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Adolescents in secure residential care mostly suffer from serious behavioural problems, often accompanied by trauma and adverse family circumstances. This paper presents findings of a comparison of behavioural problems and risk factors of 255 boys and girls (aged 12 to 18 years) in secure residential care in the Netherlands and their association with behavioural problems. A cross‐sectional design and standardized questionnaires were used to measure behavioural problems and individual and familial risk factors. By using independent‐sample t tests, the severity of these factors in boys and girls was compared, and by using structural equation modelling (SEM), associations between these factors and behavioural problems were investigated. The findings of the study show that post‐traumatic stress disorder (PTSD) symptoms, maladaptive emotion regulation, impaired perceived competence and internalizing behavioural problems were more severe in girls than in boys. Boys experienced more severe externalizing behavioural problems and more family problems than girls. Maladaptive emotion regulation, PTSD symptoms, perceived competence and parenting problems were related to behavioural problems. The results indicate that treatment for girls should address PTSD symptoms, perceived competence and maladaptive emotion regulation and that extra attention for family problems in the treatment of boys is warranted. [ABSTRACT FROM AUTHOR]

Purpose:The construct validity, test–retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated. Method:112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs). Results:For construct validity (N = 105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test–retest reliability coefficient was 0.96 (95% Confidence Interval 0.94–0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88–0.94) and small standard errors (SEM 5.6–7.2). Conclusion:The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change.Implications for RehabilitationThe Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS).Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS.The equivalence of scores from online, paper or interview administration is supported.A change score of ≥18 points on the scale of the AMSQ (on a scale 0–100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient. [ABSTRACT FROM AUTHOR]

Some children enter elementary school with large vocabulary delays, which negatively influence their later school performance. A rich home language environment can support vocabulary development through frequent high-quality parent-toddler interaction. Elaborated picture home activities can support this rich home language environment. This study compares the effects of a multimedia versus a paper elaborated picture on the parent-toddler interaction and toddlers' vocabulary development. In a within-subjects design, 20 toddlers (age 3-4) discussed a multimedia and a paper elaborated picture with a parent. Results showed that toddlers knew significantly more words (receptively and expressively) after both activities. Moreover, the improvement in receptive vocabulary knowledge was significantly larger with the multimedia elaborated picture compared with the paper-based picture. In addition, both parent and toddler engaged in a significant higher level of decontextualized language in response to multimedia. The present study shows that multimedia elaborated pictures can support parents at home to engage in a parent-toddler interaction that is richer and supports the development of receptive vocabulary more compared with traditional paper-based activities. In the future, multimedia-based home activities for toddlers' vocabulary development, supporting parent-child interaction, can be offered relatively cheap and easily via internet. [ABSTRACT FROM AUTHOR]

Abstract: Background and Purpose: Physiotherapy (PT) and occupational therapy (OT) are key professions providing treatment for the arm after stroke; however, knowledge about the content of these treatments is scant. Detailed data are needed to replicate interventions, evaluate their effective components, and evaluate PT and OT practice. This paper describes PT and OT treatment for the severely affected arm in terms of duration, content according to components and categories of the International Classification of Human Functioning, Disability and Health, and to analyze differences between professions. Methods: Design: This is a retrospective analysis of randomized trial data. Participants: 46 patients after stroke with poor arm motor control recruited from inpatient neurological units from three rehabilitation centers in the Netherlands. Procedure: PTs and OTs recorded duration and content of arm treatment interventions for 8 weeks using a bespoke treatment schedule with 15 International Classification of Human Functioning, Disability and Health categories. Results: PTs and OTs spent on average 4–7 min per treatment session (30 min) on arm treatment. OTs spent significantly more time providing arm treatment and treatment at the activities level than PTs. PTs spent 79% of their arm treatment time on body functions, OTs 41%. OTs spent significantly more time on “moving around using transportation,” “self care,” and “household tasks” categories. Conclusions: Patients after stroke with a severely affected arm and an unfavorable prognosis for arm motor recovery receive little arm‐oriented PT and OT. Therapists spent most arm treatment time on body functions. There was a considerable overlap in the content of PT and OT in 12 of the 15 categories. Results can be generalized only to patients with poor arm motor control and may not represent practice in other countries. [ABSTRACT FROM AUTHOR]

