes over time) and the within-person level (time-specific fluctuations). Participants were 945 ethnic majority students (MageW1 = 9.86 years, SD = 1.21; 471 girls) from 51 grade 3–6 classrooms in the Netherlands. Children reported (increasingly) more positive outgroup attitudes when their internal motivation was structurally high (between-person effects) and temporarily high (within-person effect), and less positive attitudes when their external motivation was structurally and temporarily high. The between-person effects were independent of the ethnic composition and the antiprejudice climate of the classroom. These findings may help in developing interventions aimed at reducing prejudice in late childhood. Public Significance Statement: The present study showed that children's temporal and structural motivations to respond without prejudice are relevant for their attitudes toward ethnic others. Children are and become more positive toward other-ethnic peers if they find this personally relevant and attractive, but not if they want to act nonprejudiced to avoid social disapproval. These findings are important for attempts to reduce children's prejudice. [ABSTRACT FROM AUTHOR]

The influence of group norms is often tested via people's norm perceptions. Yet, people's group norm perceptions can be inaccurate, which raises the question to what extent effects of perceived norms indicate real group influence. The present study sought to obtain a better understanding of the value of group norm perceptions in social influence research. We used (longitudinal) data collected in 51 primary school classrooms in the Netherlands (Grades 3–6) and examined how majority of children's (N = 779; aged 7–13 years) perceptions of the anti‐prejudice norm of their classroom peer group affected their ethnic outgroup attitudes both concurrently and over time. We divided these perceptions into a consensual and a unique part and investigated the moderating role of ingroup identification. Results showed concurrent effects of the consensual and unique norm perceptions, but a longitudinal effect of the consensual perceptions only. Classroom identification increased the concurrent effect of unique norm perceptions but decreased their longitudinal effect. Our findings indicate that norm perceptions can be important sources of actual group influence as long these perceptions are consensually shared, and that especially high identifiers rely less on their unique norm perceptions over time. [ABSTRACT FROM AUTHOR]

Through an in-depth, historically embedded study of the craft revolution in Dutch beer brewing that began in the 1970s, we illuminate how organizational fields may experience regenerative change through the reemergence of traditional arrangements. The remarkable resurgence of craft in this context, following the rapid industrialization of the twentieth century that left only industrially produced pilsner in its wake, serves as the basis of our process theory of regenerative institutional change through logic reemergence. The results of our qualitative analysis show that institutional logics that appear dead or decomposed may never truly die, as they leave remnants behind that field actors can rediscover, repurpose, and reuse at later stages. We show how, in the Netherlands, networks of individuals that had access to the remnants of craft brewing were regenerated, in part fueled by increasing exposure to British, Belgian, and German craft brewing, and how these networks ultimately succeeded in reviving traditional prescriptions for beer and brewing, as well as restoring previously abandoned brewery forms and technologies and beer styles. These activities led not only to a sudden proliferation of alternatives to the dominant industrial pilsner but also to fundamental changes in the meaning and organization of beer brewing, as they were associated with the reinvigoration of institutional orders that preceded those of the corporation and the market. Yet we also observe how, on the ground, remnants of traditional craft often needed to be blended with contemporaneous elements from modern industrialism, as well as foreign representations of craft, to facilitate reemergence. We thus argue that regenerative institutional change likely resembles a dualistic process of restoration and transformation. [ABSTRACT FROM AUTHOR]

In this paper we study to what extent parental field of study affects a person's educational level and field of study. We employ information on 8800 respondents from the Family Survey Dutch Population (1992-2009). Our results first of all show that, over the last five decades, economic fields of study have become more fashionable among men. In sharp contrast, mainly tracks in agriculture have lost most of their appeal. Among women, medical, economic and socio-cultural fields have gained attractiveness. Second, we established that parental field of study is of significant importance for reaching a high level of education for children, and that the relevance of parental field of study is increasing over the years. Moreover, symmetry in fields could be established when it comes to the intergenerational transmission of field of study. Our results support the idea that educational expansion does not necessarily lead to increasing meritocracy in western societies.

Although parents' relationships with teachers are considered to be an important aspect of parental school involvement, few studies have examined their implications for students' school adjustment. The present study provided further insight into the relevance of teachers' perceptions of the parent-teacher relationship by examining their link to teachers' perceptions of student-teacher relational conflict. Participants were 36 native Dutch teachers who rated their relationships with 230 Grade 4-6 students (59 Turkish-Dutch, 62 Moroccan-Dutch, and 109 native Dutch) and their parents. It was found that the perceived parent-teacher relationship could explain ethnic differences in student-teacher conflict that were previously unaccounted for. Moreover, the effect of the parent-teacher relationship was most pronounced for students with more perceived inattention/hyperactivity problems. Results are discussed in light of their theoretical importance and practical implications. (Contains 2 tables, 1 figure, and 2 footnotes.)

