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A 31-year-old man with a history of hypertrophic cardiomyopathy and alcohol septal ablation one week before was presented after an out of hospital cardiac arrest in the setting of an anterior wall ST-elevation myocardial infarction. Immediate coronary angiography showed an unidentified foreign object within the left anterior descending coronary artery (LAD), later identified as the cover of a balloon that had been unintentionally inserted and abandoned within the LAD during the alcohol septum ablation one week earlier. Intracoronary imaging confirmed the presence of endothelial damage and thrombus formation within the LAD explaining acute myocardial infarction. The patient was treated by surgical retrieval of the balloon cover, extended septal myectomy and coronary artery bypass grafting (CABG) of the LAD. This case is both an example of unintentional neglect of unexpected objects, and the importance of multimodality imaging and multidisciplinary teamwork to get to a correct diagnosis and treatment.

INTRODUCTION: Heavy menstrual bleeding (HMB) affects a quarter of all women, with half having no structural cause. Dutch guidelines recommend a stepped care approach to the management of such idiopathic HMB, starting with medication or a levonorgestrel-releasing intrauterine device (LNG-IUD), before progressing to endometrial ablation, and ultimately, hysterectomy. However, practice variation between hospitals could lead to suboptimal health outcomes and increased healthcare costs for some women.OBJECTIVES: To evaluate adherence to stepped care for women with idiopathic HMB and to identify practice variation among Dutch hospitals.STUDY DESIGN: This population-based cross-sectional study used Dutch insurance claims data from primary and secondary care for all women with idiopathic HMB referred to a gynecologist between January 2019 and December 2020. We calculated the average number of treatments in the 3 years before each treatment step at each hospital, making adjustments for age, socioeconomic status, and ethnicity. Variation in medical practice was measured by the coefficient of variation (CV).RESULTS: We studied 20,715 women treated with LNG-IUDs (56%), endometrial ablation (36%), laparoscopic hysterectomy (13%), or vaginal hysterectomy (4%) in 93 hospitals. Before endometrial ablation, on average 47% used medication (hospital range 27%-71%; CV 0.17) and 16% used an LNG-IUD (hospital range 8%-29%, CV 0.32). Before hysterectomy, 52% (hospital range 28%-65%, CV 0.16) used medication, 21% (hospital range 6%-38%, CV 0.35) used an LNG-IUD, and 23% underwent endometrial ablation (hospital range 0%-59%, CV 0.55). On average, women underwent 0.63 (hospital range 0.36-1.00, adjusted rate 0.40-0.98, CV 0.17) and 0.96 (hospital range 0.56-1.45, adjusted rate 0.56-1.44, CV 0.18) treatments before endometrial ablation and hysterectomy, respectively.CONCLUSIONS: Considerable practice variation exists among Dutch hospitals in the stepped care approach to idiopathic HMB. Improving adherence to this approach could improve quality of care and reduce costs.

Aims ST-depression and T-wave inversion are frequently present on the post-resuscitation electrocardiogram (ECG). However, the prognostic value of ischaemic ECG patterns is unknown. Methods and results In this post-hoc subgroup analysis of the Coronary Angiography after Cardiac arrest (COACT) trial, the first in-hospital post-resuscitation ECG in out-of-hospital cardiac arrest patients with a shockable rhythm was analysed for ischaemic ECG patterns. Ischaemia was defined as ST-depression of ≥0.1 mV, T-wave inversion in ≥2 contiguous leads, or both. The primary endpoint was 90-day survival. Secondary endpoints were rate of acute unstable lesions, levels of serum troponin-T, and left ventricular function. Of the 510 out-of-hospital cardiac arrest patients, 340 (66.7%) patients had ischaemic ECG patterns. Patients with ischaemic ECG patterns had a worse 90-day survival compared with those without [hazard ratio 1.51; 95% confidence interval (CI) 1.08–2.12; P = 0.02]. A higher sum of ST-depression was associated with lower survival (log-rank = 0.01). The rate of acute unstable lesions (14.5 vs. 15.8%; odds ratio 0.90; 95% CI 0.51–1.59) did not differ between the groups. In patients with ischaemic ECG patterns, maximum levels of serum troponin-T (μg/L) were higher [0.595 (interquartile range 0.243–1.430) vs. 0.359 (0.159–0.845); ratio of geometric means 1.58; 1.13–2.20] and left ventricular function (%) was worse (44.7 ± 12.5 vs. 49.9 ± 13.3; mean difference −5.13; 95% CI −8.84 to −1.42). Adjusted for age and time to return of spontaneous circulation, ischaemic ECG patterns were no longer associated with survival. Conclusion Post-arrest ischaemic ECG patterns were associated with worse 90-day survival. A higher sum of ST-depression was associated with lower survival. Adjusted for age and time to return of spontaneous circulation, ischaemic ECG patterns were no longer associated with survival.

Background: In intermediate- and high-risk non-ST elevated acute coronary syndrome (NSTE-ACS) patients, a routine invasive approach is recommended. The timing of coronary angiography remains controversial. To assess whether an immediate (

OBJECTIVES: The optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32°C and 36°C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm.DESIGN: Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.SETTING: Nineteen hospitals in The Netherlands.PATIENTS: The Coronary Angiography after Cardiac Arrest trial randomized successfully resuscitated patients with shockable rhythm and absence of ST-segment elevation to a strategy of immediate or delayed coronary angiography. In this substudy, 459 patients treated with mild therapeutic hypothermia (32.0-34.0°C) or targeted normothermia (36.0-37.0°C) were included. Allocation to targeted temperature management strategy was at the discretion of the physician.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: After 90 days, 171 patients (63.6%) in the mild therapeutic hypothermia group and 129 (67.9%) in the targeted normothermia group were alive (hazard ratio, 0.86 [95% CI, 0.62-1.18]; log-rank p = 0.35; adjusted odds ratio, 0.89; 95% CI, 0.45-1.72). Patients in the mild therapeutic hypothermia group had longer ICU stay (4 d [3-7 d] vs 3 d [2-5 d]; ratio of geometric means, 1.32; 95% CI, 1.15-1.51), lower blood pressures, higher lactate levels, and increased need for inotropic support. Cerebral Performance Category scores at ICU discharge and 90-day follow-up and patient-reported Mental and Physical Health Scores at 1 year were similar in the two groups.CONCLUSIONS: In the context of out-of-hospital cardiac arrest with shockable rhythm and no ST-elevation, treatment with mild therapeutic hypothermia was not associated with improved 90-day survival compared with targeted normothermia. Neurologic outcomes at 90 days as well as patient-reported Mental and Physical Health Scores at 1 year did not differ between the groups.