Background: Observational studies performed in Asian populations suggest that eating rate is related to BMI. This paper investigates the association between self-reported eating rate (SRER) and body mass index (BMI) in a Dutch population, after having validated SRER against actual eating rate. Methods: Two studies were performed; a validation and a cross-sectional study. In the validation study SRER (i.e., 'slow', 'average', or 'fast') was obtained from 57 participants (men/women = 16/41, age: mean ± SD = 22.6 ± 2. 8 yrs., BMI: mean ± SD = 22.1 ± 2.8 kg/m²) and in these participants actual eating rate was measured for three food products. Using analysis of variance the association between SRER and actual eating rate was studied. The association between SRER and BMI was investigated in cross-sectional data from the NQplus cohort (i.e., 1473 Dutch adults; men/women = 741/732, age: mean ± SD = 54.6 ±11.7 yrs., BMI: mean ± SD = 25.9 ± 4.0 kg/m²) using (multiple) linear regression analysis. Results: In the validation study actual eating rate increased proportionally with SRER (for all three food products P < 0.01). In the cross-sectional study SRER was positively associated with BMI in both men and women (P = 0.03 and P < 0.001, respectively). Self-reported fast-eating women had a 1.13 kg/m² (95% CI 0.43, 1.84) higher BMI compared to average-speed-eating women, after adjusting for confounders. This was not the case in men; self-reported fast-eating men had a 0.29 kg/m² (95% CI -0.22, 0.80) higher BMI compared to average-speed-eating men, after adjusting for confounders. Conclusions: These studies show that self-reported eating rate reflects actual eating rate on a group-level, and that a high self-reported eating rate is associated with a higher BMI in this Dutch population. [ABSTRACT FROM AUTHOR]

Objective. This paper describes the perceptions of operating theatre staff in Australia and The Netherlands regarding the influence of logistical or operational reasons that may affect the scheduling of unplanned surgical cases. It is proposed that logistical or operational issues can influence the priority determination of queue position of surgical cases on the emergency waiting list. Methods. A questionnaire was developed and conducted in 15 hospitals across The Netherlands and Australia, targeting anaesthetists, managers, nurses and surgeons. Statistical analyses revolved around these four professional groups. Six hypotheses were then developed and tested based on the responses collected from the participants. Results. There were significant differences in perceptions of logistics delay factors across different professional groups when patients were waiting for unplanned surgery. There were also significant differences among different groups when setting logistical priority factors for planning and scheduling unplanned cases. The hypotheses tests confirm these differences, and the findings concur with the paradigmatic differences mentioned in the literature. These paradigmatic differences among the four professional groups may explain some of the tensions encountered when making decisions about scheduling emergency surgical queues, and therefore should be taken into consideration for management of operating theatres. Conclusions. Queue positions of patients waiting for unplanned surgery, or emergency surgery, are determined by medical clinicians according to clinicians' indication of clinical priority. However, operating theatre managers are important in facilitating smooth operations when planning for emergency surgeries. It is necessary for surgeons to understand the logistical challenges faced by managers when requesting logistical priorities for their operations. [ABSTRACT FROM AUTHOR]

Nowadays, almost everyone uses the World Wide Web (WWW) to search for information of any kind. In education, students frequently use the WWW for selecting information to accomplish assignments such as writing an essay or preparing a presentation. The evaluation of sources and information is an important sub-skill in this process. But many students have not yet optimally developed this skill. On the basis of verbal reports, eye-tracking data and navigation logs, this study investigated how novices in the domain of psychology evaluate Internet sources as compared to domain experts. In addition, two different verbal reporting techniques, namely thinking aloud and cued retrospective reporting, were compared in order to examine students' evaluation behaviour. Results revealed that domain expertise has an impact on individuals' evaluation behaviour during Web search, such that domain experts showed a more sophisticated use of evaluation criteria to judge the reliability of sources and information and selected more reliable information than domain novices. Furthermore, the different verbal reporting techniques did not lead to different conclusions on criteria use in relation to domain expertise, although in general more utterances concerning evaluation of sources and information were expressed during cued retrospective reporting. Lay Description What is already known about this topic: When searching the Web, students assess the reliability of information and sources in a spontaneous manner., Students tend to use superficial criteria when judging the trustworthiness of web-based information and sources., Little is known about the differences between domain experts and novices in terms of the ways they spontaneously evaluate web-based information and sources., What this paper adds: Domain knowledge influences evaluation behaviour, with greater domain knowledge leading to more reliable selection of sources., A comparison of techniques for measuring evaluation behaviour when searching the Web for information reveals that different techniques, such as thinking aloud and cued retrospective reporting, have different pros and cons whose implications depend on the research questions being addressed., Implications for practice and/or policy: In formal education, more attention should be paid to equipping students with the requisite skills in searching for and evaluating web-based information. Embedded process-oriented instructional designs are needed that foster the appropriate evaluation behaviours. [ABSTRACT FROM AUTHOR]