This research, conducted in the Netherlands, examines whether native adolescents' tolerance of practices by Muslim immigrants (e.g., the founding of Islamic schools) is affected by the type of considerations (e.g., educational freedom vs. integration of Muslims in Dutch society). Using an experimental questionnaire design (N = 970), the findings show that adolescents (13-17 years) became less tolerant when considerations against these practices were presented, whereas tolerance was not affected by considerations in favor of the practices. In addition, the level of tolerance of adolescents who strongly identified as Dutch was not affected by the different considerations, but lower identifiers were less tolerant when considerations against the practices were given. The effects of the different considerations did not differ for age and for educational level. The implications of this research for improving adolescent's tolerance of practices by Muslim actors are discussed. (Contains 1 table and 1 figure.)

Among 36 ethnic-Dutch school teachers in the Netherlands, the present study examined the role of ethnic incongruence in perceived student-teacher relationship quality. Teachers rated their relationships with 59 Turkish-Dutch, 62 Moroccan-Dutch, and 109 ethnic-Dutch students attending grades 4 through 6 (M[subscript age] = 10.81 years, SD = 1.05). On average, relationships were less favorable for the Moroccan-Dutch students only. However, the effects of ethnic incongruence were most pronounced among students with strong perceived inattention/hyperactivity and among teachers endorsing lower levels of multiculturalism (the view that different cultures deserve equal treatment). Results support the notion that ethnically incongruent relationships may be perceived as less favorable than ethnically congruent ones due to cultural misunderstandings and intergroup bias. Practical implications are discussed. (Contains 3 figures and 3 tables.)

This study investigates the relation between religious group identification and ethnic and national identity among Moroccan-Dutch Muslim adolescents (11-18 years) and their parents (n = 369). Compared to their parents, adolescents showed higher national identification and lower religious and ethnic group identification. However, for adolescents and their parents, there were similar positive relations between Muslim and ethnic identifications, and both identifications were negatively related to Dutch identification. For early adolescents, parent's religious group identification was strongly related to their religious identification and ethnic and national identifications. These associations were not significant for middle adolescents. It is concluded that research on children from immigrant Muslim families should not only focus on ethnicity but on religious identity in particular. (Contains 4 tables and 2 figures.)

The distinctiveness of physical aggression from other antisocial behavior is widely accepted but little research has explicitly focused on young children to empirically test this assumption. A Multitrait-Multimethod Matrix (MTMM) approach was employed to confirm the distinctiveness of physical aggression from nonaggressive antisocial behavior in early childhood. In addition, the convergent validity of teacher reports of physical aggression was investigated on a measure that contained age-appropriate behavior items selected from the Preschool Behavior Questionnaire (PBQ). Assessments of physical aggression versus nonaggressive antisocial behavior of 117 kindergartners with different behavior profiles were obtained using three measures varying in source and/or method: (a) teacher reports on the PBQ, (b) short interviews with teachers, and (c) classroom observations. The MTMM matrix was analyzed using confirmatory factor analysis (CFA). The results provided reasonable support for the discrimination between physical aggression and nonaggressive antisocial behavior. In addition, strong support was found for the convergent validity of teacher-reported physical aggression using PBQ items. (Contains 1 figure and 1 table.)

The present study used an interpersonal theoretical perspective to examine the interactions between Dutch teachers and kindergartners. Interpersonal theory provides explanations for dyadic interaction behaviors by stating that complementary behaviors (dissimilar in terms of control, and similar in terms of affiliation) elicit and sustain each other. We observed 69 kindergarten children (M[subscript age] = 5.79 years) and their 37 regular teachers during a dyadic interaction task. Every 5 s, independent observers rated teachers' and children's behaviors along the interpersonal dimensions of control and affiliation. Teachers reported on children's shyness and the quality of the teacher-child relationship. Multilevel modeling provided correlational evidence for complementarity within and between dyads. Cross-lagged analyses revealed that teachers showed complementarity for control and that children showed complementarity for affiliation. Children also reacted complementarily with respect to control but only if they were shy or shared positive relationships with their teachers. Implications for theory and practice are discussed. (Contains 2 figures and 2 tables.)

According to the deprovincialization thesis, interethnic contact involves a reappraisal and distancing from the ingroup. Contact can broaden one's horizon by acknowledging and recognizing the value of other cultures and thereby putting the taken-for-granted own cultural standards into perspective. The current research uses data from three surveys to examine the relationship between quantity of outgroup contact and ingroup distance (ingroup identification and ingroup feelings) among native Dutch participants. More positive contact with ethnic outgroups was expected to lead to a higher endorsement of multiculturalism, that, in turn, is related to a stronger distancing from the ingroup. Findings in all three studies support the deprovincialization thesis. In addition, in Study 3, mediation is found independently of outgroup threat. Findings across the three studies confirm the stability of the results and cross-validate the deprovincialization thesis. (Contains 6 tables and 6 footnotes.)

