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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]

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]

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]

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]

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]

Abstract This paper presents evidence that companies across three continental European countries (Belgium, Germany and the Netherlands) provide varying degrees of analyst recommended nonfinancial disclosures to the marketplace. This study is the first to examine the relationship of Jenkins Committee nonfinancial disclosure levels with the accuracy and dispersion of financial analysts' earnings forecasts. Seemingly unrelated regression tests show that larger companies and companies with a global focus voluntarily provide higher levels of both forward looking and historical nonfinancial disclosures. Additionally, higher levels of forward looking nonfinancial disclosures are associated with lower dispersion and higher accuracy in financial analysts' earnings forecasts. [ABSTRACT FROM AUTHOR]

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]

Background and Aims A strong correlation exists between smoking and the use of alcohol and cannabis. This paper uses polygenic risk scores to explore the possibility of overlapping genetic factors. Those scores reflect a combined effect of selected risk alleles for smoking. Methods Summary-level P-values were available for smoking initiation, age at onset of smoking, cigarettes per day and smoking cessation from the Tobacco and Genetics Consortium ( n between 22 000 and 70 000 subjects). Using different P-value thresholds (0.1, 0.2 and 0.5) from the meta-analysis, sets of 'risk alleles' were defined and used to generate a polygenic risk score (weighted sum of the alleles) for each subject in an independent target sample from the Netherlands Twin Register ( n = 1583). The association between polygenic smoking scores and alcohol/cannabis use was investigated with regression analysis. Results The polygenic scores for 'cigarettes per day' were associated significantly with the number of glasses alcohol per week ( P = 0.005, R2 = 0.4-0.5%) and cannabis initiation ( P = 0.004, R2 = 0.6-0.9%). The polygenic scores for 'age at onset of smoking' were associated significantly with 'age at regular drinking' ( P = 0.001, R2 = 1.1-1.5%), while the scores for 'smoking initiation' and 'smoking cessation' did not significantly predict alcohol or cannabis use. Conclusions Smoking, alcohol and cannabis use are influenced by aggregated genetic risk factors shared between these substances. The many common genetic variants each have a very small individual effect size. [ABSTRACT FROM AUTHOR]

In this paper, we examined how identification with urban districts as a common ingroup identity and perceived ingroup prototypicality influence the attitudes of residents toward other ethnic groups in their neighborhood. The overall conclusion of two field studies (N = 214 and N = 98) is that for majority-group members, there may be a positive relation between identification with an overarching identity and outgroup attitudes but only when they perceive their ingroup as low in prototypicality for the overarching group (Study 1 and 2). Conversely, for minority-group members, there may be a positive relation between identification and outgroup attitudes but only when they perceive their ingroup as high in prototypicality for the overarching group (Study 2). Outgroup prototypicality did not moderate the relation between identification and outgroup attitudes. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Although critical differences exist between large companies and small- and medium-sized enterprises ( SMEs), limited empirical research has been done on human resource (HR)-related corporate social responsibility ( CSR). In this paper we study aging workforce management ( AWM) as a component of CSR. Our study was conducted in the Netherlands through a randomly distributed online questionnaire. Managers and team leaders of 201 SMEs responded. The data were analyzed using multiple hierarchical regression analysis. Our results are twofold: first, findings suggest that CSR policies in micro organizations with fewer than five employees seem to be strongly associated with AWM; and second, that companies with a focus on integration of older workers in daily activities do not perceive their actions as HR-related. Using AWM as part of CSR helps to give insight into the role of the owner, company size and the nature of implicit CSR practices. Our study demonstrates that the use of AWM in CSR research can lead to valuable insights and therefore, our overarching research question is answered that AWM can be used when studying CSR. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Becker J, van Rijswijk J, Versteijnen B, Evers A, van den Akker E, van Beek E, Bolte A, Rijnders R, Mol B, Moons K, Porath M, Drogtrop A, Schuitemaker N, Willekes C, Westerhuis M, Visser G, Kwee A. Is intrapartum fever associated with ST-waveform changes of the fetal electrocardiogram? A retrospective cohort study. BJOG 2012;119:1410-1416. Objective To investigate the association between maternal intrapartum fever and ST-waveform changes of the fetal electrocardiogram. Design Retrospective cohort study. Setting Three academic and six non-academic teaching hospitals in the Netherlands. Population Labouring women with a high-risk singleton pregnancy in cephalic position beyond 36 weeks of gestation. Methods We studied 142 women with fever (≥38.0°C) during labour and 141 women with normal temperature who had been included in two previous studies. In both groups, we counted the number and type of ST-events and classified them as significant (intervention needed) or not significant, based on STAN® clinical guidelines. Main outcome measures Number and type of ST-events. Results Both univariable and multivariable regression analysis showed no association between the presence of maternal intrapartum fever and the number or type of ST-events. Conclusions Maternal intrapartum fever is not associated with ST-segment changes of the fetal electrocardiogram. Interpretation of ST-changes in labouring women with fever should therefore not differ from other situations. [ABSTRACT FROM AUTHOR]