The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the design and cohort characteristics of the Social Spectrum Study: a clinical cohort study that used a two-phase sampling design to identify children at risk for ASD. After screening 1281 children aged 2.5-10 years who had been consecutively referred to one of six mental health services in the Netherlands, children who screened positive for ASD (n = 428) and a random selection of screen negatives (n = 240) were invited to participate in diagnostic assessments and questionnaires regarding the child, family and society. A 1-year follow-up was also conducted. Results from this study may contribute to knowledge of the identification and characterization of children with ASD, family processes, and the impact of ASD on the family and society. [ABSTRACT FROM AUTHOR]

Context The handover represents a high-risk event in which errors are common and lead to patient harm. A better understanding of the cognitive mechanisms of handover errors is essential to improving handover education and practice. Objectives This paper reports on an experiment conducted to study the effects of learner knowledge, case complexity (i.e. cases with or without a clear diagnosis) and their interaction on handover accuracy and cognitive load. Methods Participants were 52 Dutch medical students in Years 2 and 6. The experiment employed a repeated-measures design with two explanatory variables: case complexity (simple or complex) as the within-subject variable, and learner knowledge (as indicated by illness script maturity) as the between-subject covariate. The dependent variables were handover accuracy and cognitive load. Each participant performed a total of four simulated handovers involving two simple cases and two complex cases. Results Higher illness script maturity predicted increased handover accuracy (p < 0.001) and lower cognitive load (p = 0.007). Case complexity did not independently affect either outcome. For handover accuracy, there was no interaction between case complexity and illness script maturity. For cognitive load, there was an interaction effect between illness script maturity and case complexity, indicating that more mature illness scripts reduced cognitive load less in complex cases than in simple cases. Conclusions Students with more mature illness scripts performed more accurate handovers and experienced lower cognitive load. For cognitive load, these effects were more pronounced in simple than complex cases. If replicated, these findings suggest that handover curricula and protocols should provide support that varies according to the knowledge of the trainee. [ABSTRACT FROM AUTHOR]

Under certain conditions, statistical evidence is more persuasive than anecdotal evidence in supporting a claim about the probability that a certain event will occur. In three experiments, it is shown that the type of argument is an important condition in this respect. If the evidence is part of an argument by generalization, statistical evidence is more persuasive compared with anecdotal evidence (Experiments 1 and 2). In the case of argument by analogy, statistical and anecdotal evidences are equally persuasive (Experiments 2 and 3). However, if the case in the anecdotal evidence is dissimilar from the case in the claim, statistical evidence is again more persuasive (Experiment 3). The implications of these results for the concept of argument quality are discussed. Zhaiyao Author Note Dans quelles conditions les preuves statistiques sont-elles supérieures aux preuves anecdotiques en soutien á une affirmation? Le rôle du type d'argument Hans Hoeken (Ph.D., University of Tilburg, 1995) is a professor at the Department of Business Communication Studies, Centre for Language Studies, Radboud University Nijmegen, the Netherlands. His research focuses on language and persuasion. Lettica Hustinx (Ph.D., Radboud University Nijmegen, 1996) is an associate professor at the department of Dutch language and culture, Centre for Language Studies, Radboud University Nijmegen, the Netherlands. Her research interest focuses on argumentation and persuasion. This research was supported by a grant from NWO (360-80-020), the Dutch Research Foundation. We thank Hans Beentjes, Berna Hendriks, Margot van Mulken, Donna Rouner, and two anonymous reviewers for their insightful comments and advice on earlier versions of this paper. Résumé Correspondence concerning this paper should be addressed to Hans Hoeken, Department of Business Communication Studies, Radboud University Nijmegen, P.O. Box 9103, NL 6500 HD, The Netherlands. E-mail: . [ABSTRACT FROM AUTHOR]

Gasunie buys and sells gas. This paper is about calculating the failure rate of the gas transport system of Gasunie in the Netherlands. The pipes in the network are connected at certain stations which may operate at degraded levels due to technical problems. The transport system, modelled as an optimization problem, needs to be checked for feasibility for every configuration of the degradation levels at all stations in order to see whether the system fails or not. The discrete probability distributions of the degradation levels at every station in the network are given. The number of possible combinations of degradation levels is huge and the computations for the feasibility of the gas network are computer-intensive. This paper presents a new algorithm for approximating this rate and it is parsimonious in actually checking for feasibility. [ABSTRACT FROM AUTHOR]

The voicing contrast is neutralized syllable and word finally in Dutch and German, leading to alternations within the morphological paradigm (e.g., Dutch ‘bed(s)’, be[t]-be[d]en, German ‘dog(s)’, Hun[t]-Hun[d]e). Despite structural similarity, language-specific morphological, phonological and lexical properties impact on the distribution of this alternation in the two languages. Previous acquisition research has focused on one language only, predominantly focusing on children’s production accuracy, concluding that alternations are not acquired until late in the acquisition process in either language. This paper adapts a perceptual method to investigate how voicing alternations are represented in the mental lexicon of Dutch and German 3-year-olds. Sensitivity to mispronunciations of voicing word-medially in plural forms was measured using a visual fixation procedure. Dutch children exhibited evidence of overgeneralizing the voicing alternation, whereas German children consistently preferred the correct pronunciation to mispronunciations. Results indicate that the acquisition of voicing alternations is influenced by language-specific factors beyond the alternation itself. [ABSTRACT FROM AUTHOR]