Among early adolescents (10-12 years) in the Netherlands, this study examined the academic self-concept in terms of the big-fish-little-pond effect (BFLPE). The BFLPE implies that students in classes where the average achievement is low will have a higher academic self-concept than equally achieving students in classes where the average achievement is high. The social comparison process assumed to underlie this effect was examined by focusing on classmates' average achievement and the perceived relative achievement position in the school class. It was found that the perceived class position mediated the relationship between classmates' achievement and the academic self-concept. In addition, the effect of classmates' achievement on perceived relative academic position was stronger in smaller compared to larger classes. Furthermore, it was investigated whether classmates' gender was differently important for social comparison processes in the academic domain. It turned out that students' academic self-concept was affected by the achievements of same-gender classmates. Achievements of opposite-gender classmates only had an effect on the academic self-concept when the number of these classmates was small. The findings of this study support the theoretical principles underlying the big-fish-little-pond effect and are relevant for debates about class sizes and the utility of academic selective schooling. (Contains 1 figure, 3 tables and 4 notes.)

This study conducted among Christian, Muslim, and nonreligious early adolescents living in the Netherlands used intergroup theory for examining religious group evaluations. There was evidence for a religious group divide with a third of the Christian and nonreligious participants explicitly indicating negative feelings toward Muslims, and Muslim children having negative feelings toward Christians, nonbelievers, and Jews. Furthermore, the Muslim early adolescents had high religious in-group identification and higher identification was associated with more negative feelings toward nonbelievers and Jews. In addition, the results show that increased opportunities in school for contact between early adolescents from different religious and nonreligious groups contributes to more positive group relations. It is argued that the pattern of results is in agreement with an intergroup perspective in which the role of the broader social context and the concrete situation is taken into account. (Contains 6 notes and 3 tables.)

A confirmatory factor analytic study was conducted to obtain evidence for physical aggression as a distinct construct of nonaggressive antisocial behavior in young children. Second, the authors investigated factorial invariance across gender. Teachers completed the Preschool Behavior Questionnaire (PBQ) for two independent samples of kindergartners (N = 487; N = 1,557). Behavior items were selected representing physically aggressive versus nonaggressive antisocial behavior. To obtain support for the two-factor model, the authors also examined associations with subtypes of internalizing behavior. Confirmatory factor analyses confirmed that physical aggression constitutes a distinct construct from nonaggressive antisocial behavior for young children. In support of the model, differential associations with internalizing behavior and different outcomes with respect to gender differences were found. Factorial noninvariance across gender was found for physical aggression, and explanations for those gender differences are discussed. (Contains 3 tables.)

Using social-cognitive domain theory and social identity theory, tolerance judgments of practices by Muslim actors among Dutch adolescents (12-17) were investigated. The findings for Study 1 (N = 180) demonstrated that participants evaluated 4 practices using different types of reasons: personal, social-conventional, and moral. In Study 2 (N = 970), participants were more tolerant of acts considered to be a personal issue than of acts that pertained to moral issues (social-conventional acts were in the middle). Furthermore, participants were more tolerant of the particular practices than of campaigns for public support of co-Muslims for these practices. Level of education, in-group identification, and multiculturalism had much weaker effects in the moral than in the other domains. Age was negatively related to tolerance.

Among 9th-grade students (248 girls, 255 boys) from a large multiethnic school, the authors examined 2 aspects of anticipated situational engagement in relation to 3 types of hypothetical teacher behavior: authoritarian, authoritative, permissive. Furthermore, the authors investigated the moderating roles of students' personal (trait-like) engagement and gender. Multilevel analyses showed differential effects of teacher behavior type. Anticipated situational engagement was generally highest with the authoritative teacher and lowest with the authoritarian teacher. However, students' personal engagement and gender qualified these effects. The effects of the authoritative and authoritarian teachers versus the permissive teachers on anticipated situational engagement were more positive (or less negative) for students with high versus low personal engagement. Also, the positive effects of the authoritative and permissive teachers versus the authoritarian teacher were stronger for female students than for male students. Results show that anticipated situational engagement should be understood by examining the combined influences of contextual and individual characteristics. (Contains 2 tables, 4 figures, and 4 notes.)

Peer victimization based on one's ethnic group membership contributes to the problems and conflicts of ethnic minority children around the world. With ethnic discrimination, a part of the self is implicated. Hence, it is likely that being treated negatively on the basis of one's ethnicity has a negative influence on ethnic self-esteem and thereby on feelings of global self-worth. Following structural models of the self it was predicted that ethnic self-esteem mediates the relationship between ethnic peer discrimination and global self-worth. To test this prediction a large scale study (N= 2682) was conducted among Turkish, Moroccan, Surinamese and Dutch young adolescents (aged 10 to 13) living in The Netherlands. Using structural equation analysis, we found the predicted mediation for all four groups of participants. In addition, to examine the precise role of ethnic discrimination we also considered other types and dimensions of peer victimization. Our distinction between reasons (personal and ethnic) and types (teasing/name calling and social exclusion form play) of peer victimization fitted the data adequately. Global self-worth was more strongly related to experiences with teasing and name calling than to social exclusion. (Contains 3 tables and 4 footnotes.)