The randomized REVELATION (REVascularization With PaclitaxEL-Coated Balloon Angioplasty Versus Drug-Eluting Stenting in Acute Myocardial InfarcTION) trial showed that in the setting of ST-segment elevation myocardial infarction (STEMI), a drug-coated balloon (DCB) strategy was non-inferior to a drug-eluting stent (DES) strategy in terms of fractional flow reserve assessed at 9 months. The aim of the present study is to evaluate the long-term clinical outcome of this treatment strategy.Between October 2014 and November 2017, a total of 120 patients with a non-severely calcified culprit lesion in a native coronary artery and a residual stenosis of50% after predilation were randomized to treatment with DCB or DES. Primary clinical endpoint was the occurrence of major adverse cardiac events, defined as death, recurrent myocardial infarction, or target-lesion revascularization, the occurrence of definite ST, and non-coronary artery bypass grafting (CABG) major bleeding.Complete clinical follow-up at 2 years was available for 109 patients (91%). A major adverse cardiac event occurred in 3 patients (5.4%) in the DCB group and 1 patient (1.9%) in the DES group (hazard ratio, 2.86; 95% confidence interval, 0.30-27.53; P=.34). Between 9 months and 2 years, only 1 additional event occurred (target-lesion revascularization in a patient randomized to DCB).In this randomized study of DCB vs DES in selected patients presenting with STEMI, 2-year clinical outcome was excellent and comparable between the DCB and DES groups.

Objectives: We aimed to explore the impact of time to percutaneous coronary intervention (PCI) (T2P) on 1-year mortality in non-ST-elevation myocardial infarction (NSTEMI) patients. Background: The current guidelines recommend an early invasive strategy for NSTEMI patients. However, impact of an early invasive strategy on mortality is a matter of debate. For that reason, real world data are of great value to determine the optimal treatment window. Methods: This retrospective single center cohort study was performed in a high-volume PCI center in Amsterdam, The Netherlands. Intermediate- and high-risk NSTEMI patients undergoing PCI were included. The main discriminant was timing of PCI after admission (T2P), stratified according to different time windows (7 days). We analyzed 1-year mortality and the time distribution of overall survival. Results: In total, 848 patients treated between January 1, 2016 and January 1, 2018 were included in the analysis. T2P was 7 days in 236 patients. The mean GRACE-risk score was 127.1 (SD 28.7), 130.0 (33.1), 133.8 (32.1), and 148.7 (34.6) respectively, p = 7 days (OR = 3.20; 95% CI = 1.06–9.68). Conclusions: In an unselected cohort of patients with NSTEMI, treatment by PCI 7 days after admission resulted in worse outcome.

Background: Patients with acute coronary syndrome (ACS) might represent a specific subgroup, in which bioresorbable scaffold implantation in percutaneous coronary intervention (PCI), might lead to better outcomes when compared to conventional treatment with metallic drug eluting stents. In this prespecified subgroup analysis of the Amsterdam Investigator-Initiated Absorb Strategy All-Comers (AIDA) trial, we evaluated the clinical outcomes of Absorb bioresorbable vascular scaffold (BVS) versus Xience everolimus eluting stent (EES) treated patients presenting either with or without ACS. Methods and results: We classified AIDA patients on the basis of clinical presentation of ACS or of no-ACS. The rate of the 2-year primary endpoint of target vessel failure (TVF) was similar after treatment with Absorb BVS or Xience EES in ACS patients (10.2% versus 9.0% respectively; P = 0.49) and in no-ACS patients (11.7% versus 10.7%, respectively; P = 0.67) Definite or probable device thrombosis occurred more frequently with Absorb BVS compared to Xience EES in ACS patients (4.3% versus 1.7%, respectively, P = 0.03) as well as in no-ACS patients (2.4% versus 0.2%, respectively; P = 0.002). There were no statistically significant interactions between clinical presentation and randomized device modality for TVF (P = 0.80) and for the endpoint of definite or probable device thrombosis (P = 0.17). Conclusion: In the AIDA trial, the 2-year outcomes of PCI with Absorb BVS versus Xience EES were consistent in ACS and no-ACS patients: similar rates for TVF and consistently higher rates of definite or probable stent thrombosis under Absorb BVS versus Xience EES. There were no statistically significant interactions between clinical presentation and randomized device modality.

Objectives This study sought to assess the efficacy and safety of a drug-coated balloon (DCB) strategy versus drug-eluting stent (DES) in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). Background In primary percutaneous coronary intervention for STEMI, stenting has proved to be beneficial with regard to repeat revascularization, but not recurrent myocardial infarction or death, compared with balloon angioplasty alone. A strategy of DCB angioplasty without stenting might abolish the potential disadvantages of stent implantation while reducing the probability of restenosis observed in plain old balloon angioplasty. Methods In the prospective, randomized, single-center REVELATION trial, we compared DCB with DES in patients presenting with STEMI. Patients with a new, nonseverely calcified culprit lesion in a native coronary artery and a residual stenosis of Results A total of 120 patients were included. At 9 months after enrolment, the mean fractional flow reserve value was 0.92 ± 0.05 in the DCB group (n = 35) and 0.91 ± 0.06 in the DES group (n = 38) (p = 0.27). One abrupt vessel closure requiring treatment occurred after treatment with DCB. Up to 9-months follow-up, 2 patients required nonurgent target lesion revascularization (1 in each group). Conclusions In the setting of STEMI, the DCB strategy was noninferior to DES in terms of fractional flow reserve assessed at 9 months. Furthermore, it seemed to be a safe and feasible strategy. (Revascularization With Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stenting in Acute Myocardial Infarction [REVELATION]; NCT02219802)

Contains fulltext : 245649.pdf (Publisher’s version ) (Open Access) Recently, the European Society of Cardiology (ESC) has updated its guidelines for the management of patients with acute coronary syndrome (ACS) without ST-segment elevation. The current consensus document of the Dutch ACS working group and the Working Group of Interventional Cardiology of the Netherlands Society of Cardiology aims to put the 2020 ESC Guidelines into the Dutch perspective and to provide practical recommendations for Dutch cardiologists, focusing on antiplatelet therapy, risk assessment and criteria for invasive strategy.