The purpose of this study was threefold, namely (1) to differentiate between multiproblem families and control families on characteristics and processes within the family based on a theoretical framework, (2) to identify multiproblem families by establishing cut-off scores on various questionnaires, and (3) to categorize multiproblem families into subtypes by cluster analyses. Various questionnaires were administered to multiproblem families (n = 85) and control families (n = 150). Results showed that what we propose to refer to as multiproblem families present a broad range of problems on seven domains: (1) child factors, (2) parental factors, (3) childrearing problems (inadequate or inconsistent parenting), (4) family functioning problems, (5) contextual problems, (6) social network problems, and (7) mental health care problems. Further, reliable cut-off scores were established for various questionnaires. Finally, three types of families were found: (1) community-problem families, (2) multiproblem families, and (3) child-focused mild-problem families. This paper looks to advance an evidence-based definition and assessment of 'multiproblem families' suggesting the possible value of defining and assessing multiproblem families in relation to these seven dimensions. Moreover, the classification of multiproblem families stresses the importance of providing tailored treatments. [ABSTRACT FROM AUTHOR]

The share of older migrants in Dutch cities is increasing. However, only limited knowledge has been gained about the urban conditions that older migrants live in and how these compare to those of their native Dutch counterparts. This paper contributes to filling this knowledge gap using detailed information on residential patterns, housing conditions and levels of neighbourhood deprivation in the city of Amsterdam in the Netherlands, and links this information to data about housing and neighbourhood satisfaction and perceived safety. Empirical evidence demonstrates that there is strong path dependence with regard to the places in which one finds different groups of older non-Western migrants. Older non-Western migrants in Amsterdam are highly concentrated in disadvantaged neighbourhoods. The number of concentrations has increased significantly over the past decade, as well as the concentration levels. Nevertheless, we did not find indications of social isolation. With regard to housing conditions, we found better conditions for socio-economically similar groups of native Dutch and Surinamese 55+ residents, compared to Turkish and Moroccan 55+ residents. These conditions correspond with levels of housing satisfaction. Surinamese older people are more positive about their neighbourhoods. We hypothesise that this is related to the restructuring of neighbourhoods where Surinamese 55+ residents are concentrated. Although the immediate environment of older non-Western people is characterised by high levels of social deprivation, this does not translate into dissatisfaction with social relations or feelings of lack of safety. This suggests that their residential concentration in particular urban neighbourhoods may also bring significant opportunities. [ABSTRACT FROM PUBLISHER]

Clinical and research staff who work around magnetic resonance imaging (MRI) scanners are exposed to the static magnetic stray fields of these scanners. Although the past decade has seen strong developments in the assessment of occupational exposure to electromagnetic fields from MRI scanners, there is insufficient insight into the exposure variability that characterizes routine MRI work practice. However, this is an essential component of risk assessment and epidemiological studies. This paper describes the results of a measurement survey of shift-based personal exposure to static magnetic fields (SMF) (B) and motion-induced time-varying magnetic fields (dB/dt) among workers at 15 MRI facilities in the Netherlands. With the use of portable magnetic field dosimeters, >400 full-shift and partial shift exposure measurements were collected among various jobs involved in clinical and research MRI. Various full-shift exposure metrics for B and motion-induced dB/dt exposure were calculated from the measurements, including instantaneous peak exposure and time-weighted average (TWA) exposures. We found strong correlations between levels of static (B) and time-varying (dB/dt) exposure (r = 0.88–0.92) and between different metrics (i.e. peak exposure, TWA exposure) to express full-shift exposure (r = 0.69–0.78). On average, participants were exposed to MRI-related SMFs during only 3.7% of their work shift. Average and peak B and dB/dt exposure levels during the work inside the MRI scanner room were highest among technical staff, research staff, and radiographers. Average and peak B exposure levels were lowest among cleaners, while dB/dt levels were lowest among anaesthesiology staff. Although modest exposure variability between workplaces and occupations was observed, variation between individuals of the same occupation was substantial, especially among research staff. This relatively large variability between workers with the same job suggests that exposure classification based solely on job title may not be an optimal grouping strategy for epidemiological purposes. [ABSTRACT FROM AUTHOR]

