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The Dutch Central Government wants to focus on preventing mental health issues and the educational system needs to play a role in that process. Research has already shown that art therapy has significant positive results on mental wellbeing, so the question was asked whether arts in the education could help relief mental health stress of children. Specific attention for the effects of drama on social skills of children is justified, because higher social skills are associated with lower psychosocial stress, which in turn seems to be related to improved mental health. This study is a meta-analysis on current research, which was then compared to older meta-analyses on the same topic. Results are promising and consistent with earlier meta-analyses. The average effect size of the current research was found to be 1.174 in current research, but more empirical research on the relationship between drama and social skills is needed to warrant a decisive conclusion.

Tics can have a serious impact on the quality of life of children and their families. Behavioural therapy is an evidence-based first line treatment for tic disorders. This randomised controlled trial studied the efficacy of a brief, condensed group-based programme for children with tics (Dutch Trial Registry NL8052, 27 September 2019). Tackle your Tics is a four-day group treatment, including exposure and response prevention and supporting components, delivered by therapists and 'experts by experience'. We collected outcome measures at baseline (T1), directly post-treatment (T2), and at three- and 6-months follow-up (T3, T4) including tic severity (primary outcome measure), tic-related impairment, quality of life, tic-related cognitions, emotional/behavioural functioning, family functioning, treatment satisfaction and adherence. Outcomes directly post-treatment improved in both the treatment group (n = 52) and waiting list (n = 54), but showed no statistically significant differences between the conditions (differential change over time T1-T2) on tic severity (Yale Global Tic Severity Scale), quality of life (Gilles de la Tourette Syndrome Quality of Life Scale), tic-related cognitions and family functioning. At longer term (T3), again no between-group difference was found on tic severity, but tic-related impairment, quality of life and emotional/behavioural functioning significantly improved in the treatment group compared to the waiting list. Mean treatment satisfaction scores were favourable for both children and parents. Directly posttreatment, Tackle your Tics showed no superior effect compared to waiting list. However, on longer term this brief four-day group treatment was effective in improving tic-related impairment, quality of life and emotional/behavioural functioning. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the effects of a training program focusing on improvement of emotional intelligence (EI) and support staffs' awareness of their behaviour towards people with an intellectual disability based on interactional patterns. The support provided regarding the needs for autonomy, relatedness, and competence was observed in line with self-determination theory (SDT). Method: A pre-test/post-test control group design (N = 29) was used, with 17 support staff participating in the experimental group. For both groups, video recordings of interactions between staff and clients were analysed with an SDT-observation system. Results: The results showed that a training program focusing on EI and interactional patterns positively affected the support provided by staff with regard to clients' needs for autonomy, relatedness, and competence. Conclusions: As most EI studies focus on insights and understanding of oneself, this study is an important first step in focusing on staff behaviour during daily interactions.

In two experiments, the claim was tested that the font "Dyslexie", specifically designed for people with dyslexia, eases reading performance of children with (and without) dyslexia. Three questions were investigated. (1) Does the Dyslexie font lead to faster and/or more accurate reading? (2) Do children have a preference for the Dyslexie font? And, (3) is font preference related to reading performance? In Experiment 1, children with dyslexia (n = 170) did not read text written in Dyslexie font faster or more accurately than in Arial font. The majority preferred reading in Arial and preference was not related to reading performance. In Experiment 2, children with (n = 102) and without dyslexia (n = 45) read word lists in three different font types (Dyslexie, Arial, Times New Roman). Words written in Dyslexie font were not read faster or more accurately. Moreover, participants showed a preference for the fonts Arial and Times New Roman rather than Dyslexie, and again, preference was not related to reading performance. These experiments clearly justify the conclusion that the Dyslexie font neither benefits nor impedes the reading process of children with and without dyslexia.

Background: To deliver high‐quality collaborative care, residents need to be trained across the boundaries of their medical specialty (intraprofessional learning). The current literature does not provide insights into the underlying processes that influence intraprofessional learning. The aim of this study was to gain insight into the processes that occur during intraprofessional workplace learning in residency training, by exploring everyday intraprofessional interactions experienced by residents, with the ultimate objective of improving collaborative practice. Method: We conducted a focused ethnography using field observations and in‐depth interviews with residents at an academic children's hospital in the Netherlands. In 2022, nine residents from four different medical specialties were shadowed and/or interviewed. In total, >120 hours of observation and 10 interviews were conducted. Data collection and analysis were conducted iteratively and discussed in a research team with diverse perspectives, as well as with a sounding board group of stakeholders. Results: Residents were involved in numerous intraprofessional interactions as part of their daily work. We identified three themes that shed light on the underlying processes that occur during intraprofessional workplace learning: (1) residents' agency, (2) ingroups and outgroups and (3) communication about intraprofessional collaboration. Conclusions: Collaborative practice offers many intraprofessional learning opportunities but does not automatically result in learning from, with and about other specialties to improve intraprofessional collaborative care. Overarching the identified themes, we emphasise the pivotal role of the resident–supervisor dyad in facilitating residents' engagement in the learning opportunities of complex intraprofessional care. Furthermore, we propose that promoting deliberate practice and shared responsibility in collaborative care are crucial to better prepare residents for their roles and responsibilities in delivering high‐quality collaborative patient care. Unraveling underlying processes in #intraprofessional #workplacelearning in residency training: agentic behavior, stereotyping and learning from collaboration experiences are explored. [ABSTRACT FROM AUTHOR]

This study examined the role of instruction for spelling performance and spelling consciousness in the Dutch language. Spelling consciousness is the ability to reflect on one's spelling and correct errors. A sample of 115 third-grade spellers was assigned to a strategy-instruction, strategic-monitoring, self-monitoring, or control condition representing different types of metacognitive aspects. The results showed that students in all three training conditions made more progress in both spelling performance and spelling consciousness than students in the control condition. With respect to spelling consciousness, only students in the strategy-instruction condition made significant improvement between pretest and posttest. Students made more progress in spelling performance on regular words than on loan words. Students in all four conditions became more accurate at assessing which words they could spell correctly. Students in the control condition more frequently overestimated their spelling ability.

In the Netherlands, Turkish-Dutch children constitute a substantial group of children who learn to speak Dutch at the age of four after they learned to speak Turkish. These children are generally academically less successful. Academic success appears to be affected by both language proficiency and working memory skill. The goal of this study was to investigate the relationship between language skills and working memory in Turkish-Dutch and native-Dutch children from low-income families. The findings revealed reduced Dutch language and Dutch working-memory skills for Turkish-Dutch children compared to native-Dutch children. Working memory in native-Dutch children was unrelated to their language skills, whereas in Turkish-Dutch children strong correlations were found both between Turkish language skills and Turkish working-memory performance and between Dutch language skills and Dutch working-memory performance. Reduced language proficiencies and reduced working-memory skills appear to manifest itself in strong relationships between working memory and language skills in Turkish-Dutch children. The findings seem to indicate that limited verbal working-memory and language deficiencies in bilingual children may have reciprocal effects that strongly warrants adequate language education.

