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Introduction: Individuals with ADHD continue to face stigma, which can negatively impact their access to, adherence to, and quality of mental health services, as well as their overall wellbeing. Perspectives of various stakeholders regarding priorities for stigma reduction remain underexplored. This study explores young adult, parent, teacher, and mental health care professional perspectives on unmet needs of children and young adults with ADHD in the Netherlands, in the context of stigma reduction. Method: A total of 24 respondents participated in seven small focus group discussions (FGDs). The FGDs facilitated in-depth discussions exploring stakeholder group perspectives on unmet needs of children and young adults with ADHD in educational, professional, and social settings. Data was analyzed using thematic content analysis. Results: Three thematic categories of unmet needs were identified: (1) a lack of awareness, knowledge, and understanding of ADHD; (2) insufficient personalized approaches in education and health care; and (3) limited accessibility of information and support services. Within theme 1, respondents primarily highlighted the importance of improving education for primary school teachers and mental health care professionals. Theme 2 underscored the need for increased capacity for personalization and attention to the sociopsychological factors of ADHD, alongside recognizing strengths. Theme 3 emphasized the need for easy access to reliable information and mental health care, including peer networks, as well as proper follow-up and continuity of care. Discussion and Conclusion: Findings highlight the need for improving our understanding of ADHD as a complex biopsychosocial condition, which requires specific adjustments in education and mental health care. Interventions to improve support and disrupt stigmatization should meet diverse needs, incorporate multi-level strategies, and involve key stakeholders.

In this article, we reflect on our experiences with teaching ethnographic skills and sensibilities to MSc students at a Dutch university. Using methods such as (self)observation, journaling and reflection, we highlight dilemmas (conceptual, practical, ethical) faced by students when doing ethnographic fieldwork and dilemmas that emerged in classroom discussions, including: the tension between participation and observation, member checking, and what constitutes meaningful intervention. We invoke the notion of agony to express a sense of struggle in dealing with these dilemmas and we introduce the sensitising concepts of "agonistic sensemaking" and "agonistic spacemaking" as ways to jointly explore divergent responses to the issues at hand, while rethinking our views on good ethnographic research and pedagogy. Our reflections serve to explore the potential of agonistic learning in higher education by generating productive debate from the tensions of difference, promote a reflexive approach to ethnography and social science research, and inform curriculum development.

Education of children with moderate to severe intellectual disabilities requires adequate assessment of their educational needs and potential to learn. Dynamic testing using analogical reasoning tasks may be a promising way to perform such an assessment. However, it remains unclear how dynamic testing with these children may be done in practice. Therefore, we sought expert opinions on operationalizing learning potential and dynamic testing. We performed a three-round online Delphi study (N = 37) with experts in psychological educational assessment of children with moderate to severe intellectual disabilities in special schools and specialized day-care centres in the Netherlands. Consensus was found on a conceptual and an operational definition of learning potential, describing step-by-step how learning potential could be measured in daily practice. This included a pre-test, training, post-test design with the inclusion of a graduated prompts protocol for mediation and an observation checklist focussing on response to mediation. Based on examples from the Analogical Reasoning Learning Test, we assessed consensus on adapted design requirements for dynamic testing using analogical reasoning. Experts agreed that dynamic testing using analogical reasoning tasks might be suitable for children with moderate intellectual disabilities. A key concern was whether performance on analogical reasoning task was within reach of children with severe intellectual disabilities. The panel recommended research into the type of mediation needed to support the learning of analogical reasoning tasks. Further development and evaluation of dynamic testing for children with moderate to severe intellectual disabilities may build on the recommendations of this panel of experts.

Teaching can be emotionally demanding. The current study investigated how teachers handle demanding situations in class, and how their behavioral and physiological reactions shape their emotions after the lesson. Interpersonal behaviors of 80 secondary school teachers were coded based on video recordings of one real-life lesson. During the lesson, heart rate and cardiac output were recorded continuously as indicator of relative challenge versus threat motivational states. Overall, teachers differed substantially in the number of demanding situations and how they changed their interpersonal behavior and physiological responses. Although teachers' behavioral and physiological changes were not a straightforward predictor of their emotional outcomes, especially teachers with dispositional low agency or communion were at risk of less positive and more negative emotions.

Student-teacher relationship drawings were employed to investigate how students' mental representations of student-teacher relationships were affected by their gender, age, and shyness across the Netherlands and China. The sample included 752 third- to sixth-graders (48.5% boys; M[subscript age] = 9.96) from the Netherlands and 574 third- to sixth-graders (53.7% boys; M[subscript age] = 11.48) from China. Students' drawings were double-coded on eight relationship dimensions. Multiple group models showed that Chinese students' drawings scored lower on anger/tension, role reversal, emotional distance/isolation, and global pathology but higher on vulnerability than those of Dutch students. Boys' drawings displayed higher global pathology than girls' drawings and this difference was larger in the Netherlands than in China. Other associations between student characteristics (gender, age, shyness) and drawing dimensions were equally strong across countries. As an implication, findings from Western countries may not necessarily generalize to students and teachers in Eastern countries. Drawing may be a promising method to further understand differences and similarities in the formation of student-teacher relationships across countries.

Introduction: The first aim of this study was to explore the mental functions of patients with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) in mental health care. The second aim was to examine the differences in mental functions between people with MID-BIF and those with higher educational levels (i.e. further education [FE] and higher education [HE]). Materials and methods: Eleven mental functions were assessed using the Shedler-Westen Assessment Procedure (SWAP-200-NL). In total, 245 patients were included, divided into three groups (MID-BIF: N = 52; FE: N = 86; HE: N = 107). Results: Results showed that the MID-BIF group scored relatively high on three mental functions (i.e. the capacity for impulse control and regulation, capacity for defensive functioning, and capacity to construct and use internal standards and ideals). One mental function scored relatively low (the capacity for adaptation, resiliency, and strength). Regarding group comparisons, similar patterns in average scores emerged, and the HE group scored higher than the MID-BIF and the FE groups on most mental functions. Discussion: The mental functions of the HE group were most adaptive, whereas the mental functions of the FE and MID-BIF groups were less adaptive and on a similar level in each of these groups.

Students' learning environments often change during school career, due to school transitions and the introduction of educational innovations, causing discontinuity in teaching and learning. Success of students entering a new learning environment depends in part on their prior expectations of education, as these influence later perceptions. Heterogeneity between students, however, needs to be acknowledged. In seeking to determine expectation profiles and their potential linkage to divergent perceptions of education, we longitudinally surveyed secondary school students regarding their expectations before, and their perceptions one and two years after entering an innovative learning environment. We identified three expectation profiles that differed in terms of students' motivation, learning conceptions, and affective strategies: optimistic, moderately optimistic, and pessimistic. For each profile, perceptions developed differently over time, with the moderately optimistic and pessimistic students being at risk in different ways. Results imply that expectations deserve a more prominent place when designing innovative learning environments.