The elements and intensity of case management (CM) practices should be established according to patients’ needs. Therefore, greater understanding of patients’ needs in such community-based programmes is essential. This paper addresses this issue by characterizing two groups of patients receiving CM or a standard treatment programme (STP) and identifying the characteristics of patients receiving CM services. We recruited 241 patients with schizophrenia from 10 Adult Mental Health Centres in Barcelona (Catalonia, Spain). We analyzed the profile of new patients included in a clinical, non-intensive CM program against that of patients in a STP. CM patients, compared with STP patients, have a lower educational level and quality of life; greater use of health care services, and higher levels of psychiatric symptoms, disability and unmet needs. Community psychiatric visits, social services, education, physical health and needs were significantly associated with CM services. This study may help in identifying patients’ needs and strengthening the CM programme. [ABSTRACT FROM AUTHOR]

The present paper investigates how people identify with groups depending on the clarity of a group's identity content. According to self-categorization theory, self-stereotyping (i.e., projection of group prototypes onto self) should be the cognitive process underlying social identification. We argue, however, that this is only plausible in clearly defined groups. If a group is unclear in terms of its identity content, we argue that self-anchoring (i.e., projection of personal self onto group) accounts for social identification. In line with these hypotheses, two studies (with minimal and real groups) reveal that self-anchoring positively predicts the level of social identification and entitativity in unclearly, but not clearly defined groups. Conversely, self-stereotyping positively predicts the level of social identification in clearly, but not unclearly defined groups. Together, these findings are the first to demonstrate the differential impact of cognitive projection processes on social identification depending on group clarity. [ABSTRACT FROM AUTHOR]

Aim The aims of this paper are, first, to identify the determinants of the 'intention to leave' of nurses working at a general hospital, and, second, to provide recommendations for various stakeholders targeting prevention of premature leaving to various post-exit destinations. Background Nurse turnover is a serious problem, especially given the increased need for professional medical care because of demographic changes, and puts severe pressure on health-care management staff. In order to meet future requirements for nursing staff, it is of utmost importance to empirically study their intention to leave either their department or hospital, and to identify the determinants of these various intentions to leave. Method A cross-sectional survey was completed by 318 nurses working at various departments at a general hospital in Eindhoven, the Netherlands. Data were collected in May 2011. Using binary regression analysis, various determinants of nurses' reported post-exit career choices could be identified. Conclusion Nurses' intention to leave is determined by their general satisfaction with management and leadership quality, their satisfaction with pay and benefits, their job satisfaction and work-to-home interference issues they have to deal with, but not by career development opportunities. Implications for nursing management Preventing nurses from leaving their department or hospital requires careful attention from management and human resources professionals working in hospitals. In particular, the line managers who actually supervise nurses on a daily basis are key in ensuring that nurses are satisfied with their management and with the rewards they receive, and are able to cope with work-home interference. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to analyze whether professionals who work with people with an upper limb deficiency (ULD) received questions about sexuality from their patients and whether they addressed sexuality themselves, and to analyze their knowledge and comfort level, approach and attitudes towards sexuality. An online questionnaire, including questions on self-perceived sexological competence and the Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale (KCAASS) was used to asses these aspects. One out of three professionals had received a question about sexuality from their patients. Nearly one out of five professionals had addressed sexuality themselves. Professionals who received a question about sexuality from patients or addressed this issue themselves had significantly higher scores on self-perceived knowledge about sexuality and on self-perceived conversation skills compared to professionals who did not. The scores on the KCAASS Knowledge and Comfort of professionals who received a question about sexuality or addressed the issue of sexuality were significantly higher than those of professionals who did not. Sexuality is thus only scantly discussed by professionals working with patients with an ULD. Professionals indicated they do not feel confident nor comfortable enough to address this issue. They also experience a lack of appropriate knowledge to address sexuality with patients. Professionals reported a need for courses and training on both knowledge and conversation skills concerning sexuality. In addition, a protocol and necessary facilities need to be provided for the team working with people with an ULD in order to be able to address sexuality systematically. [ABSTRACT FROM AUTHOR]

zwijnenberg n.c. & bours g.j.j.w. (2012) Nurse practitioners and physician assistants in Dutch hospitals: their role, extent of substitution and facilitators and barriers experienced in the reallocation of tasks. Journal of Advanced Nursing 68(6), 1235-1246. Abstract Aims. This paper is a report of a study exploring the role of nurse practitioners and physician assistants, the extent of substitution and the barriers and facilitators experienced by them as a consequence of substitution in public hospitals. Background. Nurse practitioners and physician assistants are emerging worldwide. However, despite the large amount of evidence showing the added value of these professionals, little evidence is available concerning the role, extent of substitution and facilitators and barriers experienced by them as a consequence of substitution. Methods. Interviews were conducted and a questionnaire was completed by 43 nurse practitioners and 13 physician assistants employed in public hospitals in the south of the Netherlands in 2007. Results. Nurse practitioners and physician assistants performed a broad spectrum of tasks, but differed significantly in the time spent and the kind of tasks performed. Nurse practitioners spent 25% (10·4 hours; sd = 5·5) and physician assistants 40% (18·7 hours; sd = 7·6) of their time on medical procedures. They both also performed new tasks or tasks for which there previously was insufficient capacity. Many of them experienced policy/organizational, legal, financial or facility problems in the reallocation of tasks. Conclusion. Nurse practitioners and physician assistants have wide ranging but different responsibilities in public hospitals. By performing medical procedures and new tasks or tasks for which there was not enough capacity, they function as substitutes and supplements for doctors. However, barriers are affecting the extent of substitution. The challenge ahead is to remove the barriers experienced by nurse practitioners and physician assistants. [ABSTRACT FROM AUTHOR]