Background: Client-centred models of care emphasise the importance of collaborative working between staff and clients with an intellectual disability (ID). How people with an ID perceive the nature of their engagement with staff is relatively unknown. This study investigated the perceptions of staff and people with an ID about the goals for their meetings and what aspects of the meetings they viewed as important. Method: Interviews were carried out with 9 client-staff dyads. Prior to their meeting, staff and clients were asked about their expectations. Afterwards, both parties were asked about what they believed happened during the interaction. The participants' answers were subjected to a thematic analysis. Results: People with an ID appreciated the opportunity to tell their story and valued reliable, practical support and advice. A trusting relationship was important to both clients and staff. Only staff viewed promoting clients' autonomy as important. Conclusion: Staff and people with an ID appear to differ in their expectations and perceptions regarding regular support meetings.

Introduction: The standard treatment for patients with focal drug-resistant epilepsy (DRE) who are not eligible for open brain surgery is the continuation of anti-seizure medication (ASM) and neuromodulation. This treatment does not cure epilepsy but only decreases severity. The PRECISION trial offers a non-invasive, possibly curative intervention for these patients, which consist of a single stereotactic radiotherapy (SRT) treatment. Previous studies have shown promising results of SRT in this patient population. Nevertheless, this intervention is not yet available and reimbursed in the Netherlands. We hypothesize that: SRT is a superior treatment option compared to palliative standard of care, for patients with focal DRE, not eligible for open surgery, resulting in a higher reduction of seizure frequency (with 50% of the patients reaching a 75% seizure frequency reduction at 2 years follow-up). Methods: In this waitlist-controlled phase 3 clinical trial, participants are randomly assigned in a 1:1 ratio to either receive SRT as the intervention, while the standard treatments consist of ASM continuation and neuromodulation. After 2-year follow-up, patients randomized for the standard treatment (waitlist-control group) are offered SRT. Patients aged ≥ 18 years with focal DRE and a pretreatment defined epileptogenic zone (EZ) not eligible for open surgery will be included. The intervention is a LINAC-based single fraction (24 Gy) SRT treatment. The target volume is defined as the epileptogenic zone (EZ) on all (non) invasive examinations. The seizure frequency will be monitored on a daily basis using an electronic diary and an automatic seizure detection system during the night. Potential side effects are evaluated using advanced MRI, cognitive evaluation, Common Toxicity Criteria, and patient-reported outcome questionnaires. In addition, the cost-effectiveness of the SRT treatment will be evaluated. Discussion: This is the first randomized trial comparing SRT with standard of care in patients with DRE, non-eligible for open surgery. The primary objective is to determine whether SRT significantly reduces the seizure frequency 2 years after treatment. The results of this trial can influence the current clinical practice and medical cost reimbursement in the Netherlands for patients with focal DRE who are not eligible for open surgery, providing a non-invasive curative treatment option. Trial registration: Clinicaltrials.gov Identifier: NCT05182437. Registered on September 27, 2021. [ABSTRACT FROM AUTHOR]

An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5–12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED—but not HD—participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably 'easier to treat' than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 (https://www.onderzoekmetmensen.nl/en/trial/25997). [ABSTRACT FROM AUTHOR]

Although there is scientific evidence for an increased prevalence of sleep disorders during the coronavirus disease 2019 (COVID-19) pandemic, there is still limited information on how lifestyle factors might have affected sleep patterns. Therefore, we followed a large cohort of participants in the Netherlands (n  = 5,420) for up to 1 year (September 2020–2021) via monthly Web-based questionnaires to identify lifestyle changes (physical activity, cigarette smoking, alcohol consumption, electronic device use, and social media use) driven by anti–COVID-19 measures and their potential associations with self-reported sleep (latency, duration, and quality). We used the Containment and Health Index (CHI) to assess the stringency of anti–COVID-19 measures and analyzed associations through multilevel ordinal response models. We found that more stringent anti–COVID-19 measures were associated with higher use of electronic devices (per interquartile-range increase in CHI, odds ratio (OR) = 1.47, 95% confidence interval (CI): 1.40, 1.53), less physical activity (OR = 0.94, 95% CI: 0.90, 0.98), lower frequency of alcohol consumption (OR = 0.63, 95% CI: 0.60, 0.66), and longer sleep duration (OR = 1.11, 95% CI: 1.05, 1.16). Lower alcohol consumption frequency and higher use of electronic devices and social media were associated with longer sleep latency. Lower physical activity levels and higher social media and electronic device use were related to poorer sleep quality and shorter sleep duration. [ABSTRACT FROM AUTHOR]

This study compared Dutch alumni who previously participated in an honors program (n = 72) to non-honors alumni who entered university as high-achieving high school students (n = 72) with regard to (1) final university grade point average (GPA) and (2) early career outcomes. Final grades were drawn from university files. Using an online questionnaire, participants were asked to rate themselves on work engagement and other characteristics in their current jobs. Results indicate that, compared to the non-honors control group, honors alumni had a higher study GPA at the end of their studies and higher work engagement after graduation, while job characteristics were found to be similar. Implications for educators and job recruiters are discussed.

This study examined the immediate and sustained effects of three training conditions on both spelling performance and spelling consciousness of 72 third-grade low- and high-skilled spellers. Spellers were assigned to a strategy-instruction, self-correction, or no-correction condition. The role of spelling ability and word characteristic were also taken into account. Regarding the immediate effects, the strategy-instruction condition was more effective for spelling performance, and more effective for spelling consciousness pertaining to loan words than the no-correction condition. Regarding the sustained effects on spelling performance and spelling consciousness, the positive effect of the strategy-instruction condition faded out after training. The four training sessions were insufficient for establishing long-lasting effects.

Objective: This primary care study examined time trends in the incidence of anorexia nervosa (AN) and bulimia nervosa (BN) in the Netherlands across four decades. Methods: A nationwide network of general practitioners, serving approximately 1% of the total Dutch population, recorded newly diagnosed patients with AN and BN in their practices from 1985 to 2019 (2,890,978 person‐years). DSM‐IV diagnostic criteria were consistently used and the same psychiatrist was responsible for the final diagnostic decision. Incidence rates (IRs) were calculated for: the total population (all ages), females overall, and females per 5‐year age category. Time trends in IRs were analyzed using JoinPoint regression analyses. Results: In four decades, the incidence of AN among 10‐ to 14‐year‐old females increased significantly from 8.6 to 38.6 per 100,000 person‐years (average period percentage change [APPC] = 56.7; 95% confidence interval [CI] = 6.5–130.6. The overall incidence of AN was stable, with IRs ranging from 6.0 (95% CI = 4.3–8.1) to 8.4 (95% CI = 6.4–10.8). The IR of BN decreased significantly from 8.7 (95% CI = 6.7–11.0) to 3.2 (95% CI = 2.0–4.9) in the 2000s, before leveling off in the 2010s (IR 3.2; 95% CI = 2.0–4.8). Discussion: The incidence of AN among 10‐ to 14‐year‐old girls increased significantly over four decades. Both biological and sociocultural factors, for example, early pubertal timing and the impact of social media, might explain this. In other age groups and overall, the incidence of AN remained stable. The significant decrease of the incidence of BN in the previous decades halted in the last decade. Public Significance: An important finding of the present study is that for 10‐ to 14‐year‐old girls, the risk for developing anorexia nervosa has increased significantly over 40 years. More healthcare facilities for younger people are needed, and prevention programs could include social media use. For bulimia nervosa, the general decrease in the occurrence of new cases has halted in the 2010s. [ABSTRACT FROM AUTHOR]