This article describes the role of the culture coordinator in general formal education, in primary and secondary schools in the Netherlands. This article describes how they function in their professional environment and in contact with artists, providers of educational programs, and cultural institutions. In order to describe the everyday practice of the work of a coordinator and to bring to light the network in which they operate, a group of teachers kept a logbook for one year, describing per week what they did, and which issues concerned them most. The article concludes that the position of the coordinator is fragile, because of its dependency on personal relations with cultural institutions and as a result of the pressure from regular teaching tasks.

Autistic children are often reported less socially connected, while recent studies show autistic children experiencing more loneliness in school than allistic (i.e. non-autistic) children, contradicting the traditional view that autistic children lack social motivation. This study aimed to understand individual differences in how social connectedness is construed, between and within groups of autistic and allistic pupils, using a multimethod approach. Forty-seven autistic and 52 neurodiverse-allistic classmates from two special primary schools participated (8-13 years). Proximity sensors worn by pupils on playgrounds during recess measured (1) total time in face-to-face contacts, (2) number of contact partners, and (3) centrality in playground networks. Peer reports measured (4) reciprocal friendships and (5) centrality in classmate networks. To evaluate their "feelings" of connectedness, pupils rated the level of loneliness in school. Compared with allistic pupils, autistic pupils had fewer reciprocal friendships, but similar total time in social contacts, number of partners, classmate/playground centrality, and levels of loneliness. Lower levels of loneliness related to higher classmate centrality in autistic children, but longer time in social contacts in allistic children. For these autistic children, being liked as part of a peer group seems essential. Understanding relevant differences in children's needs could lead to a more welcoming school climate.

Humans are driven by an intrinsic motivation to learn, but the developmental origins of curiosity-driven exploration remain unclear. We investigated the computational principles guiding 4-year-old children's exploration during a touchscreen game (N = 102, F = 49, M = 53, primarily white and middle-class, data collected in the Netherlands from 2021-2023). Children guessed the location of characters that were hiding following predictable (yet noisy) patterns. Children could freely switch characters, which allowed us to quantify "when" they decided to explore something different and "what" they chose to explore. Bayesian modeling of their responses revealed that children selected activities that were more novel and offered greater learning progress (LP). Moreover, children's interest in making LP correlated with better learning performance. These findings highlight the importance of novelty and LP in guiding children's exploration.

Object exploration is considered a driver of motor, cognitive, and social development. However, little is known about how early childhood education and care settings facilitate object exploration. This study examined if children's exploration of objects during free play was facilitated by the use of particular spatial components (floor, tables, and activity centers) and types of play (solitary, social, and parallel). Participants were 61 children (aged 11 to 48 months and 50.8% boys, socioeconomic levels representative of the Dutch population). Intraindividual variability in children's object exploration was predicted by the use of particular spatial components and the social setting, with small-to-medium effect sizes. Solitary and parallel play were positively associated with complex object exploration, especially when sitting or standing at child-height tables. During social play, object exploration was mostly absent.

This preregistered study examined how a collaborative school culture and schools' collective efficacy are related to educational professionals' attitudes, personal self-efficacy, and classroom practices concerning education for high-ability students based on survey data from 875 educational professionals (teachers, counselors, and school leaders). Multilevel analyses indicated that a collaborative school culture was positively related to educators' personal self-efficacy, but negatively to their attitudes toward special provisions for high-ability students. Collective efficacy for teaching high-ability students positively related to educators' personal self-efficacy and attitudes toward special provisions for high-ability students, as well as teachers' differentiated classroom practices for high-ability students. Overall, a collaborative school culture and collective efficacy for teaching high-ability students were mostly associated with positive outcomes in educational professionals (teachers, managers, and school counselors).

Objective: Maladaptive daydreaming (MD) is characterized by vivid, excessive fantasy activity that becomes prioritized over other activities and may result in avoidant coping strategies. Little is known about the relationship between MD and internalized stigma in the neurodivergent sample. The current study aimed to examine emotional dysregulation, escapism and self-perception (self-esteem and internalized stigma) as potential determinants of MD in three groups: adults on the autism spectrum, with ADHD, and both diagnoses ("AuDHD"), including their neurodivergent symptoms (autistic traits, empathizing, ADHD symptoms). Methods: A sample of 293 persons (139 with ADHD, 74 on the autism spectrum, and 80 with both diagnoses) completed self-report scales concerning ADHD symptoms, autism spectrum symptoms, empathizing, self-esteem, daydreaming as escapism, emotional dysregulation, maladaptive daydreaming, and internalized stigma. A correlation analysis was implemented. Additionally, a group comparison and quantile regression for the 25th, 50th, and 75th percentile of maladaptive daydreaming in the three groups were executed. Results: The results showed that internalized stigma, emotional dysregulation, escapism, and self-esteem have significant associations with MD in the neurodiverse sample. The ADHD group achieved the lowest scores in emotional dysregulation, discrimination experience, and social withdrawal. The groups did not vary in MD rates, stereotype endorsement, stigma resistance, nonacceptance of emotional responses, and impulse control difficulties. The AuDHD group achieved higher results than the ASD group only in the ADHD symptoms. Quantile regression revealed differences in the predictors of maladaptive daydreaming in the three groups. ADHD symptoms and self-suppression escapism were significant predictors for the higher levels of MD in persons with singular autism or ADHD diagnosis. Conclusion: The results showed no differences in MD rates, although there were significant variations in predictive features among the three samples. The role of internalized stigma and self-esteem was highlighted in the results as significant associates of MD prevalence. These outcomes expand the current knowledge in the context of maladaptive daydreaming, internalized stigma, self-esteem and emotional dysregulation in a neurodiverse sample and allow for proposing clinical applications and further research directions.

