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Organizations offer activities and programmes to improve their employees' health. These workplace health promotion (WHP) activities usually have an individualized and top-down focus, a low uptake among employees, and are perceived to be out of line with employees' experiences and definitions of health. This paper follows up on studies that have broadened the focus of WHP by including social relations and delves deeper into how daily practices and experiences of (un)belonging at work relate to workplace health. Based on ethnographic research in two companies in the Netherlands, this paper analyses how (un)belonging is expressed and experienced by employees. The paper shows that employees define health at work as a social practice. It also demonstrates how dynamics at work shape different dimensions of (un)belonging that, in turn, affect employees' perceived health at work. These findings indicate the importance of including (un)belonging in the workplace as an ingredient of WHP. [ABSTRACT FROM AUTHOR]

The paper addresses the problem of evaluating the Implicit McMillan degree |$\delta{m}$| of |$W^{-1}(s)$|⁠ , where |$W^{-1}(s)$| denotes the transfer function of a passive |$RLC$| electrical network.1 The Implicit McMillan degree |$\delta{m}$| specifies the minimum number of dynamic elements needed to completely characterize the passive |$RLC$| network, i.e. an electrical network that contains only passive elements (capacitors, inductors and resistors) and associates it with the rank properties of the passive element matrices. A fact that in the circuit literature is intuitively accepted but not rigorously proved is that this degree must be equal to the minimum number of independent dynamical elements in the network Livada (2017, Implicit network descriptions of RLC networks and the problem of re engineering. Ph.D. Thesis, City, University of London) and Leventides et al. (2014, McMillan degree of impedance, admittance functions of RLC networks. In 21st International Symposium on Mathematical Theory of Networks and Systems. The Netherlands: Groningen). In this paper, we investigate this finding, showing that the maximum possible Implicit McMillan degree |$\delta{m}$| of such networks is given by |$rankL+rankC$| and that this value is reached when certain necessary and sufficient conditions are satisfied. 1 [ABSTRACT FROM AUTHOR]

Objective To investigate medication prescription patterns among children with JIA, including duration, sequence and reasons for medication discontinuation. Methods This study is a single-centre, retrospective analysis of prospective data from the electronic medical records of JIA patients receiving systemic therapy aged 0–18 years between 1 April 2011 and 31 March 2019. Patient characteristics (age, gender, JIA subtype) and medication prescriptions were extracted and analysed using descriptive statistics, Sankey diagrams and Kaplan–Meier survival methods. Results Over a median of 4.2 years follow-up, the 20 different medicines analysed were prescribed as monotherapy (n  = 15) or combination therapy (n  = 48 unique combinations) among 236 patients. In non-systemic JIA, synthetic DMARDs were prescribed to almost all patients (99.5%), and always included MTX. In contrast, 43.9% of non-systemic JIA patients received a biologic DMARD (mostly adalimumab or etanercept), ranging from 30.9% for oligoarticular persistent ANA-positive JIA, to 90.9% for polyarticular RF-positive JIA. Among systemic JIA, 91.7% received a biologic DMARD (always including anakinra). When analysing medication prescriptions according to their class, 32.6% involved combination therapy. In 56.8% of patients, subsequent treatment lines were initiated after unsuccessful first-line treatment, resulting in 68 unique sequences. Remission was the most common reason for DMARD discontinuation (44.7%), followed by adverse events (28.9%) and ineffectiveness (22.1%). Conclusion This paper reveals the complexity of pharmacological treatment in JIA, as indicated by: the variety of mono- and combination therapies prescribed, substantial variation in medication prescriptions between subtypes, most patients receiving two or more treatment lines, and the large number of unique treatment sequences. [ABSTRACT FROM AUTHOR]

Objectives In the Netherlands, a case of euthanasia of an incompetent patient with dementia and an advance euthanasia directive (AED) caused great societal unrest and led to a petition signed by more than 450 physicians. In this paper, we investigate these physicians' reasons and underlying motives for supporting the 'no sneaky euthanasia' petition, with the aim of gaining insight into the dilemmas experienced and to map out topics in need of further guidance. Methods Twelve in-depth interviews were conducted with physicians recruited via the webpage 'no sneaky euthanasia'. General topics discussed were: reasons for signing the petition, the possibilities of euthanasia in incompetent patients and views on good end-of-life care. Data were interpreted using thematic content analysis and the framework method. Results Reasons for supporting the petition are dilemmas concerning 'sneaky euthanasia', the over-simplified societal debate, physicians' personal moral boundaries and the growing pressure on physicians. Analysis revealed three underlying motives: aspects of handling a euthanasia request based on an AED, good end-of-life care and the doctor as a human being. Conclusions Although one of the main reasons for participants to support the petition was the opposition to 'sneaky euthanasia', our results show a broader scope of reasons. This includes their experience of growing pressure to comply with AEDs, forcing them to cross personal boundaries. The underlying motives are related to moral dilemmas around patient autonomy emerging in cases of decision-making disabilities in advanced dementia. To avoid uncertainty regarding patients' wishes, physicians express their need for reciprocal communication. [ABSTRACT FROM AUTHOR]