The shape of a word pronunciation time distribution supplies information about the dynamic interactions that support reading performance. Speeded word-naming pronunciation and response time distributions were collected from 20 sixth grade Dutch students with dyslexia and 23 age-matched controls. The participants' pronunciation times were modeled and contrasted with a lognormal inverse power-law mixture distribution. Identical contrasts were also conducted on the same participants' response time distributions derived from flanker, color-naming, and arithmetic tasks. Results indicated that children with dyslexia yield slower, broader, and more variable pronunciation time distributions than their age-matched counterparts. This difference approximated a self-similar rescaling between the two group's aggregate pronunciation time distributions. Moreover, children with dyslexia produced similar, but less prominent trends toward slower and more variable performance across the three non-reading tasks. The outcomes support a proportional continuum rather than a localized deficit account of dyslexia. The mixture distribution's success at describing the participants' pronunciation and response time distributions suggests that differences in proportional contingencies among low-level neurophysiological, perceptual, and cognitive processes likely play a prominent role in the etiology of dyslexia.

How can it be explained that early literacy and numeracy share variance? We specifically tested whether the correlation between four early literacy skills (rhyming, letter knowledge, emergent writing, and orthographic knowledge) and simple sums (non-symbolic and story condition) reduced after taking into account preschool attention control, short-term memory, speed of processing, visual-spatial skills, vocabulary, and shared book reading. 228 Dutch native preschoolers (mean age 54.25; SD = 2.12 months) participated. The results revealed that 1) all literacy skills were related to sums (non-symbolic and story condition), 2) rhyming was the strongest predictor of non-symbolic sums, and letter knowledge of sums in story context, 3) visual-spatial skills explained part of the shared variance in the non-symbolic condition and visualspatial skills, vocabulary and short-term memory explained part of the shared variance in sums in story context. Implications for the preschool curriculum and early interventions are discussed.

Background: Sex education programs have been developed with paid care staff as sex educators. However, no information is available about whether these programs are being delivered. Method: The aim of this study was to investigate whether paid care staff working in an organisation specialised in the care of people with mild to moderate intellectual disability teach sex education or not. An online questionnaire was therefore constructed to assess the important factors associated with teaching sex education. Results: Of the 163 staff members who completed the questionnaire, 39% provided sex education. Results show that it was mainly provided reactively. The main factor was the perceived social norm towards teaching sex education. Conclusions: If we want paid care staff to teach sex education reactively, then we need to focus on changing the perceived social norm. However, if we want them to teach sex education proactively, a new needs assessment should be conducted in order to identify the important factors to motivate and enable them to provide sex education.

Background: People with intellectual disabilities face barriers that affect their sexual health. Sex education programmes have been developed by professionals working in the field of intellectual disabilities with the aim to overcome these barriers. The aim of this study was to explore the development of these programmes. Methods: Sex education programmes geared to people with intellectual disabilities were examined in the context of the Intervention Mapping protocol. Data were obtained via interviews with the programme developers. Results: All programmes lack specific programme outcomes, do not have a theoretical basis, did not involve members of relevant groups in the development process and lack systematic evaluation. Conclusions: Based on our findings and the literature, we conclude that these programmes are unlikely to be effective. Future programmes should be developed using a more systematic and theory- and evidence-based approach. (Contains 6 tables.)

Aim: Cardiac diseases remain a leading cause of cardiovascular disease (CVD) related hospitalisation and mortality. That is why research to improve our understanding of pathophysiological processes underlying cardiac diseases is of great importance. There is a strong need for healthy and diseased human cardiac tissue and related clinical data to accomplish this, since currently used animal and in vitro disease models do not fully grasp the pathophysiological processes observed in humans. This design paper describes the initiative of the Netherlands Heart Tissue Bank (NHTB) that aims to boost CVD-related research by providing an open-access biobank. Methods: The NHTB, founded in June 2020, is a non-profit biobank that collects and stores biomaterial (including but not limited to myocardial tissue and blood samples) and clinical data of individuals with and without previously known cardiac diseases. All individuals aged ≥ 18 years living in the Netherlands are eligible for inclusion as a potential future donor. The stored samples and clinical data will be available upon request for cardiovascular researchers. Conclusion: To improve the availability of cardiac tissue for cardiovascular research, the NHTB will include extensive (cardiac) biosamples, medical images, and clinical data of donors with and without a previously known cardiac disease. As such, the NHTB will function as a translational bridge to boost a wide range of cardiac disease-related fundamental and translational studies. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, more than one million patients have type 2 diabetes (T2D), and approximately 36% of these patients have chronic kidney disease (CKD). Yearly medical costs related to T2D and CKD account for approximately €1.3 billion and €805 million, respectively. The FIDELIO-DKD trial showed that the addition of finerenone to the standard of care (SoC) lowers the risk of CKD progression and cardiovascular (CV) events in patients with CKD stages 2–4 associated with T2D. This study investigates the cost-effectiveness of adding finerenone to the SoC of patients with advanced CKD and T2D compared to SoC monotherapy. Methods: The validated FINE-CKD model is a Markov cohort model which simulates the disease pathway of patients over a lifetime time horizon. The model was adapted to reflect the Dutch societal perspective. The model estimated the incremental costs, utilities, and incremental cost-effectiveness ratio (ICER). Sensitivity and scenario analyses were performed to assess the effect of parameter uncertainty on model robustness. Results: When used in conjunction with SoC, finerenone extended time free of CV events and renal replacement therapy by respectively 0.30 and 0.31 life years compared to SoC alone, resulting in an extension of 0.20 quality-adjusted life years (QALYs). The reduction in renal and CV events led to a €6136 decrease in total lifetime costs per patient compared to SoC alone, establishing finerenone as a dominant treatment option. Finerenone in addition to SoC had a 83% probability of being dominant and a 93% probability of being cost-effective at a willingness-to-pay threshold of €20,000. Conclusion: By reducing the risk of CKD progression and CV events, finerenone saves costs to society while gaining QALYs in patients with T2D and advanced CKD in the Netherlands. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate whether bilingually raised children in the Netherlands, who receive literacy instruction in their second language only, show an advantage on Dutch phoneme-awareness tasks compared with monolingual Dutch-speaking children. Language performance of a group of 47 immigrant first-grade children with various different cultural backgrounds and a subsample of 29 Turkish--Dutch bilingual immigrant children was compared with those of 15 first-grade monolingual native Dutch children from similar low-socioeconomic backgrounds. All children were tested on Dutch phoneme awareness, vocabulary and word decoding. The Turkish--Dutch children were also tested on Turkish phoneme awareness and Turkish vocabulary. Dutch vocabulary scores of the bilingual children were below that of the monolingual Dutch children. Neither the entire group of bilingual children nor the subsample of Turkish--Dutch children were better or worse on phoneme awareness than monolingual Dutch children. However, Turkish--Dutch children scored better on the Dutch tasks for phoneme awareness and vocabulary than on the Turkish tasks. Language proficiency in the adopted language of bilingual children appears to quickly exceed that of their native language, when no instruction in the first language is provided. (Contains 4 tables.)

