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Objective: To identify the 100 most-cited articles in DH and analyze their characteristics. Material and Methods: A search was performed on the Web of Science (WoS) and the 100 most-cited articles were selected. The following data were extracted: citations, year of publication, authorship, institution, country, journal, language, study design, topic of interest, conflict of interest (COI), and sponsorship. The VOSviewer software was used to visualize bibliometric networks. Poisson regression analysis was performed to measure associations between several citations and the characteristics of the studies. Results: The number of citations ranged from 346 to 48. The most-cited article was published in 1997 by Holland in the Journal of Clinical Periodontology. This journal published the most papers, followed by the Journal of Oral Rehabilitation and Journal of Dentistry. Laboratory research, review, and clinical trial were the study designs most prevalent. Reviews (p<0.05; PR= 1.853) and method development studies (p<0.05; PR= 1.853) had a more chance to present more citations. The main topics of interest were the clinical effectiveness of desensitizers and in vitro analysis of dentin morphology. Sponsorship and COI were underreported. England and USA presented the greatest number of citations and connections in the coauthorship network map. Conclusion: Most of the articles were original research, and their topics of interest were mainly the clinical effectiveness of desensitizing agents and dentin morphology. [ABSTRACT FROM AUTHOR]

People frequently assume that attitudes towards the government's involvement in the economy differentiate left- from right-wing politics. This paper compares this idea to a version of acceptance of inequality theory, where acceptance of inequality is the principal element of left–right competition, but the specific inequality motivating individuals' left–right choice may differ. Using multilevel regression models with survey data from the World Values Survey, as well as two case studies, this paper finds that: (a) acceptance of inequality is a better context-independent predictor of left-right self-placements around the world; and (b) in the Netherlands and Denmark, the correlation between acceptance of an inequality (regarding class or immigration) and right-wing self-placement is stronger when the specific issue dimension is salient to citizens. However, the paper finds no equivalent interaction effect for attitudes towards economic statism. The evidence thus supports the view that the left–right dimension concerns acceptance of inequality, rather than economic interventionism. [ABSTRACT FROM AUTHOR]

Demand response (DR) can potentially provide a cost-efficient alternative for balancing the electricity grid by replacing fossil-fuelled power plants for the provision of flexible capacity. This paper aims to quantify the cost reduction potential of DR from a system perspective. Historical data of balancing markets are studied using regression and average bid price analysis to quantify the effect of the participation of DR resources on the price of flexible capacity for the provision of balancing reserves by focusing on two case studies in Great Britain and the Netherlands. It is estimated that DR bids are, on average, 35% lower than the market average. The regression analysis concluded that 1% higher participation of DR in balancing markets leads, on average, to a 2.7% lower prices for flexible capacity. The results verify the hypothesis that flexible DR capacity is offered at a lower price on balancing markets compared to conventional generation resources, resulting in lower costs for grid operators to balance the grid, thus reducing societal costs for electricity provision and overall emissions through the integration of low-carbon balancing resources. [ABSTRACT FROM AUTHOR]

Copyright of Urban Studies (Sage Publications, Ltd.) is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: A valid distribution of key anthropometric parameters among participants is often a perquisite of ergonomics research. OBJECTIVE: In this paper, we investigated the accuracy of self-reported stature and body mass of the population in the Netherlands. METHODS: Data from 4 experiments was synthesized where in each experiment, participants self-reported their stature and body mass prior to being measured, of which they were not notified before. RESULTS: Statistical analysis of 249 records indicated that on average, participants overreported their stature by 1.31 cm and underreported their mass by 1.45 kg. This is especially true for people with a BMI≥25. CONCLUSION: Two models were proposed to adjust the self-reported stature and body mass for ergonomic researchers in a survey or recruitment. Limitations in using the models are highlighted as well. [ABSTRACT FROM AUTHOR]

Background: To develop public health intervention models using micro-simulations, extensive personal information about inhabitants is needed, such as socio-demographic, economic and health figures. Confidentiality is an essential characteristic of such data, while the data should reflect realistic scenarios. Collection of such data is possible only in secured environments and not directly available for open-source micro-simulation models. The aim of this paper is to illustrate a method of construction of synthetic data by predicting individual features through models based on confidential data on health and socio-economic determinants of the entire Dutch population. Methods: Administrative records and health registry data were linked to socio-economic characteristics and self-reported lifestyle factors. For the entire Dutch population (n = 16,778,708), all socio-demographic information except lifestyle factors was available. Lifestyle factors were available from the 2012 Dutch Health Monitor (n = 370,835). Regression model was used to sequentially predict individual features. Results: The synthetic population resembles the original confidential population. Features predicted in the first stages of the sequential procedure are virtually similar to those in the original population, while those predicted in later stages of the sequential procedure carry the accumulation of limitations furthered by data quality and previously modelled features. Conclusions: By combining socio-demographic, economic, health and lifestyle related data at individual level on a large scale, our method provides us with a powerful tool to construct a synthetic population of good quality and with no confidentiality issues. [ABSTRACT FROM AUTHOR]

Background: Local policymakers require information about public health, housing and well-being at small geographical areas. A municipality can for example use this information to organize targeted activities with the aim of improving the well-being of their residents. Surveys are often used to gather data, but many neighborhoods can have only few or even zero respondents. In that case, estimating the status of the local population directly from survey responses is prone to be unreliable. Methods: Small Area Estimation (SAE) is a technique to provide estimates at small geographical levels with only few or even zero respondents. In classical individual-level SAE, a complex statistical regression model is fitted to the survey responses by using auxiliary administrative data for the population as predictors, the missing responses are then predicted and aggregated to the desired geographical level. In this paper we compare gradient boosted trees (XGBoost), a well-known machine learning technique, to a structured additive regression model (STAR) designed for the specific problem of estimating public health and well-being in the whole population of the Netherlands. Results: We compare the accuracy and performance of these models using out-of-sample predictions with five-fold Cross Validation (5CV). We do this for three data sets of different sample sizes and outcome types. Compared to the STAR model, gradient boosted trees are able to improve both the accuracy of the predictions and the total time taken to get these predictions. Even though the models appear quite similar in overall accuracy, the small area predictions at neighborhood level sometimes differ significantly. It may therefore make sense to pursue slightly more accurate models for better predictions into small areas. However, one of the biggest benefits is that XGBoost does not require prior knowledge or model specification. Data preparation and modelling is much easier, since the method automatically handles missing data, non-linear responses, interactions and accounts for spatial correlation structures. Conclusions: In this paper we provide new nationwide estimates of health, housing and well-being indicators at neighborhood level in the Netherlands, see 'Online materials'. We demonstrate that machine learning provides a good alternative to complex statistical regression modelling for small area estimation in terms of accuracy, robustness, speed and data preparation. These results can be used to make appropriate policy decisions at a local level and make recommendations about which estimation methods are beneficial in terms of accuracy, time and budget constraints. [ABSTRACT FROM AUTHOR]

Two Twitter-based corpus studies are reported to account for the increasing preference in The Netherlands for the stigmatized subject use of the object pronoun hun 'them.' Twitter data were collected to obtain a sufficient number of hun -tokens, but also to investigate the validity of two hypotheses on the preference for hun , this is, that subject- hun is a contrast profiler which thrives in contexts of evaluation and qualification, and that subject- hun is propelled by its dynamic social meaning, being a tool for nonposh and streetwise self-stylization. Although the latter is not normally a predictor included in regression analyses of constructional choice, it turns out that expressively spruced up tweets with vivid contrast profiling are the prime biotope of subject- hun. Along the way, this paper reviews the potential of Twitter data for the reconciliation of macro-big-data analysis with micro-sociolinguistic focus, but it also reports and attempts to remedy three concerns. [ABSTRACT FROM AUTHOR]