Contains fulltext : 235070.pdf (Publisher’s version ) (Open Access) BACKGROUND: The effect of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients who are successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) on left ventricular function is currently unknown. METHODS: This prespecified sub-study of a multicentre trial evaluated 552 patients, successfully resuscitated from out-of-hospital cardiac arrest without signs of STEMI. Patients were randomized to either undergo immediate coronary angiography or delayed coronary angiography, after neurologic recovery. All patients underwent PCI if indicated. The main outcomes of this analysis were left ventricular ejection fraction and end-diastolic and systolic volumes assessed by cardiac magnetic resonance imaging or echocardiography. RESULTS: Data on left ventricular function was available for 397 patients. The mean (± standard deviation) left ventricular ejection fraction was 45.2% (±12.8) in the immediate angiography group and 48.4% (±13.2) in the delayed angiography group (mean difference: -3.19; 95% confidence interval [CI], -6.75 to 0.37). Median left ventricular end-diastolic volume was 177 ml in the immediate angiography group compared to 169 ml in the delayed angiography group (ratio of geometric means: 1.06; 95% CI, 0.95-1.19). In addition, mean left ventricular end-systolic volume was 90 ml in the immediate angiography group compared to 78 ml in the delayed angiography group (ratio of geometric means: 1.13; 95% CI 0.97-1.32). CONCLUSION: In patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, immediate coronary angiography was not found to improve left ventricular dimensions or function compared with a delayed angiography strategy. CLINICAL TRIAL REGISTRATION: Netherlands Trial Register number, NTR4973.

Published online: 30 September 2020 Efforts by European countries to disperse refugees across the country often implicitly presuppose permanent settlement in dispersal locations. Migrant (re)settlement theories, however, suggest that onward mobility after (social) housing allocation is a more likely outcome. This paper explores refugees' onward residential trajectories after dispersal in the Netherlands, including possible onward international mobility. We follow refugees who entered the municipal registers in 1998 and 1999 (N = 13,490) over a ten‐year period after taking up residence in the first private dwelling. We find that residential trajectories are related to the household situation and vary considerably across origin groups. In general, ‘stable trajectories’, with a continuation of the type of initial location after dispersal (rural, suburban or urban), are most common. About half of the refugees who stayed in the Netherlands did not leave the municipality of allocation during their a private housing trajectory. Yet, those who were allocated to rural municipalities have in the majority of the cases relocated over time. We find some evidence that social networks and transitions to home ownership are associated with rural to urban movement. Recent policy changes that allow for more participation in the housing allocation procedures of the refugees themselves may reduce resettlement needs and costs for refugees. This paper was funded by ITEM Institute

During recent decades, the educational outcomes of the children of immigrants have been extensively studied, with a growing emphasis on the heterogeneity of the so-called second generation. Yet, the impact of host country citizenship on children's educational outcomes has only received limited attention so far, although children of immigrants do not get automatic birthright citizenship in most European countries. Focusing on the Netherlands, this paper compares educational trajectories among citizen and non-citizen children of immigrants. Register data and sequence analysis are used to map and cluster the trajectories of a full cohort of second-generation students from the start of secondary school. We apply a variant of optimal matching focusing on sequences of transitions, which enables us to uncover different patterns of (im)mobility within a stratified school system better than the standard approach. Multinomial logistic regressions show that students who acquire Dutch citizenship are significantly more likely to follow upward trajectories, taking advantage of the system's flexibility and “back doors”. Conversely, not having Dutch citizenship is associated with a higher risk of dropout and school interruptions. These findings are in line with our theoretical expectation that, during the naturalisation process, parents acquire or further develop important resources for navigating a complex educational system such as the Dutch one.

First Published May 3, 2021 Whereas the so-called ‘citizenship premium’ in the labour market has been widely studied, we know little about how naturalisation affects immigrants’ lives beyond work and income. Focusing on the Netherlands, this paper analyses the relationship between citizenship acquisition and immigrant residential mobility, in particular the propensity of immigrants to move away from areas with high concentrations of migrants. We draw on register data from Statistics Netherlands (N = 234,912). We argue that possessing Dutch citizenship reduces spatial stratification by diminishing the risk of housing market discrimination, thereby facilitating mobility outside of migrant-concentrated areas. Our findings show that naturalised immigrants are 50% more likely to move out of concentrated neighbourhoods, all else constant. The effect of naturalisation is especially relevant for renting without housing benefits and for home ownership, and for mid-risk immigrants who earn around the median income and hold permanent jobs, whose applications face strong scrutiny from landlords, rental agencies and mortgage lenders.

Contains fulltext : 229274.pdf (Publisher’s version ) (Closed access) BACKGROUND: Whether sex is associated with outcomes of out-of-hospital cardiac arrest (OHCA) is unclear. OBJECTIVES: This study examined sex differences in survival in patients with OHCA without ST-segment elevation myocardial infarction (STEMI). METHODS: Using data from the randomized controlled Coronary Angiography after Cardiac Arrest (COACT) trial, the primary point of interest was sex differences in OHCA-related one-year survival. Secondary points of interest included the benefit of immediate coronary angiography compared to delayed angiography until after neurologic recovery, angiographic and clinical outcomes. RESULTS: In total, 522 patients (79.1% men) were included. Overall one-year survival was 59.6% in women and 63.4% in men (HR 1.18; 95% CI: 0.76-1.81;p = 0.47). No cardiovascular risk factors were found that modified survival. Women less often had significant coronary artery disease (CAD) (37.0% vs. 71.3%;p

Does citizenship facilitate access to employment and higher status jobs? Existing studies have produced mixed results across mostly single case studies in Europe and North America. To investigate whether this heterogeneity depends on varying institutional and socio-economic conditions, in this paper we analyse the labour market outcomes of immigrants who have naturalised in 13 West European countries. Our empirical analysis draws on data from the 2014 European Labour Force Survey Ad Hoc Module on immigrants. In order to cope with the selective nature of the naturalisation process, we employ a bivariate probit model that accounts for unobserved characteristics of naturalising immigrants. Our main results show a positive relationship across these destination countries between citizenship and the probability of employment, as well as between citizenship and occupational status, but only for immigrant men from developing countries. For women and for migrants from developed countries, we observe no significant differences between citizens and non-citizens. Liberalising the access to citizenship does not diminish the positive returns on employment from naturalisation. For immigrant men from developing countries there is evidence of a trade-off between easier access to citizenship and the returns on occupational status.