This study focused on the precursors of spelling difficulties in first grade for children with specific language impairment (SLI). A sample of 58 second-year kindergartners in the Netherlands was followed until the end of first grade. Linguistic, phonological, orthographic, letter knowledge, memory, and nonverbal-reasoning skills were considered as precursors, as was spelling level at an earlier point in time. Spelling difficulties at the end of first grade were most accurately identified by letter knowledge at the beginning of first grade and word spelling at the middle of first grade. It is concluded that spelling development in children with SLI can be seen as an autocatalytic process in which, without intervention, poor spellers generally remain poor spellers, and good spellers remain good spellers. A focus on early spelling intervention is thus emphasized. (Contains 4 tables.)

The last decades have seen increased emphasis on the quality of training for direct-care staff serving people with intellectual disabilities. Nevertheless, it is unclear what the key aspects of effective training are. Therefore, the aim of the present meta-analysis was to establish the ingredients (i.e., goals, format, and techniques) for staff training that are related to improvements of staff behaviour. Our literature search concentrated on studies that were published in a period of 20 years. Fifty-five studies met the criteria, resulting in 502 single-subject designs and 13 n greater than 1 designs. Results revealed important information relevant to further improvement of clinical practice: (a) the combination of in-service with coaching-on-the-job is the most powerful format, (b) in in-service formats, one should use multiple techniques, and verbal feedback is particularly recommended, and (c) in coaching-on-the-job formats, verbal feedback should be part of the program, as well as praise and correction. To maximize effectiveness, program developers should carefully prepare training goals, training format, and training techniques, which will yield a profit for clinical practice. (Contains 5 tables.)

Systematic-phonics instruction appears to be more effective than nonsystematic phonics instruction for teaching reading (Ehri, Nunes, Stahl, & Willows, 2001). In the present study, a systematic phonics approach was directly compared with a nonsystematic phonics approach for kindergarten children. Both approaches were delivered using computer programs teaching the same Dutch grapheme-phoneme correspondences. Both phonics-trained groups progressed to the same extent on productive letter-sound knowledge compared to the control group. However, on measures of phonemic awareness, spelling, and reading, the systematic phonics group made more progress than the nonsystematic phonics group and the control group. (Contains 4 figures, 2 tables and 1 footnote.)

This study investigated whether task instructions affect sound-isolation performance. The effects of phoneme class and phoneme position were also assessed. Two hundred Dutch kindergartners were presented with a free-sound-isolation task and its constrained counterparts: an initial-, a middle-, and a final-sound-isolation task. All tasks contained 17 CVC words. Children's performance on the free-sound-isolation task was better than on the constrained tasks. On all four tasks, children made fewer errors in isolating the initial phoneme than the final phoneme. Isolating the middle phoneme proved to be the most demanding. The effect of phoneme class depended on the type of task and on phoneme position. Findings were placed against the background of sonority and word-final phoneme vocalization in Dutch. (Contains 1 table and 2 figures.)

This study focused on the relationship between both achievement level and diagnostic label and sociometric status and self-image of students in Dutch elementary education. In particular, differences between students with specific learning disabilities (SLD) and students with general learning disabilities (GLD) were studied, in regular as well as in special education. A total of 1,300 students participated, 861 in general and 439 in (separate) special education schools. Students with GLD were more often rejected and had a lower self-image than students with SLD. These results seemed to hold mainly for girls and for students with GLD in general education. No argument in favor of or against inclusive education can be advanced based on the results of this study, but the findings highlight the potential role of low achievement in peers' dislike of girls. Moreover, the results suggest the importance of investigating subgroups of students with LD in future research. (Contains 7 tables.)

Lexical-decision studies with experienced English and French readers have shown that visual-word identification is not only affected by pronunciation inconsistency of a word (i.e., multiple ways to pronounce a spelling body), but also by spelling inconsistency (i.e., multiple ways to spell a pronunciation rime). The aim of this study was to compare the reading behavior of young Dutch readers with dyslexia to the behavior of readers without dyslexia. All students participated in a lexical-decision task in which we presented pronunciation-consistent words and pseudowords. Half of the pronunciation-consistent stimuli were spelling consistent and the other half were spelling inconsistent. All three reader groups, that is, students with dyslexia, age-match students, and reading-match students, read spelling-consistent words faster than spelling-inconsistent words. Overall reading speed of students with dyslexia was similar to that of reading-match students, and was substantially slower than that of age-match students. The results suggest that reading in students with or without dyslexia is similarly affected by spelling inconsistency. Subtle qualitative differences emerged, however, with respect to pseudoword identification. The conclusion was that the findings were best interpreted in terms of a recurrent-feedback model.

In two experiments, the authors tested the effect of two types of reading on the spelling memory of strange or sound-spelling inconsistent words in Dutch students with and without learning disabilities: standard reading and regularized reading. Standard reading refers to reading the word the way it has to be read. Regularized reading refers to reading a sound-spelling inconsistent word as if it is sound-spelling consistent. In Experiment 1, both groups showed a short-term effect. Shortly after training, all students who participated in the regularized-reading condition showed better spelling performance than students who took part in a standard-reading condition. One week after training, spelling knowledge of students without learning disabilities appeared to be more stable than that of students with learning disabilities. In Experiment 2, only students with learning disabilities participated. The results reveal that more training substantially enhanced spelling performance in the long term, and repetition of the regularized word was even more effective. A recurrent network account served as the guiding principle to explain the results.

This study is aimed at describing the findings of high-resolution nerve ultrasound in children with Noonan syndrome (NS) and related disorders experiencing pain in their legs. This retrospective cohort study was conducted in the NS expert center of the Radboud University Medical Center in the Netherlands. Patients were eligible if they were younger than 18 years, clinically and genetically diagnosed with NS or a NS related disorder, and experienced pain in their legs. Anamneses and physical examination were performed in all children. In addition, high-resolution nerve ultrasound was used to assess nerve hypertrophy and, if needed, complemented spinal magnetic resonance imaging was performed. Over a period of 6 months, four children, three with NS and one child with NS with multiple lentigines, who experienced pain of their legs were eligible for inclusion. Muscle weakness was found in two of them. High-resolution nerve ultrasound showed (localized) hypertrophic neuropathy in all patients. One child underwent additional spinal magnetic resonance imaging, which showed profound thickening of the nerve roots and plexus. Conclusion: In the four children included with a NS and related disorders, pain was concomitant with nerve hypertrophy, which suggests an association between these two findings. The use of high-resolution nerve ultrasound and spinal magnetic resonance imaging might result in better understanding of the nature of this pain and the possible association to nerve hypertrophy in patients with NS and related disorders. What is Known: • Children with Noonan syndrome and related disorders may report pain in their legs, which is often interpreted as growing pain. • Some adults with Noonan syndrome and related disorders have hypertrophic neuropathy as a possible cause of neuropathic pain. What is New: • This is the first study using high-resolution nerve ultrasound in children with Noonan syndrome and related disorders experiencing pain in their legs. • Hypertrophic neuropathy was diagnosed as possible cause of pain in four children with Noonan syndrome and related disorders. [ABSTRACT FROM AUTHOR]