arts e.e.a., landewe-cleuren s.a.n.t., schaper n.c. & vrijhoef h.j.m. (2012) The cost-effectiveness of substituting physicians with diabetes nurse specialists: a randomized controlled trial with 2-year follow-up. Journal of Advanced Nursing 68(6), 1224-1234. Abstract Aims. To evaluate the cost-effectiveness of an intervention substituting physicians with nurse specialists. Background. Increasing populations of people with diabetes in most Western countries require creative solutions that give high-quality chronic care while controlling costs. Instigating nurse specialists as a substitute for physicians yields positive results in this area. Research about such interventions in a hospital-based setting is limited. Methods. This paper is a report of a study of a randomized, non-blinded clinical trial including people with diabetes mellitus types 1 and 2. In the intervention group nurse specialists were the central carers, providing care that conformed to a preset protocol. Patients were included between 2004 and 2007. Costs, quality of life and adverse events were measured, cost-effect ratios and incremental cost-effect ratios were calculated based on health-resource utilization rates, corresponding market prices and national tariffs from 2007. Results. Health related quality of life scores did not differ significantly between the control and the intervention group. In the intervention group, fewer patients were hospitalized and fewer side effects from drugs were reported compared to controls. Nurse specialists as central care givers generated a modest reduction in costs per quality adjusted life year gained compared to usual care. Conclusion. Nurse specialists give diabetes care that is similar to care provided by physicians in terms of quality of life and economic value. Instigating a nurse specialist as central carer yields opportunities to generate cost savings. Developing interventions which also focus on prevention of complications is recommended when aiming for long-term organisational cost savings. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper considers therapeutic approaches to residential care with specific attention to the question of family involvement. It builds on a body of literature indicating the potential of residential care as a positive intervention for young people, and examines the contention that - even when family problems contribute to a young person's accommodation in residential care - family involvement could improve long-term outcomes. The literature reviewed indicates that family involvement is indeed important. Mixed research findings reflect the diversity of approaches to family-centred practice, but there is evidence of benefits in relation to a range of child outcomes. However, the literature also shows that family-centred residential care is not easy to achieve. More than parent-child contact, it entails genuine involvement of parents, in decision-making and in children's daily lives. Professionals - including social workers and residential care workers - must not only be concerned with the care and development of the child, but also with the role of the parent in their child's development, understood within an ecological perspective. [ABSTRACT FROM AUTHOR]

Reliably predicting vegetation distribution requires habitat distribution models (HDMs) that are ecologically sound. Current correlative HDMs are increasingly criticized because they lack sufficient functional basis. To include functional information into these models, we integrated two concepts from community ecology into a new type of HDM. We incorporated: 1) species selection by their traits in which only those species that pass the environmental filter can be part of the community (assembly theory); 2) that the occurrence probability of a community is determined by the extent to which the community mean traits fit the required traits as set by the environment. In this paper, our trait-based HDM is presented and its predictive capacity explored. Our approach consists of two steps. In step 1, four plant traits (stem-specific density and indicator values for nutrients, moisture and acidity) are predicted from four dominant environmental drivers (disturbance, nutrient supply, moisture supply and acidity) using regression. In step 2, these traits are used to predict the occurrence probability of 13 vegetation types, covering the majority of vegetation types across the Netherlands. The model was validated by comparison to the observed vegetation type for 263 plots in the Netherlands. Model performance was within the range of conventional HDMs and decreased with increasing uncertainty in the environment-trait relationships and with an increasing number of vegetation types. This study shows that including functionality into HDMs is not necessarily at the cost of model performance, while it has several conceptual advantages among including an increased insight in the functional characteristics of the vegetation and sources of unpredictability in community assembly. As such it is a promising first step towards more functional HDMs. Further development of a trait-based HDM hinges on replacing indicator values by truly functional traits and the translation of these relationships into mechanistic relationships. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 133-143 The professional nursing practice environment and nurse-reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered. [ABSTRACT FROM AUTHOR]