Does partisan ideology influence whether Europeans are willing to use nuclear weapons, and if so, how? The US nuclear weapons stationed in Europe have been at the core of European security since the Cold War, but we have still yet to learn what would make Europeans be willing to support their use. In this paper, we present the results of a survey, in which we asked citizens in Germany and the Netherlands about their views on the use of the US nuclear weapons stationed on their territory in four distinct scenarios. Our results indicate that voters of right-wing parties are more likely to approve of the use of nuclear weapons in both countries. There are, however, important differences between the two countries in terms of the degree to which the participants oppose the use of nuclear weapons. These results have implications for NATO's nuclear deterrence posture. [ABSTRACT FROM AUTHOR]

Background: Achieving people-centred health care systems requires new and innovative strategies to capture information about whether, and to what degree, health care is successful in improving health from the perspective of the patient. Patient-reported outcome measures (PROMs) and Patient-reported experience measures (PREMs) can bring some of these new insights, and are increasingly used in research, clinical care, and policymaking.Methods: This paper reflects the ongoing discussions and findings of the OECD PaRIS Working Group on Patient-reported Indicators for Mental Health Care.Results: The OECD has been measuring quality of care for mental health conditions over the last 14 years through the Health Care Quality and Outcomes (HCQO) program; nonetheless, information on how persons with mental health problems value the services they receive, and impact of the services, remains limited. As of 2018, a survey from the OECD showed that only five of the twelve countries surveyed (Australia, Israel, Netherlands, Sweden, United Kingdom) reported PROMs and PREMs collection on a regular basis in mental health settings. The paper details some of the challenges specific to the collection and use of PROMs and PREMs in mental health care, and examples from countries which have implemented comprehensive programmes to gather information about PROMs and PREMs for individuals receiving mental health services.Conclusions: Given the health and economic impact of mental ill-health across all OECD countries, there is significant value to being able to assess the quality and outcomes of care in this area using internationally-comparable measures. Continued international harmonisation of PROMs and PREMs for mental health through international coordination is a key way to facilitate the sharing of national experiences, promote the use of PROMs and PREMs, and create meaningful indicators for national and international benchmarking. [ABSTRACT FROM AUTHOR]

Background: Achieving people-centred health care systems requires new and innovative strategies to capture information about whether, and to what degree, health care is successful in improving health from the perspective of the patient. Patient-reported outcome measures (PROMs) and Patient-reported experience measures (PREMs) can bring some of these new insights, and are increasingly used in research, clinical care, and policymaking.Methods: This paper reflects the ongoing discussions and findings of the OECD PaRIS Working Group on Patient-reported Indicators for Mental Health Care.Results: The OECD has been measuring quality of care for mental health conditions over the last 14 years through the Health Care Quality and Outcomes (HCQO) program; nonetheless, information on how persons with mental health problems value the services they receive, and impact of the services, remains limited. As of 2018, a survey from the OECD showed that only five of the twelve countries surveyed (Australia, Israel, Netherlands, Sweden, United Kingdom) reported PROMs and PREMs collection on a regular basis in mental health settings. The paper details some of the challenges specific to the collection and use of PROMs and PREMs in mental health care, and examples from countries which have implemented comprehensive programmes to gather information about PROMs and PREMs for individuals receiving mental health services.Conclusions: Given the health and economic impact of mental ill-health across all OECD countries, there is significant value to being able to assess the quality and outcomes of care in this area using internationally-comparable measures. Continued international harmonisation of PROMs and PREMs for mental health through international coordination is a key way to facilitate the sharing of national experiences, promote the use of PROMs and PREMs, and create meaningful indicators for national and international benchmarking. [ABSTRACT FROM AUTHOR]

