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Background: Community nurses (CNs) play an important role in supporting healthy lifestyles, including healthy eating behaviour of patients. However, many CNs do not incorporate healthy eating support in their daily routines to the fullest extent possible. This study aimed to explore (1) the associations between nurse-related behavioural determinants and self-reported healthy eating support practices of Dutch CNs and (2) CNs' need for additional knowledge. Methods: In this cross-sectional survey design, 244 Dutch CNs completed an online, self-administered questionnaire in October-November 2021. The 60 questionnaire items were related to CNs' characteristics, nurse-related determinants, healthy eating support practices (observing problems, having a conversation about patients' dietary behaviour, motivating patients to eat and drink healthier and supporting patients in goal setting) and the need for additional knowledge. The items on determinants and practices used a 5-point Likert scale. Adjusted prevalence ratios (PRadjusted) with 95% confidence intervals (95%CIs) were obtained for the associations between determinants and practices, using adjusted Poisson regression with robust variance estimations. Results: More CNs practiced observing problems (75%) and having a conversation (70%) than did motivating patients (45%) and supporting goal setting (28%) at least often. A more positive attitude (PRadjusted 1.8; 95%CI 1.5–2.2), greater self-efficacy (PRadjusted 1.3; 95%CI 1.1–1.5), greater motivation (PRadjusted 1.5; 95%CI 1.3–1.7) and better abilities (PRadjusted 1.4; 95%CI 1.2–1.6) were associated with a greater prevalence of supporting healthy eating at least often (vs. never to sometimes). Barriers were not associated with healthy eating support (PRadjusted 1.1; 95%CI 1.0-1.2). CNs especially desired more knowledge on diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia; methods for motivating patients to start and for supporting patients to sustain healthy eating; and dealing with patient autonomy. Conclusions: This study suggests that nurse-related behavioural determinants such as attitude, self-efficacy, motivation and ability should be addressed to improve CNs' competences in healthy eating support. In addition, based on self-reported need for additional knowledge, it is recommended to pay attention to evidence-based behaviour change techniques, dealing with patient autonomy, and diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia. Reporting method: The STROBE Statement was followed for reporting. [ABSTRACT FROM AUTHOR]

In this study, a mixed-method design was employed to investigate the association between a student-centred, problem-based learning (PBL) method and law students' motivation. Self-determination theory (SDT) states that autonomous motivation, which is associated with higher academic performance, can be reached when there is fulfillment of three psychological needs: autonomy, competence and relatedness. PBL aims to trigger autonomous motivation. In Study 1, 85 PBL law students (37% male; Mean age = 21.99 years) and 69 law students of a lecture-based, non-PBL program (39% male; Mean age = 22.72 years) filled out the Self-Regulation Questionnaire and an adapted version of the Work-related Basic Need Satisfaction Scale in order to measure autonomous and controlled motivation and perceived autonomy, competence and relatedness. In order to compare both groups, two MANOVAs were conducted and results showed differences neither in autonomous and controlled motivation, nor in feelings of autonomy and competence. However, PBL students experienced more relatedness. Additionally, in Study 2, focus-group discussions that were conducted indicated that PBL contains both autonomy-supportive and controlling elements, which might explain why no differences were found in perceptions of autonomy and autonomous and controlled motivation between PBL and non-PBL students. Furthermore, students reported that tutorial groups in PBL contributed to feelings of relatedness.

A few years ago, the Erasmus School of Law implemented problem-based learning (PBL) as an instructional method in the bachelor's program. Transition to a PBL program often brings some difficulties for the teaching staff. To find out whether the implementation at the Erasmus School of Law has been successful, students and teachers were asked about their experiences with and perceptions of the PBL program. Both students and teachers reported positive study behaviors, such as regular studying and active involvement of students as a result of PBL. However, some issues also arose after implementing PBL: staff members reported dissatisfaction regarding the PBL program and students reported feelings of insufficient preparation for the legal profession. Recommendations on how to address these issues are discussed.