Background: Previous studies, performed between 2009–2019, in the Netherlands observed an until now still unexplained increased risk for pneumonia among residents living close to goat farms. Since data were collected in the provinces Noord-Brabant and Limburg (NB-L), an area with relatively high air pollution levels and proximity to large industrial areas in Europe, the question remains whether the results are generalizable to other regions. In this study, a different region, covering the provinces Utrecht, Gelderland, and Overijssel (UGO) with a similar density of goat farms, was included to assess whether the association between goat farm proximity and pneumonia is consistently observed across the Netherlands. Methods: Data for this study were derived from the Electronic Health Records (EHR) of 21 rural general practices (GPs) in UGO, for 2014–2017. Multi-level analyses were used to compare annual pneumonia prevalence between UGO and data derived from rural reference practices ('control area'). Random-effects meta-analysis (per GP practice) and kernel analyses were performed to study associations of pneumonia with the distance between goat farms and patients' home addresses. Results: GP diagnoses of pneumonia occurred 40% more often in UGO compared to the control area. Meta-analysis showed an association at a distance of less than 500m (~70% more pneumonia compared to >500m) and 1000m (~20% more pneumonia compared to >1000m). The kernel-analysis for three of the four individual years showed an increased risk up to a distance of one or two kilometers (2–36% more pneumonia; 10–50 avoidable cases per 100,000 inhabitants per year). Conclusions: The positive association between living in the proximity of goat farms and pneumonia in UGO is similar to the previously found association in NB-L. Therefore, we concluded that the observed associations are relevant for regions with goat farms in the entire country. [ABSTRACT FROM AUTHOR]

Well-being was assessed in 568 low-achieving Dutch students (ages 7-15) by means of a self-image scale consisting of 39 statements and peer acceptance through sociometric nomination and rank-order procedures. Students in special education had a slightly better self-image and were more accepted by peers than low-achieving students in regular education. (Contains references.) (Author/CR)

Introduction: Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. Methods: We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients' perspective on these outcomes. Results: Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. Conclusion: Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term. Key Findings: Major inconsistencies in prehospital and in-hospital management emphasizes the need to implement a standardizing prehospital treatment protocol. A large proportion of patients experience symptoms 12 months after the event, including muscle and mental health issues; Patients express a preference to receive more consistent advice when restarting their normal activities and/or sports. [ABSTRACT FROM AUTHOR]

Background and Aims: While some articles describe outcome of pregnancy in autoimmune hepatitis (AIH), there are less data evaluating influence of AIH control on maternal and perinatal outcomes. This study analysed outcomes of pregnancy and related possible risk factors in AIH. Method: A retrospective multicentre cohort study on pregnancy in AIH was performed in 11 hospitals in the Netherlands. Maternal and neonatal outcomes were collected from records and completed by interview. Risk factors—including incomplete response, relapse and cirrhosis—for adverse outcomes were identified using logistic regression analysis. Results: Ninety‐seven pregnancies in 50 women resulted in 70 deliveries (72%) with a live birth rate of 98.5%. AIH relapse occurred in 6% during pregnancy, and in 27% of post‐partum episodes. Absence of complete biochemical response at conception was identified as risk factor for the occurrence of gestational and post‐partum relapses. Relapse of AIH in the year before conception was a risk factor for the occurrence of both gestational relapses and post‐partum relapses. No complete biochemical response increased the risk for hypertensive disorders during pregnancy and intrahepatic cholestasis of pregnancy (ICP). Cirrhosis was found to be a risk factor for miscarriages, but not for other outcomes. Conclusion: Pregnancy in AIH is related to an increased incidence of maternal and fetal/neonatal complications; in most cases, outcome is good. Incomplete biochemical response at conception or relapse in the year before conception are risk factors for gestational and post‐partum relapses, for hypertensive disorders and for ICP. Cirrhosis was a risk factor for miscarriages. [ABSTRACT FROM AUTHOR]

Background: High-dose chemotherapy with autologous stem cell rescue (HDCT) is a promising treatment for patients with stage III, HER2-negative, homologous recombination deficient (HRD) breast cancer. Clinical effectiveness and cost-effectiveness are currently under investigation in an international multicenter randomized controlled trial. To increase the chance of successful introduction of HDCT into daily clinical practice, we aimed to identify relevant factors for smooth implementation using an early comprehensive assessment framework. Methods: This is a qualitative, multi-stakeholder, exploratory research using semi-structured interviews guided by the Constructive Technology Assessment model, which evaluates the quality of a novel health technology by clinical, economic, patient-related, and organizational factors. Stakeholders were recruited by purposeful stratified sampling and interviewed until sufficient content saturation was reached. Two researchers independently created themes, categories, and subcategories by following inductive coding steps, these were verified by a third researcher. Results: We interviewed 28 stakeholders between June 2019 and April 2021. In total, five overarching themes and seventeen categories were identified. Important findings for optimal implementation included the structural identification and referral of all eligible patients, early integration of supportive care, multidisciplinary collaboration between- and within hospitals, (de)centralization of treatment aspects, the provision of information for patients and healthcare professionals, and compliance to new regulation for the BRCA1-like test. Conclusions: In anticipation of a positive reimbursement decision, we recommend to take the highlighted implementation factors into consideration. This might expedite and guide high-quality equitable access to HDCT for patients with stage III, HER2-negative, HRD breast cancer in the Netherlands. [ABSTRACT FROM AUTHOR]

Weaknesses Missing data The primary aim of data collection by GPs is patient management, and the data are therefore not customized for medical research purposes This implies that only information deemed to be relevant to the patient's care is collected and entered into the patient's file. Key Features The Integrated Primary Care Information Project (IPCI) database contains longitudinal data of patients of a group of general practitioners (GPs) in The Netherlands. Data validity Because data in the GP systems are collected with patient management as the main goal, caution is needed when using IPCI data for research purposes. The Integrated Primary Care Information database The Integrated Primary Care Information (IPCI) database is a database containing longitudinal, routinely collected data from computer-based patient records of around 350 GP practices throughout The Netherlands. [Extracted from the article]