The current COVID-19 pandemic confines people to their homes, disrupting the fragile social fabric of deprived neighbourhoods and citizen's participation options. In deprived neighbourhoods, community engagement is central in building community resilience, an important resource for health and a prerequisite for effective health promotion programmes. It provides access to vulnerable groups and helps understand experiences, assets, needs and problems of citizens. Most importantly, community activities, including social support, primary care or improving urban space, enhance health through empowerment, strengthened social networks, mutual respect and providing a sense of purpose and meaning. In the context of inequalities associated with COVID-19, these aspects are crucial for citizens of deprived neighbourhoods who often feel their needs and priorities are ignored. In this perspectives paper, illustrated by a varied overview of community actions in the UK and The Netherlands, we demonstrate how citizens, communities and organizations may build resilience and community power. Based on in-depth discussion among the authors we distilled six features of community actions: increase in mutual aid and neighbourhood ties, the central role of community-based organizations (CBOs), changing patterns of volunteering, use of digital media and health promotion opportunities. We argue that in order to enable and sustain resilient and confident, 'disaster-proof', communities, areas which merit investment include supporting active citizens, new (digital) ways of community engagement, transforming formal organizations, alignment with the (local) context and applying knowledge in the field of health promotion in new ways, focussing on learning and co-creation with citizen initiatives. [ABSTRACT FROM AUTHOR]

This paper focuses on the accuracy of COVID-19-related knowledge during the 2020 pandemic. We look at the effects of traditional vs. digital news use and distinguish between positive (number of recoveries) and negative (number of casualties) knowledge. Importantly, the moderating role of crisis context is examined when tracing media effects on knowledge. Relying on a four-wave panel survey fielded in the Netherlands, we find that people's knowledge became more accurate over the course of the crisis. News exposure did not lead to more accuracy, in fact, a negative relation was found. The impact of digital news use weakened as the crisis continued. [ABSTRACT FROM AUTHOR]

Microvascular dysfunction (MVD) is a common pathophysiological change that occurs in various diseases, such as type 2 diabetes mellitus (T2DM), heart failure, dementia, and depression. Recent technical advances have enabled noninvasive measurement and quantification of microvascular changes in humans. In this paper, we describe the protocols of the microvascular measurements applied in the Maastricht Study, an ongoing prospective, population-based cohort study of persons aged 40–75 years being carried out in the southern part of the Netherlands (baseline data assessment, November 2010–January 2020). The study includes a variety of noninvasive measurements in skin, retina, brain, and sublingual tissue, as well as plasma and urine biomarker assessments. Following this, we summarize our main findings involving these microvascular measurements through the end of 2018. Finally, we provide a brief perspective on future microvascular investigations within the framework of the Maastricht Study. [ABSTRACT FROM AUTHOR]

Study Question: Can we develop a web-based sex education programme (programme running in a web browser) that addresses the needs of subfertile couples who are advised expectant management for at least 6 months?Summary Answer: The 'Pleasure & Pregnancy' programme addresses couples' needs, is likely to improve couples' sexual functioning, and is subsequently hypothesised to improve the chance of natural pregnancy.What Is Known Already: According to professional guidelines (e.g. the Netherlands and UK) couples with unexplained subfertility and a good chance of natural pregnancy, should be advised at least 6 months of expectant management. Adherence to expectant management is challenging as couples and gynaecologist prefer a more active approach. Targeting sexuality may be useful as subfertility is a risk factor for decreased sexual functioning.Study Design, Size, Duration: A novel programme was developed according to the three steps of the Medical Research Councils' (MRC) framework. First, relevant literature was explored. Second, an interdisciplinary expert panel developed a theory (based on a systematic literature review and patient interviews) on how the chance of natural conception can be improved. Third, the expected process and outcomes were modelled.Participants/materials, Setting, Methods: Two licenced clinical sexologists, two gynaecologists, a clinical embryologist and two midwife-researchers, all from Belgium and the Netherlands, proposed components for the sex education programme. PubMed was searched systematically for randomised controlled trials (RCTs) evaluating the proposed components in different patient populations. The needs of 12 heterosexual Dutch or Belgian couples who were advised expectant management were explored with in-depth interviews. The content and delivery characteristics of the novel programme were described in detail with the aid of 'Intervention Taxonomy'. To model the outcomes, a protocol for an RCT was designed, registered and submitted for publication.Main Results and the Role Of Chance: To help maintain or improve sexual functioning, mainly pleasure, and hence increase pregnancy rates, the web-based Pleasure & Pregnancy programme contains a combination of psychosexual education and couple communication, mindfulness and sensate focus exercises. Information on the biology of conception and interaction with fertility clinic staff and peers were added based on couples' needs to increase potential acceptability.Limitations and Reason For Caution: This paper outlines the development phase of a sex education programme according to the MRC-framework. Whether the Pleasure & Pregnancy programme actually is acceptable, improves sexual functioning, increases pregnancy rates and is cost-effective remains to be determined.Wider Implications Of the Findings: No previous interactive web-based sex education programme has aimed to increase the natural pregnancy rate of subfertile couples by targeting their sexual pleasure. The Pleasure & Pregnancy programme addresses couples' needs and its effect on sexual functioning and pregnancy rate is plausible but remains to be demonstrated by an RCT which is currently ongoing.Study Funding/competing Interest(s): Funding was provided by The Netherlands Organisation for Health Research and Development (ZonMw), Flanders Research Foundation and the University of Amsterdam. C.B.L. is editor-in-chief of Human Reproductionbut was blinded to all parts of the peer review process. The remaining authors have no conflict of interest to report.Trial Registration Number: Not applicable. [ABSTRACT FROM AUTHOR]