Background Diagnostics and care for people with intellectual disabilities (ID) and psychiatric disorders need to be improved. This can be done by using assessment instruments to routinely measure the nature and severity of psychiatric symptoms. Up until now, in the Netherlands, assessment measures are seldom used in the psychiatric care for this population. The objective of the present paper is to evaluate the use of the Brief Symptom Inventory (BSI), a widely used standardised questionnaire in general psychiatry, in a well-defined sample of people with borderline intellectual functioning or mild ID diagnosed with one or more psychiatric disorders. Methods A total of 224 psychiatric outpatients with either borderline intellectual functioning or mild ID participated in this study. All participants were new patients of Kristal, Centre for Psychiatry and Intellectual Disability in the Netherlands, in the period between 1 April 2008 and 1 October 2009. All participants were assessed by a multidisciplinary team, including a certified psychiatrist. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria were applied. The mean total intelligence quotient was measured with the Wechsler Adult Intelligence Scale (WAIS-III). The BSI was administered in an assisted fashion. Utility and psychometric properties of the BSI were investigated. Internal consistency coefficients (Cronbach's alphas) were computed. Bivariate correlations between the sub-scales were computed to assess differentiation between the scales. Mean sub-scale scores were compared between different DSM-IV-TR subgroups to investigate the discriminant abilities of the scales. A confirmatory factor analysis was conducted. Results The results suggest that the BSI is practically useful. Internal consistencies ranged from 0.70 to 0.96 and thus are considered good to adequate. Sub-scale inter-correlations showed there is a degree of differentiation between the sub-scales. Discriminant validity was shown for the sub-scales depression, anxiety and phobic anxiety. Confirmatory factor analysis showed that the underlying structure of the BSI could be described by the same nine-factor model as reported in previous studies. Conclusions As a result of the psychometric properties illustrated, this study supports the use of the BSI as a screener for psychopathology and a general outcome measure in people with ID. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Djelantik A, Kunst A, van der Wal M, Smit H, Vrijkotte T. Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort: population attributive fractions for Amsterdam. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03205.x. Objective To estimate the contribution of pre-pregnancy excessive weight to the occurrence of adverse pregnancy outcomes and to detect the differences in these contributions between different ethnic groups. Design Prospective multi-ethnic community-based cohort study. Setting The prevalence of excessive weight is increasing and in general higher in immigrant groups in many industrialised countries. Maternal excessive weight, like smoking during pregnancy, is an important risk factor for adverse pregnancy outcomes. Population A total of 8266 pregnant women, living in the Netherlands, were included in the ABCD study between January 2003 and March 2004. Methods After applying the exclusion criteria, the analysis included 7871 pregnancies. Binomial log-linear regression analyses were performed to estimate relative risks (RRs) expressing the association between overweight/obesity and small-for-gestational-age (SGA), large-for-gestational-age (LGA), preterm birth (PTB; <37 weeks of gestation) and extreme PTB (<32 weeks of gestation), controlling for parity, maternal age, education level and smoking. Next, the RRs were used to estimate population attributive fractions (PAF) for Amsterdam and separately for several ethnic groups. Main outcome measures The RRs and PAFs. Results The PAFs for overweight/obesity were: SGA −4.9%, LGA 15.3%, PTB 6.6% and extreme PTB 22.0%. In absolute terms, this corresponds to −47 SGA infants, 126 LGA infants, 35 PTB and 20 extreme PTB per year in Amsterdam. Except for SGA, these PAFs were higher than those for smoking (6.2%, −3.9%, 5.5% and 10.6%, respectively). The contribution of overweight/obesity to LGA and PTB was higher in non-Western immigrant groups. Conclusions Overweight/obesity has become an important contributor to the occurrence of adverse pregnancy outcomes in Amsterdam. For most outcomes, these contributions are larger than those for smoking. Development of special obesity prevention programmes for young women is required, especially focused on immigrant groups. [ABSTRACT FROM AUTHOR]

Through nature conservation practices, farmers can strongly enhance nature quality and biodiversity in rural areas. In this paper, the social psychological underpinnings of farmers' nature conservation practices are investigated using the Theory of Planned Behavior, to which the concepts of self-identity and personal norms were added. A distinction is made between nature conservation practices done on a non-subsidised basis and nature conservation practices for which farmers receive some form of remuneration from the Dutch government. Eighty-five arable farmers participated in our survey. Results show that our model explains more variance in the intention to perform non-subsidised than subsidised nature conservation practices. Also, the concepts of self-identity and personal norms appear to be related to the intention to perform non-subsidised, not subsidised conservation. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Ravelli A, Jager K, de Groot M, Erwich J, Rijninks-van Driel G, Tromp M, Eskes M, Abu-Hanna A, Mol B. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG 2011;118:457-465. To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care. Population-based cohort study from 2000 up to and including 2006. The Netherlands Perinatal Registry. A total of 751 926 singleton term hospital births. We assessed the impact of travel time by car, calculated from the postal code of the woman's residence to the 99 maternity units, on neonatal outcome. Logistic regression modelling with adjustments for gestational age, maternal age, parity, ethnicity, socio-economic status, urbanisation, tertiary care centres and volume of the hospital was used. Mortality (intrapartum, and early and late neonatal mortality) and adverse neonatal outcomes (mortality, Apgar <4 and/or admission to a neonatal intensive care unit). The mortality was 1.5 per 1000 births, and adverse outcomes occurred in 6.0 per 1000 births. There was a positive relationship between longer travel time (≥20 minutes) and total mortality (OR 1.17, 95% CI 1.002-1.36), neonatal mortality within 24 hours (OR 1.51, 95% CI 1.13-2.02) and with adverse outcomes (OR 1.27, 95% CI 1.17-1.38). In addition to travel time, both delivery at 37 weeks of gestation (OR 2.23, 95% CI 1.81-2.73) or 41 weeks of gestation (OR 1.52, 95% CI 1.29-1.80) increased the risk of mortality. A travel time from home to hospital of 20 minutes or more by car is associated with an increased risk of mortality and adverse outcomes in women at term in the Netherlands. These findings should be considered in plans for the centralisation of obstetric care. [ABSTRACT FROM AUTHOR]

This paper documents the investigation of the impact of metropolitan structure on the commute behavior of urban residents in the Netherlands. Not only has the impact of monocentrism versus polycentrism been analyzed, but the influence of metropolitan density and size has also been considered, together with the ratio of employment to population and the growth of the population and employment. Furthermore, data are used at a variety of levels of analysis ranging from the individual worker to the metropolitan region rather than being drawn from aggregate level statistics alone. Multilevel regression modeling is applied to take account of the interdependencies among these levels of aggregation. With regard to mode choice, the results indicate that the probability of driving an auto to work is lower in employment-rich metropolitan regions, and rises as the number of jobs per resident has grown strongly. Furthermore, women in most polycentric regions are less likely to commute as an auto driver. All else being equal, commute distances and times for auto drivers are longer in most polycentric regions than in monocentric urban areas. In addition, commute time as an auto driver rises with metropolitan size, whereas commute distance depends on employment density and the growth of the number of jobs per resident. The investigation shows that metropolitan structure, although significantly influencing commute patterns, explains only a small part of the variation of individuals’ commute behavior. [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]