IMPORTANCE: Ischemic heart disease is a common cause of cardiac arrest. However, randomized data on long-term clinical outcomes of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients successfully resuscitated from cardiac arrest in the absence of ST segment elevation myocardial infarction (STEMI) are lacking. OBJECTIVE: To determine whether immediate coronary angiography improves clinical outcomes at 1 year in patients after cardiac arrest without signs of STEMI, compared with a delayed coronary angiography strategy. DESIGN, SETTING, AND PARTICIPANTS: A prespecified analysis of a multicenter, open-label, randomized clinical trial evaluated 552 patients who were enrolled in 19 Dutch centers between January 8, 2015, and July 17, 2018. The study included patients who experienced out-of-hospital cardiac arrest with a shockable rhythm who were successfully resuscitated without signs of STEMI. Follow-up was performed at 1 year. Data were analyzed, using the intention-to-treat principle, between August 29 and October 10, 2019. INTERVENTIONS: Immediate coronary angiography and PCI if indicated or coronary angiography and PCI if indicated, delayed until after neurologic recovery. MAIN OUTCOMES AND MEASURES: Survival, myocardial infarction, revascularization, implantable cardiac defibrillator shock, quality of life, hospitalization for heart failure, and the composite of death or myocardial infarction or revascularization after 1 year. RESULTS: At 1 year, data on 522 of 552 patients (94.6%) were available for analysis. Of these patients, 413 were men (79.1%); mean (SD) age was 65.4 (12.3) years. A total of 162 of 264 patients (61.4%) in the immediate angiography group and 165 of 258 patients (64.0%) in the delayed angiography group were alive (odds ratio, 0.90; 95% CI, 0.63-1.28). The composite end point of death, myocardial infarction, or repeated revascularization since the index hospitalization was met in 112 patients (42.9%) in the immediate group and 104 patients (40.6%) in the delayed group (odds ratio, 1.10; 95% CI, 0.77-1.56). No significant differences between the groups were observed for the other outcomes at 1-year follow-up. For example, the rate of ICD shocks was 20.4% in the immediate group and 16.2% in the delayed group (odds ratio, 1.32; 95% CI, 0.66-2.64). CONCLUSIONS AND RELEVANCE: In this trial of patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, a strategy of immediate angiography was not found to be superior to a strategy of delayed angiography with respect to clinical outcomes at 1 year. Coronary angiography in this patient group can therefore be delayed until after neurologic recovery without affecting outcomes. TRIAL REGISTRATION: trialregister.nl Identifier: NTR4973

For many children of immigrants to Europe, being born in aEuropean country does not give them rights of citizenship. Toacquire citizenship of the country of their birth, they typically relyon their parents’ naturalisation. While many European countrieshave tightened requirements for citizenship over recent decades,the impact of new regulations on immigrants’ children propensityto naturalise has gone largely unexplored. This paper analyses theimpact of two restrictive legislative changes in the Netherlands:the re-introduction of a dual citizenship restriction in 1997, andthe introduction of civic integration requirements in 2003. Usingregister data and event-history models, we analyse the acquisitionof Dutch citizenship by children born in the Netherlandsbetween 1995 and 2010 to immigrant parents. We find thatthe dual citizenship restriction puts families off naturalising whilemandatory civic integration sees them postpone naturalisation.The intergenerational impact of naturalisation reforms is alsoreflected in the extent to which both parents are involved in thenaturalisation process. Children eligible under stricterrequirements are more likely to naturalise with one parent insteadof both, in contrast to earlier eligibility cohorts. These findingsshed light on key family dynamics in the acquisition of hostcountry citizenship.

Objectives/background: In patients with multivessel coronary artery disease (MVD) the decision whether to treat a single culprit vessel or to perform multivessel revascularisation may be challenging. The purpose of this study was to evaluate the long-term outcome of multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel only (CV-PCI) in patients with stable coronary artery disease or non-ST elevation acute coronary syndrome. Methods: In this dual-centre, prospective, randomised study a total 215 patients with MVD were randomly assigned to MV-PCI or CV-PCI. The primary endpoint was the occurrence of major adverse cardiac events (MACE) including death, myocardial infarction (MI), and repeat revascularisation. Secondary endpoints were the combined endpoint of death or MI, the individual components of the primary endpoint, and the occurrence of stent thrombosis. Patients were followed up to 5 years after enrolment. Results: The occurrence of the primary endpoint was similar at 28% versus 31% in the MV-PCI and CV-PCI group, respectively (hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.53–1.44, p = 0.59). The rate of repeat revascularisation was 15% versus 24% (HR 0.59, 95% CI 0.32 to 1.11, p = 0.11), whereas definite or probable stent thrombosis occurred in 2% versus 0% (p = 0.44). Conclusions: In this randomised study comparing the strategies for MV-PCI and CV-PCI in patients with MVD, no difference was found in the occurrence of MACE after 5 years. We observed a numerically higher rate of death or MI and a lower rate of repeat revascularisation after MV-PCI, although these findings were not statistically significant.

This chapter explores a number of fundamental issues that arise when studying Europeanization. It first explains what Europeanization is and what it is not, why some parts of political life seem more affected by the process of European integration than others, and how to interpret variation between member states of the European Union. It then considers the theoretical debates about the relevance of Europeanization, focusing on new institutionalism, goodness of fit, mediating factors, and domestic compliance. It also provides examples of Europeanization studies. It reviews main trends in Europeanization research on policy domains, politics, and polity. Finally, the chapter considers research design issues in Europeanization studies.

Published online: 01 Sep 2017 Can citizenship improve the economic integration of immigrants, and if so, how? Scholars traditionally understand a citizenship premium in the labour market, besides access to restricted jobs, as the result of a positive signal of naturalisation towards employers. While we do not discard these mechanisms, we argue that explanations should also take into account that migrants anticipate rewards and opportunities of naturalisation by investing in their human capital development. We thus expect to observe improved employment outcomes already before the acquisition of citizenship. We use micro-level register data from Statistics Netherlands from 1999 until 2011 (N?=?94,320) to test this expectation. Results show a one-time boost in the probability of having employment after naturalisation, consistent with the prevalent notion of positive signalling. However, we find that the employment probability of naturalising migrants already develops faster during the years leading up to citizenship acquisition, even when controlling for endogeneity of naturalisation. We conclude that it is not just the positive signal of citizenship that improves employment opportunities, but also migrants’ human capital investment in anticipation of naturalisation.