Background The use of foresight studies is common in some policy fields, but not in public health. Interest in such studies is growing. This paper gives a general overview of the Dutch Public Health Foresight Study (PHFS) 2018, providing insight into what performing a broad scenario exercise in the field of public health entails and its societal impacts. Methods The aim of the PHFS-2018 was: (a) to show how public health and healthcare in the Netherlands will develop over the next 25 years if we pursue our current course and detect 'new' developments; (b) to give options for dealing with the major future societal challenges. Part a was addressed by means of a quantitative business-as-usual scenario exercise complemented with qualitative thematic studies, and part b by elaborating courses of action for three key challenges, based on stakeholder consultation. Typical aspects of the PHFS methods are a multidisciplinary, participatory and conceptual approach and using a broad definition of health. Results The PHFS-2018 is the basis for the upcoming National Health Policy Memorandum and the Trend Scenario is the baseline for the National Prevention Agreement. Unexpectedly, the findings about increasing mental pressure in young people received most attention. There still is room for expanding use of the study to its full potential. Conclusions Long-term thinking could be stimulated by using back casting techniques and stronger involvement of policy-makers in the elaboration of options for action. Lessons learned from developing intersectoral policy at the local level could be applied at the national level. [ABSTRACT FROM AUTHOR]

Aims: The European Society of Cardiology (ESC) guidelines state that heart failure nurse specialists (heart-failure nurses) with specific competences are essential for a successful heart-failure-management programme. Thus, the Heart Failure Association (HFA) of the ESC developed the heart failure nurse curriculum (HFA curriculum). Several ESC member states developed cardiovascular education programmes to enable nurses to deliver high specialist care, but little is known of whether these curricula are in line with the HFA curriculum. Therefore, this paper describes the extent to which cardiovascular education programmes in Belgium, The Netherlands and Germany correspond to the HFA curriculum. Methods and results: A case study approach was adopted to obtain an in-depth understanding of the programme contents in relation to the HFA curriculum. For this purpose, representatives of the educational programmes and/or delegates of the national cardiovascular nursing organization shared their educational curricula. All of the studied cardiovascular education programmes aim to provide heart failure and/or cardiovascular nurses with essential competences for implementation of evidence based and guideline derived care. However, every cardiovascular education programme has a different focus/area of attention. Cardiovascular education in Belgium discusses aspects of all core-learning objectives of the HFA curriculum and emphasizes mostly knowledge aspects of these. Learning objectives in cardiovascular education in The Netherlands focus on chronic diseases in general and on learning objectives concerning patient education, support in self-care and management of device and pharmacological therapy. Cardiovascular education in Germany discusses most learning objectives; however, not all learning objectives receive equal attention. Conclusions: Although local cardiovascular education programmes adopt certain aspects of the HF curriculum, the curriculum as a whole is not adopted. [ABSTRACT FROM AUTHOR]

The value of 'the arts' in community development is increasingly being recognized. This paper contributes to emerging insights on the various impacts of the arts on communities by highlighting when and how they can have binding and dividing effects on a community. We draw on a participatory research project conducted in Pingjum, a village in the Netherlands that hosts many cultural activities and in which many artists live. We discuss how the arts in Pingjum influence the community in the village. In our discussion, we pay attention to the sense of community that the arts generate, the meeting opportunities they provide and how the community is engaged by some artists. Our study shows that the influence of the arts is context-dependent, with the arts having both binding and dividing effects on the community in Pingjum. In terms of the value of the arts for community development, we emphasize three key issues: that the arts (i) do not have only advantages for a community; (ii) do not engage the entire community; and (iii) could potentially contribute to community fragmentation. Given these issues, we argue that the arts should be considered as one of several supportive means in community development processes. Ideally, they are integrated into a wider community development strategy and planning, and exist alongside other associations and activities in a community. In this way, the arts can contribute to the robustness of a community and assist it in developing the capacity and resources to flourish. [ABSTRACT FROM AUTHOR]