Background: Parkinson's disease (PD) is a neurodegenerative condition affecting the quality of life. Due to a worsening of oral health in PD patients with the progression of the disease, oral health‐related quality of life (OHRQoL) could be impaired as well. Objectives: To assess whether PD patients in The Netherlands experience worse OHRQoL than historical controls, and to investigate which factors are associated with OHRQoL in PD patients. Materials & Methods: In total, 341 PD patients (65.5 ± 8.4 years) and 411 historical controls (62.6 ± 5.3 years) participated. Both groups completed a questionnaire. The PD patients were asked questions regarding demographics, PD, oral health, and OHRQoL. The historical controls filled in demographic information and questions regarding OHRQoL. The latter construct was assessed using the Dutch 14‐item version of the Oral Health Impact Profile (OHIP‐14). Data were analysed using independent samples t‐tests and univariate and multivariate linear regression analysis. Results: The mean OHIP‐14 score was higher in PD patients (19.1 ± 6.7) than in historical controls (16.5 ± 4.4) (t(239) = 6.5; p <.001). OHRQoL in PD patients was statistically significant associated with motor aspects of experiences of daily living (B = 0.31; t(315) = 7.03; p <.001), worsening of the oral environment during disease course (B = 3.39; t(315) = 4.21; p <.001), being dentate (B = −5.60; t(315) = −4.5; p <.001), tooth wear (B = 2.25; t(315) = 3.29; p =.001), and possible burning mouth syndrome (B = 5.87; t(315) = 2.87; p =.004). Conclusion: PD patients had a lower OHRQoL than historical controls. Besides, PD‐related variables and oral health‐related variables were associated with OHRQoL. [ABSTRACT FROM AUTHOR]

Numerous developmental studies assess general cognitive ability, not as the primary variable of interest, but rather as a background variable. Raven's Progressive Matrices is an easy to administer non-verbal test that is widely used to measure general cognitive ability. However, the relatively long administration time (up to 45 min) is still a drawback for developmental studies as it often leaves little time to assess the primary variable of interest. Therefore, we used a machine learning approach - regularized regression in combination with cross-validation - to develop a short 15-item version. We did so for two age groups, namely 9 to 12 years and 13 to 16 years. The short versions predicted the scores on the standard full 60-item versions to a very high degree r = 0.89 (9-12 years) and r = 0.93 (13-16 years). We, therefore, recommend using the short version to measure general cognitive ability as a background variable in developmental studies. [ABSTRACT FROM AUTHOR]

This paper aimed at investigating the effects of work-related norm violations (i.e., violations of interpersonal and work regulation norms) and individuals' general beliefs about the world (i.e., social axioms: reward for application, social cynicism) on feelings of shame and guilt in Turkey and in the Netherlands. An experimental study involving 103 Turkish and 111 Dutch participants showed that work norm violations elicited feelings of guilt and shame differently in Turkey and the Netherlands. Specifically, interpersonal norm violation in Turkey elicited feelings of shame and guilt more strongly than did violation of a work regulation norm, whereas no differential effects were found in the Netherlands. As expected, violation of a work regulation norm elicited feelings of shame and guilt more strongly in the Netherlands than in Turkey, whereas violation of an interpersonal norm elicited feelings of shame and guilt more strongly in Turkey than in the Netherlands. The findings provide further evidence for the moderating effects of social axioms: in both countries, participants high in social cynicism felt less ashamed when they violated a work regulation norm than did those low in social cynicism. Our findings are relevant for understanding the underlying mechanisms of norm violations at work, thereby offering a new avenue for investigating cultural differences in the workplace. The latter may be of particular relevance in times of globalization and diversity in the workplace. [ABSTRACT FROM AUTHOR]

In an experimental study and a field study, we studied whether high-commitment human resource management (HC-HRM) is more effective when employees can make sense of HRM (attribute HRM to management). In the experimental study (n = 354), employees' HC-HRM perceptions were evoked by a management case, and their attributions were manipulated with an information pattern based on the three dimensions of the covariation principle of the attribution theory: distinctiveness, consistency, and consensus. As expected, the results showed that the effect of HC-HRM on affective organizational commitment was stronger when employees understood HRM as was intended by management. This experimental finding was confirmed in a cross-level field study (n = 639 employees within 42 organizations): the relationship between HC-HRM, on one hand, and affective organizational commitment and innovative behavior, on the other hand, was stronger under the condition that employees could make sense of HRM. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aim: Transanal total mesorectal excision (TaTME) has been suggested as a potential solution for the resection of challenging mid and low rectal cancer. This relatively complex procedure has been implemented in many centres over the last years, despite the absence of long‐term safety data. Recently, concern has arisen because of an increase in local recurrence in the implementation phase. The aim of this study was to assess the correlation between accumulated experience and local recurrences. Method: An independent clinical researcher performed an external audit of consecutive series of all TaTME procedures in six centres in the Netherlands. Kaplan–Meier estimated local recurrence rates were calculated and multivariate Cox proportional hazards regression analysis performed to assess risk factors for local recurrence. Primary outcome was the local recurrence rate in the initial implementation (cases 1–10), continued adoption (cases 11‐40) and prolonged experience (case 41 onward). Results: Six hundred and twenty‐four consecutive patients underwent TaTME for rectal cancer with a median follow‐up of 27 months (range 1–82 months). The estimated 2‐ and 3‐year local recurrence rates were 4.6% and 6.6%, respectively. Cox proportional hazards regression revealed procedural experience to be an independent factor in multivariate analysis next to advanced stage (ycMRF+, pT3‐4, pN+) and pelvic sepsis. Corrected analysis projected the 3‐year local recurrence rates to be 9.7%, 3.3% and 3.5% for the implementation, continued adoption and prolonged experience cohorts, respectively. Conclusion: This multicentre study shows a high local recurrence rate (12.5%) after implementation of TaTME which lowers to an acceptable rate (3.4%) when experience increases. Therefore, intensified proctoring and further precautions must be implemented to reduce the unacceptably high risk of local recurrence at units starting this technique. [ABSTRACT FROM AUTHOR]