In educational theory, deep processing (i.e., connecting different study topics together) and self-regulation (i.e., taking control over one's own learning process) are considered effective learning strategies. These learning strategies can be influenced by the learning environment. Problem-based learning (PBL), a student-centered educational method, is believed to stimulate the use of these effective learning strategies. Several aspects of PBL such as discussions of real-life problems, selecting literature by the students themselves, and formulating answers to learning issues encourage students' use of deep processing and self-regulation. In the present study, third-year PBL law students were compared to third-year law students of a lecture-based program with respect to their learning strategies, which were measured with the Inventory Learning Styles (ILS; Vermunt in "British Journal of Educational Psychology," 68, 149-171, 1998). In addition, the relation between time invested in self-study and learning strategies, when taking the instructional method into account, was explored. Results showed that PBL students reported to apply deep processing, self-regulation, and external regulation more frequently than their non-PBL counterparts. PBL seems to contribute to the use of effective learning strategies, but PBL students also relied more often on external sources for their regulation, such as teachers, course material, and assessment.

Aim: To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes. Background: Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long‐term complications from chronic lifestyle‐related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential. Design: A qualitative descriptive study. Methods: Data were collected in the Netherlands in 2018–2019 via semi‐structured face‐to‐face interviews with 18 nurses. Interview guide themes were informed by the COM‐B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis. Results: Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse–patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context. Conclusion: It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet. Impact: The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self‐management. Well‐fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients. Patient or Public Contribution: A nurse provided feedback on the interview guide. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of computer-tailored nutrition education with objective outcome measures. Design: A 3-group randomized, controlled trial with posttests at 1 and 6 months post-intervention. Setting: Worksites and 2 neighborhoods in the urban area of Rotterdam. Participants: A convenience sample of healthy Dutch adults (n = 442). Interventions: A computer-tailored intervention delivered on CD-ROM; a computer-tailored intervention delivered in print; and a generic information condition. Main Outcome Measures: Blood lipids (total, high-density lipoprotein, and low-density lipoprotein cholesterol, and triacylglycerol) were measured by analyzing venous blood samples. Analysis: Linear mixed model procedure. Results: There were no significant differences among the 3 intervention groups in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triacylglycerol. Conclusions and Implications: Contrary to results based on self-report data, no effects of the computer-tailored interventions were found based on objective outcomes. This contradiction calls for a critical reflection on the use of computer-tailored nutrition education interventions and the need to improve those interventions. Furthermore, this study indicates that feasible methods are needed to objectively assess the impact of computer-tailored nutrition education interventions in free-living subjects. (Contains 2 tables and 1 figure.)

This study investigated the minimally required feedback elements of a computer-tailored dietary fat reduction intervention to be effective in improving fat intake. In all 588 Healthy Dutch adults were randomly allocated to one of four conditions in an randomized controlled trial: (i) feedback on dietary fat intake [personal feedback (P feedback)], (ii) P feedback and feedback on one's own behavior relative to that of peers [personal-normative feedback (PN feedback)], (iii) PN feedback and practical suggestions on how to change fat intake [personal-normative-action feedback (PNA feedback)] and (iv) generic information. Data on fat intake, awareness of one's own fat intake and intention to change were collected 1 and 6 months post-intervention. Between-group differences were tested with analysis of variance. Among respondents with high fat intakes at baseline (risk consumers) and those who underestimated their fat intake at baseline (underestimators), differences in awareness and (saturated) fat intake were found between the generic and PNA feedback conditions. Compared with generic information P feedback was more effective in changing awareness and intention among the underestimators, and PN feedback was more effective in changing intention among both risk consumers and underestimators. In conclusion, the combination of personal, normative and action feedback is required for inducing change in fat intake and improving awareness of fat intake. (Contains 3 tables.)

Objective: To test and compare the efficacy of interactive- and print-delivered computer-tailored nutrition education targeting saturated fat intake reduction. Design: A 3-group randomized, controlled trial (2003-2005) with posttests at 1 and 6 months post-intervention. Setting: Worksites and 2 neighborhoods in the urban area of Rotterdam. Participants: A convenience sample of healthy Dutch adults (n = 442). Interventions: An interactive, computer-tailored intervention delivered on a CD-ROM (interactive-tailored condition); a print-delivered, computer-tailored intervention (print-tailored condition); and print-delivered, generic information. Main Outcome Measures: Total and saturated fat intake (grams/day and percentage-energy) and energy intake per day assessed with validated food frequency questionnaires at 1 and 6 months post-intervention. Analysis: Multilevel linear regression analyses. Results: Mean total fat, saturated fat, and energy intakes were significantly lower in both tailored conditions compared to the generic condition at 1-month follow-up. These differences were still significant for the print-tailored condition at 6-months follow-up. Effects were most pronounced among participants with unfavorable fat intakes at baseline. There were no significant differences between the 2 tailoring conditions. Conclusions and Implications: The results indicate that interactive and print-delivered computer-tailored interventions can have similar short-term effects on fat intake and that the effects of the print-delivered tailored feedback are maintained in the longer term.