The ethnic classroom composition and classmates' ethnic attitudes can affect how students experience their classroom social environment (CSE). Following the imbalance of power thesis and prior research on ethnic attitudes, this cross-sectional study examined if ethnic classroom composition (i.e., proportion of in-group and Herfindahl Index) and classmates' explicitly and implicitly measured ethnic attitudes predicted secondary school students' (Mage = 13.31 years; 58.1% female) classroom belonging, popularity and likability, classroom cohesion and conflict in mixed classes in the Netherlands. Differences between non-ethnic Dutch (n = 248) versus ethnic Dutch students (n = 141) were examined as well. Ethnic Dutch students report an overall more negative CSE than their non-ethnic Dutch classmates. Multilevel analyses indicated that a higher proportion of in-group peers affected non-ethnic Dutch students' popularity and likability negatively. Moreover, classmates' explicitly measured ethnic attitudes were predictive of student popularity while classmates' implicitly measured ethnic attitudes were predictive of student likability. Finally, classmates implicitly measured ethnic attitudes moderated the effect of proportion in-group peers on students' shared experience of classroom belonging. These results show that promoting classroom diversity is not enough to create a positive CSE for all students. Classmates' ethnic attitudes are also important to consider. [ABSTRACT FROM AUTHOR]

Background: Patients with multiple rib fractures without a clinical flail chest are increasingly being treated with rib fixation; however, high-quality evidence to support this development is lacking. Methods: We conducted a prospective multicenter observational study comparing rib fixation to non-operative treatment in all patients aged 18 years and older with computed tomography confirmed multiple rib fractures without a clinical flail chest. Three centers performed rib fixation as standard of care. For adequate comparison, the other three centers performed only non-operative treatment. As such clinical equipoise formed the basis for the comparison in this study. Patients were matched using propensity score matching. Results: In total 927 patients with multiple rib fractures were included. In the three hospitals that performed rib fixation, 80 (14%) out of 591 patients underwent rib fixation. From the nonoperative centers, on average 71 patients were adequately matched to 71 rib fixation patients after propensity score matching. Rib fixation was associated with an increase in hospital length of stay (HLOS) of 4.9 days (95%CI 0.8–9.1, p = 0.02) and a decrease in quality of life (QoL) measured by the EQ5D questionnaire at 1 year of 0.1 (95% CI − 0.2–0.0, p = 0.035) compared to non-operative treatment. A subgroup analysis of patients who received operative care within 72 h showed a similar decrease in QoL. Up to 22 patients (28%) who underwent surgery experienced implant-related irritation. Conclusions: We found no benefits and only detrimental effects associated with rib fixation. Based on these results, we do not recommend rib fixation as the standard of care for patients with multiple rib fractures. Trial registration: Registered in the Netherlands Trial Register NTR6833 on 13/11/2017. [ABSTRACT FROM AUTHOR]

Purpose: The treatment of the posterior fragment in trimalleolar fractures differs from hospital to hospital in the Netherlands. A nationwide survey was performed to evaluate the fixation criteria and practice variation. Methods: An online cross-sectional survey amongst (orthopaedic) trauma surgeons was performed in the Netherlands. It consisted of three sections: a general section, a section showing preoperative images of six cases and a section with postoperative images of nine cases. Results: A total of 151 surgeons completed the online survey. 45% of the respondents indicated that they fixated the posterior fragment if smaller than 25% of the intra-articular surface. 48% preferred an open posterior approach to fixate the posterior fragment. There was good consensus in treatment for the two cases with Bartonicek type 4 fractures (operative treatment in 73 and 72% respectively). Little consensus was found for Bartonicek type 2 and 3 fractures (88% opted for operative treatment in one case, but 89% for conservative treatment in the second case). Reoperation was mostly considered in cases with a step-off of more than 1 mm (by 33–38% of the respondents). There was great variation in the choice of treatment if only the size of the posterior fragment was considered. Other fixation criteria such as postoperative step-off or instability after fixation of the lateral and medial malleoli are taken into account. In cases where fixation was needed, a percutaneous approach and an open posterolateral approach were equally preferred. Conclusions: There is much variation in treatment of the posterior malleolar fracture amongst orthopaedic and trauma surgeons in the Netherlands. The percutaneous approach and open posterolateral approach to fixate the posterior malleolar fracture seem to be equally used in the Netherlands. Still, there is no uniformity in treatment of posterior malleolar fracture, especially for Bartonicek 2 and Bartonicek 3 fractures. Reoperation is considered by less than half of the surgeons in case of postoperative persistent step-off of more than 1 mm. [ABSTRACT FROM AUTHOR]

There is a considerable body of research that has explored the impact of school characteristics on the self-esteem of racial and ethnic minority group children. This work, however, has been mainly conducted among African Americans and has various conceptual and methodological problems. The present large-scale study in 182 classes from 82 schools has tried to go beyond this research by focusing on different groups of early adolescents in the Netherlands and by using multilevel analysis. This analysis allows to examine the importance of both individual and classroom determinants for personal global and ethnic self-esteem. It was found that both global self-esteem and ethnic self-esteem depend partly on the classroom context. Multicultural education and teachers' reactions to ethnic harassment affected self-esteem positively. In addition, the proportion of Dutch pupils affected ethnic self-esteem among ethnic minority groups negatively but not that of the Dutch. Furthermore, ethnic minority group participants were found to possess higher ethnic self-esteem and higher global self-esteem than the Dutch. In addition, boys had more positive self-esteem than girls.