I exploit a Dutch reform in the regulatory discount curve that makes the liabilities of pension funds and insurance companies (P&Is) more sensitive to changes in 20-year interest rates but less so to longer maturity rates. Following the reform, P&Is reduced their longest maturity bond holdings but increased those with 20-year maturities, steepening the long end of the yield curve. Using the reform as a shock to identify price elasticities of demand at the sector level based on holdings across maturity buckets and time, I show that banks are more price elastic than other investors and absorb demand shocks. [ABSTRACT FROM AUTHOR]

Purpose: This study explored endurance athletes' and coaches' views on recovery strategies, focusing on their use across competition levels, perceived importance and effectiveness, and common barriers. Methods: Endurance athletes (26.6% international, 35.7% national, 28.7% regional, and 9.1% other levels; mean experience 10.04 [7.84] y, n = 143) and coaches (mean experience 17.45 [12.44] y, n = 20) completed an online survey on frequency of usage, perceived importance, effectiveness, and common barriers of 25 recovery strategies. Data were coded and analyzed thematically. A Fisher exact test (P <.05) was conducted on 5-point Likert-scale responses. Results: Predominant strategies among athletes were hydration, hot showers, and carbohydrate (mean scores 4.62 [0.60], 4.32 [0.82], and 4.17 [0.87]). Only antioxidants showed significant variation in use across levels (P =.033). Coaches favored warm-down/cooling (4.56 [0.62]), hydration (4.41 [0.80]), and extra protein (4.12 [0.70]). Both groups ranked hydration as most important and effective. Athletes ranked extra protein and warm-down/cooling second and third, while coaches considered extra sleep/naps, warm-down/cooling, and extra protein equally important. Barriers of both populations included insufficient time (14.41%), limited knowledge (13.72%), lack of resources (12.63%), and skepticism regarding benefits and effectiveness (12.63%). Conclusions: Athletes show no significant differences in recovery choices based on competitive level, except for antioxidants. Coaches and athletes have partially different views on effective recovery. Furthermore, a lack of time, as well as a lack of (shared) knowledge and education, hinders the effective implementation of recovery strategies for athletes. [ABSTRACT FROM AUTHOR]

Aim: The degree to which people with intellectual and visual disabilities can use technology relies on the level of support they receive. However, there is a lack of knowledge about the relationship between the constructs effort expectancy, attitudes, and behavioural intentions of support people (i.e. relatives and healthcare professionals) regarding the use of such technologies for people with intellectual and visual disabilities. The aim of this study was to gain insight into how these constructs are connected and to explore their relationship with support person's characteristics and the support need levels of people with intellectual and visual disabilities. Methods: In total, 186 support people from a Dutch healthcare organisation focusing on people with intellectual and visual disabilities participated in an online questionnaire. We used a regression analysis to explore how the constructs, the characteristics, and the level of support needs were related. Results: Both effort expectancy (β =.35; t(185) = 5.04; p <.001) and attitude (β =.75; t(185) = 15.55; p <.001) of support people were related to the intention to use technologies. The effect of effort expectancy (β =.04; t(177) =.74; p =.462) on the intention to use technologies was mediated through attitude (β =.74; t(177) = 13.28; p <.001). Younger support people scored higher on attitude than older support people. Conclusions: Support people's effort expectancy and attitude play a significant role in their intention to use technologies when supporting people with intellectual and visual disabilities, with attitude emerging as pivotal factor. IMPLICATIONS FOR REHABILITATION: A better understanding of the relationship between effort expectancy, attitude, and the intention to use technologies in support people may facilitate the implementation of technologies. The intentions of support people to use technologies is not related to the level of support needs of people with intellectual and visual disabilities. Younger support people have a more positive attitude towards technology for people with support needs compared to older support people. A positive attitude has a strong and positive relationship to a higher behavioural intention. Therefore, when implementing technologies, healthcare organisations should pay special attention to the attitude of support people towards the use of technologies for people with support needs. [ABSTRACT FROM AUTHOR]

Objective: This article extends pre‐pandemic theories, empirically testing the salience of pandemic‐based absolute and relative resources and time availability mechanisms for understanding gendered divisions of childcare across the COVID‐19 pandemic. Background: Multiple cross‐sectional studies have examined gender differences in pandemic divisions of childcare, yet few longitudinal studies exist, particularly using pandemic‐specific theoretical mechanisms. Method: The authors used five waves (six data points, April 2020–November 2021) of probability‐based longitudinal data from the Netherlands to estimate fixed‐effects regression models (person‐wave data; 2165 mothers and 1839 fathers) to analyze the division of childcare. Results: Essential occupation was associated with a relative decrease in childcare tasks for mothers but not fathers. Mothers whose partner worked in an essential occupation experienced a relative increase in childcare tasks. Time availability also mattered; primarily for fathers. Working from home was associated with a relative increase in father's involvement in childcare, whereas an increase in work hours was associated with a decrease. Unemployment affected mothers only and was associated with an increase in relative childcare. Conclusion: Having an essential occupation potentially functioned as a new resource for some mothers to bargain for more gender‐egalitarian divisions of care but also reaffirmed the relative importance of men's paid employment over that of women's in shaping divisions of care. Time availability played a role in divisions of care during the pandemic, but mostly for fathers. Implications: The findings extend traditional resources and time availability theories to explain pandemic‐based gender differences in the division of care across the pandemic. [ABSTRACT FROM AUTHOR]

After the fall of the Rutte IV (2022–2024) government on 7 July 2023, new elections were held on 22 November 2023. The biggest shock of the election was the emergence of the radical right Freedom Party (PVV) as the largest party in Parliament (37 seats, out of 150). A new party, the New Social Contract (NSC), founded by former Christian Democrat MP Pieter Omtzigt, entered Parliament with 20 seats. Although unable to recreate its dramatic success at the Provincial elections in the spring, the Farmer-Citizen Movement (BBB) nevertheless increased its representation from 1 to 7 seats. Although it had lost 10 seats, the Liberal Party (VVD) was seen as a logical choice to join these three winners in forming a new right-wing Cabinet. Formation was hampered by a distrust of the commitment of the PVV to democracy and the rule of law. Ultimately, a 'program' or 'extra-parliamentary' Cabinet was proposed. The leaders of the parliamentary parties would remain in Parliament rather than becoming ministers in the new Cabinet and half of the new cabinet ministers would be sought outside of politics. In the end, these goals were not fully achieved, although the new Prime Minister, Dick Schoof, had had a career in the civil service rather than politics. Most of the ministers came from the ranks of the four parliamentary parties. The new Cabinet was installed on 2 July 2024. [ABSTRACT FROM AUTHOR]