Background: Mastering fractions seems among the most critical mathematical skills for students to acquire in school as fraction understanding significantly predicts later mathematic achievements, but also broader academic and vocational prospects. As such, identifying longitudinal predictors of fraction understanding (e.g., mastery of numbers and operations) is highly relevant. However, almost all existing studies identifying more basic numerical skills as predictors of fraction understanding rest on data acquired in face‐to‐face testing—mostly in classrooms. Objectives: In this article, we evaluated whether results obtained in these previous studies generalized to data from the curriculum‐based online learning environment Bettermarks for mathematics used in schools in the Netherlands. Methods: We considered data from more than 5000 students who solved over 1 million mathematical problem sets on basic mathematical skills, fractions, but also algebra. Results and Conclusions: In line with previous findings, we found that fraction understanding was predicted significantly by more basic mathematical skills. Our analyses also indicated that algebra achievement was predicted significantly by fraction understanding beyond influences of more basic mathematical skills. Implications: Together, these findings generalized previous results based on face‐to‐face testing to the context of data from online learning environments and thus, indicate that data from such large‐scale online learning environments may well qualify to provide significant insights into the hierarchical development of mathematical skills. Lay Description: What is already known about this topic: Understanding fractions is one of the most difficult mathematical skill for students to learn in school.Longitudinal studies using face‐to‐face testing indicated that fraction understanding as well as achievements in algebra can robustly be predicted by prior mathematics skills. What this paper adds: We evaluated data from more than 5,000 Dutch students who performed over 1 million curriculum‐based mathematical problem sets in an online learning environment.Our analyses showed that fraction understanding as well as achievements in algebra and can be predicted by prior mathematics skills. Implications for practitioners: These results indicated that previous results from face‐to‐face testing generalize to data obtained from large‐scale online learning environments.Thus, these results open up a new avenue for research using online learning environments on the development of mathematical skills. [ABSTRACT FROM AUTHOR]

Background: Online and blended learning need an appropriate assessment strategy which ensures academic integrity. During the pandemic, many universities have chosen for online proctoring. Although some earlier examples suggest that online proctoring may reduce cheating, the potential side‐effects of proctoring are largely unknown. Objectives: Therefore, this study aims to identify the effects of proctoring on students' self‐reported temptation to cheat and potentially undesirable side‐effects, including test anxiety, perceived exam difficulty, and performance. In addition, we examine which contextual and student characteristics affect test anxiety during online exams. Methods: For this, we collected four waves of survey data throughout a year of teaching during the pandemic at one faculty of a Dutch university, resulting in a total sample of 1760 students within 105 courses. Results and Conclusions: Multi‐level analyses showed that while proctoring had no effect on the temptation to cheat, exam difficulty or performance, students reported higher levels of test anxiety. Some learning strategies, internet literacy, access to a reliable technology and a dedicated study space as well as gender and financial stress affect their test anxiety. To conclude, the decision to use online proctoring needs to consider the undesirable side‐effect on test anxiety. We discuss practical implications for university administrators, educational designers and teachers to reduce test anxiety. Lay Description: What is already known about this topic: Proctoring is often used to ensure academic integrity in online exams.Some evidence shows that proctoring reduces cheating.Little is known about the potential negative side‐effects of proctoring. What this paper adds: The use of proctoring has no effect on the temptation to cheat.The use of proctoring results in increased test anxiety.Several student characteristics and contextual factors reduce text anxiety. Implications for practice: Consider potential negative side‐effects when choosing for proctoring.Time management and internet literacy training might reduce test anxiety.Simulating the exam environment might be used to reduce test anxiety. [ABSTRACT FROM AUTHOR]

In the face of increasing and diversifying graduate application numbers, evidence‐based selective admissions have become a pressing issue. By conducting multilevel regression analyses on institutional admissions data from a Dutch university, this study aims to determine the predictive value of undergraduate academic indicators for graduate study success on research masters' programs in the life sciences. The results imply that in addition to undergraduate grade point average, undergraduate thesis grade is a valid predictor of graduate grade point average. To a small extent, the examined undergraduate academic indicators also predict graduate degree completion and time to degree. The results from this study can be used by admissions committees for evaluating and improving their current practices of graduate selective admissions. Practitioner points: There is substantial scientific evidence that undergraduate grade point average (UGPA) is a valid predictor of certain dimensions of graduate study success. This paper adds to this evidence by showing that undergraduate thesis grade is also a valid predictor of graduate grade point average (GGPA).The predictive power of the type of prior higher education institution for the examined dimensions of graduate study success is small at best.Undergraduate academic indicators are better predictors of GGPA than of graduate degree completion or time to degree.The results of this study can be used for improving admissions decision‐making at graduate schools, especially ones with a research‐oriented curriculum. [ABSTRACT FROM AUTHOR]

The idea that citizens' support for environmental policies depends on their economic interest and the community that one lives in, has been debated extensively in the environmental attitudes literature. However, this literature has not differentiated between separate policy dimensions that concern measures that affect specific groups in different ways. This paper differentiates between a nature/agriculture dimension that divides those who prioritize the agrarian interest from those who prioritize the protection of nature and a climate/energy dimension that divides those who prioritize industrial interest from those who prioritize fighting climate change, using a new survey in the Netherlands (N = 11,327). This two‐dimensional model meets three criteria: scalability, validity, and utility. Scalability is shown by factor analysis and Mokken scaling. Validity is shown by regression analyses that show that whether one lives in a rural or an urban community predicts one's position on the nature/agriculture dimension and that one's financial security predicts one's position on the climate/energy dimension. The utility is shown by regression analyses where the two dimensions are used to predict voting behavior. The Green Party voters favor nature and climate protection, the Liberal Party voters have the opposite views, the Christian‐Democrats favor agricultural interests and the Freedom Party favor industrial interests. [ABSTRACT FROM AUTHOR]

The definition of health has been shifting from disease absence to physical, emotional and social well‐being. To demedicalise societal problems, the term Positive Health (PH) was introduced—a concept focused on the ability to adapt and to self‐manage, in the face of physical, emotional and social challenges. The concept of PH receives broad attention, among others because a PH dialogue tool is intensively being used as a communication instrument while reflecting on patients' health, but a PH measurement instrument is not yet fully established. Recently, however, a 17‐item PH measurement model was proposed. In this paper, a factor analysis and regression analyses were performed to test the factorial validity and concurrent validity of this PH measurement model based on a representative sample of the Dutch population (n = 1016, 50.0% women; age: from 15 until 39 = 29.8%, from 40 until 65 = 43.0%, older than 65 = 27.2%; education levels: low = 28.7%, medium = 42.6%, high = 28.7%). These tests are crucial to understand how well the PH measurement model is suitable as a measurement instrument. The factor analysis provided support for the factorial validity of the proposed PH measurement model. When comparing the proposed PH measurement model with domains of other measurements of health (i.e. BRS, HR‐SWB, ICECAP, and EQ5D), to test the concurrent validity, the model explained more than half of the variance in measurements of the domains happiness (R2 = 0.60) and overall self‐rated health (R2 = 0.57), but explained less than a quarter of the variance in measurements of autonomy (R2 = 0.17 / R2 = 0.13), personal growth (R2 = 0.21), stability (R2 = 0.20), self‐care (R2 = 0.15), and resilience (R2 = 0.24). Two of the six domains of the PH measurement model—mental functioning and daily functioning—were weakly related to the other measurements of health. The results of this study imply that the PH measurement model is suitable to measure multiple dimensions of health. They also suggest that the PH measurement model may not be an encompassing measure for the concepts measured through other health measurements and might explain variance in health beyond these other measurements. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to address the problem of designing league regulatory mechanisms given the multi-dimensionality of competitive balance and the proliferation of empirical measures. Design/methodology/approach: A three-stage approach is adopted. Firstly, a taxonomy of empirical measures of competitive balance is proposed, identifying two fundamental dimensions – win dispersion and performance persistence. Secondly, a simple two-team model of league competitive balance is used to explore the dispersion–persistence relationship. Third, correlation and regression analysis of seven empirical measures of competitive balance for the 18 best-attended top-tier domestic football leagues in Europe over the 10 seasons, 2008–2017, are used to (1) validate the proposed categorisation of empirical measures into two dimensions; and (2) investigate the nature of the dispersion–persistence relationship across leagues. Findings: The simple model of league competitive balance implies a strong positive dispersion–persistence relationship when persistence effects increase for big-market teams relative to those for the small-market teams. However, the empirical evidence indicates that while leagues such as the Spanish La Liga exhibit a strong positive dispersion–persistence relationship, other leagues show little or no relationship, and some leagues, particularly, the English Premier League and top-tier divisions in Belgium and Netherlands, have a strong negative dispersion–persistence relationship. The key policy implication for leagues is the importance of understanding the direction and impact of dispersion and persistence effects on the demand for league products. Originality/value: The variability in the strength and direction of the dispersion–persistence relationship across leagues is an important result that undermines the "one-size-fits-all" approach to designing league regulatory mechanisms. [ABSTRACT FROM AUTHOR]