The notion that naturalisation matters for the economic integration of immigrants is well established in the literature, but why and to whom that is, remains surprisingly ambiguous. The citizenship premium is traditionally assumed to result from increased labour market access and positive signalling towards employers, but these mechanisms fail to explain increased earnings derived from paid employment, which has been the predominant focus in most studies. We argue that naturalisation needs to be understood in the context of the life course, as immigrants anticipate rewards and opportunities of citizenship acquisition by investing in their human capital development. Insofar as naturalisation subsequently leads to higher earnings, we expect that the citizenship premium mostly reflects better employment opportunities rather than access to better paying jobs. To test these assumptions, we use high-quality register data from Statistics Netherlands, covering the period 1999–2011. These data contain almost all registered foreign-born individuals in The Netherlands (N = 74,531) and allow us to track immigrant cohorts over time. Results show that naturalisation confers a one-time boost in earnings after naturalisation, but particularly for migrants from economically less developed countries and unemployed migrants. Furthermore, earnings develop faster leading up to naturalisation than afterwards, consistent with the notion of anticipation. The relevance of citizenship for employed immigrants in part results from an increase in working hours, but is not explained by variation in labour market sectors. We conclude that citizenship matters in terms of earnings from labour, but that its impact is not universal and manifests predominantly leading up to naturalisation.

Published online: 14 October 2019 This paper investigates states commitment to human rights, democracy and rule of law through ratifying Council of Europe treaties. We present a first comprehensive analysis of ratifications of all 221 Council of Europe treaties that opened for ratification since 1949 among the 47 current member states. Applying a multilevel Cox regression, we observe a strong influence of external sources for states’ commitment and find evidence for both coercion and emulation mechanisms. First, upcoming EU membership is strongly and positively associated with treaty ratification, corroborating the relevance of accession conditionality in making countries to commit to human rights and democracy. Second, states are much more likely to ratify if a neighbouring country has ratified at the same time, which confirms a strong pattern of regional diffusion of rights acceptance in Europe. However, we find that this pattern of regional diffusion is stronger among states with lower levels of democracy, suggesting that emulation proceeds through mimicry. Finally, our analysis shows that Council of Europe treaty ratification is especially strong during the first years after treaty opening, suggesting that ratification reflects concerted efforts by states involved in the negotiation of regional treaties.

AIMS Patients with acute coronary syndrome (ACS) might represent a specific subgroup, in which bioresorbable scaffold implantation in percutaneous coronary intervention, might lead to better outcomes when compared to conventional treatment. ACS patients (STE-ACS patients in particular) are generally younger, and most often have lesions with softer plaques, a lower plaque burden and less extensive coronary artery disease. In this pre-specified subgroup analysis of the AIDA trial, we evaluated the clinical outcomes of Absorb BVS versus Xience EES treated patients presenting with or without ACS. Methods and results This analysis includes the 2-year outcomes of all 1845 patients randomized in the AIDA trial subdivided by clinical presentation, a pre-specified subgroup analysis. We compared patients presenting with ACS with those presenting without ACS (ACS versus no-ACS patients). Patients presenting with ACS were further sub-categorized according to the presence or absence of ST-segment elevation at presentation (STE-ACS versus NSTE-ACS patients). Baseline status by clinical presentation was known in all patients, and 842 (45.6%) patients presented with ACS, 456 (25.2%) with STE-ACS and 377 (20.4%) with NSTE-ACS.The rate of the 2-year primary endpoint of target vessel failure (TVF) was similar after treatment with Absorb BVS or Xience EES in ACS patients (10.2% versus 9.0% respectively; p=0.49) and in no-ACS patients (11.7% versus 10.7% respectively; p=0.67) Definite or probable device thrombosis occurred more frequently with Absorb BVS compared to Xience EES in ACS patients (4.3% versus 1.7% respectively, p=0.03) as well as in no-ACS patients (2.4% versus 0.2% respectively; p=0.002). There were no statistically significant interactions between clinical presentation and randomized device modality for TVF (p=0.80) and for the endpoint of definite or probable device thrombosis (p=0.17). Conclusions In ACS patients within AIDA, we found no difference in rates of target vessel failure between the Absorb BVS and Xience EES groups. Rates of definite or definite/probable device thrombosis were higher in the Absorb BVS group throughout all clinical presentations. No significant interaction between ACS and no-ACS patients and the occurrence of TVF Acknowledgement/Funding The AIDA trial was financially supported by an unrestricted research grant from Abbott Vascular.

Published online: 13 May 2019 While the global increase of expatriate dual citizenship acceptance over the past decades has been widely observed, the temporal and spatial contexts of this trend have remained understudied. Based on a novel data set of expatriate dual citizenship policies worldwide since 1960, we find that dual citizenship toleration has increased in the last half century from one-third to three-quarter of states globally. We argue that these domestic policy changes should be understood in light of normative pressure in a world where restrictions on individual choice in citizenship status are increasingly contested and where liberalisation is reinforced through interdependence and diaspora politics. We apply Cox proportional hazard models to examine dual citizenship liberalisation and find that states are more likely to move to a tolerant policy if neighbouring states have done so and that they tend to do so in conjunction with extending voting rights to citizens residing abroad and receiving remittances from abroad. Contrary to other studies, we do not observe significant variation by regime type. The contribution to this publication by Maarten Vink is financed by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 682626).