Although resting metabolic rate (RMR) is crucial for understanding athletes' energy requirements, limited information is available on the RMR of Paralympic athletes. The aim of this study was to determine RMR and its predictors in a diverse cohort of Paralympic athletes and evaluate the agreement between measured and predicted RMR from both newly developed and pre-existing equations. This cross-sectional study, conducted between September 2020 and September 2022 in the Netherlands and Norway, assessed RMR in Paralympic athletes by means of ventilated hood indirect calorimetry and body composition by means of dual-energy x-ray absorptiometry. Sixty-seven Paralympic athletes (male: n = 37; female: n = 30) competing in various sports, with a spinal cord disorder (n = 22), neurologic condition (n = 8), limb deficiency (n = 18), visual or hearing impairment (n = 7), or other disability (n = 12) participated. RMR, fat-free mass (FFM), body mass, and triiodothyronine (T3) concentrations were assessed. Multiple regression analyses were conducted with height, FFM, body mass, sex, T3 concentration, and disabilities as potential predictors of RMR. Differences between measured and predicted RMRs were analyzed for individual accuracy, root mean square error, and intraclass correlation. Mean ± SD RMR was 1386 ± 258 kcal/d for females and 1686 ± 302 kcal/d for males. Regression analysis identified FFM, T3 concentrations, and the presence of a spinal cord disorder, as the main predictors of RMR (adjusted R 2 = 0.71; F = 50.3; P <.001). The novel prediction equations based on these data, as well as pre-existing equations of Chun and colleagues and Nightingale and Gorgey performed well on accuracy (>60% of participants within 10% of measured RMR), had good reliability (intraclass correlation >0.78), and low root mean square error (≤141 kcal). FFM, total T3 concentrations, and presence of spinal cord disorder are the main predictors of RMR in Paralympic athletes. Both the current study's prediction equations and those from Chun and colleagues and Nightingale and Gorgey align well with measured RMR, offering accurate prediction equations for the RMR of Paralympic athletes. [ABSTRACT FROM AUTHOR]

Adolescent mental health and life satisfaction are grounded in social and economic factors. However, studies investigating these relations across European and Asian contexts, using identical questionnaires, are scarce. The 2017/18 Health Behaviour of School-aged Children (HBSC) study conducted with 4,168 Dutch adolescents (Mage 13.0 years) and 1,948 Hong Kong adolescents (Mage 13.1 years) aged 11, 13, and 15 reported on family status and affluence, school experiences, relations with parents and friends, psychological symptoms (irritability/bad temper, feeling low or nervous, difficulty sleeping), and life satisfaction. Dutch boys had the lowest number of psychological symptoms. Dutch girls and Hong Kong girls and boys reported significantly more symptoms. Dutch boys had the highest level of life satisfaction, followed by Dutch girls and, subsequently, Hong Kong girls and boys. In the Netherlands and Hong Kong, communicative and supportive relationships with parents, low school pressure, school liking, and helpful fellow students related to less psychological symptoms and higher life satisfaction. In addition, family affluence further enhanced life satisfaction. It is concluded that cultural and gender differences may permeate the structuring of adolescent relations with parents, teachers, and peers but that an identical set of social and economic determinants affect adolescent girls' and boys' symptoms and satisfaction in a highly similar fashion in the Netherlands and Hong Kong. [ABSTRACT FROM AUTHOR]

Not all approaches to collaborative housing deliver equally on affordability, accessibility, and autonomy. Some cases may become expensive or enclaved, while others that are accessible and affordable may have little collaboration. This paper compares eight cases of collaborative housing in Milan and Amsterdam to understand how collaboration projects deal with demands for affordability, accessibility, and autonomy. We identify four categories of collaborative housing—common, self-promoted, co-managed, and developer-led—along the two axes of tenure type and project initiator. Trade-offs in affordability, accessibility, and autonomy always persist; however, each can be fostered by three of the types (all but developer-led) when explicitly established as core values of the project. [ABSTRACT FROM AUTHOR]

This paper compares social mix strategies in Denmark and the Netherlands, focusing on policy rationale, policy instruments and the role of the national government. Physical restructuring of the housing stock and housing allocation criteria are the main instruments used in both countries. A notable difference is the role of the national government. In the Netherlands, urban policies have been decentralised in the last decades and national government funding has largely disappeared. Municipalities must apply before they can use certain measures. In Denmark, the national governance in relation to deprived areas is much stronger and using social mix measures in selected neighbourhoods is mandatory. The comparison shows that differences in governance of social mix strategies can have important consequences for housing rights and could also have an impact on the policies' effectiveness. [ABSTRACT FROM AUTHOR]

In the benefits scandal, the Dutch state wrongfully accused at least 35,000 Dutch parents of young children of committing fraud with subsidies for childcare, based on ethnic profiling. Especially families with heritage in the former Dutch colonies in the Caribbean and Suriname were hit. Because they had to compensate for this supposed 'fraud', families were often thrown into severe debt and years of financial and legal struggle, a struggle that is ongoing for many. For the parents of more than 2,000 children, this even led to the loss of custody of their children. The Dutch state has formally acknowledged that 'institutional racism' was part of the problem, yet the scandal remains analysed by many, especially white scholars and journalists, as unintended, incidental and unrelated to Dutch colonial history. This commentary addresses the scandal as a case of an enduring colonial legacy of targeting racialised and gendered citizens in social policy. 'Fraud' is a social policy category through which this is made possible and violence continues to be inflicted upon racialised and gendered members of the Dutch population. [ABSTRACT FROM AUTHOR]

Previous studies have shown that parents with a history of childhood abuse are at increased risk of perpetrating child abuse. To break the cycle of childhood abuse we need to better understand the mechanisms that play a role. In a cross-sectional extended family design including three generations (N = 250, 59% female), we examined the possible mediating role of parental psychopathology and emotion regulation in the association between a history of childhood abuse and perpetrating child abuse. Parents' own history of childhood abuse was associated with perpetrating abuse toward their children, and externalizing (but not internalizing) problems partially mediated this association statistically. Implicit and explicit emotion regulation were not associated with experienced or perpetrated abuse. Findings did not differ across fathers and mothers. Findings underline the importance of (early) treatment of externalizing problems in parents with a history of childhood abuse, to possibly prevent the transmission of child abuse. [ABSTRACT FROM AUTHOR]

The presence of minoritized representatives is considered essential to advance the interests and inclusion of minoritized groups. But do minoritized citizens prefer politicians like them? Drawing on nineteen focus groups (N = 98) with minoritized Dutch and German citizens, I ask how citizens evaluate (descriptive) representatives. Citizens see descriptive representation as intersectional. They value politicians – regardless of descriptive status – who imagine their lived reality, politically judge, and act on that basis, and enhance emancipation and group legitimacy. Many see descriptive representatives as better able to do so. Yet, in practice, citizens examine if descriptive politicians share their political judgements and act for them within established politics. The findings suggest that increasing numbers is necessary but not sufficient. Whether citizens perceive representation depends on the space descriptive representatives have within the political system to articulate marginalized identities and concerns. Citizens' evaluations reflect differences in self-identification, privilege/disadvantage, group histories, electoral systems, and representation legacies. [ABSTRACT FROM AUTHOR]