Summary: Usually in latent class (LC) analysis, external predictors are taken to be cluster conditional probability predictors (LC models with external predictors), and/or score conditional probability predictors (LC regression models). In such cases, their distribution is not of interest. Class‐specific distribution is of interest in the distal outcome model, when the distribution of the external variables is assumed to depend on LC membership. In this paper, we consider a more general formulation, that embeds both the LC regression and the distal outcome models, as is typically done in cluster‐weighted modelling. This allows us to investigate (1) whether the distribution of the external variables differs across classes, (2) whether there are significant direct effects of the external variables on the indicators, by modelling jointly the relationship between the external and the latent variables. We show the advantages of the proposed modelling approach through a set of artificial examples, an extensive simulation study and an empirical application about psychological contracts among employees and employers in Belgium and the Netherlands. [ABSTRACT FROM AUTHOR]

Background: The main aim of this paper is to see to what extent mortality patterns between migrants living in the Netherlands converge. This might be an indicator of health and health care acculturation.Methods: This is an observational study on the basis of standard mortality registration data collected between 1996 and 2007. Eight ethnic groups living in Amsterdam are examined to see if mortality converges or diverges over time. Trends in mortality are studied using Poisson regression. The life expectancy between groups is compared for three time periods.Results: The data showed that for males and females the life expectancy and death rates improved between 1996-1999 and 2004-2007. Most ethnic groups, both males and females, followed this positive trend. For most indicators the ethnic groups converged in terms of mortality. The data also shows the healthy migrant effect with those in Amsterdam from Dutch origin having a relatively high mortality and low life expectancy.Discussion: In this paper the "healthy migrant effect" can be clearly observed. An important cause is the emigration of the original and relatively affluent and healthy Dutch population to suburban areas. Mortality trends tend to converge between ethnic groups during the period 1997-2000 and 2004-2007. The data presented here shows further that trends in mortality and life expectancy which apply to all ethnic groups are much more powerful as this convergence. One wonders if bridging the mortality gap between groups is of much benefit for minority groups, or that minority groups would benefit more from an overall decrease in mortality.Conclusion: Mortality trends that apply to all groups tend to be much stronger compared with trends for individual groups. This shows that dynamics affecting all groups similarly have a considerably stronger effect on mortality outcomes in various ethnic groups compared with possible convergence. [ABSTRACT FROM AUTHOR]

Purpose: Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach: The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings: Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications: These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value: The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders. [ABSTRACT FROM AUTHOR]

This study aimed to investigate children's potential for reasoning by analogy utilizing a newly‐developed computerized dynamic test, and the potential differential influence of executive functions (cognitive flexibility, attention, and planning) on static and dynamic measures of analogical reasoning. Participants included 64 children (mean age = 7.55). The study employed a two‐session experimental test‐training‐test design. Based on randomized blocking, half of the children received a graduated prompts training between pre‐test and post‐test, and the other half did not. Trained children improved more than control children in both their accuracy scores and number of accurately applied transformations from pre‐test to post‐test. It was further found that cognitive flexibility, attention and planning, is associated with successful solving of analogies. Training children in analogical reasoning seemed to reduce the effect of executive functions. It was also found that that children who were more cognitively flexible needed more prompts during the training. Lay Description: What is already known about this topic: Analogical reasoning is of great importance to scholastic performance and everyday learning.Computerized dynamic tests are promising for measuring children's potential for analogical reasoning.Executive functions have been found to influence analogical reasoning performance.Dynamic testing compensates for the influence of executive functions What this paper adds: A newly developed computerized dynamic test of analogical reasoning can detect individualized learning paths and instructional needs of children of various ability levels.Training children in analogical reasoning as part of a computerized dynamic test seems to reduce the effect of executive functioning.Children's instructional needs are related to cognitive flexibility. Implications for practice and/or policy: Computerized dynamic testing of analogical reasoning is a useful instrument for identification purposes.These tests provide information about children's problem‐solving behaviour, and the type and number of instructions they need when solving new tasks, offering insights relevant for individualized education plans.Individual differences in children's (improvements in) analogical reasoning seem to be related to their executive functioning. [ABSTRACT FROM AUTHOR]

This study reports on an Evidence Centered Design (ECD) project in the Netherlands, involving the theory exam for prospective car drivers. In particular, we illustrate how cognitive load theory, task-analysis, response process models, and explanatory item-response theory can be used to systematically develop and refine task models. Based on a cognitive model for driving, 353 existing items involving rules of priority at intersections, were coded on intrinsic task features and task presentation features. Hierarchical regression analyses were carried out to determine the contribution of task features to item difficulty and item discrimination. A substantial proportion of variance in both item difficulty and item discrimination parameters could be explained by intrinsic task-features, including rules and signs (25%, 18.6%), task-intersection features (13.4%, 14.1%), and a smaller small proportion to item presentation features (3.5%, 7.1%) of the total variance. It is concluded that the systematic approach of discerning task features and determining the impact on item parameters has added value as an ECD-tool for evaluating existing assessments that are planned to be innovated. The paper concludes with a discussion of practical implications. [ABSTRACT FROM AUTHOR]

Traditional benchmarking implicitly assumes that decision making units operate in isolation from their peers. For arable production systems in particular, this assumption is unlikely to hold in reality. This paper quantifies spatial spillovers on input‐specific inefficiency using data envelopment analysis and a second‐stage bootstrap truncated regression model. The bootstrap algorithm is extended to allow for the estimation of the parameter of the spatial weight matrix, which captures the proximity between producers. The empirical application concerns Dutch arable farms for which latitudes and longitudes are available. The average inefficiency across years was 3.87% for productive inputs and 2.98% for damage abatement inputs under variable returns to scale. For productive inputs technical inefficiency, statistically significant spillover effects from neighbours' age and their degree of specialisation depended on the type of the spatial weight matrix used (inverse distance or k‐nearest neighbours). Statistically significant spillover effects of subsidy payments were adverse while statistically significant spillover effects from insurance payments were beneficial. For damage abatement inputs technical inefficiency, statistically significant adverse effects were found for neighbours' age and subsidy payments and beneficial effects from neighbours' insurance payments and their degree of specialisation. [ABSTRACT FROM AUTHOR]