Rationale, aims and objective: Primary Care Plus (PC+) focuses on the substitution of hospital‐based medical care to the primary care setting without moving hospital facilities. The aim of this study was to examine whether population health and experience of care in PC+ could be maintained. Therefore, health‐related quality of life (HRQoL) and experienced quality of care from a patient perspective were compared between patients referred to PC+ and to hospital‐based outpatient care (HBOC). Methods: This cohort study included patients from a Dutch region, visiting PC+ or HBOC between December 2014 and April 2018. With patient questionnaires (T0, T1 and T2), the HRQoL and experience of care were measured. One‐to‐two nearest neighbour calliper propensity score matching (PSM) was used to control for potential selection bias. Outcomes were compared using marginal linear models and Pearson chi‐square tests. Results: One thousand one hundred thirteen PC+ patients were matched to 606 HBOC patients with well‐balanced baseline characteristics (SMDs <0.1). Regarding HRQoL outcomes, no significant interaction terms between time and group were found (P >.05), indicating no difference in HRQoL development between the groups over time. Regarding experienced quality of care, no differences were found between PC+ and HBOC patients. Only travel time was significantly shorter in the HBOC group (P ≤.001). Conclusion: Results show equal effects on HRQoL outcomes over time between the groups. Regarding experienced quality of care, only differences in travel time were found. Taken as a whole, population health and quality of care were maintained with PC+ and future research should focus more on cost‐related outcomes. [ABSTRACT FROM AUTHOR]

How can depression be associated with both instability and inertia of affect? Koval et al. (2013, Emotion, 13, 1132) showed that this paradox can be solved by accounting for the statistical overlap between measures of affect dynamics. Nevertheless, these measures are still often studied in isolation. The present study is a replication of the Koval et al. study. We used experience sampling data (three times a day, 1 month) of 462 participants from the general population and a subsample thereof (N = 100) selected to reflect a uniform range of depressive symptoms. Dynamics measures were calculated for momentary negative affect scores. When adjusting for the overlap among affect dynamics measures, depression was associated with 'dispersion' (SD) but not 'instability' (RMSSD) or 'inertia' (AR) of negative affect. The association between dispersion and depression became non‐significant when mean levels of negative affect were adjusted for. These findings substantiate the evidence that the presumed association between depression and instability is largely accounted for by the SD, while the association between dispersion and depression may largely reflect mean levels of affect. Depression may thus not be related to higher instability per se, which would be in line with theories on the adaptive function of moment‐to‐moment fluctuations in affect. [ABSTRACT FROM AUTHOR]

Background: Assertive community treatment (ACT) and Flexible assertive community treatment (FACT) are organisation models for intensive assertive outreach that were originally developed for individuals with severe mental illness. The models are increasingly applied to people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and challenging behaviour or mental illness. Research on these types of care for this population is limited. To gain experience in FACT MID/BIF in the Netherlands and to obtain insight in its outcomes, four organisations specialised in the treatment of individuals with MID/BIF and challenging behaviour participated in a 6‐year implementation and research project. Methods: A longitudinal study was set up to investigate outcomes over time. Outcome measures concerned admissions to (mental) health care, social and psychological functioning, (risk of) challenging and criminal behaviour, social participation and client satisfaction. Data were analysed using descriptive statistics and linear mixed models. Results: Over time, clients showed improvement in their social and psychiatric functioning and living circumstances. The number of admissions to (mental) health care diminished as well as the number of contacts with police and justice, the level of social disturbance and the risk factors for challenging and criminal behaviour. Problems related to finances, work and substance abuse remained unchanged. Conclusions: The results are encouraging and give rise to continued development of and broader research on FACT MID/BIF. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms are common in children with developmental language disorder (DLD). However, risk and protective factors contributing to these problems are currently underspecified. Aims: The current longitudinal study examined the role of emotion‐regulation (ER) strategies in the severity of depressive symptoms in children with and without DLD, taking into account the severity of communication problems of children with DLD. Methods & Procedures: We followed clinically referred children with DLD (n = 114, 49% girls) and without DLD (n = 214, 58% girls) between the ages of 8 and 16 years across an 18‐month period. Participants completed self‐report questionnaires at three time points. Parents of children with DLD reported on their child's communication problems. Outcomes & Results: Multilevel analyses confirmed higher levels of depressive symptoms in youngsters with DLD compared with peers without DLD, with a decrease across time in the DLD group. In both groups, higher levels of approach and increasing avoidant strategies aimed at distraction or trivializing a problem explained lower depressive symptoms, whereas more worry and externalizing strategies contributed to more depressive symptoms. Within the DLD group, semantic language problems were associated with higher depressive symptoms. However, this relation was mediated by the tendency to worry or use externalizing strategies. Conclusions & Implications: Results suggest that interventions for children with DLD should focus on enhancing their adaptive ER strategies to help them cope with daily stressors just as in the general population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study was to assess the prevalence of diabetes among patients with periodontitis and to evaluate whether diabetes is related to extent and severity of periodontitis. Method: This is a retrospective study of data observed over a 10‐year period in patients referred to a specialized clinic for periodontology in the Netherlands. Patients received at the intake appointment a full‐mouth periodontal examination, and based on the clinical data, patients were classified with respect to extent and severity of periodontitis. In addition, the prevalence of diabetes was recorded, based on self‐report. Results: A total of 5375 periodontitis patients were included in the study sample (mean age of 50 years). The prevalence of diabetes in this patient sample was 3.7% (n=192). No relation between diabetes and extent or severity of periodontitis could be established. Conclusion: The prevalence of diabetes in a predominantly “controlled” diabetic population was not related to the extent and/or severity of periodontitis along with the finding that the prevalence was lower than the national diabetes prevalence in the Netherlands. [ABSTRACT FROM AUTHOR]

Background Patient-reported outcome measures ( PROMs) are increasingly used to establish the value of health care. In order to reflect value, PROMs should measure outcomes that matter to patients. However, patients are not always involved in the development of PROMs. This study therefore aimed to investigate whether PROMs, which were developed without patient involvement, are relevant to patients and whether the level of importance allocated towards aspects of these PROMs varies between patient groups. Methods All patients from 20 Dutch hospitals undergoing hip or knee surgery in 2014 were invited to a PROMs survey. Participants were asked to rate the importance of each of the items in the HOOS-Physical Function Short form or the KOOS-Physical Function Short form, the EQ-5D and the NRS pain. Results Most outcomes were considered important. However, 77.7% of hip surgery patients rated being able to run as unimportant. Being able to kneel (32.7%) or squat (39.6%) was not important to a considerable minority of knee surgery patients. Pain, especially during rest, was considered very important by both hip (68.2%) and knee (66.5%) surgery patients. Patients who were older, male, experienced overall bad health and psychological health considered many items from the PROMs less important than other patients. Discussion Patients differ in what they consider important. Health-care professionals should explore patients' preferences and discuss which treatment options best fit patients' preferences. Additionally, if PROMs are used in performance measurement, further research is needed to look at whether and how variation in patient preferences can be taken into account. [ABSTRACT FROM AUTHOR]