Background: Some individuals have exercise-induced lower leg pain (ELP) caused by a chronic exertional compartment syndrome (CECS). As intracompartmental muscle pressure measurements are invasive with suboptimal test characteristics, other diagnostic tools are needed. Recently, ultrasound-based muscle compartment thickness analysis at 10mmHg (d10) and 80mmHg (d80) external pressure was introduced for this purpose. The difference in compartment thickness at these two external pressures induced by the study device is used to calculate muscle compressibility, a possible marker for CECS. Purpose: The purpose of this study was to investigate the reliability of a novel ultrasound compressibility technique using two distinct internal landmarks at the lower leg in a diverse group of asymptomatic adults. Study design: Cross-sectional study Methods: Healthy volunteers (n=35; 21 female; median age 40 years, range 19-72; BMI 24.1 kg/m2, range 18.3-31.6) not having ELP underwent serial compressibility measurements (n=1678) of both legs by three observers at the tibialis anterior (TA) using the interosseous membrane (IM) and transition zone IM to tibial bone (TZIT) as internal landmarks. Inter- and intra-observer reliability was calculated for values of d10, d80 and compressibility using intraclass correlations (ICC). Results: TA compartments are less compressible using the IM landmark compared to the TZIT landmark (10.5% vs 12.5%; p<0.001). Inter-observer ICC for IM was always higher (d10 0.85; d80 0.82; compressibility 0.51) than for TZIT (d10 0.65; d80 0.53; compressibility 0.20). The intra-observer reliability for d10 and d80 was excellent (ICC>0.90) for all three observers. ICC of compressibility varied among observers and ranged from 0.76 to 0.48, with higher ICCs demonstrated for IM compared to TZIT. Conclusion: Ultrasound based anterior tibial muscle compressibility measurements have moderate inter-observer reliability and excellent intra-observer reliability if the interosseous membrane is used as internal landmark. Future studies are aimed to test muscle compressibility after exercise and in CECS. Level of Evidence: Level 3 [ABSTRACT FROM AUTHOR]

Objectives: The Negative Adjustment Scale (NAS) is used to measure adjustment to having a sibling with a disability. However, several adaptations to the scale have been made, and implementation varies across studies and countries. This study examined the psychometric properties across different versions and provides directions for future use and development of the NAS. Methods: The sample comprised 400 siblings aged 6–16 years old from Norway, the Netherlands and Belgium. Measurement invariance was assessed across age groups (8–11 vs. 12–16 years) and translations (Norwegian vs. Dutch), using a multi-group confirmatory factor analysis. The psychometric properties of the parent version were assessed among 102 parents from the Dutch sample. Results: The internal consistency of the NAS was acceptable to good in all versions. A single factor model held across age groups and translations, although higher order invariance was not supported. The child and parent report versions of the NAS did not significantly correlate. Conclusions: The NAS generally has sufficient psychometric properties. However, these vary across age groups, translations, and informants, causing the NAS to be less appropriate for comparisons between groups. Further adaptation of the NAS or developing a new scale for siblings of children with disabilities, is advised. [ABSTRACT FROM AUTHOR]

Young adults determined five needs which must be met to transition to adulthood: support, housing, study and work, income, and well-being. This study aimed to identify and describe subgroups of young adults and determine to what extent they meet the needs for independence, and to assess relations between subgroups and demographic characteristics. We conducted secondary data analysis of a population-based questionnaire, which included 2291 young adults (M age = 20.8 years, 71% female) living in South Limburg, the Netherlands. We adopted a person-centred approach, that is, latent class analysis, and identified four classes: Thriving (39%), Lacking support and well-being (29%), Widely struggling (18%) and Financially challenged (14%). Females and non-university students/graduates had higher odds of being members of the least thriving classes. Future research should focus on how support and cumulative disadvantage affect later life outcomes. We should broaden community, educational and institutional support systems to encourage and sustain meaningful relationships. [ABSTRACT FROM AUTHOR]

Background: Multiple diseases, such as Adolescent Idiopathic Scoliosis (AIS), present at adolescent age and the impact on quality of life (QoL) prolongs into adulthood. For the EQ-5D, a commonly used instrument to measure QoL, the current guideline is ambiguous whether the youth or adult version is to be preferred at adolescent age. To assess which is most suitable, this study tested for equivalence along predefined criteria of the youth (EQ-5D-5L) and adult (EQ-5D-Y-5L) version in an adolescent population receiving bracing therapy for AIS. Methodology: 107 adolescents were recruited from 4 scoliosis centers in the Netherlands between March 2022 and January 2023; they completed both EQ-5D's and the SRS-22r (scoliosis-specific questionnaire). The following criteria were evaluated using the individual and sum of domains (level-sum-score (LSS)). Our primary criterion for non-equivalence of the EQ-5D's was less than excellent (≤ 0.9) intra-individual agreement using Intraclass Correlation Coefficient (ICC) analysis for LSS and weighted (quadratic) kappa for domains. Secondary criteria were differences in ceiling using McNemar test; a different number of quantified hypotheses for construct validity achieved using the SRS-22r as comparator; differences in test-retest reliability by comparing ICC/kappa values using a Z-test. Results: Adolescents had a mean age of 14 years (range 12–18), and 78% were female. Ceiling was mostly comparable between EQ-5D's, ranging from 78 to 81% for mobility and self-care, 52–54% for usual activities, and 31–36% for pain/discomfort. The EQ-5D-5L showed more ceiling (57%) compared to the EQ-5D-Y-5L (41%) on anxiety/depression (p = 0.006). Agreement between the EQ-5D's did not meet our criterion for the LSS (ICC 0.79 (95% confidence interval 0.70–0.85)), and decreased further at the domain-level. Both EQ-5D's achieved 5/7 validity hypotheses. Test-retest reliability was slightly better for EQ-5D-5L LSS (ICC 0.76 (0.64–0.84)) compared to EQ-5D-Y-5L LSS (ICC 0.69 (0.55–0.79)), although this was statistically insignificant (p = 0.284). This pattern was similar for most domains. Conclusions: The EQ-5D versions showed insufficient agreement, and cannot be considered fully equivalent. While they were similar in terms of validity and test-retest reliability, differences in score distribution were present. Taken together, we advise using the EQ-5D-5L to monitor the QoL in adolescent patients with AIS, as it avoids switching instruments and thus data discontinuities. Future studies should verify these findings in different patient groups and the general population. [ABSTRACT FROM AUTHOR]