Background: Multiple Osteochondromas (MO) is a rare genetic disorder characterised by the presence of numerous benign bone tumours, known as osteochondromas. Within the spectrum of debilitating symptoms associated with MO, pain is recognized as a major problem. Interestingly, our clinical observations suggest that fatigue is also a significant concern but has merely been touched upon in MO literature. This study aims to (1) assess the level of pain and fatigue in adult patients with MO; (2) compare fatigue in MO to healthy subjects and patients with Rheumatoid Arthritis (RA); (3) identify associated variables for pain and fatigue in patients with MO. Methods: In this cross-sectional study, 353 adult MO patients completed a survey with validated questionnaires on pain, fatigue and psychosocial factors. Pain and fatigue were assessed with the Numeric Rating Scale (NRS), and fatigue was also measured with the Checklist Individual Strength (CIS). Fatigue (CIS) was compared with reference scores of healthy subjects and patients with RA, using a one-sample t-test. Multiple linear regression models for pain and fatigue were developed using a-priori selected independent variables based on a theoretical framework (ICF-model). Results: Pain was reported by 87.8% (NRS = 3.19±2.6) and fatigue by 90.4% (NRS = 4.1±2.6) of patients with MO. Fatigue scores for MO (CIS = 84.1±15.3) were significantly higher (p<0.001) compared to reference scores of healthy subjects and patients with RA. The multivariable analysis for pain provided a final regression model with six variables (R2 = 0.445, p<0.001) of which fear avoidance beliefs and fatigue had the strongest association. For the fatigue models NRS (R2 = 0.455, p<0.001) and CIS (R2 = 0.233, p<0.001), the strongest associations were found with anxiety and depression respectively. Conclusions: Pain and fatigue are highly prevalent in patients with MO. Fatigue is significantly higher compared to healthy subjects and patients with RA. Several variables associated with pain and fatigue have been identified that could help improve multidisciplinary treatment plans. [ABSTRACT FROM AUTHOR]

Objectives: Based on protection motivation theory, we investigate how indicators of threat perception (perceived severity, perceived vulnerability, and fear arousal) and coping appraisal (hope) are associated with older people's motivation to engage in protective behavior after the outbreak of COVID-19. Methods: We use multivariate regression analyses with a sample of 40,282 individuals from 26 countries participating in the SHARE Corona Survey. Results: We find that 15% of all respondents stayed home completely—mainly the oldest and vulnerable people with prior health risk conditions. On average, older Europeans responded strongly to the recommended protective behavior measures (6 out of 7 measures adopted). Among the threat perception indicators, fear arousal is the main motivator for protective behavior, whereas the coping appraisal indicator hope shows an equally strong association. Discussion: Given the negative health effects of fear, our findings may help evaluate and revise governmental policy responses and communication strategies. [ABSTRACT FROM AUTHOR]

Traffic congestion which has been a common problem faced by almost all of the metropolitan cities across the world is caused by non-recurring traffic incidents such as accidents and vehicle breakdowns in many cases. Therefore, accurate prediction of the incident duration has become an essential part of Intelligent Transport Systems (ITS). Although the data-driven deterministic regression models can serve this purpose, the performances of these models are subject to varying test conditions. In this study, we consider two different data-sets, one from Singapore and the other from the Netherlands, and explore stochastic models (Bayesian Support Vector Regression, i.e. BSVR and Gaussian Process, i.e. GP) that not only perform prediction but also provide error bars as confidence measures along with the predicted values. Moreover, we also verify whether these methods can anticipate when the predictions are unreliable. To this end, we analyze the specificity and sensitivity of the two methods for detecting prediction errors with different tolerance levels. We observe that for 70% specificity, the sensitivity of BSVR and GP is 67% and 78% respectively, for the incidents in Singapore. On the other hand, for the incidents in the Netherlands, the two methods have 55% and 60% sensitivity respectively, for the same level of specificity. Therefore, our proposed method of Bayesian models with error bars leads to more reliable predictions of the traffic incident duration, as well as forecasts to some extent when the predictions are unreliable. [ABSTRACT FROM AUTHOR]

Task solving processes and changes in these processes have long been expected to provide valuable information about children's performance in school. This article used electronic tangibles (concrete materials that can be physically manipulated) and a dynamic testing format (pretest, training, and posttest) to investigate children's task solving processes and changes in these processes as a result of training. We also evaluated the value of process information for the prediction of school results. Participants were N = 253 children with a mean age of 7.8 years. Half of them received a graduated prompts training; the other half received repeated practice only. Three process measures were used: grouping behaviour, verbalized strategies, and completion time. Different measures showed different effects of training, with verbalized strategies showing the largest difference on the posttest between trained and untrained children. Although process measures were related to performance on our dynamic task and to math and reading performance in school, the amount of help provided during training provided the most predictive value to school results. We concluded that children's task solving processes provide valuable information, but the interpretation requires more research. Lay Description: What is already known about this topic: Dynamic testing provides information on a child's ability to learn.Solving process information provides indications for intervention.Computerized testing can be of great help in recording process information. What this paper adds: Process‐oriented dynamic testing provides explanatory information beyond traditional tests.The use of a tangible user interface (TUI) console uncovers valuable information on solving processes.Process measures are related to series completion performance, math, and reading.Need for instruction is the best predictor of math and reading ability.Implications for practice and/or policy: A framework for interpreting process information is necessary in dynamic testing.Process‐oriented dynamic testing may be more suitable to inform education.TUIs provide a more natural testing environment. [ABSTRACT FROM AUTHOR]

In the present study, we investigated whether online learning behaviours (navigation and writing activities) mediated the relation between learner characteristics (prior knowledge, vocabulary knowledge, working memory, and motivation) and declarative knowledge. Specifically, we investigated whether the quality of participants' written assignments could further explain this relation. For this purpose, 62 fifth‐grade children participated in a WebQuest hypermedia assignment on the subject of the heart. Results showed that online learning behaviours did not mediate the relations between learner characteristics and declarative knowledge when the assignment quality was not included in the model. Adding assignment quality, however, revealed two serial mediation models. Prior knowledge predicted declarative knowledge via the writing activity "copying behaviour" and assignment quality, and vocabulary knowledge predicted declarative knowledge via the navigation activity "time spent on assignment pages" and assignment quality. These results show the importance of taking into account assignment quality when investigating knowledge acquisition in hypermedia environments. Lay Description: What is currently known about the subject matter: Learning in hypermedia creates high cognitive load and is therefore difficult for children.Prior knowledge, vocabulary, working memory, and motivation predict declarative knowledge.It is unclear how online learning behaviour and assignment quality affect this relation. What this paper adds: Quality of children's written assignment is important in hypermedia learning.Prior knowledge predicts declarative knowledge via copying behaviour and assignment quality.Vocabulary marginally predicts declarative knowledge via the time spent reading instructions and assignment quality. Implications of study findings for practitioners: How well children perform their hypermedia assignment affects their declarative knowledge.Practitioners should monitor if children with low vocabulary understand assignment instructions.Practitioners should help weaker students to distinguish between main points and side issues. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Interaction between staff and patients with a diagnosis of personality disorder in forensic settings is important for quality of care, but research is lacking on what determines this interaction. What the paper adds to existing knowledge?: Insight, emotion‐focused coping and emotion regulation of staff influence the interaction between staff and these patients.Staff who understand their own thoughts, feelings and behaviour better (more insight) needed less support, encouragement or back‐up from their patients. Staff who cope by getting upset, blaming themselves or fantasizing about solutions (emotion‐focused coping) on the contrary needed more support from their patients.Emotion regulation had an impact on the relation between coping and hostile staff behaviour. When staff get upset (emotion‐focused coping) and try to think differently about the situation (reappraisal), this makes them behave in a more hostile manner towards their patients. When staff suppress their emotions and also distract themselves or engage in social activities (avoidance‐focused coping), they behave in a less hostile manner towards their patients. What are the implications for practice?: In order to provide compassionate care for their patients, staff ought to be trained in self‐compassion. This may help them not to get upset, blame themselves or fantasize about solutions and to understand their own thoughts, feelings and behaviour better. As a result, staff may need less support, encouragement or back‐up from their patients.Context is important: Staff ought to suppress their emotions when emotions run high, but only when they also care for themselves by distracting themselves or engaging in social activities. Facing and regulating their emotions by changing what they think about the situation (reappraisal) may be more appropriate once emotions have settled down. This may help staff to remain compassionate towards their patients in the long run and avoid burn‐out or compassion fatigue due to ignoring their own needs and boundaries. Introduction: Research is lacking on what determines interaction between staff and patients with a diagnosis of personality disorder in forensic settings. Aim: To test whether coping, self‐reflection, insight and emotion regulation are related to the behaviour of staff towards these patients, and to test the possible moderating and mediating effect of emotion regulation. Method: Using a cross‐sectional design, 76 direct care staff of a forensic clinic completed questionnaires on all variables. Relations were tested using simple linear regression, mediation and moderation analyses. Results: Insight and emotion‐focused coping of staff were related to seeking less and more support from patients, respectively. Emotion regulation by reappraisal combined with emotion‐focused coping was associated with more hostile behaviour by staff, and suppression combined with avoidance‐focused coping with less hostile behaviour. Conclusion: Insight, emotion‐focused coping and emotion regulation of staff influence the quality of care of patients with a diagnosis of personality disorder in forensic settings. Future research ought to include contextual factors. Implications for practice: Enhancing self‐compassion may improve insight and reduce emotion‐focused coping. Context is important: Taking the needs of staff into account may involve suppressing emotions combined with avoidance in a highly emotional situation while facing and reappraising the situation when emotions are low. [ABSTRACT FROM AUTHOR]