Introduction: The demand for alternative nicotine/tobacco products is not well established. This paper uses a behavioral economic approach to test whether smokers have differential demand for conventional factory-made, electronic, and very low nicotine content cigarettes (FMCs/ECs/VLNCs) and uses the prospective cohort design to test the predictive validity of demand indices on subsequent use of commercially available FMCs and ECs.Methods: Daily smokers (≥16 years) from the Netherlands completed an online survey in April 2014 (N = 1215). Purchase tasks were completed for FMCs, ECs, and VLNCs. Participants indicated the number of cigarettes they would consume in 24 h, across a range of prices (0-30 euro). The relationship between consumption and price was quantified into four indices of demand (intensity, Pmax, breakpoint, and essential value). A follow-up survey in July 2015 measured FMC and EC use.Results: At baseline, greater demand was observed for FMCs relative to ECs and VLNCs across all demand indices, with no difference between ECs and VLNCs. At follow-up, greater baseline FMC demand (intensity, essential value) was associated with lower quit rates and higher relapse. EC demand (Pmax, breakpoint, essential value) was positively associated with any EC use between survey waves, past 30 day EC use, and EC purchase between waves.Conclusions: Smokers valued FMCs more than ECs or VLNCs, and FMCs were less sensitive to price increases. Demand indices predicted use of commercially available products over a 15 month period. To serve as viable substitutes for FMCs, ECs and VLNCs will need to be priced lower than FMCs.Implications: Purchase tasks can be adapted for novel nicotine/tobacco products as a means to efficiently quantify demand and predict use. Among current daily smokers, the demand for ECs and VLNCs is lower than FMCs. [ABSTRACT FROM AUTHOR]

Study Question: Is there an association between maternal occupational exposure to solvents, pesticides and metals as assessed by expert-based assessment and congenital anomalies in the offspring?Summary Answer: There is an association between maternal occupational exposure to solvents and congenital anomalies in the offspring, including neural tube defects, congenital heart defects and orofacial clefts.What Is Known Already: One important environmental risk factor for development of congenital anomalies is maternal occupational exposure to chemicals in the workplace prior to and during pregnancy. A number of studies have assessed the association with often conflicting results, possibly due to different occupational exposure assessing methods.Study Design, Size, Duration: For this systematic review with meta-analysis, the search terms included maternal occupation, exposure, congenital anomalies and offspring. Electronic databases MEDLINE and EMBASE were searched for English studies up to October 2017.Participants/materials, Setting, Methods: Two reviewers independently screened all citations identified by the search. Case-control studies and cohort studies were included if (I) they reported on the association between maternal occupational exposure to solvents, pesticides or metals and congenital anomalies, and (II) assessment of occupational exposure was performed by experts. Data on study characteristics, confounders and odds ratios (ORs) were extracted from the included studies for four subgroups of congenital anomalies. Methodological quality was assessed using the Newcastle-Ottawa Scale. In the meta-analysis, random effects models were used to pool estimates.Main Results and the Role Of Chance: In total, 2806 titles and abstracts and 176 full text papers were screened. Finally, 28 studies met the selection criteria, and 27 studies could be included in the meta-analysis. Our meta-analysis showed that maternal occupational exposure to solvents was associated with neural tube defects (OR: 1.51, 95%CI: 1.09-2.09) and congenital heart defects (OR: 1.31, 95%CI:1.06-1.63) in the offspring. Also maternal occupational exposure to glycol ethers, a subgroup of solvents, was associated with neural tube defects (OR: 1.93, 95%CI: 1.17-3.18) and orofacial clefts (OR: 1.95, 95%CI: 1.38-2.75) in the offspring. Only one study investigated the association between maternal occupational exposure to solvents and hypospadias and found an association (OR: 3.63, 95%CI: 1.94-7.17). Results of the included studies were consistent. In our meta-analysis, we found no associations between occupational exposure to pesticides or metals and congenital anomalies in the offspring.Limitations, Reasons For Caution: A limited number of studies was included, which made it impossible to calculate pooled estimates for all congenital anomalies, analyse individual chemicals or calculate exposure-response relations. Bias could have been introduced because not all included studies corrected for potentially confounding factors.Wider Implications Of the Findings: Employers and female employees should be aware of the possible teratogenic effects of solvent exposure at the workplace. Therefore, is it important that clinicians and occupational health specialist provide women with preconception advice on occupational solvent exposure, to reduce the congenital anomaly risk.Study Funding/competing Interest(s): NSp was paid by the Graduate School of Medical Sciences (MD/PhD program), UMCG, Groningen, the Netherlands. EUROCAT Northern Netherlands is funded by the Dutch Ministry of Health, Welfare and Sports. There are no competing interests.Registration Number: CRD42017053943. [ABSTRACT FROM AUTHOR]

Over the past 20 years, the care for transgender adolescents has developed throughout many countries following the 'Dutch Approach' initiated in the 90s in pioneer countries as the Netherlands, United States and Canada, with increasing numbers of children and adolescents seeking care in transgender clinics. This medical approach has considerable positive impacts on the psychological outcomes of these adolescents, and several studies have been recently published underlining the relative safety of such treatments. This paper reviews the current standards of care for transgender children and adolescents with particular emphasis on disparities among countries and short-tomedium-term outcomes. Finally, it highlights ethical considerations regarding categorization of gender dysphoria, timing of treatment initiation, infertility and how to deal with the long-term consequences. [ABSTRACT FROM AUTHOR]