Purpose The shift in nursing home care for patients with dementia from traditional task-driven environments towards patient-centered small-scale environments has implications for nursing practice. Information about its implications for nursing staff is lacking, and only a few studies have addressed staff perceptions. We sought to explore staff perceptions of required skills and to determine differences in job satisfaction, motivation, and job characteristics of staff working in both care settings. Design A secondary data analysis was conducted. The data source used was drawn from a larger study testing the effects of small-scale living (Verbeek et al., 2009). Methods Nursing staff working on a permanent basis and who were directly involved in care were eligible to participate in the study. Data on job satisfaction, motivation, and job characteristics of nursing staff working in typical small-scale and traditional care environments were derived using a questionnaire. Data were analyzed using descriptive statistics. Differences between nursing staff job satisfaction, motivation, and job characteristics were tested using multilinear regression analysis. Findings In total, 138 staff members were included (81 staff members working in traditional nursing home wards and 57 staff members working in small-scale nursing home wards). The findings showed that in typical small-scale nursing homes, job satisfaction and job motivation were significantly higher compared to those in typical traditional nursing homes. Job autonomy and social support were also significantly higher, while job demands were significantly lower in these small-scale nursing homes. Social support was found to be the most significant predictor of job motivation and job satisfaction in both types of typical nursing homes. Nursing staff working in traditional care environments more often expressed the intention to switch to small-scale environments. Conclusions Based on the findings of this study, it can be concluded that nursing homes environments differ substantially in experienced job satisfaction and job motivation. Clinical Relevance To enable a balanced work environment for nursing staff, a clear understanding of the relation between living environments and experienced job satisfaction among nursing staff is required. Since social support seems to be one of the key contributors to a supportive beneficial work climate, managers should focus on enabling this in daily nursing home care. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the association between the presence of comorbidities and the pain experience in individual patients with temporomandibular disorder ( TMD). This clinical trial comprised 112 patients with TMD pain. For all participants the presence of the following comorbid factors was assessed: pain in the neck; somatization; impaired sleep; and depression. Pain experience was evaluated using the McGill Pain Questionnaire ( MPQ). For each subject the TMD-pain experience was assessed for three dimensions - sensory, affective, and evaluative - as specified in the MPQ. The association between comorbid factors and these three dimensions of TMD-pain experience was then evaluated using linear regression models. Univariable regression analyses showed that all comorbid factors, except for one factor, were positively associated with the level of pain, as rated by the sensory description of pain, the affective component of pain, and the evaluative experience of pain. The multivariable regression analyses showed that for all MPQ dimensions, depression showed the strongest associations with pain experience. It was found that in the presence of comorbid disorders, patients with TMD experience elevated levels of TMD pain. This information should be taken into consideration in the diagnostic process, as well as in the choice of treatment. [ABSTRACT FROM AUTHOR]

Aims To estimate associations between smoking initiation, smoking persistence and smoking heaviness and caffeine consumption in two population-based samples from the Netherlands and the United Kingdom. Design Observational study employing data on self-reported smoking behaviour and caffeine consumption. Setting Adults from the general population in the Netherlands and the United Kingdom. Participants Participants from the Netherlands Twin Register [NTR: n = 21 939, mean age 40.8, standard deviation (SD) = 16.9, 62.6% female] and the Avon Longitudinal Study of Parents and Children (ALSPAC: n = 9086, mean age 33.2, SD = 4.7, 100% female). Measurements Smoking initiation (ever versus never smoking), smoking persistence (current versus former smoking), smoking heaviness (number of cigarettes smoked) and caffeine consumption in mg per day through coffee, tea, cola and energy drinks. Findings After correction for age, gender (NTR), education and social class (ALSPAC), smoking initiation was associated with consuming on average 52.8 [95% confidence interval (CI) = 45.6-60.0; NTR] and 59.5 (95% CI = 51.8-67.2; ALSPAC) mg more caffeine per day. Smoking persistence was also associated with consuming more caffeine [+57.9 (95% CI = 45.2-70.5) and +83.2 (95% CI = 70.2-96.3) mg, respectively]. Each additional cigarette smoked per day was associated with 3.7 (95% CI = 1.9-5.5; NTR) and 8.4 (95% CI = 6.9-10.0; ALSPAC) mg higher daily caffeine consumption in current smokers. Smoking was associated positively with coffee consumption and less strongly with cola and energy drinks. For tea, associations were positive in ALSPAC and negative in NTR. Conclusions There appears to be a positive association between smoking and caffeine consumption in the Netherlands and the United Kingdom. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Perceived constraints to providing patient care in their own morally justified way may cause moral distress (MD) in neonatal nurses and physicians. Negative long-term effects of MD include substandard patient care, burnout and leaving the profession. Aim To assess the immediate impact of perceived inappropriate patient care on nurses' and physicians' MD intensity, and explore a possible moderating effect of ethical climate. Design In a repeated measures design, after baseline assessment, each participant completed self-report questionnaires after five randomly selected shifts. Data were analysed with logistic and Tobit regression . Participants Data were collected among 117 of 147 eligible nurses and physicians (80%) in a level- III neonatal intensive care unit in the Netherlands. Results At baseline, overall MD was relatively low; in nurses, it was significantly higher than in physicians. Few morally distressing situations were reported in the repeated measurements, but distress could be intense in these cases; nurses' and physicians' scores were comparable. Physicians were significantly more likely than nurses to disagree with their patients' level of care ( p = 0·02). Still, perceived overtreatment, but not undertreatment, was significantly related to distress intensity in both professional groups; ethical climate did not moderate this effect. Substandard patient care due to lack of continuity, poor communication and unsafe levels of staffing were rated as more important causes of MD than perceived inappropriate care. Conclusions Although infrequently perceived, overtreatment of patients caused considerable distress in nurses and physicians. Our unit introduced multidisciplinary medical ethical decision making 5 years ago, which may partly explain the low MD at baseline. Relevance to clinical practice MD might be prevented by improved continuity of care, safe levels of staffing and better team communication, along with other targeted interventions with demonstrated effectiveness, such as palliative care programs and facilitated ethics conversations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate, from a societal perspective, the cost utility and cost effectiveness of a nonpharmacologic face-to-face treatment program compared with a telephone-based treatment program for patients with generalized osteoarthritis (GOA).Methods: An economic evaluation was carried out alongside a randomized clinical trial involving 147 patients with GOA. Program costs were estimated from time registrations. One-year medical and nonmedical costs were estimated using cost questionnaires. Quality-adjusted life years (QALYs) were estimated using the EuroQol (EQ) classification system, EQ rating scale, and the Short Form 6D (SF-6D). Daily function was measured using the Health Assessment Questionnaire (HAQ) disability index (DI). Cost and QALY/effect differences were analyzed using multilevel regression analysis and cost-effectiveness acceptability curves.Results: Medical costs of the face-to-face treatment and telephone-based treatment were estimated at €387 and €252, respectively. The difference in total societal costs was nonsignificantly in favor of the face-to-face program (difference €708; 95% confidence interval [95% CI] -€5,058, €3,642). QALYs were similar for both groups according to the EQ, but were significantly in favor of the face-to-face group, according to the SF-6D (difference 0.022 [95% CI 0.000, 0.045]). Daily function was similar according to the HAQ DI. Since both societal costs and QALYs/effects were in favor of the face-to-face program, the economic assessment favored this program, regardless of society's willingness to pay. There was a 65-90% chance that the face-to-face program had better cost utility and a 60-70% chance of being cost effective.Conclusion: This economic evaluation from a societal perspective showed that a nonpharmacologic, face-to-face treatment program for patients with GOA was likely to be cost effective, relative to a telephone-based program. [ABSTRACT FROM AUTHOR]