Purpose: The investigation goal is the analysis of the relation between healthcare expenditures and other resources, and COVID-19 fatality rates among European countries to design effective health policies for crisis management. Design/methodology/approach: Research methodology is based on descriptive statistics and various parametric methods, also including a linear model of regression to analyze basic relationships of variables under study. Findings: Results show that a lower COVID-19 fatality rate is associated with higher levels of health expenditure (% GDP), of healthcare expenditure per capita, health expenditure in preventive care (% GDP), hospitals per million inhabitants, physicians, nurses, hospital beds and curative acute care beds per 1,000 inhabitants. Regression analysis shows that a 1% increase in healthcare expenditures per capita of countries, it reduces the level of COVID-19 fatality rate by 0.74%. In fact, many countries in Eastern Europe with low healthcare expenditures per capita in 2019 (e.g., Bulgaria, Romania, Hungary, Poland, Latvia, Slovakia, Lithuania, etc.), they have experienced high COVID-19 fatality rates. Instead, a lot of countries in Western Europe, with high healthcare expenditures per capita, such as Germany, Denmark, Austria, and the Netherlands, they had resilient health systems to face pandemic crisis and lower COVID-19 fatality rates. Practical implications: These findings suggest strategies of systematic and continuous investments in healthcare, medical technologies, and ICT infrastructures to support effective health policy of crisis management in countries to face future pandemic crisis and other emergencies in society. Originality/value: The explanation of critical role of high health expenditure (% GDP) and healthcare expenditure per capita to support robust health systems that bolster the resilience in nations to face health emergencies and worldwide crises. [ABSTRACT FROM AUTHOR]

To assess the cultural competence (CC) of GP trainees and GP trainers. Design and setting: A cross-sectional survey study was conducted at the GP Training Institute of Amsterdam UMC. We included 92 GP trainees and 186 GP trainers. We measured the three domains of cultural competency: 1) knowledge, 2) culturally competent attitudes and 3) culturally competent skills. Regression models were used to identify factors associated with levels of CC. Participants rated their self-perceived CC at the beginning and end of the survey, and the correlation between self-perceived and measured CC was assessed. Approximately 94% of the GP trainees and 81% of the GP trainers scored low on knowledge; 45% and 42%, respectively, scored low on culturally competent attitudes. The level of culturally competent skills was moderate (54.3%) or low (48.4%) for most GP trainees and GP trainers. The year of residency and the GP training institute were significantly associated with one or more (sub-)domains of CC in GP trainees. Having >10% migrant patients and experience as a GP trainer were positively associated with one or more (sub-) domains of cultural competence in GP trainers. The correlation between measured and self-perceived CC was positive overall but very weak (Spearman correlation coefficient ranging from −0.1–0.3). The level of cultural competence was low in both groups, especially in the knowledge scores. Cultural competence increased with experience and exposure to an ethnically diverse patient population. Our study highlights the need for cultural competence training in the GP training curricula. General practitioner (GP) trainees find cross-cultural consultations stressful due to a self-perceived lack of cultural competence (CC). The level of CC in general practice is as yet unknown. On average, the level of CC was low for the majority of GP trainees and GP trainers, especially for the scores on knowledge. CC increased with experience and exposure to an ethnically diverse patient population. GP trainees and trainers perceived a lack of covered education on various topics related to the care of migrants. Our study highlights the need for cultural competence training in the GP training curricula. [ABSTRACT FROM AUTHOR]

Why is it that many people fail to seek retirement planning advice when doing so is clearly indicated? Distrust of financial intermediaries is often presented as the common answer. But this paper shows that trust issues are only part of the answer; an appreciable proportion of individuals experience anxiety at the prospect of visiting a financial adviser. In the present investigation, financial adviser anxiety is studied among 950 Dutch adults over the age of 50. Anxiety levels were measured using a six-item scale that was administered as part of a larger nationwide investigation on retirement attitudes and behaviour. Findings revealed that nearly one-third of respondents reported having moderate to severe levels of anxiety at the prospect of visiting a financial professional. Furthermore, a hierarchical regression analysis revealed that strong predictors of anxiety included one's educational level, income, age, level of future time perspective, risk tolerance, financial knowledge and scepticism regarding whether advice from a financial professional can be trusted. A cluster analysis using demographic and psychological covariates identified three separate groups of older adults that were found to differ in terms of their mean level of anxiety. Those who had low levels of education and low incomes were found to disproportionately display high levels of financial adviser anxiety. [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]

Background: The COVID-19 pandemic impacted cancer diagnosis and treatment. However, little is known about end-of-life cancer care during the pandemic. Aim: To investigate potentially inappropriate end-of-life hospital care for cancer patients before and during the COVID-19 pandemic. Design: Retrospective population-based cohort study using data from the Netherlands Cancer Registry and the Dutch National Hospital Care Registration. Potentially inappropriate care in the last month of life (chemotherapy administration, >1 emergency room contact, >1 hospitalization, hospitalization >14 days, intensive care unit admission or hospital death) was compared between four COVID-19 periods and corresponding periods in 2018/2019. Participants: A total of 112,919 cancer patients (⩾18 years) who died between January 2018 and May 2021 were included. Results: Fewer patients received potentially inappropriate end-of-life care during the COVID-19 pandemic compared to previous years, especially during the first COVID-19 peak (22.4% vs 26.0%). Regression analysis showed lower odds of potentially inappropriate end-of-life care during all COVID-19 periods (between OR 0.81; 95% CI 0.74–0.88 and OR 0.92; 95% CI 0.87–0.97) after adjustment for age, sex and cancer type. For the individual indicators, fewer patients experienced multiple or long hospitalizations, intensive care unit admission or hospital death during the pandemic. Conclusions: Cancer patients received less potentially inappropriate end-of-life care during the COVID-19 pandemic. Because several factors may have contributed, it is unclear whether this reflects better quality care. However, these findings raise important questions about what pandemic-induced changes in care practices can help provide appropriate end-of-life care for future patients in the context of increasing patient numbers and limited resources. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders (CMD) are highly prevalent among sick-listed precarious workers and often lead to long-term sickness-absence, work disability and unemployment. This study aimed to identify predictors of a longer time until return to work (RTW) and prolonged duration of sickness absence in sick-listed precarious workers with CMD. Methods: We conducted a secondary Cox regression analysis using existing data from two Dutch randomized controlled trials and one cohort study among sick-listed precarious workers with CMD (N = 681). Age, gender, baseline employment status, study allocation, severity of psychological symptoms and RTW self-efficacy were evaluated for their predictive value on time until sustainable (≥ 28 days) RTW and duration of sickness absence during 12-month follow-up. In this study, time until sustainable RTW and duration of sickness absence are distinct dependent variables, because they are not mutually exclusive. Results: Age above 50 years (HR 0.57, 95% CI 0.39–0.82), severe psychological symptoms (HR 0.64, 95% CI 0.43–0.93), unemployment (HR 0.19 95% CI 0.11–0.33) and loss of employment contract during sickness absence (HR 0.25, 95% CI 0.14–0.47) were predictive of a longer time until RTW. Male gender (HR 0.77, 95% CI 0.62–0.97), severe psychological symptoms (HR 0.64, 95% CI 0.46–0.87), unemployment (HR 0.47, 95% CI 0.27–0.84) and loss of employment contract (HR 0.48, 95% CI 0.26–0.90) predicted a prolonged duration of sickness absence. Conclusions: Unemployment at the moment of sick-listing, loss of employment contract during sickness absence, and severe psychological symptoms are predictors of both a longer time until RTW and prolonged duration of sickness absence among sick-listed precarious workers with CMD. This knowledge assists occupational health and mental health professionals in the early identification of workers at risk of long-term sickness absence, enabling them to arrange targeted occupational rehabilitation support and mental health care. Trial registration: The included randomized controlled trials were prospectively registered in the Dutch national trial register under NTR4190 (September 27, 2013) and NTR3563 (August 7, 2012). [ABSTRACT FROM AUTHOR]