Farm animals may harbor viral pathogens, some with zoonotic potential which can possibly cause severe clinical outcomes in animals and humans. Documenting the viral content of dust may provide information on the potential sources and movement of viruses. Here, we describe a dust sequencing strategy that provides detailed viral sequence characterization from farm dust samples and use this method to document the virus communities from chicken farm dust samples and paired feces collected from the same broiler farms in the Netherlands. From the sequencing data, Parvoviridae and Picornaviridae were the most frequently found virus families, detected in 85–100% of all fecal and dust samples with a large genomic diversity identified from the Picornaviridae. Sequences from the Caliciviridae and Astroviridae familes were also obtained. This study provides a unique characterization of virus communities in farmed chickens and paired farm dust samples and our sequencing methodology enabled the recovery of viral genome sequences from farm dust, providing important tracking details for virus movement between livestock animals and their farm environment. This study serves as a proof of concept supporting dust sampling to be used in viral metagenomic surveillance. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 outbreaks on 69 Dutch mink farms in 2020 were studied to identify risk factors for virus introduction and transmission and to improve surveillance and containment measures. Clinical signs, laboratory test results, and epidemiological aspects were investigated, such as the date and reason of suspicion, housing, farm size and distances, human contact structure, biosecurity measures, and presence of wildlife, pets, pests, and manure management. On seven farms, extensive random sampling was performed, and age, coat color, sex, and clinical signs were recorded. Mild to severe respiratory signs and general diseases such as apathy, reduced feed intake, and increased mortality were detected on 62/69 farms. Throat swabs were more likely to result in virus detection than rectal swabs. Clinical signs differed between virus clusters and were more severe for dark-colored mink, males, and animals infected later during the year. Geographical clustering was found for one virus cluster. Shared personnel could explain some cases, but other transmission routes explaining farm-to-farm spread were not elucidated. An early warning surveillance system, strict biosecurity measures, and a (temporary) ban on mink farming and vaccinating animals and humans can contribute to reducing the risks of the virus spreading and acquisition of potential mutations relevant to human and animal health. [ABSTRACT FROM AUTHOR]

Background and purpose: The electrocardiogram (ECG) is frequently obtained in the work-up of COVID-19 patients. So far, no study has evaluated whether ECG-based machine learning models have added value to predict in-hospital mortality specifically in COVID-19 patients. Methods: Using data from the CAPACITY-COVID registry, we studied 882 patients admitted with COVID-19 across seven hospitals in the Netherlands. Raw format 12-lead ECGs recorded within 72 h of admission were studied. With data from five hospitals (n = 634), three models were developed: (a) a logistic regression baseline model using age and sex, (b) a least absolute shrinkage and selection operator (LASSO) model using age, sex and human annotated ECG features, and (c) a pre-trained deep neural network (DNN) using age, sex and the raw ECG waveforms. Data from two hospitals (n = 248) was used for external validation. Results: Performances for models a, b and c were comparable with an area under the receiver operating curve of 0.73 (95% confidence interval [CI] 0.65–0.79), 0.76 (95% CI 0.68–0.82) and 0.77 (95% CI 0.70–0.83) respectively. Predictors of mortality in the LASSO model were age, low QRS voltage, ST depression, premature atrial complexes, sex, increased ventricular rate, and right bundle branch block. Conclusion: This study shows that the ECG-based prediction models could be helpful for the initial risk stratification of patients diagnosed with COVID-19, and that several ECG abnormalities are associated with in-hospital all-cause mortality of COVID-19 patients. Moreover, this proof-of-principle study shows that the use of pre-trained DNNs for ECG analysis does not underperform compared with time-consuming manual annotation of ECG features. [ABSTRACT FROM AUTHOR]

Objective: High levels of physical activity (PA) and optimal nutrition independently improve healthy aging, but few data are available about how PA may influence food preferences in older populations. Therefore, the aim of our study was to establish if there is an association between habitual PA and intake of nutrient-dense foods (i.e. fruits and vegetables). Design: A cross-sectional survey was conducted. Setting: The Netherlands. Participants: 2466 older adults (56% male, age 62±9 yr). Measurements: PA was assessed using the short questionnaire to assess health (SQUASH) and participants were classified into quintiles of weekly PA (MET-h/wk). Total fruit and vegetable intake was assessed using a validated food frequency questionnaire (FFQ) and were corrected for energy intake (g/kcal/d) in the analyses. Multiple regression analyses were performed to determine the association between PA and fruit and vegetable intake, including covariates. Results: Being in the higher quintiles of PA (Q3, Q4 and Q5) was positively associated with more daily fruit and vegetable consumption, even after correction for total energy intake (Q3; β=0.089, P<0.001, Q4; β=0.047, P=0.024, Q5; β=0.098, P<0.001). Conclusions: Older adults who are moderately to highly physically active tend to consume more fruit and vegetable compared to less active peers, when corrected for total energy intake. Female gender, under- and overreporting dietary intake (Goldberg score), non-smoking, high level of education, less alcohol consumption and a lower body mass index positivity affected this relationship. Our data will help health-care professionals to accelerate their efforts to treat and prevent chronic diseases. [ABSTRACT FROM AUTHOR]

Purpose: Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists' experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice. Methods: A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used. Results: Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention. Conclusion: The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria. [ABSTRACT FROM AUTHOR]

Objective: Shared decision making (SDM) for cancer treatment yields positive results. However, it appears that discussing essential topics for SDM is not fully integrated into treatment decision making yet. Therefore, we aim to explore to what extent discussion of therapy options, treatment consequences, and personal priorities is preferred and perceived by (former) cancer patients. Methods: An online questionnaire was distributed by the Dutch Federation of Cancer Patient Organisations among (former) cancer patients in 2018. Results: Among 3785 (former) cancer patients, 3254 patients (86%) had discussed treatments with their health care provider (HCP) and were included for analysis. Mean age was 62.1 ± 11.5; 55% were female. Discussing the option to choose no (further) treatment was rated by 2751 (84.5%) as very important (median score 9/10—IQR 8–10). Its occurrence was perceived by 28% (N = 899), and short‐ and long‐term treatment consequences were discussed in 81% (N = 2626) and 53% (N = 1727), respectively. An unmet wish to discuss short‐ and long‐term consequences was reported by 22% and 26%, respectively. Less than half of the (former) cancer patients perceived that personal priorities (44%) and future plans (34%) were discussed. Conclusion: In the perception of (former) cancer patients, several essential elements for effective SDM are insufficiently discussed during cancer treatment decision making. [ABSTRACT FROM AUTHOR]

Objective: For patients who are discharged to go home after a hospitalisation, timely and adequately informing their general practitioner is important for continuity of care, especially at the end of life. We studied the quality of the hospital discharge letter for patients who were hospitalised in their last year of life. Methods: A retrospective medical record review was performed. Included patients had been admitted to the hospital during the period 1 January to 1 July 2017 and had died within a year after discharge. Results: Data were collected from records of 108 patients with cancer or other diseases. For 57 patients (53%), the discharge letter included information that related to their limited life expectancy (e.g., agreements about treatment limitations), whereas the patient's limited life expectancy was addressed in the medical record in 76 cases (70%). We found related information in discharge letters for 36 patients (66%) who died <3 months compared to 21 patients (40%) who died 3–12 months after hospitalisation (p < 0.01). Conclusion: For patients with a limited life expectancy going home after a hospitalisation, one out of two hospital discharge letters lacked any information addressing their limited life expectancy. Specific guidelines for medical information exchange between care settings are needed. [ABSTRACT FROM AUTHOR]