The aim of the current research was to examine to what degree basic personality dimensions serve as determinants of job crafting behaviour and to investigate how this behaviour can be influenced via behavioural intentions. In Study 1, we investigated the relationship of approach and avoidance temperament with job crafting in terms of seeking resources, seeking challenges, and reducing demands in a sample of 193 international employees. In Study 2 ( n = 130 employees), we experimentally manipulated the current motivational state in terms of approach/avoidance goals and measured job crafting behaviours in a follow-up survey. Results confirmed that employees scoring high on approach temperament report to seek resources and demands, whereas employees scoring high on avoidance temperament tend to reduce hindering demands in the workplace. Furthermore, the manipulation of goals had indirect effects on job crafting via behavioural intentions. Although the effects of the concentration on approach goals on job crafting were contradictory to our expectations, the pursuit of avoidance goals led to higher demands-reducing behaviour. Taking everything together, we provide important insights into the effects of basic personality dimensions on job crafting behaviour and highlight the possibilities and boundaries for managers to influence the job crafting behaviours of employees. Practitioner points Our study provides insights about which types of employees alter their job demands and resources., Employees scoring high on approach temperament seek resources and demands, whereas employees scoring high on avoidance temperament reduce demands., Managers are able to influence job crafting behaviour indirectly by stimulating the pursuit of approach and/or avoidance goals., A sole focus on (performance) approach goals might have hindering effects in terms of positive job crafting behaviours. [ABSTRACT FROM AUTHOR]

In this study, we examine how the classic elements of affect, cognition, and behaviour combine to form within-person trajectories of organizational commitment. We test several key features of this 'dynamic microstructure' of commitment in an experience sampling setting (25 weekly measurements) among 72 organizational entrants and 23 exiters. We find support for the idea that within-person change in affect is slower than within-person change in cognition and behaviour. We find no support for the notion that affect would influence cognition and behaviour at the within-person level. In fact, we have strong indications that the episodes of committing (organizational entry) and uncommitting (organizational exit) are mainly cognition driven. We discuss the implications of our study for tripartite attitude theory and commitment theory. Practitioner points Organizational commitment can generally best be fostered via rational appeals. If a long-term investment and sustained commitment is called for, emotional appeals work best., Alumni officers may suffice with focusing purely on emotive appeals in upholding residual commitments of their alumni. [ABSTRACT FROM AUTHOR]

Background and Aims Between 2000 and 2005 the average percentage of Δ9-tetrahydrocannabinol (THC) in marijuana as sold in Dutch coffeeshops has increased substantially; the potency of domestic products (Nederwiet and Nederhasj) has particularly increased. In contrast with imported marijuana, Nederwiet hardly contained any cannabidiol (CBD), a cannabinoid that is thought to offset some of the adverse effects of THC. In 2005, the THC content in Nederwiet was significantly lower than in 2004. This study investigates the further decrease or increase of cannabinoids in these cannabis products. Methods From 2005 to 2015 five different cannabis products were bought anonymously in 50 coffeeshops that were selected randomly each year from all coffeeshops in the Netherlands. A total of 2126 cannabis samples were bought, consisting of 664 Nederwiet samples (most popular), 537 Nederwiet samples (supposed strongest varieties), 183 imported herbal cannabis samples, 140 samples of cannabis resin made of Nederwiet and 602 samples of imported cannabis resin. All samples were analysed chemically for their THC, CBD and cannabinol (CBN) content. Results Between 2005 and 2015, the mean potencies of the most popular and the strongest Nederwiet and of imported cannabis resin were 16.0 ± 4.0%, 17.0 ± 3,9% and 16.5 ± 6.3%, respectively. Imported herbal cannabis (6.5 ± 3.5%) and cannabis resin made from Nederwiet (30.2 ± 16.4%) contained, respectively, less (β = -10.0, P < 0.001) and more (β = 13.7, P < 0.001) THC than imported cannabis resin. Linear regression models were used to study the trends in THC of the different cannabis products over time. A marginal, but significant ( P < 0.001), overall decline of THC per year of 0.22% was found in all cannabis products. However, no significant difference was found between the five products in the THC linear trajectories across time. Of all the cannabis products, only imported cannabis resin contained a relatively high CBD/THC ratio (median 0.42). Conclusion The average tetrahydrocannabinol (THC) content of the most popular herbal cannabis products in the Netherlands has decreased slightly since 2005. The popular Nederwiet type still has a relatively high THC to cannabidiol ratio. [ABSTRACT FROM AUTHOR]