Introduction: The digitalization of healthcare poses a risk of exacerbating health inequalities. Dutch public libraries offer freely accessible e-health courses given by trainers. However, there is limited knowledge on whether these libraries successfully reach and support those in need. This study aimed to explore trainers' perspectives on the challenges, successes, and potential improvements in digital health skill education in a library setting. Materials and methods: Trainers of the e-health course were interviewed. Topics included: the role of the library in digital health skills education, the successes and challenges in reaching groups with a low socioeconomic position, the perceived impact of the digital health skills education, and strategies for future improvement in digital health skills education. A deductive analysis based upon the interview guide topics was performed. A second inductive analysis was applied to identify underlying patterns. Coding was done independently and cross-checked. Codebooks and themes were determined in discussion with authors. Results: Three themes emerged. 1) Trainers' services, skills and expertise: Trainers identified older adults, youth, people with low (digital) literacy, the unemployed, and people from non-native cultural backgrounds as the groups most in need of support. Trainers felt equipped to address these groups' needs. 2) The libraries' reach: improving engagement, perceived accessibility, and clients' barriers: Despite trainers' efforts to adjust the course to the target groups' level of commitment, digital and literacy levels, and logistics, the digital health course predominantly engages older adults. Experienced barriers in reach: limited perceived accessibility of the public library and clients' personal barriers. 3) Collaborations with healthcare, welfare and community organizations: Trainers emphasized that collaborations could enhance the diversity and number of participants. Current partnerships provided: reach to target groups, teaching locations, and referral of clients. Discussion: Trainers in public libraries recognize a various target groups that need support in digital health skill development. The study identified three challenges: accessibility of the digital health course, reach of the public library, and clients' personal barriers. Public libraries have potential to support their target groups but need strategies to improve their engagement and reach. Collaborations with healthcare, welfare, and community organizations are essential to improve their reach to those most in need of support. [ABSTRACT FROM AUTHOR]

Today’s public institutions are faced with vast uncertainty surrounding the development of AI technology. In light of this challenge, they have been making concerted efforts at imagining the AI future and its governance. This study sheds light on these current efforts in AI futuring. Dissecting Dutch and UK policy reports on long term AI governance, our analysis shows that while the UK’s dominant imaginary pushes an optimistic techno-solutionist roll-out of AI technology, the Dutch imaginary is more cautiously geared towards regulating and societally integrating AI. Interestingly, both case-studies exhibit relatively “flattened” forms of futuring that diverge from typical futuring work in terms of depth and detailedness. Hypotheses are explored to understand the observation of “flattened futuring” in the AI field. [ABSTRACT FROM AUTHOR]

Background: Specialist palliative care teams (SPCTs) have significant benefits for patients with advanced disease or frailty, including improved quality of life, greater satisfaction with care, and less potentially inappropriate care at the end of life. Experienced SPCTs are recognised to have higher referral rates compared to novice teams. The aim of this study was to assess the development of hospital-wide integration of specialist palliative care (PC) and of SPCTs in Dutch hospitals between 2014 and 2020. Methods: Three cross-sectional surveys of SPCTs in Dutch hospitals were conducted in 2015, 2018 and 2021. Key members of the hospital SPCTs completed questionnaires about the preceding year that included items on hospital and PC program characteristics, hospital-wide integration of specialist PC, and SPCT characteristics (92 hospitals in 2015, 79 in 2018 and 74 in 2021). The analysis included hospitals with an operational SPCT, as determined by providing inpatient PC consultation services. Univariate analyses compared hospitals and SPCTs by year. Significance was determined by p-values < 0.05. Results: In 2014, 65% of participating hospitals provided inpatient PC consultations (n = 48). This increased to 92% in 2017 (n = 58) and 98% in 2020 (n = 48). Over the years, participating hospitals showed an increasing level of hospital-wide integration of specialist PC, such as an increased number of dedicated PC outpatient clinics (56% in 2020, compared with 47% in 2017 and 27% in 2014). The annual number of inpatient referrals to SPCTs has increased significantly over the years. The SPCTs have developed significantly in various aspects, including collaboration between primary and hospital care, the availability of services to patients at home and non-clinical activities. Conclusion: Over the years, Dutch hospitals have shown growth in hospital-wide integration of specialist PC. Specialist palliative care teams have made significant progress in increasing inpatient consultations, and in improving collaboration between primary and hospital care. [ABSTRACT FROM AUTHOR]

Background: Emergency department (ED) crowding is a growing concern worldwide and associated with negative effects. In 2013, 68% of Dutch ED-managers experienced crowding on several days of the week. This resulted into the introduction in phases of an ambulance diversion dashboard, in order to influence ED input. Increasing numbers of Dutch EDs have implemented this dashboard, visualizing regional ambulance diversions by means of a traffic light. Methods: This is a descriptive study of a nationwide online survey of Dutch EDs, conducted between January and October 2023. It included both qualitative and quantitative questions. The outcomes and analysis are derived from descriptive data of respondents' experience of crowding as well as their usage and perceived effectiveness of the ambulance diversions dashboard. Results: At the time of the survey, 62 of 82 Dutch EDs (75.6%) actually used the dashboard, of which 56 EDs responded (90.3% response rate). 69.7% Of ED managers experienced ED crowding more than three times a week. Of the respondents using the dashboard, 52.8% reported it only occasionally alleviates ED inflow. The purported reasons are the limited number of patients affected by the red light (ambulance diversion) and the presence of regional crowding. The effects of the orange light (impending ambulance diversion) on ED input differ greatly among hospitals, mostly due to their own internal agreements. In accordance, many respondents (53.6%) expressed dissatisfaction with the resources available to them to alleviate crowding. Conclusion: After conducting a national survey, ED crowding is reported as a persisting nationwide problem with its prevalence largely unchanged since the introduction of the ambulance diversion dashboard. Most hospitals reported having insufficient resources to alleviate it. The effects of the ambulance diversion dashboard to decrease crowding are apparently limited because it affects a small portion of total ED presentations and because of the influence of regional crowding. The main function of the orange light is to increase ED throughput and output rather than reducing ED input. [ABSTRACT FROM AUTHOR]