Background: Abdominal computed tomography (CT) is the standard imaging method for patients with suspected colorectal liver metastases (CRLM) in the diagnostic workup for surgery or thermal ablation. Diffusion-weighted and gadoxetic-acid-enhanced magnetic resonance imaging (MRI) of the liver is increasingly used to improve the detection rate and characterization of liver lesions. MRI is superior in detection and characterization of CRLM as compared to CT. However, it is unknown how MRI actually impacts patient management. The primary aim of the CAMINO study is to evaluate whether MRI has sufficient clinical added value to be routinely added to CT in the staging of CRLM. The secondary objective is to identify subgroups who benefit the most from additional MRI.Methods: In this international multicentre prospective incremental diagnostic accuracy study, 298 patients with primary or recurrent CRLM scheduled for curative liver resection or thermal ablation based on CT staging will be enrolled from 17 centres across the Netherlands, Belgium, Norway, and Italy. All study participants will undergo CT and diffusion-weighted and gadoxetic-acid enhanced MRI prior to local therapy. The local multidisciplinary team will provide two local therapy plans: first, based on CT-staging and second, based on both CT and MRI. The primary outcome measure is the proportion of clinically significant CRLM (CS-CRLM) detected by MRI not visible on CT. CS-CRLM are defined as liver lesions leading to a change in local therapeutical management. If MRI detects new CRLM in segments which would have been resected in the original operative plan, these are not considered CS-CRLM. It is hypothesized that MRI will lead to the detection of CS-CRLM in ≥10% of patients which is considered the minimal clinically important difference. Furthermore, a prediction model will be developed using multivariable logistic regression modelling to evaluate the predictive value of patient, tumor and procedural variables on finding CS-CRLM on MRI.Discussion: The CAMINO study will clarify the clinical added value of MRI to CT in patients with CRLM scheduled for local therapy. This study will provide the evidence required for the implementation of additional MRI in the routine work-up of patients with primary and recurrent CRLM for local therapy.Trial Registration: The CAMINO study was registered in the Netherlands National Trial Register under number NL8039 on September 20th 2019. [ABSTRACT FROM AUTHOR]

Purpose: Vitamin D deficiencies are common in elderly, which increases the risk for, e.g., bone fractures. Identification of determinants of vitamin D status may provide leads for specific deficiency prevention strategies. Although determinants of vitamin D status have been studied in various populations, this has not been examined in elderly that have a physically active lifestyle. Methods: Vitamin D status of 450 physically active elderly who do not use vitamin D supplements was determined and information on possible determinants (demographic, dietary intake and physical activity) was collected around a prolonged four day walking event in July and analyzed in linear regression models. Results: The average summertime serum 25(OH)D concentration was 88.8 ± 22.4 nmol/L. Only 2% of the participants had a 25(OH)D concentration below 50 nmol/L. Dietary intake of vitamin D was 4.0 ± 1.9 µg/day, and the participants spent 12.4 ± 8.6 h/week on outdoor activities. In the multivariate model, lower age (= − 0.48, 95% CI − 0.80 to − 0.16), lower BMI (= − 0.86, 95% CI − 1.62 to − 0.10), being a moderate to high drinker versus a non-drinker (= 7.97, 95% CI 0.43–15.51) and more outdoor physical activity (= 0.25, 95% CI 0.01–0.50) were significantly associated with higher 25(OH)D concentrations. Conclusions: In physically active elderly, vitamin D status was very high in summertime, with few deficiencies, suggesting that elderly with a physical active lifestyle might not necessarily need supplements during the summer period. Lower age, lower BMI, higher alcohol intake and more outdoor physical activity had a significant association with vitamin D status. [ABSTRACT FROM AUTHOR]

Background: Based on excellent outcomes from high-volume centres, laparoscopic liver resection is increasingly being adopted into nationwide practice which typically includes low-medium volume centres. It is unknown how the use and outcome of laparoscopic liver resection compare between high-volume centres and low-medium volume centres. This study aimed to compare use and outcome of laparoscopic liver resection in three leading European high-volume centres and nationwide practice in the Netherlands. Method: An international, retrospective multicentre cohort study including data from three European high-volume centres (Oslo, Southampton and Milan) and all 20 centres in the Netherlands performing laparoscopic liver resection (low-medium volume practice) from January 2011 to December 2016. A high-volume centre is defined as a centre performing >50 laparoscopic liver resections per year. Patients were retrospectively stratified into low, moderate- and high-risk Southampton difficulty score groups. Results: A total of 2425 patients were included (1540 high-volume; 885 low-medium volume). The median annual proportion of laparoscopic liver resection was 42.9 per cent in high-volume centres and 7.2 per cent in low-medium volume centres. Patients in the high-volume centres had a lower conversion rate (7.4 versus 13.1 per cent; P<0.001) with less intraoperative incidents (9.3 versus 14.6 per cent; P=0.002) as compared to low-medium volume centres. Whereas postoperative morbidity and mortality rates were similar in the two groups, a lower reintervention rate (5.1 versus 7.2 per cent; P=0.034) and a shorter postoperative hospital stay (3 versus 5 days; P<0.001) were observed in the high-volume centres as compared to the low-medium volume centres. In each Southampton difficulty score group, the conversion rate was lower and hospital stay shorter in high-volume centres. The rate of intraoperative incidents did not differ in the low-risk group, whilst in the moderate-risk and high-risk groups this rate was lower in high-volume centres (absolute difference 6.7 and 14.2 per cent; all P<0.004). Conclusion: High-volume expert centres had a sixfold higher use of laparoscopic liver resection, less conversions, and shorter hospital stay, as compared to a nationwide low-medium volume practice. Stratification into Southampton difficulty score risk groups identified some differences but largely outcomes appeared better for high-volume centres in each risk group. [ABSTRACT FROM AUTHOR]

Background: A better understanding of the burden of respiratory syncytial virus (RSV) infections in primary care is needed for policymakers to make informed decisions regarding new preventive measures and treatments. The aim of this study was to develop and evaluate a protocol for the standardised measurement of the disease burden of RSV infection in primary care in children aged < 5 years.Methods: The standardised protocol was evaluated in Italy and the Netherlands during the 2019/20 winter. Children aged < 5 years who consulted their primary care physician, met the WHO acute respiratory infections (ARI) case definition, and had a laboratory confirmed positive test for RSV (RT-PCR) were included. RSV symptoms were collected at the time of swabbing. Health care use, duration of symptoms and socio-economic impact was measured 14 days after swabbing. Health related Quality of life (HRQoL) was measured using the parent-proxy report of the PedsQL™4.0 generic core scales (2-4 years) and PedsQL™4.0 infant scales (0-2 years) 30 days after swabbing. The standardised protocol was evaluated in terms of the feasibility of patient recruitment, data collection procedures and whether parents understood the questions.Results: Children were recruited via a network of paediatricians in Italy and a sentinel influenza surveillance network of general practitioners in the Netherlands. In Italy and the Netherlands, 293 and 152 children were swabbed respectively, 119 and 32 tested RSV positive; for 119 and 12 children the Day-14 questionnaire was completed and for 116 and 11 the Day-30 questionnaire. In Italy, 33% of the children had persistent symptoms after 14 days and in the Netherlands this figure was 67%. Parents had no problems completing questions concerning health care use, duration of symptoms and socio-economic impact, however, they had some difficulties scoring the HRQoL of their young children.Conclusion: RSV symptoms are common after 14 days, and therefore, measuring disease burden outcomes like health care use, duration of symptoms, and socio-economic impact is also recommended at Day-30. The standardised protocol is suitable to measure the clinical and socio-economic disease burden of RSV in young children in primary care. [ABSTRACT FROM AUTHOR]