Background Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain. Methods In this multicenter trial, we randomly assigned 552 patients who had cardiac arrest without signs of STEMI to undergo immediate coronary angiography or coronary angiography that was delayed until after neurologic recovery. All patients underwent PCI if indicated. The primary end point was survival at 90 days. Secondary end points included survival at 90 days with good cerebral performance or mild or moderate disability, myocardial injury, duration of catecholamine support, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, major bleeding, occurrence of acute kidney injury, need for renal-replacement therapy, time to target temperature, and neurologic status at discharge from the intensive care unit. Results At 90 days, 176 of 273 patients (64.5%) in the immediate angiography group and 178 of 265 patients (67.2%) in the delayed angiography group were alive (odds ratio, 0.89; 95% confidence interval [CI], 0.62 to 1.27; P=0.51). The median time to target temperature was 5.4 hours in the immediate angiography group and 4.7 hours in the delayed angiography group (ratio of geometric means, 1.19; 95% CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points. Conclusions Among patients who had been successfully resuscitated after out-of-hospital cardiac arrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days. (Funded by the Netherlands Heart Institute and others; COACT Netherlands Trial Register number, .)Patients who had cardiac arrest without ST-segment elevation were assigned to undergo either immediate coronary angiography or delayed coronary angiography (after neurologic recovery). All patients underwent PCI if indicated. There was no significant between-group difference in overall survival at 90 days.

Published online: 04 February 2019 Despite increasingly liberal practices around the world, dual citizenship acceptance is still contested. Surprisingly, few studies exist on what drives public attitudes towards political membership in two or more states. Based on data from the 2012 Dutch Parliamentary Election Study (N = 1,677) we investigate the discrepancy in negative attitudes in the Netherlands towards dual citizenship of immigrants who acquire Dutch citizenship, on the one hand, and more positive attitudes towards Dutch citizens acquiring a foreign citizenship, on the other. We find that negative views of immigrant dual citizenship are associated with strong in-group identification and out-group derogation, whereas experiencing a sense of symbolic group threat is associated with negative views of both immigrant and emigrant dual citizenship.

[Background] To date, no specific drug-eluting stent (DES) has fully proven its superiority over others in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention., [Objectives] The purpose of this study was to compare the safety and efficacy of coronary artery stents in STEMI patients in a patient-level network meta-analysis. [Methods] Eligible studies were dedicated randomized controlled trials comparing different stents in STEMI patients undergoing percutaneous coronary intervention with at least 12 months of clinical follow-up. Of 19 studies identified from the published data, individual patient data were collected in 15 studies with 10,979 patients representing 87.7% of patients in the overall network of evidence. The primary endpoint was the composite of cardiac death, reinfarction, or target lesion revascularization. [Results] Overall, 8,487 (77.3%) of 10,979 STEMI patients were male and the mean age was 60.7 years. At a median follow-up of 3 years, compared with bare-metal stents (BMS), patients treated with paclitaxel-, sirolimus-, everolimus-, or biolimus-eluting stents had a significantly lower risk of the primary endpoint (adjusted hazard ratios [HRs]: 0.74 [95% confidence interval (CI): 0.63 to 0.88], 0.65 [95% CI: 0.49 to 0.85], 0.70 [95% CI: 0.53 to 0.91], and 0.66 [95% CI: 0.49 to 0.88], respectively). The risk of primary endpoint was not different between patients treated with BMS and zotarolimus-eluting stents (adjusted HR: 0.83 [95% CI: 0.51 to 1.38]). Among patients treated with DES, no significant difference in the risk of the primary outcome was demonstrated. Treatment with second-generation DES was associated with significantly lower risk of definite or probable stent thrombosis compared with BMS (adjusted HR: 0.61 [95% CI: 0.42 to 0.89]) and first-generation DES (adjusted HR: 0.56 [95% CI: 0.36 to 0.88]). [Conclusions] In STEMI patients, DES were superior to BMS with respect to long-term efficacy. No difference in long-term efficacy and safety was observed among specific DES. Second-generation were superior to first-generation DES in reducing stent thrombosis. (Clinical Outcomes After Primary Percutaneous Coronary Intervention [PCI] Using Contemporary Drug-Eluting Stent [DES]: Evidence From the Individual Patient Data Network Meta-Analysis; CRD42018104053)., This study was funded by Biosensors international. Drs. Chichareon, Modolo, Collet, and Tenekecioglu have received a grant from Biosensors during the conduct of the study. Dr. Collet has received grants and personal fees from Heartflow Inc.; and has received personal fees from Philips and Abbott Vascular outside of the submitted work. Dr. Piek has received nonfinancial support from Abbott Vascular; and has received personal fees and nonfinancial support from Philips/Volcano outside of the submitted work. Dr. Spaulding has received grants and personal fees from Cordis, Johnson & Johnson, during the conduct of the study; has received personal fees from Stentys, Medtronic, Abbott, and Terumo; and has received grants from Biosensors and Boston Scientific outside of the submitted work. Dr. Hofma has received unrestricted research grants from Abbott Vascular to the Research Department of the Division of Cardiology of the Medical Center Leeuwarden, during the conduct of the XAMI study. Dr. Pijls has received grants from Abbott and Hexacath; has equity in Philips, ASML, General Electric, and Heart Flow; and has received consultant fees from Boston Scientific outside of the submitted work. Dr. Räber has received grants to his institution from Abbott, Biotronik, Boston Scientific, Heartflow, Sanofi, and Regeneron; and has received speaker fees from Abbott, Amgen, AstraZeneca, CSL Behring, Sanofi, and Vifor. Dr. Sabaté has received personal fees from and served as a consultant for Abbott Vascular outside of the submitted work. Dr. Stoll is a full-time employee of Biosensors International. Dr. Stone has received personal fees from Terumo, Amaranth, Medical Development Technologies, Shockwave, Valfix, TherOx, Reva, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Matrizyme, Miracor, Neovasc, V-wave, Abiomed, Claret, Backbeat, Sirtex, Ancora, Qool Therapeutics, and SpectraWave; holds equity in Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, Caliber, SpectraWave, Biostar family of funds, and MedFocus family of funds; is director of SpectraWave; and his institution, Columbia University, has received royalties from Abbott for sale of the MitraClip. Dr. Windecker has received grants from Amgen, Abbott, Boston Scientific, Bristol-Myers Squibb, Bayer, Biotronik, Edwards, Medtronic, Sinomed, and Polares outside of the submitted work. Dr. Onuma has served as a member of the Advisory Board of Abbott Vascular. Dr. Serruys has received personal fees from Abbott Laboratories, AstraZeneca, Biotronik, Cardialysis, GLG Research, Medtronic, Sino Medical Sciences Technology, Société Europa Digital Publishing, Stentys France, Svelte Medical Systems, Philips/Volcano, St. Jude Medical, Qualimed, and Xeltis outside of the submitted work.