Introduction: To capture the patient's attitude toward remote monitoring of motor neuron disease (MND) in care and clinical trials, and their concerns and preferences regarding the use of digital technology. Methods: We performed an international multi-centre survey study in three MND clinics in The Netherlands, the United Kingdom, and Australia. The survey was co-developed by investigators and patients with MND, and sent to patients by e-mail or postal-mail. The main topics included: patients' attitude towards remote care, participating in decentralized clinical trials, and preferences for and concerns with digital technology use. Results: In total, 332 patients with MND participated. A majority of patients indicated they would be happy to self-monitor their health from home (69%), be remotely monitored by a multidisciplinary care team (75%), and would be willing to participate in clinical trials from home (65%). Patients considered respiratory function and muscle strength most valuable for home-monitoring. The majority of patients considered the use of at least three devices/apps (75%) once a week (61%) to be acceptable for home-monitoring. Fifteen percent of patients indicated they would not wish to perform home-measurements; reporting concerns about the burden and distress of home-monitoring, privacy and data security. Conclusion: Most patients with MND exhibited a positive attitude toward the use of digital technology in both care and clinical trial settings. A subgroup of patients reported concerns with home-monitoring, which should be addressed in order to improve widespread adoption of remote digital technology in clinical MND care. [ABSTRACT FROM AUTHOR]

This paper describes how individuals update their retirement plans in response to substantial shocks in pension wealth during the Great Recession. Using a unique combination of survey and administrative panel data from before and after the Great Recession in the Netherlands, we investigate the causal relation between wealth and retirement expenditure goals. We separate 'pure' wealth effects from macro factors such as general pessimism. The estimates show that a negative shock in annuitized pension wealth of 100 euros reduced retirement expenditure goals with 24–33 euros. The effects are relatively large for old and high-income individuals. [ABSTRACT FROM AUTHOR]

Background: Everyday people are exposed to multiple environmental factors, such as surrounding green, air pollution and traffic noise. These exposures are generally spatially correlated. Hence, when estimating associations of surrounding green, air pollution or traffic noise with health outcomes, the other exposures should be taken into account. The aim of this study was to evaluate associations of long-term residential exposure to surrounding green, air pollution and traffic noise with mortality.Methods: We followed approximately 10.5 million adults (aged ≥ 30 years) living in the Netherlands from 1 January 2013 until 31 December 2018. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 and 1000 m), annual average ambient air pollutant concentrations [including particulate matter (PM2.5), nitrogen dioxide (NO2)] and traffic noise with non-accidental and cause-specific mortality, adjusting for potential confounders.Results: In single-exposure models, surrounding green was negatively associated with all mortality outcomes, while air pollution was positively associated with all outcomes. In two-exposure models, associations of surrounding green and air pollution attenuated but remained. For respiratory mortality, in a two-exposure model with NO2 and NDVI 300 m, the HR of NO2 was 1.040 (95%CI: 1.022, 1.059) per IQR increase (8.3 µg/m3) and the HR of NDVI 300 m was 0.964 (95%CI: 0.952, 0.976) per IQR increase (0.14). Road-traffic noise was positively associated with lung cancer mortality only, also after adjustment for air pollution or surrounding green.Conclusions: Lower surrounding green and higher air pollution were associated with a higher risk of non-accidental and cause-specific mortality. Studies including only one of these correlated exposures may overestimate the associations with mortality of that exposure. [ABSTRACT FROM AUTHOR]

This study investigates individual preferences for work arrangements in a discrete choice experiment. Based on sociological and economic literature, we identified six essential job attributes—earnings, job security, training opportunities, scheduling flexibility, prestige of the company, and gender composition of the work team—and mapped these into hypothetical job offers. Out of three job offers, with different specifications in the respective job attributes, respondents had to choose the offer they considered as most attractive. In 2017, we implemented our choice experiment in two large-scale surveys conducted in two countries: Germany (N = 2,659) and the Netherlands (N = 2,678). Our analyses revealed that respondents considered all six job attributes in their decision process but had different priorities for each. Moreover, we found gendered preferences. Women preferred scheduling flexibility and a company with a good reputation, whereas men preferred jobs with high earnings and a permanent contract. Despite different national labor market regulations, different target populations, and different sampling strategies for the two surveys, job preferences for German and Dutch respondents were largely parallel. [ABSTRACT FROM AUTHOR]

As a result of the 2015 refugee crisis, a substantial number of voters experienced a sudden and unexpected influx of asylum seekers in their neighbourhood in the Netherlands. We examined whether and why local exposure to asylum seekers leads to more support for the radical right (i.e. PVV). Our analyses are based on a longitudinal individual-level panel dataset including more than 19,000 respondents (1VOP) who were interviewed just before and shortly after the height of the refugee crisis. We enriched this dataset with detailed information about where asylum seekers were housed from the Central Agency for the Reception of Asylum Seekers. Our empirical study resembles a natural experiment, because some residents experienced an increase in exposure to asylum seekers but similar residents did not. PVV support increased during the refugee crisis and especially among residents who became more exposed to asylum seekers in their neighbourhood. [ABSTRACT FROM AUTHOR]