Purpose: Olaparib is a poly (ADP-ribose) polymerase (PARP) inhibitor indicated for ovarian and metastatic breast cancer. Increased serum creatinine levels have been observed in patients taking olaparib, but the underlying mechanism is unknown. This study aimed to investigate if patients receiving olaparib have increased creatinine levels during olaparib treatment and whether this actually relates to a declined glomerular filtration rate (GFR). Methods: We retrospectively identified patients using olaparib at the Netherlands Cancer Institute – Antoni van Leeuwenhoek (NKI-AVL) from 2012 until 2020. Patients with at least one plasma or serum sample available at baseline/off treatment and during olaparib treatment were included. Cystatin C levels were measured, creatinine levels were available and renal function was determined by calculating the estimated glomerular filtration rate (eGFR) using the Creatinine Equation (CKD-EPI 2009) and the Cystatin C Equation (CKD-EPI 2012). Results: In total, 66 patients were included. Olaparib treatment was associated with a 14% increase in median creatinine from 72 (inter quartile range (IQR): 22) μmol/L before/off treatment to 82 (IQR: 20) μmol/L during treatment (p < 0.001) and a 13% decrease in median creatinine-derived eGFR from 86 (IQR: 26) mL/min/1.73 m2 before/off treatment to 75 (IQR: 29) mL/min/1.73 m2 during treatment (p < 0.001). Olaparib treatment had no significant effect on median cystatin C levels (p = 0.520) and the median cystatin C–derived eGFR (p = 0.918). Conclusions: This study demonstrates that olaparib likely causes inhibition of renal transporters leading to a reversible and dose-dependent increase in creatinine and does not affect GFR, since the median cystatin C–derived eGFR was comparable before/off treatment and during treatment of olaparib. Using the creatinine-derived eGFR can give an underestimation of GFR in patients taking olaparib. Therefore, an alternative renal marker such as cystatin C should be used to accurately calculate eGFR in patients taking olaparib. [ABSTRACT FROM AUTHOR]

A selection of measured cross sections and vector analyzing powers, A x and A y , are presented for the p → d break-up reaction. The data are taken with a polarized proton beam with a kinetic energy of 135 MeV using the Big Instrument for Nuclear-polarization Analysis (BINA) at KVI, the Netherlands. With this setup, A x is extracted for the first time for a large range of energies as well as polar and azimuthal angles of the two outgoing protons. For most of the configurations, the results at small and large relative azimuthal angles differ in behavior when comparing experimental data with the theoretical calculations. We also performed a more global comparison of our data with theoretical calculations. The cross-section results show huge values of χ 2 /d.o.f.. The absolute values of χ 2 /d.o.f. for the components of vector analyzing powers, A x and A y , are smaller than the ones for the cross section, partly due to larger uncertainties for these observables. However, also for these observables no satisfactory agreement is found for all angular combinations. This implies that the present models of a three-nucleon force are not able to provide a satisfactory description of experimental data. [ABSTRACT FROM AUTHOR]

Aims: To estimate the societal costs and quality of life of people with type 2 diabetes and to compare these results with those of people with normal glucose tolerance or prediabetes. Methods: Data from 2915 individuals from the population‐based Maastricht Study were included. Costs were assessed through a resource‐use questionnaire completed by the participants; cost prices were based on Dutch costing guidelines. Quality of life was expressed in utilities using the Dutch EuroQol 5D‐3L questionnaire and the SF‐36 health survey. Based on normal fasting glucose and 2‐h plasma glucose values, participants were classified into three groups: normal glucose tolerance (n = 1701); prediabetes (n = 446); or type 2 diabetes (n = 768). Results: Participants with type 2 diabetes had on average 2.2 times higher societal costs than those with normal glucose tolerance (€3,006 and €1,377 per 6 months, respectively) and had lower utilities (0.77 and 0.81, respectively). No significant differences were found between participants with normal glucose tolerance and those with prediabetes. Subgroup analyses showed that higher age, being female and having two or more diabetes‐related complications resulted in higher costs (P < 0.05) and lower utilities. Conclusions: This study showed that people with type 2 diabetes have substantially higher societal costs and lower quality of life than people with normal glucose tolerance. The results provide important input for future model‐based economic evaluations and for policy decision‐making. What's new?: The high costs of type 2 diabetes, together with its impact on quality of life, place a great burden on both the individual affected and society as a whole.People with type 2 diabetes have, on average, 2.2 times higher societal costs and experience a lower quality of life than people without type 2 diabetes.The total societal costs for people with ≥2 diabetes complications are 4.4 times higher than total societal costs for people without complications. [ABSTRACT FROM AUTHOR]

Aims: The risk to develop adverse drug reactions (ADRs) is high for paediatric patients. This is, amongst other reasons, due to the inevitable use of off-label and unlicensed medicines. Moreover, there is limited knowledge on ADRs in children. Thus, adequate recognition may be challenging. The lack of dedicated studies and the voluntary nature of pharmacovigilance systems used to gain insight into the characteristics of ADRs contribute to this problem. The goal of this study is to identify whether ADRs in paediatric patients are adequately documented by the medical team and whether they are subsequently reported to the national pharmacovigilance system. Methods: All patients admitted to the paediatric medium care of the Radboudumc Amalia Children's hospital during 1 month, and using one or more drugs, were included. Two researchers analysed retrospectively and independently the number of possible ADRs in the medical records. The ADRs were listed per paediatric subspecialty, to evaluate any differences in documentation and reporting of the ADRs. Subsequently, the causality, severity, and seriousness of the ADRs were assessed. The ADRs were categorised by system organ class and drug class. The national pharmacovigilance centre was consulted to check if there were any reports coming from our hospital and to collect the total number of reports. Results: The medical records of 301 patients were analysed, 81 patients were suffering from one or more ADRs. In total 132 suspected ADRs were found, divided among 19 different paediatric subspecialties. Numbers were too small to investigate the differences in ADR documentation. Of these found ADRs, 55% were not explicitly noted as such in the medical records by the treating physician. None of the ADRs were reported to the national pharmacovigilance centre. Most ADRs scored 'possible' in the causality assessment, were mild or moderate, and a small number were serious. The ADRs occurred in 25 different organ systems. In total 25 different drug classes were involved. Conclusions: The results of the present study show that a large number of ADRs are not registered in the medical records and are not reported to the national pharmacovigilance system. Furthermore, it is shown that the number of ADRs occurring at our centre is much higher than the number reported to the national pharmacovigilance centre. Only an average of 513 ADRs in paediatric patients are reported per year nationwide, suggesting that there is extensive underreporting. [ABSTRACT FROM AUTHOR]