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Introduction: Cooperation is key to provide integrated dementia care. However, different kinds of (personal and organisational) interests will affect collaboration in integrated dementia care (IDC) networks. Hence, it is crucial to understand how interests influence relations in IDC-networks in order to shape future policies. Methods: A sequential mixed methods single case study design was used, in three phases: a Social Network Analysis (SNA) based on data from questionnaires (n = 24-26), explorative interviews with network partners (n = 14) and a focus group with network coordinators (n = 7) to explore the conceptual generalisability of the single case of the IDC-network. Results: The SNA revealed that highly connected organisations were often established care organisations that deliver case management, while smaller care organisations or welfare organisations tend to be less connected. Care-related, strategic, and financial interests influence participation of organisations in the IDC-network, while personal intrinsic motivations determine a representative's contribution to the network. Especially conflicting interests strongly influence the network structure. Discussion and conclusion: We conclude that conflicting interests in IDC-networks stand in the way of reaching the collective goal of an IDC-network, i.e., optimising the wellbeing of people with dementia and their informal caregivers in the region. Thus, IDC-networks should act to manage, resolve and prevent disputes arising from conflicting interests. [ABSTRACT FROM AUTHOR]

Background: Molecular tumor boards (MTBs) provide rational, genomics‐driven, patient‐tailored treatment recommendations. Worldwide, MTBs differ in terms of scope, composition, methods, and recommendations. This study aimed to assess differences in methods and agreement in treatment recommendations among MTBs from tertiary cancer referral centers in The Netherlands. Materials and Methods: MTBs from all tertiary cancer referral centers in The Netherlands were invited to participate. A survey assessing scope, value, logistics, composition, decision‐making method, reporting, and registration of the MTBs was completed through on‐site interviews with members from each MTB. Targeted therapy recommendations were compared using 10 anonymized cases. Participating MTBs were asked to provide a treatment recommendation in accordance with their own methods. Agreement was based on which molecular alteration(s) was considered actionable with the next line of targeted therapy. Results: Interviews with 24 members of eight MTBs revealed that all participating MTBs focused on rare or complex mutational cancer profiles, operated independently of cancer type–specific multidisciplinary teams, and consisted of at least (thoracic and/or medical) oncologists, pathologists, and clinical scientists in molecular pathology. Differences were the types of cancer discussed and the methods used to achieve a recommendation. Nevertheless, agreement among MTB recommendations, based on identified actionable molecular alteration(s), was high for the 10 evaluated cases (86%). Conclusion: MTBs associated with tertiary cancer referral centers in The Netherlands are similar in setup and reach a high agreement in recommendations for rare or complex mutational cancer profiles. We propose a "Dutch MTB model" for an optimal, collaborative, and nationally aligned MTB workflow. Implications for Practice: Interpretation of genomic analyses for optimal choice of target therapy for patients with cancer is becoming increasingly complex. A molecular tumor board (MTB) supports oncologists in rationalizing therapy options. However, there is no consensus on the most optimal setup for an MTB, which can affect the quality of recommendations. This study reveals that the eight MTBs associated with tertiary cancer referral centers in The Netherlands are similar in setup and reach a high agreement in recommendations for rare or complex mutational profiles. The Dutch MTB model is based on a collaborative and nationally aligned workflow with interinstitutional collaboration and data sharing. Worldwide, molecular tumor boards (MTBs) differ in terms of scope, composition, methods, and recommendations. This article assesses differences in methods and agreement in treatment recommendations among MTBs from tertiary cancer referral centers in The Netherlands. [ABSTRACT FROM AUTHOR]