Despite imperfections, the Dutch framework for investment screening could function as a model for more proportionate and clearer investment screening rules. From a procedural perspective, the Dutch framework illustrates that it is possible to establish objective thresholds in order to more specifically target certain companies or categories of companies. Substantively, the Dutch framework shows that the general test of 'security' can be narrowed down to more specific substantive criteria. Providing clearer procedural thresholds and substantive tests under investment screening regulations, both in the Netherlands and elsewhere, will help ensure that investments are only restricted or prohibited where genuinely necessary and proportionate in order to safeguard national security interests. The Commission and national authorities throughout the Union should therefore endeavour to establish clearer procedural thresholds and frameworks of assessment to ensure that only transactions that can reasonably pose a threat to security or public order are made subject to filing obligations and are assessed on the basis of more clearly defined substantive criteria. [ABSTRACT FROM AUTHOR]

We investigated the prevalence of azole resistance of Aspergillus fumigatus isolates in the Netherlands by screening clinical A. fumigatus isolates for azole resistance during 2013-2018. We analyzed azole-resistant isolates phenotypically by in vitro susceptibility testing and for the presence of resistance mutations in the Cyp51A gene. Over the 6-year period, 508 (11%) of 4,496 culture-positive patients harbored an azole-resistant isolate. Resistance frequency increased from 7.6% (95% CI 5.9%-9.8%) in 2013 (58/760 patients) to 14.7% (95% CI 12.3%-17.4%) in 2018 (112/764 patients) (p = 0.0001). TR34/L98H (69%) and TR46/Y121F/T289A (17%) accounted for 86% of Cyp51A mutations. However, the mean voriconazole MIC of TR34/L98H isolates decreased from 8 mg/L (2013) to 2 mg/L (2018), and the voriconazole-resistance frequency was 34% lower in 2018 than in 2013 (p = 0.0001). Our survey showed changing azole phenotypes in TR34/L98H isolates, which hampers the use of current PCR-based resistance tests. [ABSTRACT FROM AUTHOR]

Summary: Background: Fungal diseases have an ever‐increasing global disease burden, although regional estimates for specific fungal diseases are often unavailable or dispersed. Objectives: Here, we report the current annual burden of life‐threatening and debilitating fungal diseases in the Netherlands. Methods: The most recent available epidemiological data, reported incidence and prevalence of fungal diseases were used for calculations. Results: Overall, we estimate that the annual burden of serious invasive fungal infections in the Netherlands totals 3 185 patients, including extrapulmonary or disseminated cryptococcosis (n = 9), pneumocystis pneumonia (n = 740), invasive aspergillosis (n = 1 283), chronic pulmonary aspergillosis (n = 257), invasive Candida infections (n = 684), mucormycosis (n = 15) and Fusarium keratitis (n = 8). Adding the prevalence of recurrent vulvo‐vaginal candidiasis (n = 220 043), allergic bronchopulmonary aspergillosis (n = 13 568) and severe asthma with fungal sensitisation (n = 17 695), the total debilitating burden of fungal disease in the Netherlands is 254 491 patients yearly, approximately 1.5% of the country's population. Conclusion: We estimated the annual burden of serious fungal infections in the Netherlands at 1.5% of the population based on previously reported modelling of fungal rates for specific populations at risk. With emerging new risk groups and increasing reports on antifungal resistance, surveillance programmes are warranted to obtain more accurate estimates of fungal disease epidemiology and associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown that school belonging is crucial for students' school adjustment, but the construct has been operationalized in different ways. Moreover, most research has focused on adolescents and not compared its antecedents for ethnic minority versus majority students. Aims: Based on Goodenow and Grady's (1993) seminal paper, we examined classroom identification as a central aspect of school belonging in minority and majority preadolescents, and predicted it from relationships with peers and teachers, taking into account classroom ethnic composition and perceived multicultural teaching. Sample: Participants were 485 grade 4–6 students from 39 classrooms in Dutch primary schools. Of these children, 68 had a Turkish background, 72 had a Moroccan background, and 345 had a native Dutch background. Methods: Participants completed questionnaires at two waves (4.5 months apart). We used self‐reports to measure classroom identification at both waves, and student–teacher relationship closeness and conflict, multicultural teaching, and peer friendship and rejection at Wave 1. We conducted multilevel analyses to predict classroom identification at Wave 2, while controlling for classroom identification at Wave 1. Results: Children of all ethnicities reported more classroom identification over time if they were less rejected by their peers and had more co‐ethnic classmates. For minority children, both closeness and conflict with the teacher predicted less identification, but the effect of conflict appeared to result from their ethnic underrepresentation in the classroom. Conclusions: Negative peer relationships can undermine classroom identification, and the student–teacher relationship has special significance for ethnic minority students. [ABSTRACT FROM AUTHOR]