Pretreatment with P2Y12 inhibitors before primary percutaneous coronary intervention (PPCI) can reduce the incidence of major adverse cardiovascular event (MACE) rate in ST-segment elevation myocardial infarction (STEMI) patients. We investigated differences in coronary reperfusion and clinical outcomes between prehospital administration of prasugrel vs ticagrelor in a historical cohort analysis.We conducted a retrospective analysis of prospectively collected data of 533 STEMI patients, directly referred by the ambulance for PPCI, and pretreated with either prasugrel (2013-2014) or ticagrelor (2015-2016). The primary outcome measurement was coronary and myocardial reperfusion prior to and after intervention. Secondary outcome measurements included MACE and stent thrombosis (ST) at 30 days. The median time from first medical contact to balloon was 82 minutes. There was no significant difference in preprocedural and postprocedural coronary reperfusion (TIMI flow grade 3) and postprocedural ST-segment elevation resolution between the prasugrel and ticagrelor groups. No significant differences in MACE and ST rates were found between the groups. No fatal or intracranial bleedings were reported up to 30-day follow-up.Prehospital administration of both prasugrel and ticagrelor in STEMI patients is safe, without differences in preprocedural and postprocedural reperfusion and short-term clinical outcomes.

First published online: 21 July 2018 Attribution 4.0 International (CC BY 4.0) Frailty correlates with morbidity and is superior to chronological age in predicting mortality. Frailty of older migrants has important implications for the demands placed on healthcare systems. Examining 95,635 Europeans in the Survey of Health, Aging and Retirement in Europe, we investigated cross-sectional and longitudinal associations between migration and frailty at ages > 50 years. We examined whether associations differed by countries' level of healthcare coverage and access for migrants and tested mediation by home-ownership and citizenship. Cross-sectionally, first-generation migrants > 50 years old were, on average, 16.4% (95% confidence interval [CI]: 14.6, 18.2%) frailer than non-migrants after confounder-adjustment. This decreased to 12.1% (95% CI: 10.1, 14.1%) after adjustment for citizenship. The strength of association between migrant status and frailty was greater in migrants from low-or-middle-income countries, compared with mi-grants from high-income countries. Migrants into Northern, Western and Eastern Europe were 37.3% (95% CI:33.2, 41.5%), 12.2% (95% CI: 10.0, 14.6%) and 5.0% (95% CI: 0.5, 9.6%) frailer than non-migrants, respectively, but migrants into Southern Europe were no frailer than non-migrants. The strength of association between migrant status and frailty was greater in countries with lower healthcare coverage and access for migrants. However, citizenship attenuated this difference. Longitudinally, migrants were frailer than non-migrants at 50 years old and trajectories converged over time until migrants and non-migrants were equally frail by 80–90 years. Our work finds no evidence of the ‘healthy migrant effect’ outside of Southern Europe in older migrants and suggests that acculturation is a key determinant of migrant health. The project MiLifeStatus has received funding from the European Research Council (ERC) under the European Union’s Horizon2020 research and innovation programme (grant agreement No 682626)

Frailty correlates with morbidity and is superior to chronological age in predicting mortality. Frailty of older migrants has important implications for the demands placed on healthcare systems. Examining 95,635 Europeans in the Survey of Health, Aging and Retirement in Europe, we investigated cross-sectional and longitudinal associations between migration and frailty at ages >50 years. We examined whether associations differed by countries' level of healthcare coverage and access for migrants and tested mediation by home-ownership and citizenship. Cross-sectionally, first-generation migrants >50 years old were, on average, 16.4% (95% confidence interval [CI]: 14.6, 18.2%) frailer than non-migrants after confounder-adjustment. This decreased to 12.1% (95% CI: 10.1, 14.1%) after adjustment for citizenship. The strength of association between migrant status and frailty was greater in migrants from low-or-middle-income countries, compared with migrants from high-income countries. Migrants into Northern, Western and Eastern Europe were 37.3% (95% CI: 33.2, 41.5%), 12.2% (95% CI: 10.0, 14.6%) and 5.0% (95% CI: 0.5, 9.6%) frailer than non-migrants, respectively, but migrants into Southern Europe were no frailer than non-migrants. The strength of association between migrant status and frailty was greater in countries with lower healthcare coverage and access for migrants. However, citizenship attenuated this difference. Longitudinally, migrants were frailer than non-migrants at 50 years old and trajectories converged over time until migrants and non-migrants were equally frail by 80-90 years. Our work finds no evidence of the 'healthy migrant effect' outside of Southern Europe in older migrants and suggests that acculturation is a key determinant of migrant health.

Background Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated.Hypothesis We hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post cardiac arrest patients without signs of STEMI.Design In a prospective, multicenter, randomized controlled clinical trial, 552 post cardiac arrest patients with restoration of spontaneous circulation and without signs of STEMI will be randomized in a 1:1 fashion to immediate CAG and PCI (within 2 hours) versus initial deferral with CAG and PCI after neurological recovery. The primary end point of the study is 90-day survival. The secondary end points will include 90-day survival with good cerebral performance or minor/moderate disability, myocardial injury, duration of inotropic support, occurrence of acute kidney injury, need for renal replacement therapy, time to targeted temperature control, neurological status at intensive care unit discharge, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, and reasons for discontinuation of treatment.Summary The COACT trial is a multicenter, randomized, controlled clinical study that will evaluate the effect of an immediate invasive coronary strategy in post cardiac arrest patients without STEMI on 90-day survival.

Objective: Electronic foetal monitoring (EFM) together with non-invasive ST-analysis (STAN) has been suggested as a superior technique to EFM alone for foetal surveillance to prevent metabolic acidosis. This study aims to compare the cost-effectiveness of these two techniques from both maternal (short term) as neonatal (long term) perspective to guide clinical decision-making. Methods: We created two models: a maternal model, focused on the difference in mode of delivery as most important outcome, and a neonatal Markov model focused on the differences in metabolic acidosis – and its relationship to cerebral palsy (CP) – as the most relevant outcome to estimate the long-term cost-effectiveness. The cost to prevent one instrumental delivery was estimated in the maternal model. The costs to prevent one metabolic acidosis and the costs per quality adjusted life years were calculated in the neonatal model. Results: The average costs of STAN are only €34 higher when compared to EFM alone. From maternal perspective the cost of preventing one instrumental delivery was estimated at €2602. From neonatal perspective the cost to prevent one case of metabolic acidosis was €14 509. Over the long term, STAN becomes a dominant (cost saving) strategy if >1% of the patients exposed to metabolic acidosis acquire CP. Conclusions: Our study suggests that STAN, when compared to EFM alone, can be a cost-effective strategy from both a maternal and neonatal perspective.