Background: Prior research indicates a positive association between socioeconomic position and health literacy levels. We hypothesize comparable socioeconomic gradients for food literacy. This study aims to determine the level of self-perceived food literacy and health promotion literacy among adults with a low and medium level of education and from various subgroups, as well as the association between these food and health literacy levels. Furthermore, this study aims to explore the associations of self-perceived food literacy (SPFL) and health promotion literacy (HPL) in BMI.Methods: A cross-sectional study was conducted among employees with a low and medium level of education. Descriptive analyses were performed to compute SPFL and HPL levels. Analyses of variance were performed to test differences between subgroups. The correlation between SPFL and HPL was computed by Pearson's r. Multivariate linear regression analyses were used to explore 1) the association between SPFL and HPL adjusted for demographic characteristics 2) the associations between SPFL and HPL in BMI.Results: The majority (63.1%) of all participants (n = 222) scored low on SPFL and 34.5% scored inadequate or problematic on HPL. No significant educational or weight-status differences were found in SPFL or HPL levels. On most levels, women compared to men and older compared to younger employees scored significantly higher. A small positive correlation between the two mean levels was found, r = .25, P < .001 (n = 203). Multivariate linear regression analyses showed a significant association between SPFL and HPL (B = .31, 95% CI = .15-.48). No significant associations between SPFL and HPL in BMI were found.Conclusions: This study suggests there is room for improvement in SPFL and HPL among adults with a low and medium level of education. Future research should consider comparing low and middle socioeconomic with high socioeconomic groups when exploring food and health literacy. Regarding health promotion activities for adults with a low and medium level of education, it is recommended to focus on improving both food and health literacy. Furthermore, more research is needed to explore direct proxies of weight-status to better understand the role of food and health literacy in overweight patterns. [ABSTRACT FROM AUTHOR]

PURPOSE: Neuroendocrine carcinomas and mixed neuroendocrine non-neuroendocrine neoplasms of the gallbladder (NE GBC) are rare and highly aggressive entities. The cell of origin of NE GBC has been a matter of controversy. Here, we performed a comparative histopathologic and molecular analysis of NE GBC cases and, if present, associated precancerous lesions. PATIENTS AND METHODS: We selected cases diagnosed between 2000 and 2019 in the Netherlands. Precursors and carcinomas were immunohistochemically compared and analyzed for mutations, gene amplifications, microsatellite instability, and tumor mutational burden using an next-generation sequencing panel containing 523 cancer-related genes. In addition, presence of fusion genes was analyzed using a panel of 55 genes. RESULTS: Sixty percent of neuroendocrine cases (6/10) presented with a precursor lesion, either intracholecystic papillary neoplasm (n = 3) or biliary intraepithelial neoplasia (n = 3). Immunohistochemically, neuroendocrine components were different from the epithelial precursor lesions. Molecular profiling, however, revealed TP53 mutations shared between different components in five of six cases, indicating a clonal relation. Furthermore, 40% of cases (4/10) harbored at least one potentially actionable alteration. This included (likely) pathogenic mutations in RAD54L , ATM , and BRCA2 ; amplifications of ERBB2 and MDM2 ; and a gene fusion involving FGFR3-TACC3. All cases were microsatellite-stable and had a tumor mutational burden of < 10 mutations/Mb. CONCLUSION: Our data provide insight into the development of NE GBC and suggest a common origin of precancerous epithelial lesions and invasive neuroendocrine components, favoring the hypothesis of lineage transformation. Moreover, nearly half of the NE GBCs carried at least one potentially actionable molecular alteration, highlighting the importance of molecular testing in this highly lethal cancer. [ABSTRACT FROM AUTHOR]

Platinum‐based chemotherapy is not standard of care for unselected or genetically selected metastatic castration‐resistant prostate cancer (mCRPC) patients. A retrospective assessment of 71 patients was performed on platinum use in the Netherlands. Genetically unselected patients yielded low response rates. For a predefined subanalysis of all patients with comprehensive next‐generation sequencing, 30 patients were grouped based on the presence of pathogenic aberrations in genes associated with DNA damage repair (DDR) or aggressive variant prostate cancer (AVPC). Fourteen patients (47%) were DDR deficient (DDRd), of which seven with inactivated BRCA2 (BRCA2mut). Six patients classified as AVPC. DDRd patients showed beneficial biochemical response to carboplatin, largely driven by all BRCA2mut patients having >50% prostate‐specific antigen (PSA) decline and objective radiographic response. In the wild‐type BRCA2 subgroup, 35% had a >50% PSA decline (P =.006) and 16% radiographic response (P <.001). Median overall survival was 21 months for BRCA2mut patients vs 7 months (P =.041) for those with functional BRCA2. AVPC patients demonstrated comparable responses to non‐AVPC, including a similar overall survival, despite the poor prognosis for this subgroup. In the scope of the registration of poly‐(ADP)‐ribose polymerase inhibitors (PARPi) for mCRPC, we provide initial insights on cross‐resistance between PARPi and platinum compounds. By combining the literature and our study, we identified 18 patients who received both agents. In this cohort, only BRCA2mut patients treated with platinum first (n = 4), responded to both agents. We confirm that BRCA2 inactivation is associated with meaningful responses to carboplatin, suggesting a role for both PARPi and platinum‐based chemotherapy in preselected mCRPC patients. What's new? Platinum‐based chemotherapy is not standard of care for unselected or genetically‐selected patients with metastatic castration‐resistant prostate cancer (mCRPC). However, several studies have shown that platinum‐based chemotherapy may still have a role in postponing progression in selected patient groups. This new study investigating DNA damage repair gene alterations and response to platinum‐based chemotherapy provides evidence that deep and durable responses are primarily associated with patients harbouring BRCA2 inactivation. Based on these data and the limited available literature, platinum‐based chemotherapy followed by PARP inhibition is potentially emerging as the optimal treatment sequence in pre‐selected mCRPC patients. [ABSTRACT FROM AUTHOR]