Background: A developmental improvement of symptoms in attention-deficit/hyperactivity disorder (ADHD) is frequently reported, but the underlying neurobiological substrate has not been identified. The aim of this study was to determine whether white matter microstructure is related to developmental improvement of ADHD symptoms. Methods: A cross-sectional magnetic resonance imaging (MRI) analysis was embedded in a prospective follow-up of an adolescent cohort of ADHD and control subjects (NeuroIMAGE). Mean age at baseline was 11.9 years, mean interval of follow-up was 5.9 years. About 75.3% of the original cohort was retained successfully. Data of 101 participants with ADHD combined type at baseline and 40 healthy controls were analysed. ADHD symptoms were measured with semistructured, investigator-based interviews and Conners' questionnaires, on the basis of DSM-IV criteria. Fractional anisotropy (FA) and mean diffusivity (MD) indices of white matter microstructure were measured using whole brain diffusion tensor imaging at follow-up only. In a dimensional analysis FA and MD were related to change in ADHD symptoms. To link this analysis to DSM-IV diagnoses, a post hoc categorical group analysis was conducted comparing participants with persistent (n = 59) versus remittent (n = 42) ADHD and controls. Results: Over time, participants with ADHD showed improvement mainly in hyperactive/impulsive symptoms. This improvement was associated with lower FA and higher MD values in the left corticospinal tract at follow-up. Findings of the dimensional and the categorical analysis strongly converged. Changes in inattentive symptoms over time were minimal and not related to white matter microstructure. Conclusions: The corticospinal tract is important in the control of voluntary movements, suggesting the importance of the motor system in the persistence of hyperactive/impulsive symptoms. [ABSTRACT FROM AUTHOR]

Compulsory reemployment courses aim to increase unemployed people's chances of reemployment by enhancing their employability and job search activities. However, the course outcomes vary greatly. This study examined the conditions and mechanisms that influence the outcomes of reemployment courses. In a two-wave study of 643 participants, we assessed participants' course experience (perceived choice and perceived usefulness), motivation for finding reemployment (internalisation), and employability and job search before and after the course. The results confirmed that a more internalised motivation was positively related to most course outcomes. Unexpectedly, perceived choice was unrelated to internalised motivation and course outcomes. Instead, high perceived choice was beneficial for motivation and some course outcomes only when the participants perceived the course to be useful for finding reemployment but was detrimental when they perceived the course to be useless. Perceived usefulness was also directly and positively related to the participants' internalised motivation, which was in turn positively associated with most employability dimensions and job search activities after the course. Our results imply that the compulsory nature of reemployment courses may not be detrimental to people's motivation and course outcomes as long as they perceive the course to be useful for finding reemployment. [ABSTRACT FROM AUTHOR]

Objective: Pain is a frequent long-term consequence of stroke, but its relation to emotional and social well-being is poorly studied in stroke populations. We aimed to identify the prevalence of substantial pain among institutionalized stroke patients and to explore its relation to emotional distress (ED) and low social engagement (SE).Methods: In a cross-sectional design, we collected data of 274 chronic stroke patients in Dutch nursing homes. Observation lists were filled out in structured interviews with qualified nurse assistants who knew the residents well. Pain and SE were measured with the Resident Assessment Instrument for Long-term Care Facilities, and ED was measured with the Neuropsychiatric Inventory Questionnaire (NPIQ).Results: Substantial pain was present in 28% of the residents, mostly located in the affected body side (68%). Multilevel regression analyses revealed that this pain was independently related to a 60% increase in NPIQ score (β 3.18 [1.84-4.53]) and to clinically relevant symptoms of delusions (odds ratio [OR] 8.45 [1.82-39.05]), agitation/aggression (OR 3.82 [1.76-8.29]), depression (OR 3.49 [1.75-6.98]), and anxiety (OR 2.32 [1.08-4.97]). Substantial pain was associated with low SE when adjusted for clinical covariates (OR 4.25 [1.72-10.53]), but only in residents with no/mild or severe cognitive impairment. This relation disappeared when additionally corrected for NPIQ score (OR 1.95 [0.71-5.39]).Conclusions: Pain is a serious and multidimensional problem among institutionalized stroke patients. It is related to increased ED, which in turn can be a pathway to low SE as an indicator of social vulnerability. Future research should reveal how pain management in nursing homes can be tailored to the needs of this patient group. [ABSTRACT FROM AUTHOR]

Researchers have obtained inconsistent results on the relationship between leader narcissism and leader effectiveness evaluations. Here we draw on social role theory and recent findings on prescriptive gender stereotypes to propose that leader's and follower's gender influence the degree to which narcissistic leaders are perceived as effective. Narcissistic female leaders lack stereotypically gender appropriate qualities (e.g. kindness) and demonstrate undesirable qualities associated with the other gender (e.g. arrogance). This combination is potentially threatening to the traditionally higher status of males, thus resulting in poor leader effectiveness ratings, especially by male subordinates. Conversely, we expect narcissism to be tolerated in male leaders. We find support for this idea in a study on 145 leader subordinate dyads. Female narcissistic leaders were seen as less effective than male narcissistic leaders. However, looking more closely, these lower ratings were only found when male subordinates served as raters. Specifically, male subordinates rated female narcissistic leaders lower while their effectiveness ratings of male leaders were not affected by narcissism. Female subordinates showed no gender bias in their effectiveness evaluations of narcissistic leaders. Thus, gender differences may be an important source of inconsistencies in evaluations of narcissistic leaders. [ABSTRACT FROM AUTHOR]