Objective: We examined whether associations between the food environment, frequency of home cooking, diet quality and BMI were modified by the level of cooking skills. Design: Cross-sectional study using linear and modified Poisson regression models adjusted for age, sex, energy intake, education, income, household size and urbanisation. The frequency of home cooking was categorised into <6 and 6–7 d. Diet quality was based on a validated Dutch healthy diet index (0–150 points). Count of restaurants and food stores were determined by their count in a 1000m buffer around home and work. Cooking skills (score 1–5) were assessed using a validated questionnaire and added as interaction term. Setting: The Netherlands. Participants: 1461 adults aged 18–65 years. Results: Count of restaurants and food stores were not associated with the frequency of home cooking. A 10-unit higher count of food stores was associated with a higher diet quality (β : 0·58 (95 % CI (0·04, 1·12)), and a 10-unit higher count of restaurants was associated with a lower BMI kg/m2 (β : −0·02 (95 % CI (-0·04, −0·004)). Better cooking skills were associated with a higher likelihood of cooking 6–7 d compared with <6 d (risk ratio: 1·24 (95 % CI (1·16, 1·31)) and a higher diet quality (β : 4·45 (95 % CI (3·27, 5·63)) but not with BMI. We observed no interaction between the food environment and cooking skills (P -for-interaction > 0·1). Conclusions: Exposure to food stores was associated with a higher diet quality and exposure to restaurants with a lower BMI. Better cooking skills were associated with a higher frequency of home cooking and better diet quality but did not modify associations with the food environment. Future studies should explore different approaches to understand how individuals interact with their food environment. [ABSTRACT FROM AUTHOR]

This paper assesses whether gender plays a role when male and female participants discuss the quality of doctor-patient communication in gynaecological consultations. A European multi-centre study was conducted comprising 259 participants in 35 genderand country-specific focus groups. In all focus groups, a set of four videotaped Objective Structured Clinical Examination (OSCE) consultations was used as a prompt for discussion. The doctors' ability in communication was assessed by participants' ratings and by a quantified content analysis of their comments, using a mixed-method approach. Gender analysis was performed applying a set of generalized linear regression models. The findings indicated that gender differences were smaller than expected. The individual ratings of the overall quality of communication were similar for male and female participants, and there were hardly any differences in the content of the discussions. The only two exceptions were that female doctors were criticized more than male doctors when they made impersonal comments and that female participants were more outspoken than men, positively and negatively. The prevalence of gender similarities suggests that doctors' empathy, support, understanding and pleasantness are highly appreciated by both male and female participants and appear to transcend gender differences. [ABSTRACT FROM AUTHOR]

Background: Quality of care at the end of life in hospitals is often perceived to be lower compared to the care that is provided to people who die in their own home. Documenting and measuring indicators of common end-of-life symptoms could help improve end-of-life care in hospitals. This study provided insight into quality indicators for the end-of-life care of patients who died in a Dutch hospital, and assessed differences between deceased patients who were admitted for palliative/terminal care versus patients admitted for other reasons. Methods: In a retrospective record review study, trained nurses reviewed electronic health records (EHRs) of patients who died in 2019 (n = 2998), in a stratified sample of 20 Dutch hospitals. The nurses registered whether data was found in de EHRs about quality indicators for end-of-life care. This concerned: symptoms (pain, shortness of breath, anxiety, depressive symptoms), spiritual and psychological support and advance care planning. Multilevel regression analyses were performed to assess differences between patients who had been admitted for palliative/terminal care and patients admitted for other reasons. Results: Common end-of-life symptoms were rarely measured using a standardized method (e.g. Numeric Rating Scale, Visual Analogue Scale or Utrecht Symptom Diary). The symptom burden of pain was measured using a standardized method more often (63.3%) than the symptom burden of shortness of breath (2.2%), anxiety (0.5%) and depressive symptoms (0.3%). Similarly, little information was documented in the EHRs regarding wish to involve a spiritual counsellor, psychologist or social worker. Life expectancy was documented in 66%. The preferred place of death was documented less often (20%). The documentation of some quality indicators differed between patients who were admitted for palliative/terminal care compared to other patients. Conclusion: Except for the burden of pain, symptoms are rarely measured with standardized methods in patients who died in Dutch Hospitals. This study underlines the importance of documenting information about symptom burden and aspects related to advance care planning, and spiritual and psychological support to improve the quality of end-of-life care for patients in hospitals. Furthermore, uniformity in measuring methods improves the possibility to compare results between patient groups and settings. [ABSTRACT FROM AUTHOR]

Background Experiencing financial scarcity taxes cognitive bandwidth. This leaves less capacity to withhold temptations and makes relying on easiest default options more likely. Whether this default option is (un)healthy may depend on the amount of cultural capital acquired during life course. This study examined whether the association between financial scarcity and health behaviours is moderated by cultural capital. Methods Self-reported data were used from Dutch adults of the 2014-survey of the GLOBE study (N  = 2466). Using linear regression analysis, financial strain (no, some, great) and cultural capital (institutionalized, objectivized, incorporated) were related to body mass index (BMI), alcohol intake, sports participation, cycling and walking, fruit intake and vegetable consumption. The interaction between financial strain and cultural capital was used to assess moderation. Results Experiencing some financial strain was associated with a higher BMI (0.7 kg/m2) and less sport participation (−31.8 min/week). Great financial strain was associated with less sport participation (−41.4 min/week). Being in the lowest tertile of cultural capital was associated with a higher BMI (1.3 kg/m2), drinking less alcohol (−10.0 units/week), less sport participation (−31.5 min/week) and consuming less fruit (−2.9 pieces/week). Cultural capital had no significant moderating effect on the relationship between financial strain and these health behaviours. Conclusion Financial strain and cultural capital seem associated with different health behaviours. Cultural capital had no moderating effect on the relationship between financial strain and different health behaviours. While financial strain and cultural capital could both be entry points for interventions to improve health behaviour, underlying mechanisms require further attention. [ABSTRACT FROM AUTHOR]

Retirement is an event that often brings about great changes in a person's personal and social life. For many people, work is not only a way to fill time and earn money, but also important for their identity and meaning in life. After retirement, these benefits of work are lost, and it is expected that people will seek substitutes for this loss. This paper focuses on the effects of retirement on informal civic activities such as the support given to family and friends as well as more formal types such as volunteering and organisational involvement. Using two waves from the Netherlands Kinship Panel Study, a conditional change model is employed. Two groups are compared: men and women who kept working, and men and women who retired. Results show that following retirement, people appear to change the nature of some relationships by providing more instrumental support. Furthermore, retirees seem to start spending more time volunteering after retirement, and they increase their organisational memberships. Implications, strengths and limitations of the study are discussed. [ABSTRACT FROM PUBLISHER]