It is not uncommon for a flood defence to be combined with other societal uses as a multifunctional flood defence, from housing in urban areas to nature conservation in rural areas. The assessment of the safety of multifunctional flood defences is often done using conservative estimates. This study synthesizes new probabilistic approaches to evaluate the safety of multifunctional flood defences employed in the Netherlands and explores the results of these approaches. In this paper a case representing a typical Dutch river dike combining a flood safety function with a nature and housing function is assessed by its probability of failure for multiple reinforcement strategies considering multiple relevant failure mechanisms. Results show how the conservative estimates of multifunctional flood defences lead to a systematic underestimation of the reliability of these dikes. Furthermore, in a probabilistic assessment uncertainties introduced by multifunctional elements affect the level of safety of the dike proportional to the reliability of the dike itself. Hence, dikes with higher protection levels are more suitable to be combined with potentially harmful uses for safety, whereas dikes with low protection levels can benefit most from uses that contribute to safety. [ABSTRACT FROM AUTHOR]

Background: Need for help is perceived as an important first step towards weight related health-care use among overweight and obese individuals and several studies have reported gender as an important predisposing characteristic of need for help. Therefore, the goal of the current study is to gain insight into factors that might determine need for help for weight loss in men and women.Methods: In the current study, data from the Dutch cross-sectional survey Health Monitor 2012 was used. Overweight and obese men (N = 2218) and women (N = 2002) aged 19-64 years were selected for the current study. Potential predictors of need for help were age, ethnicity, marital status, educational level, perceived health, weight status, comorbidities, physical activity level, and income. Multiple logistic regression analyses were conducted separately among men and women to establish prediction models of need for help for weight loss.Results: The mean age of the adult women in this study population was 47.7 years and 68% was medium educated, whereas the mean age of men was 49.0 years and 63.0% was medium educated. Of the respondents, 24.9% indicated they either felt a need for help for weight loss, 6.4% already received help and 68.7% felt no need for help. Women were more likely to indicate a need for help than men (OR = 2.17). Among both genders, need for help was significantly predicted by obesity (ORmen = 3.80, ORwomen = 2.20) and "poor" perceived health (ORmen = 2.14, ORwomen = 1.94). Besides, "unmarried" (ORmen = 1.57) and suffering from comorbidities (ORmen = 1.26) predicted need for help among men. Whereas among women, need for help was predicted by younger age (i.e. 19-34 years (ORwomen = 2.07) and 35-49 years (ORwomen = 1.35)).Conclusion: The current study revealed specific predictors of need for help for weight loss for men and women. Among men, the strongest predictors were obesity and poor perceived health, whereas among women need for help was most strongly predicted by obesity and young age. Insight into these specific predictors enables health professionals to reach overweight individuals with a need for help for weight loss by connecting their need to available support. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQoL) is widely used as an outcome measure in the evaluation of treatment interventions in patients with chronic obstructive pulmonary disease (COPD). In order to address challenges associated with existing fixed-length measures (e.g., too long to be used routinely, too short to ensure both content validity and reliability), a COPD-specific item bank (COPD-SIB) was developed.Methods: Items were selected based on literature review and interviews with Dutch COPD patients, with a strong focus on both content validity and item comprehension. The psychometric quality of the item bank was evaluated using Mokken Scale Analysis and parametric Item Response Theory, using data of 666 COPD patients.Results: The final item bank contains 46 items that form a strong scale, tapping into eight important themes that were identified based on literature review and patient interviews: Coping with disease/symptoms, adaptability; Autonomy; Anxiety about the course/end-state of the disease, hopelessness; Positive psychological functioning; Situations triggering or enhancing breathing problems; Symptoms; Activity; Impact.Conclusions: The 46-item COPD-SIB has good psychometric properties and content validity. Items are available in Dutch and English. The COPD-SIB can be used as a stand-alone instrument, or to inform computerised adaptive testing. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine the one-year mortality rate and its predictors regarding long-term intensive care-treated patients together with their health-related quality of life (HRQL), place of living, healthcare use and long-term complication characteristics after intensive care unit (ICU) discharge. Methods: A retrospective cohort study was performed in a 20-bed mixed ICU. The patients that were treated for more than 72 h between 2007 and 2012 were included in this study. The one-year mortality rate was calculated, and the characteristics of the ICU survivors that died within one year after ICU discharge were further analysed. For all patients, the Dutch version of the SF-36 questionnaire was used to assess their current HRQL. The results were compared with a normal population. Additionally, patients were questioned about their place of living, and their general practitioners (GPs) were questioned about the patients' possible long-term complications. Results: Seven hundred and forty patients were included in this study, and their one-year mortality rate was 28 %, of which half died within the first week after ICU discharge. The one-year mortality rate predictors included age at the time of ICU admission, APACHE IV-predicted mortality score, number of comorbidities and ICU re-admissions. The ICU survivor HRQL was significantly lower compared with the normal population. Half of the patients did not return to their pre-hospital place of living, and numerous possible long-term complications were reported, particularly decreased tolerance, chronic fatigue and processing problems of relatives. Conclusions: One-year mortality rate of long-term ICU-treated patient was 28 %, and this was predicted by age, disease severity, comorbidities and ICU re-admissions. The ICU survivors reported a lower HRQL, and a minority of these patients returned home directly after hospital discharge; however, GPs reported numerous possible long-term complications. [ABSTRACT FROM AUTHOR]