Extramarital sexuality has always been regarded as a transgression of the accepted norms. The increasing criminalization of extramarital sexuality after the Reformation led to an intensification of the prosecution of illegitimacy by secular authorities. But in the pluriform early modern legal landscape, a whole range of judicial, semi-judicial and extrajudicial institutions and mechanisms existed to exercise control over deviant behavior.  This paper focuses on the institutional setting in which social control over illegitimacy was exercised in the early modern period in Holland and Germany, working with Martin Dinges' concept of the "uses of justice." Both regions experienced several waves of criminalization of sexuality during and after the Reformation, and women were disproportionately affected by this. However, research for both regions has shown that women were not only "passive victims" in this process but also shaped the institutions by actively making use of them. It has been suggested in the literature that, in the early modern period, Dutch women enjoyed a rather favorable position compared to women in neighboring countries and that they were granted considerable leeway in social and legal respects. Considering the differences in the legal system in both countries, the question arises whether there were fundamental differences in the way that social control was exercised over illegitimacy in Germany and the Netherlands and whether Dutch women were truly granted more leeway in a social and legal respect with regard to illegitimacy. [ABSTRACT FROM AUTHOR]

European migration and border control has occupied a prominent spot on the European political agenda. The news media present the topic in a polarized fashion and reports conflicting viewpoints on how the European Union (EU) and national governments should address the issue. We argue that this conflict in news messages can have a polarizing effect on public perceptions regarding the EU's performance on this topic, and that this effect can be moderated by the valence of news messages. A two-wave online panel survey experiment was conducted on a representative sample of the Dutch population (n = 376). The results indicate that conflict reinforces and thus polarizes policy attitudes, whereas a message's valence can change people's attitudes, which reduces the attitudinal gap. The implications of these findings concerning European border control and migration are discussed in the final section of this paper. [ABSTRACT FROM AUTHOR]

School-based health-promoting interventions show promising results in improving various health outcomes of adolescents. Unfortunately, much is still unknown about the relations between health behaviors and school performances, while improving these would give schools a stronger incentive to invest in health promotion. This paper presents the associations of several health behaviors with school performances and studies the mediating effects of psychosocial problems. Health behavior and sociodemographic data were gathered from 905 Dutch high school students via an online survey, completed in-class. These data were matched with school records of the students' overall grade average (GA) on the three core subjects in Dutch high schools (Dutch, English and Math). The associations between health behaviors and school performances, and the potentially mediating effects of psychosocial problems, were studied via mixed-effects regression models. Smoking, being bullied, compulsive and excessive internet use and low physical activity were directly associated with lower school grades. Additionally, being bullied, bullying, smoking, excessive and compulsive internet use were associated with students' grades via mediation of psychosocial problems. This means that lower school grades were (also) associated with those behaviors through the effects of psychosocial problems in those students. This study showed the strong links between health behaviors and academic achievements among adolescents. Schools and health promoters should be educated more on these relations, so that they are aware of this common interest to get more support for health-promoting interventions. Additionally, the role of psychosocial problems in the relations between behaviors and school performances should be studied further in future research. [ABSTRACT FROM AUTHOR]

Objectives: High-quality teaching performance is important to ensure patient safety and encourage residents' learning. This study aims to explore the content and phrasing of suggestions for improvement that residents provide to support excellent teaching performance of their supervisors.Methods: From February 2010 to November 2011, 577 residents were invited to evaluate 501 teachers from both surgical and medical residency training programmes from 20 hospitals. Feedback was collected through a validated formative feedback system named System for Evaluation of Teaching Qualities. Two researchers independently coded the suggestions for improvement with literature-based coding schemes on (1) content and (2) linguistic characteristics. Besides these qualitative outcomes, descriptive statistics were calculated using SPSS.Results: In total, 422 residents (73%) evaluated 488 teachers (97%), yielding 4184 evaluations. Of all teachers, 385 (79%) received suggestions for improvement focusing on teaching skills (TS), 390 (80%) on teaching attitude (TA) and 151 (31%) on personal characteristics. For 13%-47% of the suggestions for improvement, residents added (1) the location or situation where the observed TS or TA had taken place, (2) concrete examples of what teachers could do to improve or (3) (expected) effects of what the change in TS or TA would mean for residents.Conclusions: Residents provide mainly relevant suggestions for improvement that mirror important aspects of teaching performance. However, these comments often lack specific phrasing limiting their value for performance improvement. Therefore, residents are recommended to increase the specificity of the suggestions for improvement. The paper provides directions to phrase narrative feedback. [ABSTRACT FROM AUTHOR]