Background: While aiming to optimize patient value, the shift towards Value-Based Health Care (VBHC) in hospitals worldwide has been argued to benefit healthcare professionals as well. However, robust evidence regarding VBHC's workforce implications is lacking. This gap is problematic, as the motivation and health of healthcare professionals are central to the quality of care and crucial amidst contemporary workforce challenges. This study aims to qualitatively examine the implications of VBHC for healthcare professionals' motivation, job strain, and ongoing participation in VBHC. In addition, it explores how these outcomes are regulated at both the individual and organizational levels. Methods: Semi-structured interviews were conducted with 26 healthcare professionals across six Dutch hospitals. Interviewees engaged in three VBHC activities: (1) value-based outpatient consultations and/or; (2) value-based quality improvement activities; as well as in; (3) VBHC implementation. Interview questions and data analysis were guided by the Job Demands–Resources model. Results: VBHC interacts with four themes perceived to affect professional's motivation (perception of making a positive impact, enjoyability of job activities, personal development, and sense of community and support) and three themes perceived to affect job strain (workload, cognitive demands, and confidence). VBHC creates both gains (primarily increasing motivation; occasionally reducing strain) and pains (primarily increasing strain; sometimes reducing motivation). The perceived impact of VBHC depends on the fit between the individual, one's activities in VBHC, the working conditions, and the pace of VBHC implementation. An observation that warrants attention is that healthcare professionals with a 'do-er' mentality and high ambitions to optimize patient value can become demotivated to continue advancing VBHC with the same intensity, particularly due to perceived slow progress. Conclusions: While VBHC is centered around patients, this study emphasizes that the needs, experiences and changing role identities of healthcare professionals cannot be overlooked in this transition. VBHC currently presents as a double-edged sword for healthcare professionals: resulting in both gains and pains. In the move to VBHC, it is crucial to maintain alignment between the individual, their job activities, the work environment, and the pace at which VBHC unfolds. This is essential for fostering and retaining motivated individuals, who are not only vital to the workforce but also pivotal in advancing VBHC. [ABSTRACT FROM AUTHOR]

Background: The global population is undergoing a significant demographic transformation characterized by an aging population. Healthcare systems need to prepare for this shift. Challenges concerning care of older adults will be significant in the Netherlands in the coming years, as the country is just at the beginning of the predicted fast increase in its ageing population. Within healthcare systems, geriatric rehabilitation is seen as a core component. To gain more insight into how the healthcare sector is preparing for this change, this study aims to describe the actions taken and the effects of these actions within geriatric rehabilitation in the Netherlands. Methods: Following established scoping review methods, the electronic databases Medline Ovid, AMED, Cinahl, and Embase were searched for peer-reviewed papers from 2013 to 2024 reporting on geriatric rehabilitation in the Netherlands. Results: Twenty-six articles were selected, and three themes informing the actions taken were identified: (1) policy implications for geriatric rehabilitation, (2) content and structure of geriatric rehabilitation, and (3) follow-up care and prevention. Policies influence funding and this is primarily governed by diagnostic treatment combinations (DBCs). The main challenges are the exclusion of certain conditions and limited flexibility. The structure of geriatric rehabilitation has been developed to emphasize patient-centred, multidisciplinary approaches. Follow-up care and prevention strategies focus on home rehabilitation, the implementation of e-health, and support for informal caregivers. No articles focused specifically on preparedness, and a limited number of studies mentioned the use of resources for geriatric rehabilitation. Conclusions: Actions are taken in line with health policies aiming to meet the future care needs of older adults in the Netherlands. However, the actions seem to be fragmented, and an understanding of resource use and needs seems to be lacking. There is a clear need for ongoing adaptations and developments in healthcare policy and practice to meet the needs of an aging population and ensure equitable access to rehabilitation services in the Netherlands. The readiness of geriatric rehabilitation in the Netherlands for the growing population of older adults is not discussed in the included articles. Addressing preparedness and the sustainability of geriatric rehabilitation could provide important insights for ensuring good care for older adults in the Netherlands. [ABSTRACT FROM AUTHOR]

Background: Addressing the growing challenge of nurse retention requires coordinated actions at national and global levels to improve recruitment, retention policies, and investments in the nursing work environment. The nursing work environment, defined as the "organizational characteristics of a work setting that facilitate or constrain professional nursing practice", is critical in influencing whether nurses decide to leave their jobs. This study investigates the impact of differentiated nursing practices – which involved tailoring roles and responsibilities based on nurses' training, skills, and experience in Dutch hospitals – and investigated their impact on the nursing work environment and turnover intention (i.e., nurses' intentions to leave their organization). We also explored whether the work environment mediates this relationship. Methods: A multicenter longitudinal cohort study was conducted across 19 Dutch hospitals between 2019 and 2023. Nursing professionals participated via digital surveys administered before (T0) and after (T1) differentiated nursing practices were introduced. The nursing work environment was assessed using the Practice Environment Scale of the Nursing Work Index. A multilevel analysis with a random intercept and fixed slope was used to evaluate the impact of differentiated nursing practices on the work environment and on nurses' turnover intentions. Results: We received 5411 responses to our questionnaire – 4259 at T0 and 1152 at T1. Results showed that, while the overall work environment improved, particularly in the dimensions of staffing and resource adequacy, collegial nurse–physician relationships, and participation in hospital affairs, there were no significant improvements in nursing foundation for quality of care or nurse managers' ability, leadership, and support of nurses. Additionally, differentiated nursing practices did not significantly impact turnover intention, nor did the work environment mediate this relationship. Conclusions: This study is the first to explore the unique effects of practice differentiation on turnover intention mediated by the work environment. The findings suggest that, while differentiated practices can enhance certain aspects of the work environment, a more systemic and integrated approach is required for sustained improvements. Future research should include longer term studies to fully understand the complex relationship and accompanying mechanisms between differentiated nursing practices, the nursing work environment, and turnover intention. Trial registration: Clinical trial number not applicable. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals in the hospital setting frequently assume primary caregiving responsibilities, which often leads family members to perceive this as standard practice during hospitalization. This dynamic may create a gap between actual and desired levels of family involvement. The aim of this study is to explore the opinions of families about their involvement in care during the hospitalization of a relative. Methods: A sequential explanatory mixed-method study design was used, where quantitative data collection is followed by qualitative data collection for a deeper understanding of the quantitative findings. Data were collected between November 2023 and April 2024 across 15 wards in a university hospital in the north of the Netherlands. 153 family members of hospitalized patients completed the adapted Families' Importance in Nursing Care–Families' Opinions questionnaire, providing valuable quantitative data. Twenty-three of these family members were subsequently interviewed to gather qualitative insights. Data were analyzed sequentially, with the quantitative results guiding qualitative data collection. The two types of data were integrated to draw comprehensive conclusions about the significance of family involvement during hospitalization. The study adhered to the guidelines of the Good Reporting of A Mixed Method Study (GRAMMS). Results: The questionnaire scores indicate a high willingness for involvement in care during hospitalization. Subsequent in-depth interviews led to the development of a model demonstrating that this involvement is sequentially related to the themes of acknowledgement, alignment, and collaboration. Conclusions: Family members expressed a need to be acknowledged by healthcare professionals as partners in care. Role agreements and information sharing during hospital care should be aligned to achieve effective collaboration between family members and healthcare professionals. [ABSTRACT FROM AUTHOR]