Autochthony belief ("that a country is owned by its first inhabitants") can be an acceptable reason for claiming collective ownership of a territory and this claim can have negative consequences for newcomers. Children might reason that a place belongs to their in-group because "we" were here first and therefore have negative out-group attitudes. In three studies among Dutch majority group children (N = 879; Mage = 10.13 to 10.84, SD = 0.82 to 0.98; 49.7 to 54.5% girls), the expected negative association between autochthony beliefs and attitudes was found for different measures of ethnic attitudes, and was robust across gender, age, immigrant target group, ethnic identification, perceived multicultural education and classroom composition. Additionally, the association was especially strong among ethnic majority children who felt less at home in their own country but at the same time cared about being Dutch. It is concluded that a focus on autochthony belief makes a novel and relevant contribution to the intergroup developmental literature and to our limited understanding of children's attitudes toward immigrant groups and newcomers more generally. [ABSTRACT FROM AUTHOR]

Ethnic minority adolescents receive not only less formal mental health services than their ethnic majority peers but also less school-based mental health services. Little is known about the extent to which adolescents indicate their teachers help them with their mental health problems. The aim of the current study was to investigate ethnic differences in teacher-provided informal help for adolescents' internalizing problems, and whether these could be explained by differences in teacher-reported internalizing problems and teacher–adolescent relationship quality. A sample of adolescents at risk of internalizing problems and their teachers participated in the study (n = 229). Adolescents originated from four ethnic groups in the Netherlands: three ethnic minority groups (Surinamese Dutch, Turkish Dutch, Moroccan Dutch) and the ethnic majority (native Dutch). Results showed that only Moroccan Dutch adolescents reported considerably less informal help from their teachers for their internalizing problems than native Dutch adolescents, whereas Turkish Dutch and Surinamese Dutch adolescents were not found to differ from native Dutch adolescents. Teacher–student relationship quality and teacher-reported internalizing problems could not explain the differences in informal help between Moroccan Dutch and Dutch adolescents. Teachers reported significantly higher levels of conflict in their relationships with Moroccan Dutch than native Dutch adolescents, and for Moroccan Dutch adolescents, higher levels of conflict were associated with lower levels of informal help by the teacher. [ABSTRACT FROM AUTHOR]

We identify, quantify, and explain the impact of incentive‐induced early retirement (ER) of husbands on their wives' probability to retire within 1 year, using administrative data from the Netherlands. Our identification strategy is based on a policy intervention by which targeted individuals working at the central government level became unexpectedly and temporarily eligible for very generous ER benefits. This retirement window of opportunity implied for interested workers that transitions from the current job into full retirement had to be effected swiftly and irreversibly. We find that induced ER of husbands increased their wives' probability to retire by 10 percentage points. This is a strong and robust local average treatment effect. Partly, the effect runs through wives at ages when they may have been eligible for ER programs themselves. [ABSTRACT FROM AUTHOR]

Background: Traditionally, size of the posterior fragment is considered the most important indicator for fixation in trimalleolar fractures. It remains unclear which factors contribute to worse functional and radiological outcome. This study was designed to determine predictors for the development of posttraumatic osteoarthritis and worse functional outcome in trimalleolar fractures.Methods: This retrospective cohort study evaluated outcomes of 169 patients with a trimalleolar fracture treated between 1996 and 2013 in a level-1 trauma hospital in the Netherlands after a mean follow-up of 6.3 (range 2.4 to 15.9) years. The average fragment size was 17%. Twenty patients had a posterior fragment smaller than 5% of the intra-articular surface, 119 patients a fragment of 5-25% and 30 patients a posterior fragment larger than 25%. In total, 39 patients (23%) underwent fixation of the posterior fragment.Results: Clinical union was achieved in all 169 patients. The median AOFAS score after follow-up was 93 (interquartile range 76-100) and the median AAOS score was 92 (interquartile range 81-98). A persistent postoperative step-off larger than 1 mm was found in 65 patients (39%) and osteoarthritis was present in 49 patients (30%). Higher age and postoperative step-off > 1 mm were independent, significant risk factors for the development of osteoarthritis. Osteoarthritis and BMI were independent, significant risk factors for worse functional outcome.Conclusion: It is advisable to correct intra-articular step-off of intraarticular posterior malleolar fragments to reduce the risk of developing osteoarthritis and, consequently, the risk of worse functional outcome after long-term follow-up.Level Of Evidence: Level IIB. [ABSTRACT FROM AUTHOR]

This paper describes the decision-making process regarding the siting of a high voltage transmission line in the southern part of the Netherlands by TenneT, the Transmission System Operator responsible for the electricity infrastructure. TenneT started this siting process by deploying conventional decision-making procedures, which have the tendency centrally to pre-scope, and select the technical, spatial and societal characteristics of such projects. Following the resistance of activist groups and local authorities, a new siting process was set up based on community engagement (CE) and the upfront involvement of local stakeholders, so to include new frames and perspectives and by reconsidering the workings of standard procedures. With that, TenneT opened up decision-making processes. In our paper, we will identify the practical and institutional tensions and challenges that emerged from these attempts to 'open up'. The work is based on an 'inside out' description of the case: one of the researchers undertook an ethnographic study of the siting process, while the employees of TenneT directly involved in the siting process have been invited as co-authors, so to add details and the reflections of practitioners. • This paper describes a participatory decision-making process of transmission lines. • The case is analysed in terms of 'opening up' and 'closing down' decision-making. • The project developers have co-authored the paper and reflect on its analyses. [ABSTRACT FROM AUTHOR]