Aim In primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI), stenting has proved to reduce the need for repeat revascularization compared with balloon angioplasty alone. The incidence of cardiac death or recurrent myocardial infarction, though, is not reduced by stenting. This is in part attributable to stent-related complications like stent thrombosis which may occur even years after implantation. A strategy of drug coated balloon (DCB) angioplasty without stenting would abolish the potential disadvantages of stent implantation while reducing the probability of restenosis observed in plain old balloon angioplasty. Our aim is to evaluate the efficacy and safety of a DCB only strategy versus drug-eluting stents (DES) in PPCI for STEMI. Study design The REVELATION trial is a prospective, single center, randomized study, in which 120 patients presenting with STEMI will be allocated to treatment with a DCB versus DES. Appertaining to the established prognostic value of fractional flow reserve (FFR) rather than angiographic lesion severity, the functional assessment of the infarct-related lesion by FFR at 9 months after initial treatment is the primary end point. Assuming an FFR value of 0.90 after stenting and an increased risk of adverse events if post-PCI FFR

Understanding the contemporary transformation of citizenship requires insights from many disciplines and perspectives. The Oxford Handbook of Citizenship brings together multidisciplinary and comparative contributions from legal academics, political scientists, sociologists, geographers, historians, and philosophers, to set a new agenda for both theoretical and practical explorations of citizenship. The main challenges and prospects in today's world of increased migration and globalization will be explored, and attention will also be given to new forms of membership and democratic participation beyond borders, as well as to the rise of European and multilevel citizenship-developments that are increasing the potential for citizenship to operate not only at the nation-state level, but also above and below it. The Handbook will be a major reference for those engaged with citizenship from a legal, political, and cultural perspective.

In order to increase the effectiveness of migration management, the EU increasingly enters into agreements with third countries. Such co-operation aims to engage third countries in migration control mechanisms in exchange for enhanced legal migration opportunities, yet this externalization of migration policy is highly selective with regard to both participating Member States and third countries. In this paper we develop a three-level game perspective to explain why Member States and third countries participate in EU external migration policy initiatives. The three-level game links three sets of actors in two strategic interactions: Member States, EU institutions and third countries. We argue that two factors determine the outcome of negotiations: the cost of no agreement and the autonomy of central decision-makers. The model is illustrated by the successful and failed Mobility Partnership negotiations between EU Member States, the European Commission and, respectively, Cape Verde and Senegal.

In non–ST-segment elevated acute coronary syndrome (NSTE-ACS), a routine invasive approach is advocated among intermediate- or high-risk patients. It was hypothesized that modern antiplatelet therapy including ticagrelor would safely allow direct invasive management by preventing periprocedural

This contribution presents the comparative findings of the ‘protection against statelessness database’, developed by the european union democracy observatory on citizenship in collaboration with unhcr. Using the most important international standards as a benchmark, the database provides a normative assessment of the extent to which citizenship laws in 36 european states provide sufficient protection against statelessness. While section 2 explains the methodology developed by the observatory in collaboration with unhcr, and in particular the 17 ‘modes of protection against statelessness’ that have been devised, section 3 draws some comparative conclusions. This is based on a fourfold distinction – that is, whether the countries provide more protection than required by the standards; act in line with the standards; provide a limited safeguard against statelessness; or provide no safeguard at all. Concluding that a serious attempt is generally made to avoid cases of statelessness from arising, the contribution also feels there is room for improvement.

First published on October 23, 2013. This article analyzes the conditions under which ethnic minorities intensify or moderate their protest behavior. While this question has been previously asked, we find that prior studies tend to generalize explanations across a varied set of ethnic groups and assume that causal conditions can independently explain whether groups are more or less mobilized. By contrast, this study employs a technique – fuzzy-set analysis – that is geared toward matching comparable groups to specific analytical configurations of causal factors to explain the choice for strong and weak protest. The analysis draws on a sample of 29 ethnic minorities in Europe and uses three group and two contextual conditions inspired by Gurr’s ethnopolitical conflict model to understand why some ethnic minorities protest more frequently than others. We find that two group-related factors have the strongest claim to being generalizable: while territorial concentration is a necessary condition for strong protest, national pride is a necessary condition for weak protest. The contextual factors of level of democracy and ethnic fractionalization, which are often emphasized in the literature, and the perceived political discrimination of a group, are neither necessary nor individually sufficient conditions for either strong or weak protest. Hence, they help understanding some cases, but not all, and only in combination with other conditions. Such causal complexity, inherent in the phenomenon of ethnic protest, underscores the need for a case-sensitive, yet comparative, approach.

For foreign-born residents and their children, attaining citizenship in the host country confers membership, rights and participation opportunities, and encourages a sense of belonging (bloemraad 2006). From a destination country perspective, naturalisation is increasingly seen as an important part of the process of integrating immigrants. In order to optimise the use of what is sometimes termed the ‘citizenship premium’, actors in destination countries often advocate public policies that are aimed at increasing naturalisation rates among immigrants (oecd 2011; sumption and flamm 2012). The acquisition of citizenship is associated with better employment probability, higher earnings and higher occupational positions (liebig and von haaren 2011). Politically, in a democratic context, citizenship normally qualifies immigrants to take an active part in the electoral politics of the destination country (pikkov 2011; de rooij 2012).keywordsdestination countryorigin countryforeign citizenshipdual citizenshipimmigrant integrationthese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This article investigates the impact of European cooperation on the dynamics of domestic policymaking in the field of migration policy. While European migration policy has gradually communitarized since the Amsterdam Treaty, member state governments have not yet fully caught up with the new reality. This is also reflected in a state of the art that, in contrast with the developing European Union (EU) studies literature at large, is still dominated by intergovernmentalist analyses, which assume that member states have full control over the integration process. The article zooms in on the Family Reunification Directive of 2003 and its domestic political impact in the Netherlands. The Dutch case illustrates that the realities of EU migration politics are increasingly at odds with intergovernmentalist assumptions and that it is high time for scholars of migration politics to broaden their theoretical perspective.