The aim of this article is to present a chronological overview of the political reception of Tacitus' works in the northern Low Countries from the early sixteenth century to the middle of the seventeenth century. Most of the types of Tacitism proposed in the introduction are represented in the Dutch context in one way or another. A characteristic of the Dutch Tacitism(s) as discussed here is that they appear to be at the heart of the connections between academia and government in the Republic, and especially in the province of Holland. Together with a fascination for reason of state (whether accepting or rejecting it), Tacitism often carries aspects of style and taste which give it a 'risky' fascination that is part of the explanation of its success and influence among selected (predominantly elite) readerships. [ABSTRACT FROM AUTHOR]

Whistleblowers face an intensive trajectory when reporting wrongdoing. What can we learn from the experiences of whistleblowers? This article aims to give a deeper understanding of the process of whistleblowing by exploring stories and experiences of whistleblowers with their report of wrongdoing in the Netherlands. The study identifies similarities and themes in these stories. Results of 20 in-depth interviews reveal that being a whistleblower entails motivation, action, well-being, and the reaction of the organization. We conclude that these aspects all influence the process of whistleblowing, as well as the behavior of the whistleblower. Our study contributes to both practice and literature by examining these stories and their implications to support whistleblowers. [ABSTRACT FROM AUTHOR]

Debtors were stimulated to contact their creditors to negotiate a repayment plan. Contacting creditors was important because debtors were unlikely to repay the debt immediately and upon contacting, debtors could agree on a repayment plan to repay the debt in the long run. Using insights from scarcity theory and nudging techniques, a standard debt repayment letter was adapted and both letters were compared. Experimental results (N = 3,330) provide support for the use of nudging techniques as more debtors agreed on a repayment plan and response rates increased. The results underline the importance of stimulating debtors to contact their creditors. [ABSTRACT FROM AUTHOR]

West African (WA) migrants in Europe have higher hypertension rates than the host populations. For African migrants, guidelines recommend diuretics and/or calcium channel blockers (CCB) for primary cardiovascular disease prevention, but data on antihypertensive medication (AHM) prescription patterns or related hypertension control rates are lacking. We assessed AHM prescription patterns and its relation to hypertension control among hypertensive WA migrants in the Netherlands compared to the host population. Cross-sectional data from WA or Dutch origin participants from the HELIUS study were used. Participants with treated hypertension and without diabetes, cardiovascular disease, or microalbuminuria were selected. We used logistic and linear regression analyses to assess the association between AHM categories and hypertension control rates (systolic blood pressure (BP) ≤ 140 mmHg and diastolic BP ≤ 90 mmHg) and the systolic BP levels. We compared 999 WA participants and 314 Dutch participants. Hypertension control rates were lower in the WA origin compared to Dutch origin participants (44.3% versus 58.0%, p < 0.001). For WA participants, prescription rates for any AHM category were: CCB (54.8%), diuretics (18.5%) beta-blocking agents (27.3%) and renin-angiotensin system blockers (52.6%). Prescription rates were higher for CCB and similar for diuretics compared to the Dutch participants. Neither CCB nor diuretics were associated with better control rates. Compared to Dutch participants, West African participants had similar diuretic prescriptions but significantly higher prescriptions for CCB. However, neither medications was associated with better hypertension control. Future research should explore physician and patient factors to improve hypertension control. [ABSTRACT FROM AUTHOR]

Transformative experiences in an individual's life have a lasting impact on identity, belief system, and values. At the core of these experiences is the complex emotion of awe that promotes learning, making it worthwhile to study from an educational point of view. Drawing studies may provide a useful measure of awe in children—one that is more intuitive and attractive than questionnaires alone. Previous studies conducted with adults indicated that the diminished self, associated with transformative experiences, manifests in an actual decrease in size for figures representing the self in drawings. In the current study, self-representation was investigated in drawings of 10- to 12-year-old primary school children within the context of an immersive virtual reality (VR) experience that elicits the overview effect, known to lead to an intense apperception of awe. We did not replicate the adult findings regarding self-size in this younger age group. However, details and complexity in children's drawings appeared to be impacted by the awe-elicitation procedure in VR. These elements subsequently correlated to learning gains instead of the overview effect, indicating that this measure could be linked to cognitive ability. The findings of the current study contribute to a better understanding of how drawings reflect self-transcendental experiences; however, they also reveal that in younger age groups, they are not necessarily reflected in decreased self-size. [ABSTRACT FROM AUTHOR]

Simple Summary: We studied a group of 90 patients with NF1-related plexiform neurofibromas (PNs) with an average age of 15.7 years and a follow-up period of 9.8 yrs. PNs in patients with older age and PNs located in the craniofacial region or trunk were most frequently associated with plexiform neurofibroma morbidity and most frequently underwent intervention (surgery or systemic treatment). These findings may contribute to decisions on whether or not to start what treatment in NF1 patients with PNs. Background: Plexiform neurofibromas (PNs) are histologically benign peripheral nerve sheath tumors associated with neurofibromatosis type 1 (NF1) and often lead to significant morbidity due to growth. Management includes watchful waiting, surgery for partial debulking, and, since recently, systemic treatment with MEK inhibitors. However, due to the scarcity of natural history studies, our understanding of the natural progression of PNs to guide clinicians in deciding in whom and when to intervene is scarce. This study aims to describe the characteristics of NF1 patients with PNs and compare those at high risk for PN progression or experiencing significant morbidity from PN (complex PN) with NF1 patients with PNs of lower complexity. Methods: In this retrospective cohort study using clinical data from hospital records of NF1 patients with PNs seen at the Sophia Children's Hospital in the Netherlands between 2012 and 2023, we assessed determinants of clinical phenotypes and PN characteristics predictive of outcomes, including PN complexity and the timing of intervention for PN. We assessed the outcomes using logistic regression analysis and Cox regression. Results: Ninety patients with a median age at last evaluation of 15.7 years and a median follow-up duration of 9.8 years were included. Out of 90 individuals with a benign PN, 37 developed plexiform neurofibroma morbidity during follow-up. Older age was (corrected for pathogenic NF1 variant and PN location) significantly associated with plexiform neurofibroma morbidity. Cox regression revealed that craniofacial and trunk PNs were associated with a higher intervention hazard compared to limb PNs. Conclusion: Our pilot multivariate approach identified older age and the location of the PN to be mostly associated with a higher chance of plexiform neurofibroma morbidity and higher intervention hazard. This may contribute to decisions regarding in whom and when to initiate treatment in NF1 patients with PNs. [ABSTRACT FROM AUTHOR]