In this paper we shed light on the various ways in which native Dutch estimate the size of the ethnic minority population in their neighbourhood. We formulate hypotheses on how characteristics of the neighbourhood (i.e. objective group sizes, ethnic segregation, economic deprivation and crime), of surrounding neighbourhoods and experiences of interethnic contact and feelings of ethnic threat shape perceptions of the ethnic outgroup size. We employ individual-level data from the 1Vandaag Opinion Panel enriched with contextual-level data from Statistics Netherlands (24,538 respondents in 3113 neighbourhoods). Great variation in residents’ perceptions of the ethnic outgroup size exists both between neighbourhoods and within neighbourhoods. We demonstrate that native Dutch are more likely to overestimate the size of the non-Western minority population than the size of the Western minority population. Larger ethnic outgroup sizes in surrounding neighbourhoods are associated with the sense that one’s own neighbourhood also contains more minority residents. In economically deprived and high crime neighbourhoods, residents are more likely to overestimate the size of the ethnic outgroup. Furthermore, people with more interethnic contact and people who experience more ethnic threat provide higher estimations and are more likely to overestimate the ethnic outgroup size in their neighbourhood. [ABSTRACT FROM AUTHOR]

This paper estimates the impact of early retirement on mortality using Dutch administrative micro panel data. An unexpected temporary decrease in the eligibility age for retirement benefits for civil servants is used to instrument the retirement choice. We find that induced early retirement decreased the probability that a man dies within 5 years by 2.6 percentage points. The result is robust to alternative specifications and data selection criteria. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report on a process and impact evaluation of the Positief Educatief Programma (Positive Education Programme (PEP)), a whole school approach to supporting children’s well-being and creating a positive school climate in primary schools in the Netherlands. PEP adopts a competence skill enhancement approach with a focus on developing children’s positive emotions and strengths.Design/methodology/approach A process and impact evaluation was performed within the context of two schools piloting the programme. Employing questionnaires and interviews, the evaluation sought to examine the implementation of PEP, participants’ experiences with key components and the programme impact of PEP.Findings The findings reveal largely positive attitudes towards PEP. Staff and parents were positive about the core components of PEP. Results from standardised questionnaires provide preliminary evidence about the positive impact of PEP on children’s self-reported well-being and problem behaviour, teachers’ awareness of children’s strengths and overall school climate. The provision of practical strategies and activity-based resources was considered essential to the ongoing implementation of PEP.Research limitations/implications This study reports on findings from two implementation schools and therefore lacks generalisability. Further research using more robust research methods exploring the effectiveness of PEP when compared with “business as usual” is needed.Originality/value School frameworks aimed at creating a positive school climate and promoting well-being at the whole school level have not been carried out in the Netherlands to date. The results from this study provide a unique insight into the implementation and perceived impact of a whole school framework in the context of two primary schools. [ABSTRACT FROM AUTHOR]

Background: Guidelines for treatment of the posterior fracture fragment in trimalleolar fractures are scarce and show varying advices. Did the increasing size of the posterior fragment seem to relate to worse outcome in the past, nowadays this has changed to the amount of dislocation of the posterior fragment post-operatively. Despite many retrospective cohort studies and some prospective cohort studies, no consistent guideline could be derived from the current literature.Methods: The POSTFIX-study is designed as a multicenter randomized clinical trial to analyse the effects of anatomical reduction and fixation of the posterior fragment in AO 44-B3 fractures with medium-sized posterior fragment. A total of 84 patients will be included and online allocated to either anatomical reduction and fixation of the posterior fragment via the posterolateral approach (n = 42) or no fixation of the posterior fragment (n = 42). The concomitant fractured medial and lateral malleoli are treated according to the AO-principles. Functionality of the ankle as measured by the AAOS-questionnaire (American Association of Orthopaedic Surgeons) 1 year post-operatively was set as primary outcome. Main secondary outcome measures are the AAOS-questionnaire 5 years postoperatively and osteoarthritis as measured on plain radiographs 1 year and 5 years post-operatively. The Olerud and Molander score, the AOFAS-score, the VAS-pain, the Euroqol-5D and Range of Motion by physical examination will also be evaluated during the follow-up period.Discussion: The POSTFIX-trial is the first high quality multicenter randomized clinical trial worldwide to analyse the effects of anatomical fixation of the posterior fragment in trimalleolar fractures. New guidelines on anatomical reduction and fixation of the posterior fragment can in future be based on the results of this trial.Trial Registration: This trial is registered on ClinicalTrials.gov with reference number: NCT02596529 . Registered 3 November 2015, retrospectively registered. [ABSTRACT FROM AUTHOR]