The aim was to determine predictors for the development of complaints of temporomandibular disorders ( TMD) in a large sample of Dutch scuba divers who were free of any TMD complaints before they started diving actively. Five-hundred and thirty-six scuba divers (mean ± SD age = 40·4 ± 11·9 years; 34·1% women) completed a specifically developed questionnaire, either online or on paper. Stepwise forward logistic regression analysis was performed to predict the presence of TMD pain, with several potential risk factors as predictors. Four hundred and eighty-five of the 536 respondents were free of any TMD pain before they started diving actively. In this sample, TMD pain was present in 214 persons (44·1%). Four predictors contributed significantly to the presence of TMD pain, viz., clenching ( OR = 2·466), warm water ( OR = 1·685), biting on the mouthpiece ( OR = 1·598), and the quality rating of the mouthpiece ( OR = 0·887, that is, a higher rating means a smaller odds of having TMD pain). TMD pain is a common complaint among scuba divers who were free of such complaints before they started diving actively. Clenching, biting on the mouthpiece, and a low rating of the mouthpiece are predictors for the presence of TMD pain in scuba divers, while diving in cold water serves as a protective factor for TMD pain. [ABSTRACT FROM AUTHOR]

Rivers are among the most heavily managed landscapes worldwide. The meanings people ascribe to river landscapes and their preferences for management have implications for public support for management decisions. This paper reports on a postal survey (N = 1102) on perceived landscape qualities (place attachment, scenic beauty and safety perception) and public perceptions of a planned river intervention in four residential areas along the river Waal (The Netherlands). The objectives of this study were to (1) examine the relationship between place attachment and socio-demographic and geographic variables, and (2) explore the role of perceived landscape qualities in public perceptions of a planned river intervention. Multiple regression analyses showed that socio-demographic and geographic variables explain 21–41% of variation in place attachment dimensions (including place identity, place dependence, social bonding, and narrative bonding). We found that local residents have intermediate to strong bonds with the area and that village residents were more attached than city residents. Narrative bonding was tested as a separate dimension, which resulted in a coherent set of statements with good reliability. Overall, the planned intervention was positively evaluated, especially in terms of improving flood safety. Social bonding, scenic beauty, and recreational value correlated positively with the evaluation scores. Our findings emphasize the importance of place as a social environment in residents’ responses to re-landscaping river interventions and we discuss opportunities to engage local communities and sustain social processes in river management. [ABSTRACT FROM AUTHOR]

Background: Studies revealed unidirectional associations between frailty and medication‐related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi‐directional association between frailty and the risk of MRPs in community‐dwelling older adults in five European countries. Methods: Participants were 1785 older adults in the population‐based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one‐year follow‐up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross‐lagged panel modeling was used to assess bi‐directional associations. Results: The unidirectional association between frailty at baseline and the risk of MRPs at follow‐up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow‐up shows similar trends. The bi‐directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow‐up than reversed path (Wald test for comparing lagged effects: p < 0.05). Conclusion: This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways. [ABSTRACT FROM AUTHOR]

Aim. To measure how nurses' work engagement developed during the first three COVID-19 waves and to compare this with the data collected just before the outbreak. Background. The shortage of nurses is a threat to population health. COVID-19 posed nurses with personal and professional challenges that affected their work engagement. Insights into how the pandemic affected their work engagement may help hospitals retain and recruit nurses in the future. Methods. A single centre prospective survey study was conducted using the UWES-9. Results. In total, 1,697 nurses (90.5% female, mean age 41 years) completed four assessments. Each assessment showed a significant decrease in work engagement compared with that before COVID-19. Work engagement stabilized in the last two assessments. Conclusion. Work engagement decreased significantly compared with that in March 2020, just before the outbreak. Although the decrease stabilized from the 8th month to the 16th month, it did not return to pre-COVID-19 levels. Whether this stabilization was the beginning of a recovery in work engagement or reflected a permanent decline needs to be established. Implications for nursing management. Nurse leaders should facilitate nurses' self-regulation processes and encourage them to develop resources in order to maintain work engagement at a high level. [ABSTRACT FROM AUTHOR]

Background: Although risk factors for differences in SARS-CoV-2 infections between migrant and non-migrant populations in high income countries have been identified, their relative contributions to these SARS-CoV-2 infections, which could aid in the preparation for future viral pandemics, remain unknown. We investigated the relative contributions of pre-pandemic factors and intra-pandemic activities to differential SARS-CoV-2 infections in the Netherlands by migration background (Dutch, African Surinamese, South-Asian Surinamese, Ghanaians, Turkish, and Moroccan origin). Methods: We utilized pre-pandemic (2011–2015) and intra-pandemic (2020–2021) data from the HELIUS cohort, linked to SARS-CoV-2 PCR test results from Public Health Service of Amsterdam (GGD Amsterdam). Pre-pandemic factors included socio-demographic, medical, and lifestyle factors. Intra-pandemic activities included COVID-19 risk aggravating and mitigating activities such as physical distancing, use of face masks, and other similar activities. We calculated prevalence ratios (PRs) in the HELIUS population that was merged with GGD Amsterdam PCR test data using robust Poisson regression (SARS-CoV-2 PCR test result as outcome, migration background as predictor). We then obtained the distribution of migrant and non-migrant populations in Amsterdam as of January 2021 from Statistics Netherlands. The migrant populations included people who have migrated themselves as well as their offspring. We used PRs and the population distributions to calculate population attributable fractions (PAFs) using the standard formula. We used age and sex adjusted models to introduce pre-pandemic factors and intra-pandemic activities, noting the relative changes in PAFs. Results: From 20,359 eligible HELIUS participants, 8,595 were linked to GGD Amsterdam PCR test data and included in the study. Pre-pandemic socio-demographic factors (especially education, occupation, and household size) resulted in the largest changes in PAFs when introduced in age and sex adjusted models (up to 45%), followed by pre-pandemic lifestyle factors (up to 23%, especially alcohol consumption). Intra-pandemic activities resulted in the least changes in PAFs when introduced in age and sex adjusted models (up to 16%). Conclusion: Interventions that target pre-pandemic socio-economic status and other drivers of health inequalities between migrant and non-migrant populations are urgently needed at present to better prevent infection disparities in future viral pandemics. [ABSTRACT FROM AUTHOR]

In this article, we compare the presence of correlation and regression analysis in secondary education of Ireland, the Netherlands and Luxembourg, through the analysis of final-exam tasks and curricula based on the Anthropological Theory of Didactics (ATD). It points out that the same topic can appear in different ways and extent in curricula, even if the mathematics teaching goals are similar. This article is a kind of introduction to the research that explores the possibilities for the appearance of these concepts in the Hungarian mathematics education. Therefore, in the second part of the article, Hungarian curricular goals are included, and it is shown which methodology of the three studied countries has the greatest curricular basis in Hungary. [ABSTRACT FROM AUTHOR]