Abstract: The Dutch dairy chain is aiming to achieve energy-neutral production by bringing the whole chain from dairy farm to factory ultimately to be self sufficient in energy in year 2020, through a combination of wind, solar and biogas. This paper investigated the economic feasibility of producing green gas from digestion of dairy manure and other co-substrates. A simulation model of producing 17 PJ of green gas from 2 business models, stand-alone and central upgrading was developed. Probability distributions were chosen to describe the profitability and risks for individual business models and for the aggregate energy production at dairy sector level. Data sources, among others, stem from 23 operating biogas plants in Netherlands. Simulation results showed that the probability of a negative net present value (NPV) is less than 50% for both individual models. The probability that the combined business models producing 17 PJ will result in a negative NPV is 23%. A total of 109 plants are needed to produce the total energy, requiring 8.5% of the total amount of cattle manure produced in the Netherlands to be processed. Sensitivity analysis based on spearman rank correlation coefficient between NPV and each of the sample input distributions showed that biogas yield and investment costs have significant effect in determining the NPV values. [Copyright &y& Elsevier]

The study of time series models for count data has become a topic of special interest during the last years. However, while research on univariate time series for counts now flourishes, the literature on multivariate time series models for count data is notably more limited. In the present paper, a bivariate integer-valued autoregressive process of order 1 (BINAR(1)) is introduced. Emphasis is placed on models with bivariate Poisson and bivariate negative binomial innovations. We discuss properties of the BINAR(1) model and propose the method of conditional maximum likelihood for the estimation of its unknown parameters. Issues of diagnostics and forecasting are considered and predictions are produced by means of the conditional forecast distribution. Estimation uncertainty is accommodated by taking advantage of the asymptotic normality of maximum likelihood estimators and constructing appropriate confidence intervals for the fe-step-ahead conditional probability mass function. The proposed model is applied to a bivariate data series concerning daytime and nighttime road accidents in the Netherlands. [ABSTRACT FROM AUTHOR]

Abstract: Nutritional conditions in early life may causally affect health at older ages. This paper examines the effects of early life exposure to the Dutch famine (Winter 1944–45) on the prevalence of heart diseases, peripheral arterial diseases (PAD) and diabetes mellitus (DM) at ages 60–76. Analyses are performed using data from the fifth cycle of the Longitudinal Aging Study Amsterdam. Exposure to the famine is determined by reported place of residence during the Dutch famine, with those living in the cities in the West of the Netherlands defined as exposed (n = 278) and those living in the rural areas in the West or living in the North or East defined as non-exposed (n = 521). We successively compare the prevalence of heart diseases, PAD and DM at ages 60–76 of 370 males and 429 females exposed and non-exposed to the famine in early life. We distinguish four age classes of exposure in early life: gestation and infancy (ages 0–1), childhood (age 1–5), pre-adolescence (ages 6–10) and adolescence (ages 11–14). The analysis shows that exposure to severe undernutrition at ages 11–14 is significantly associated with a higher probability of developing DM and/or PAD at ages 60–76. The associations are found only in women, but not in men. If suggests that adolescence may be a critical period with respect to exposure to adverse (nutritional) conditions and that research should take this into account. These findings are relevant for children in developing countries who are exposed to severe nutritional deprivation. [Copyright &y& Elsevier]

This paper reports on an evaluation of a 'social participation' improvement project in a mental health care and care for the intellectually disabled setting. The main research question is how sociality (i.e. clients' social lives) was constructed and what consequences this had for the project and for the clients. We undertook a dual approach: investigating the predefined outcomes and analysing the improvement processes in terms of how these processes construct sociality. As to the predefined outcomes, clients' social networks were not widened, but clients felt significantly less lonely at the end of the project. In a bottom-up analysis of data gathered on the improvement processes, we articulated two ways of constructing sociality: individualization, in which clients had to verbalize their wishes (verbalization) and to act upon them more actively (enterprising); and normalization, in which a good social life was one embedded in 'normal' community. We argue that this (explorative) way of conceptualizing change corresponds with some of the quantitative findings but also brings to light aspects that would have gone unnoticed by using only the predefined outcomes. Therefore, a mixed methods approach in studying effectiveness is a fruitful addition to the quality improvement literature. [ABSTRACT FROM AUTHOR]