Pacing style reflects how individuals distribute their effort over time in working toward deadlines. As a new construct introduced in 2002, the notion of pacing style has intuitive appeal, but has been under-researched, in part, due to a measurement need. Therefore, the purpose of this research was to improve the conceptualisation of pacing style and to develop and validate a new scale-based measure. The result was the nine-item Pacing Action Categories of Effort Distribution ( PACED), consisting of deadline (complete work in a short time period just before the due date), steady (spread task activities evenly over time), and U-shaped (invest most of the effort at the start and finish of a task, with a break in between) action styles. Across eight independent samples of students, faculty, and organisational employees, we examined the dimensionality, internal consistency, stability (temporal and situational), and validity (construct, convergent, discriminant, predictive) of PACED. Results support the use of PACED as a reliable and valid measure, and we discuss several research avenues that would benefit from incorporating the concept of pacing style. [ABSTRACT FROM AUTHOR]

Background Parents with intellectual disabilities ( ID) are at risk for high levels of parenting stress. The present study evaluated resources, including parental adaptive functioning, financial resources and access to a support network, as moderators of the association between child behaviour problems and parenting stress. Method A total of 134 parents with ID and their children (ages 1-7 years) were recruited from 10 Dutch care organisations. Questionnaires were administered to the parents to obtain information on parenting stress in the parent and child domain, financial resources and their support network. Teachers and care workers reported on child behaviour problems and parental adaptive functioning, respectively. Results Parents experienced more stress with regard to their children than towards their own functioning and situation. Parenting stress was less in parents who were not experiencing financial hardship. Child behaviour problems were associated with high child-related parenting stress, not parent-related parenting stress. Large support networks decreased the association between child behaviour problems and child-related parenting stress. Financial resources did not significantly moderate the association. Conclusions Parenting stress among parents with ID is focused on problems with the child, especially when little social support is available. [ABSTRACT FROM AUTHOR]

Background and aims The municipality of Amsterdam implemented a new alcohol policy allowing alcohol outlets in two of the five nightlife areas to extend their closing times from 1 April 2009 onwards. We investigated how levels and trends of alcohol-related injuries changed after implementation of this alcohol policy, by comparing areas with extended closing times to those without. Design A controlled before-and-after evaluation to compare changes in alcohol-related injuries between intervention and control areas. Setting Central district of Amsterdam, The Netherlands. Participants Alcohol-related ambulance attendances for control and intervention areas between 1 April 2006 and 1 April 2009 (respectively, n = 544 and n = 499) and between 1 April 2009 and 1 April 2011 (respectively, n = 357 and n = 480). Measurements Alcohol-related injuries were defined as ambulance attendances for people who suffered from direct or indirect consequences of alcohol consumption. Injuries were counted per month in two intervention and three control nightlife areas. We used Poisson regression to assess changes in injuries. Findings After 1 April 2009, intervention areas showed a larger change in the level of alcohol-related injuries than control areas [incidence rate ratio 1.34, 95% confidence interval (CI) = 1.12, 1.61], but trends remained stable in all areas. This increase was only statistically significant for the following subgroups: 2.00-5.59 a.m., weekend days, men, individuals aged 25-34 years, and people transported to a hospital. However, the increase did not differ between subgroups with statistical significance. Conclusions A 1-hour extension of alcohol outlet closing times in some of Amsterdam's nightlife areas was associated with 34% more alcohol-related injuries. [ABSTRACT FROM AUTHOR]

Objectives Certain non- AIDS-related diseases have been associated with immunodeficiency and HIV RNA levels in HIV-infected patients on combination antiretroviral therapy ( cART). We aimed to investigate these associations in patients not yet on cART, when potential antiretroviral-drug-related effects are absent and variation in RNA levels is greater. Methods Associations between, on the one hand, time-updated CD4 counts and plasma HIV RNA and, on the other hand, a composite non- AIDS-related endpoint, including major cardiovascular diseases, liver fibrosis/cirrhosis, and non- AIDS-related malignancies, were studied with multivariate Poisson regression models in 12 800 patients diagnosed with HIV infection from 1998 onwards while not yet treated with cART. Results During 18 646 person-years of follow-up, 203 non- AIDS-related events occurred. Compared with a CD4 count ≥ 500 cells/μL, adjusted relative risks ( RRs) for the composite endpoint were 4.71 [95% confidence interval ( CI) 2.98-7.45] for a CD4 count < 200 cells/μL, 2.06 (95% CI 1.38-3.06) for a CD4 count of 200-349 cells/μL, and 1.19 (95% CI 0.82-1.74) for a CD4 count of 350-499 cells/μL. There was no evidence for an independent association with HIV RNA. Other important covariates were age [ RR 1.40 (95% CI 1.31-1.49) per 5 years older], hepatitis B virus coinfection [ RR 5.66 (95% CI 3.87-8.28)] and hepatitis C virus coinfection [ RR 9.26 (95% CI 6.04-14.2)]. Conclusions In persons not yet receiving cART, a more severe degree of immunodeficiency rather than higher HIV RNA levels appears to be associated with an increased risk of our composite non- AIDS-related endpoint. Larger studies are needed to address these associations for individual non- AIDS-related events. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between home environmental determinants of fruit and vegetable consumption with childhood overweight separately for low, medium and high social economic status ( SES) families. Method A cross-sectional study was carried out in 2006 among 4072 children aged 4-13 years in the city of Zwolle, the Netherlands. Of these children, data were available on measured height and weight, and from a parental questionnaire, on sociodemographic characteristics and children's fruit and vegetables intake. Associations were studied using logistic regression analyses. Results Not eating the recommended amounts of vegetables daily was associated with overweight for children with a low SES background (odds ratio [ OR]: 1.17; 95% confidence interval [ CI]: 0.66-2.07) and medium SES background ( OR: 1.73; 95% CI: 1.20-2.49). Eating < 2 pieces of fruit daily was associated with a lower OR for overweight among children with a high SES background ( OR: 0.66; 95% CI: 0.50-0.88). Determinants of eating vegetables < 7 d were: permission to take candy without asking, eating at the table < 7 d per week, eating a takeaway meal ≥ 1 d per week, eating a home cooked meal < 6 d per week and cooking together with caregiver less than 5 d per week. Conclusion Interventions regarding vegetable consumption should be tailored to families with low and medium SES background. The most promising avenues for intervention seem to be (i) to prevent eating takeaway meals on a weekly basis and, (ii) to promote eating a home cooked meal at the table and (iii) to involve children in the cooking process. Interventions should support parents in making these home environmental changes. [ABSTRACT FROM AUTHOR]