Although the concept of a "wicked legal system" has become well-known, it is not clear how to define such a system or which actors are crucial in bringing it about. This paper discusses from a historical, international, and jurisprudential perspective the Dutch Supreme Court's 1942 Review Case, in which the Court notoriously grants measures issued by the Nazi occupier the status of Dutch legislation. Although this small tale of the relationship between law, politics, and morality is little known outside the Netherlands, it raises most relevant questions about the constitutional role of a domestic judiciary during foreign occupation and about the ethos of the judiciary beyond the mere obedience of civil servants. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is highly prevalent among South Asian origin groups around the world. Not only is prevalence higher than in other ethnic groups, age at presentation is lower and these groups are more likely to experience complications. Evidence suggests that lifestyle interventions may prevent or delay the onset of diabetes. However, little is known about diabetes prevention in South Asians (SA). DH!AAN is a diabetes prevention program designed for Surinamese SA in The Netherlands. In this paper, we describe the theoretical frameworks and formative research that guided the development and cultural adaptation of DH!AAN. Cultural adaptation was based on analysis of the determinants of diet and physical activity, including socio-cultural factors, within our study population. This led to the incorporation of surface and deep structure elements in the intervention. One-to-one counseling by dieticians using motivational interviewing (MI) was the basis for the intervention. Additionally, we aimed to generate social support by including family members in parts of the intervention and group sessions to address issues relating to traditional food habits. We discuss our reflections on the development process and the choices made in developing this intervention. The results of DH!AAN will provide insight into the use of MI for this population group. Moreover, DH!AAN will provide evidence regarding the feasibility of diabetes prevention among South Asian populations. [ABSTRACT FROM AUTHOR]

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]

Issue Research has often stressed the significance of reducing door movement during surgery for preventing surgical site infections. This study investigated the possible effect of a lean A3 intervention on the reduction of door movement during surgery in a university medical center in the Netherlands. Initial assessment A digital counter recorded door movement during 8009 surgical procedures during 8 months. The number of door movements per surgical procedure ranged from 0 to 555, with a mean of 24 door movements per hour across 26 specialisms. Choice of solution We aimed to reduce door movement in one operating room for orthopedic surgery by a lean A3 intervention. This intervention was executed by means of an A3 report that promotes structured problem solving based on a Plan-Do-Check-Act cycle. Implementation The steps of the A3 report was followed and completed one-by-one by a multidisciplinary team. The effect of the changes was monitored over the course of 12 months. Evaluation The use of a lean A3 intervention resulted in a sustainable decrease of door movements by 78%, from a mean of 24 to a mean of 4 door movements per hour during orthopedic surgery at one OR. Lessons learned This paper shows the relevance of and the possibility for a reduction of door movement during surgery by lean management methods in general and an A3 intervention in particular. This intervention stimulated dialogue and encouraged knowledge-sharing and collaboration between specialized healthcare professionals and this resulted in a thorough root-cause analysis that provided synergy in the countermeasures—with, according to respondents, a sustainable result. [ABSTRACT FROM AUTHOR]

Linked Article: Sarkany et al. Br J Dermatol 2022; 186:713–720. Xeroderma pigmentosum (XP) is a genetic disease in which the system that repairs damage caused by ultraviolet (UV) radiation (which mainly comes from the sun) is faulty. Patients with XP develop eye and skin cancers from childhood and usually die in early adulthood. The main means of preventing the cancers and increasing lifespan is extreme protection against the UV found in daylight, particularly for the face, which is where the cancers mostly occur. Not enough is known about how well patients with XP protect against UV radiation. In this paper, with authors from the UK, the Netherlands and Denmark, a new method was used to estimate face exposure in 36 patients with XP over 3 weeks in the summer. The method combines measurements from a wrist‐worn UV detector with an 'activity diary' of what patients did to protect their face when outside. Some patients with XP protected themselves well whereas others did not. The difference between the face UV dose in the best and worst protecting patients was over 100‐fold. Those patients protecting themselves the least from UV exposure had exposure levels similar to healthy adults. Adults and children with XP had similar exposure to UV but achieved it differently. Adults protected less well when outside but went outside less whereas children went outside more but protected better. This variation in UV exposure is important. Poor protection in patients with XP is likely to cause cancers and premature death. As well as being useful in XP, this new method to estimate facial UV exposure may also be useful in other more common diseases, particularly patients at high risk of basal and squamous cell carcinomas, which are mostly caused by UV and mainly affect the face. Linked Article: Sarkany et al. Br J Dermatol 2022; 186:713–720. [ABSTRACT FROM AUTHOR]