Workplace conflict is a potent stressor, but most previous research has focused on its effect on productivity and performance rather than on individual well-being. This paper examines the moderating roles of an individual's internal locus of control and a problem-solving conflict management strategy. In the cross-sectional study, among 774 health care workers in the Netherlands, employees' internal locus of control did moderate the relationship between experienced conflict at work and psychological strain, which was measured using a 13-item Dutch adaptation of the Occupational Stress Indicator. In addition, this moderation was mediated by the active conflict management strategy of problem solving; people with a more internal locus of control use a problem-solving conflict management strategy more often and, as a result, experience less psychological strain in cases of workplace conflict. Implications for conflict theory, for future research, and for practice are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Routine physical examination is recommended in follow up guidelines for women with a history of breast cancer. The objective of this paper is to assess the contribution of routine physical examination in addition to mammography in the early diagnosis of breast cancer recurrences. Patients and methods: The medical follow-up documents of 669 patients were reviewed. 127 contra-lateral breast cancers (CBCs) and 58 loco-regional recurrences (LRRs) in 163 patients were included. The additional contribution of routine physical examination over mammography was evaluated with the proportions of CBCs or LRRs detected by physical examination alone. χ 2 tests were used to compare the difference of contribution of physical examination among subgroups. Results: Seven (6%) out of 127 CBCs and 13 (22%) out of 58 LRRs were detected by routine physical examination alone. Six LRRs (17%; 6/35) were in patients after breast conserving surgery and seven LRRs (30%; 7/23) in patients after mastectomy. There was a trend that the contribution of physical examination is higher in women under 60years of age in the detection of CBCs (9%; 5/57) and LRRs (28%, 8/29) than in women over 60years of age (CBCs:3%; 2/70 and LRRs:17%, 5/29; χ 2 =3.090, P =0.079). Conclusions: Twenty-two percent of loco regional breast cancer recurrences would have been detected later without physical examination. Routine physical examination may be most valuable for women with a history of breast cancer younger than 60years at follow-up visit. [Copyright &y& Elsevier]

Traditional methods to evaluate flood risk generally focus on heavy storm events as the principal cause of flooding. Conversely, fault tree analysis is a technique that aims at modelling all potential causes of flooding. It quantifies both overall flood probability and relative contributions of individual causes of flooding. This paper presents a fault model for urban flooding and an application to the case of Haarlem, a city of 147,000 inhabitants. Data from a complaint register, rainfall gauges and hydrodynamic model calculations are used to quantify probabilities of basic events in the fault tree. This results in a flood probability of 0.78/week for Haarlem. It is shown that gully pot blockages contribute to 79% of flood incidents, whereas storm events contribute only 5%. This implies that for this case more efficient gully pot cleaning is a more effective strategy to reduce flood probability than enlarging drainage system capacity. Whether this is also the most cost-effective strategy can only be decided after risk assessment has been complemented with a quantification of consequences of both types of events. To do this will be the next step in this study. [ABSTRACT FROM AUTHOR]

Abstract: In the Netherlands, the design of dikes and other water retaining structures is based on an acceptable probability (frequency) of overtopping. In 1993 a new safety concept was introduced based on total flood risk. Risk was defined as the product of probability and consequences. In recent years advanced tools have become available to calculate the actual flood risk of a polder. This paper describes the application of these tools to an existing lowland river area. The complete chain of calculations necessary to estimate the risk of flooding of a polder (or dike ring) is presented. The difficulties in applying the present day tools and the largest uncertainties in the calculations are shown. [Copyright &y& Elsevier]

Abstract: The aim of this paper is to propose a method for the evaluation of tunnel safety using probabilistic risk assessment. The framework includes three criteria; personal-, societal- and economic risk. The use of personal and societal risk is becoming more and more widespread. There are however, still some difficulties in using the economic risk criterion. As a first step towards economic risk optimisation, the cost effectiveness of addition and removal of safety measures in tunnels is investigated. Finally, the application of the three proposed criteria is further discussed for some tunnelling projects currently underway in the Netherlands. [Copyright &y& Elsevier]

Aim: To compare fine motor performance of 3-year-old children with visual impairment with peers having normal vision, to provide reference scores for 3-year-old children with visual impairment on the ManuVis, and to assess inter-rater reliability.Method: 26 children with visual impairment (mean age: 3 years 7 months (SD 3 months); 17 boys) and 28 children with normal vision (mean age: 3 years 7 months (SD 4 months); 14 boys) participated in the study. The ManuVis age band for 3-year-old children comprised two one-handed tasks, two two-handed tasks, and a pre-writing task.Results: Children with visual impairment needed more time on all tasks (p< .01) and performed the pre-writing task less accurately than children with normal vision (p< .001). Children aged 42–47 months performed significantly faster on two tasks and had better total scores than children aged 36–41 months (p< .05). Inter-rater reliability was excellent (Intra-class Correlation Coefficient = 0.96–0.99).Conclusions: The ManuVis age band for 3-year-old children is appropriate to assess fine motor skills, and is sensitive to differences between children with visual impairment and normal vision and between half-year age groups. Reference scores are provided for 3-year-old children with visual impairment to identify delayed fine motor development. [ABSTRACT FROM PUBLISHER]