Wood dust is an established carcinogen also linked to several non malignant respiratory disorders. A major limitation in research on wood dust and its health effects is the lack of (historical) quantitative estimates of occupational exposure for use in general population-based case-control or cohort studies. The present study aimed to develop a multinational quantitative Job Exposure Matrix (JEM) for wood dust exposure using exposure data from several Northern and Central European countries. For this, an occupational exposure database containing 12653 personal wood dust measurements collected between 1978 and 2007 in Denmark, Finland, France, The Netherlands, Norway, and the United Kingdom (UK) was established. Measurement data were adjusted for differences in inhalable dust sampling efficiency resulting from the use of different dust samplers and analysed using linear mixed effect regression with job codes (ISCO-88) and country treated as random effects. Fixed effects were the year of measurement, the expert assessment of exposure intensity (no, low, and high exposure) for every ISCO-88 job code from an existing wood dust JEM and sampling duration. The results of the models suggest that wood dust exposure has declined annually by approximately 8%. Substantial differences in exposure levels between countries were observed with the highest levels in the United Kingdom and the lowest in Denmark and Norway, albeit with similar job rankings across countries. The jobs with the highest predicted exposure are floor layers and tile setters, wood-products machine operators, and building construction labourers with geometric mean levels for the year 1997 between 1.7 and 1.9 mg/m3. The predicted exposure estimates by the model are compared with the results of wood dust measurement data reported in the literature. The model predicted estimates for full-shift exposures were used to develop a time-dependent quantitative JEM for exposure to wood dust that can be used to estimate exposure for participants of general population studies in Northern European countries on the health effects from occupational exposure to wood dust. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In the Netherlands, general practitioners (GPs) and emergency departments (EDs) collaborate increasingly in urgent care collaborations (UCCs) in which the two services share one combined entrance and joint triage. AIM: The objective of this study is to determine if UCCs are cost-effective compared to the usual care setting where out-of-hours GP services and EDs work separately. METHODS: This observational study compared UCCs with the usual care setting on costs by performing linear regression analyses. These costs were also combined with two performance indicators: level of patient satisfaction and the length of stay. A non-parametric bootstrap (resampling) method was performed in order to analyze the cost-effect pairs. RESULTS: During the study period, 122,061 patients visited EDs and the out-of-hours GP services. Total mean costs per episode were substantially higher in UCCs: €480 versus €392 respectively. In this study, two factors that contributed to higher costs in UCCs compared to usual care were identified. First, there was a higher proportion of GP consultations instead of cheaper medical advice for self-care in UCCs. Second, in UCCs there were more often double costs per episode, as more patients were referred to an ED after triage or consulting GP services. The cost-effectiveness analyses show that UCCs were not dominant on costeffectiveness compared to the usual care setting. DISCUSSION: A substitution of, often self-referring, patients from EDs to GP services does not result in lower costs to society, a shorter length of stay or a higher level of patient satisfaction. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate Dutch citizens' care attitudes by looking at care-giving norms and citizens' welfare state orientation and to explore to what extent these attitudes can be explained by combinations of diversity characteristics. We combined two datasets (2016 and 2018, N = 5,293) containing citizens' opinions regarding society and conducted multivariate linear and ordered probit regression analyses. An intersectional perspective was adopted to explore the influence of combinations of diversity characteristics. Results show that citizens' care-giving norms are relatively strong, meaning they believe persons in need of care should receive help from their families or social networks. However, citizens consider the government responsible for care as well. Men, younger people, people in good health and people of non-Western origin have stronger care-giving norms than others, and younger people assign relatively more responsibility to the family than the government. Level of education and religiosity are also associated with care attitudes. Primary diversity dimensions are more related to care attitudes than secondary, circumstantial dimensions. Some of the secondary dimensions interact with primary dimensions. These insights offer policy makers, social workers and (allied) health professionals the opportunity to align with citizens' care attitudes, as results show that people vary to a large extent in their care-giving norms and welfare state orientation. [ABSTRACT FROM AUTHOR]

Background Pre-stroke dependent patients (modified Rankin Scale score (mRS) ≥3) were excluded from most trials on endovascular treatment (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Therefore, little evidence exists for EVT in those patients. We aimed to investigate the safety and benefit of EVT in pre-stroke patients with mRS score 3. Methods We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic stroke in the Netherlands (MR CLEAN) Registry. All patients treated with EVT for anterior circulation AIS with pre-stroke mRS 3 were included. We assessed causes for dependence and compared patients with successful reperfusion (defined as expanded Thrombolysis in Cerebral Ischemia scale (eTICI) 2b-3) to patients without successful reperfusion. We used regression analyses with pre-specified adjustments. Our primary outcome was 90-day mRS 0-3 (functional improvement or return to baseline). Results A total of 192 patients were included, of whom 82 (43%) had eTICI <2b and 108 (56%) eTICI ≥2b. The median age was 80 years (IQR 73-87). Fifty-one of the 192 patients (27%) suffered from previous stroke and 36/192 (19%) had cardiopulmonary disease. Patients with eTICI ≥2b more often returned to their baseline functional state or improved (n=26 (26%) vs n=15 (19%); adjusted odds ratio (aOR) 2.91 (95% CI 1.08 to 7.82)) and had lower mortality rates (n=49 (49%) vs n=50 (64%); aOR 0.42 (95% CI 0.19 to 0.93)) compared with patients with eTICI <2b. Conclusions Although patients with AIS with pre-stroke mRS 3 comprise a heterogenous group of disability causes, we observed improved outcomes when patients achieved successful reperfusion after EVT. [ABSTRACT FROM AUTHOR]

Objectives Life experiences that are complex, sustained, and intense, such as active participation in music and speaking multiple languages, have been suggested to contribute to maintaining or improving cognitive performance and mental health. The current study focuses on whether lifetime musical and multilingual experiences differentially relate to cognition and well-being in older adults, and tests whether there is a cumulative effect of both experiences. Methods A total of 11,335 older adults from the population-based Lifelines Cohort Study completed a musical and multilingual background and experience questionnaire. Latent class analysis was used to categorize individuals into subgroups according to their various musical and multilingual experiences resulting in a (1) nonmusical, low-multilingual group; (2) nonmusical, high-multilingual group; (3) musical, low-multilingual group; and (4) musical high-multilingual group. To determine whether the groups differed in terms of cognition or emotional affect, differences in Ruff Figural Fluency Test (RFFT) and Positive and Negative Affect Schedule scores were investigated by means of multinomial logistic regression analysis. Results Having high-multilingual, and not musical, experience was related to better RFFT performance compared to no experience, but not to more positive affect. Having both musical and high-multilingual experiences is related to better RFFT performance and more positive affect in advanced age compared to having only one experience or none. Importantly, these results were found independently of age, level of education, and socioeconomic status. Discussion Musical and multilingual experiences are related to healthy aging, especially when combined, which supports the suggestion that a broader spectrum of lifetime experiences relates to cognitive reserve. [ABSTRACT FROM AUTHOR]

Low-cost particulate matter (PM) sensors provide new methods for monitoring occupational exposure to hazardous substances, such as flour dust. These devices have many possible benefits, but much remains unknown about their performance for different exposure monitoring strategies in the workplace. We explored the performance of PM sensors for four different monitoring strategies (time-weighted average and high time resolution, each quantitative and semi-quantitative) for assessing occupational exposure using low-cost PM sensors in a field study in the industrial bakery sector. Measurements were collected using four types of sensor (PATS+, Isensit, Airbeam2, and Munisense) and two reference devices (respirable gravimetric samplers and an established time-resolved device) at two large-scale bakeries, spread over 11 participants and 6 measurement days. Average PM2.5 concentrations of the low-cost sensors were compared with gravimetric respirable concentrations for 8-h shift periods and 1-min PM2.5 concentrations of the low-cost sensors were compared with time-resolved PM2.5 data from the reference device (quantitative monitoring strategy). Low-cost sensors were also ranked in terms of exposure for 8-h shifts and for 15-min periods with a shift (semi-quantitative monitoring strategy). Environmental factors and methodological variables, which can affect sensor performance, were investigated. Semi-quantitative monitoring strategies only showed more accurate results compared with quantitative strategies when these were based on shift-average exposures. The main factors that influenced sensor performance were the type of placement (positioning the devices stationary versus personal) and the company or workstation where measurements were collected. Together, these findings provide an overview of common strengths and drawbacks of low-cost sensors and different ways these can be applied in the workplace. This can be used as a starting point for further investigations and the development of guidance documents and data analysis methods. [ABSTRACT FROM AUTHOR]

Background the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative's future care. Objectives to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers' uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents' hospitalisations and documented advance decisions. Design a pretest–posttest design. Setting in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. Participants in total, 88 family caregivers completed baseline, intervention and follow-up assessments. Methods family caregivers' scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents' hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. Results family caregivers reported less decision-making uncertainty (−9.6, 95% confidence interval: −13.3, −6.0, P  < 0.001) and more positive perceptions of care (+11.4, 95% confidence interval: 7.8, 15.0; P  < 0.001) after the intervention. The number of advance decisions to refuse treatment was significantly higher after the intervention (21 vs 16); the number of other advance decisions or hospitalisations was unchanged. Conclusions the mySupport intervention may be impactful in countries beyond the original setting. [ABSTRACT FROM AUTHOR]