Linked Article: Prens et al. Br J Dermatol 2021; 185:177–184. Hidradenitis suppurativa is a chronic skin disease in which persistent, painful, boil‐like lesions develop especially in the armpits and groin. Treatment is often difficult, and patients with severe disease are eligible for so‐called biologic therapy. The only registered biologic agent is adalimumab, a monoclonal antibody to the inflammatory mediator called tumour necrosis factor‐α (TNF‐α), although other biologic agents such as infliximab (another TNF‐α antagonist) have been used. Unfortunately, these agents may lose their effect with time, sometimes because the patient develops antibodies to the drug, or side‐effects may develop. Little is known about the long‐term results of using these treatments in patients with hidradenitis suppurativa. In this paper, the authors from Groningen and Rotterdam in the Netherlands retrospectively studied the long‐term effectiveness and tolerability of adalimumab and infliximab in patients attending either centre with hidradenitis suppurativa. They studied 104 patients who received adalimumab 40 mg weekly or 80 mg fortnightly, the recommended dose regimen. They also studied 44 patients who were treated with infliximab 5 mg/kg every 6 to 8 weeks. Of the patients treated with adalimumab, 56·3% were still taking the drug after 1 year, and 30·5% after 2 years. Similarly, 58·3% of patients started on infliximab were still receiving the drug at 1 year, and 48·6% at 2 years. Loss of effectiveness was the chief reason for stopping the drug, although some patients developed side‐effects, particularly to infliximab. Only a few patients were tested for antibodies, which were detected in roughly a half. Generally, older patients or those with a longer disease history were more likely to persist with adalimumab therapy. The authors noted that patients with hidradenitis were less likely to persist with biologic therapy than patients with other disease indications such as psoriasis, spondyloarthritis and Crohn disease. Linked Article: Prens et al. Br J Dermatol 2021; 185:177–184. [ABSTRACT FROM AUTHOR]

Summary: Basal cell carcinomas (BCCs or "rodent ulcers") are the most common type of skin cancer and generally do not spread elsewhere on the body. They are not unusual in older people, but someone who develops lots of BCCs from an early age may have the rare genetic condition Basal Cell Naevus Syndrome (BCNS or "Gorlin syndrome"). Other clues to BCNS include an unusually shaped face, cysts in the jaw, and tiny irregularities on the palms and soles called palmar pits. The diagnosis is confirmed by testing DNA extracted from a blood sample. BCNS is caused by a mistake (mutation) in a gene called PTCH1 which is usually inherited from a parent, but occasionally develops for the first time in the embryo, in which case, the patient is described as mosaic because some body cells contain the mistake and some do not. Mosaic patients can be hard to diagnose because they tend to have a milder form of the condition (sometimes the only sign is a BCC developing in childhood) and the blood test may be negative for PTCH1 mutations. This paper, from Belgium and the Netherlands, describes two such patients: a 41 year old woman with BCCs on just one side of her body and no other features of BCNS and a 36 year old woman with BCCs, jaw cysts and palmar pits. In both patients the blood test was negative but PTCH1 mutations were found in all the BCCs tested. Confirming the diagnosis enabled the doctors to counsel these patients about possible complications of BCNS and the risk of passing it on to the next generation. Linked Article: Reinders et al. Br J Dermatol 2019; 181:587–591 [ABSTRACT FROM AUTHOR]

Summary: Atopic dermatitis (AD, atopic eczema) is a very common skin condition affecting 10‐20% of children. It affects children of all skin colours and seems to occur more often in Asian children and children with dark skin types. However, most research is performed on children with light skin types. This study, performed in Amsterdam, the Netherlands, aimed to investigate differences between AD in children with dark and light skin types. To study this, the investigators took tape strips from 53 AD children aged 0‐12 years and 50 healthy children as control (comparison). Tape stripping is a painless procedure which is ideal to perform in children, in which a small round sticker is attached to the skin. When removing this special sticker, a thin layer of skin cells remains attached to the sticker, allowing the investigators to study several aspects of skin inflammation and skin barrier. The authors found that AD skin from children with light and dark skin have similar levels and types of skin inflammation. However, they found differences in skin barrier markers between these two groups. In light skinned children, markers of good skin barrier were lower in AD skin when compared to healthy children's skin, while in dark AD skin these skin barrier markers were not significantly different from healthy dark skin. This study showed that dark‐skinned and light‐skinned AD children are similar when it concerns skin inflammation, but in light skinned AD children the skin barrier dysfunction may play an additional role in the development of AD. This suggests that AD in light and dark skin has different mechanisms of development. Linked Article: Hulshof et al. Br J Dermatol 2019; 180:621–630 [ABSTRACT FROM AUTHOR]