Background: It is generally assumed that supermarkets promote unhealthy foods more heavily than healthy foods. Promotional flyers could be an effective tool for encouraging healthier food choices; however, there is a lack of good-quality evidence on this topic. Therefore, the aim of this study was to determine the proportions of healthy and unhealthy foods on promotion in Dutch supermarket flyers. Methods: Supermarket food promotions were assessed using the weekly promotional flyers of four major Dutch supermarkets over a period of eight weeks. All promotions were evaluated for healthiness, price discount, minimum purchase amount, product category and promotion type. The level of healthiness consists of a 'healthy' group; products which have a positive effect on preventing chronic diseases and can be eaten every day. The 'unhealthy' group contain products which have adverse effects on the prevention of chronic diseases. Data were analysed using ANOVA, independent t-tests and chi-square tests. Results: A total of 1,495 promotions were included in this study. There were more promotions in the unhealthy category; 70% of promotions were categorised as unhealthy. The price discount was greater for the healthy promotions (mean 29.5%, SD 12.1) than for the two categories of unhealthy promotions (23.7%, SD 10.8; 25.4%, SD 10.5, respectively), a tendency which was mainly due to discounts in the fruit and vegetables category. To obtain the advertised discount, a significantly higher number of products had to be purchased in the unhealthy category than in the healthier categories. Promotions in the category meat, poultry and fish category occurred frequently. Compared to traditional supermarkets, discounter supermarkets had higher percentages of unhealthy food discounts, lower discount levels and lower minimum purchase amounts. Conclusion: This research confirmed that unhealthy foods are more frequently advertised than healthier foods in Dutch supermarket flyers. Moreover, consumers had to buy more products to achieve the discount when the promotion was categorized as unhealthy, providing extra incentive for buying additional unhealthy products. Future research should explore the proportion of healthy and unhealthy food discounts in relation to supermarkets' total product range, to determine if unhealthy products are over-represented in promotions or if there are more unhealthy products stocked in supermarkets overall. The findings of this study provide an important basis for future intervention and policy development aiming to achieve healthier supermarket environments. [ABSTRACT FROM AUTHOR]

Process evaluations can help us to better interpret intervention effects and provide guidance in improving interventions. This study describes the use and appreciation of FATaintPHAT, a computer-tailored intervention to prevent excessive weight gain in adolescents and link these data to the intervention effects. Use and appreciation were assessed among students (12–13 years old) from the intervention group of the FATaintPHAT evaluation study, using computer log (n = 458) and questionnaire data (n = 233, 48% response). Differences in use and appreciation between socio-demographic groups (gender, education, ethnicity, weight category), and associations with behavioural outcomes were analysed using descriptive and regression analyses. The results showed that a majority of the students (81%) was exposed to all intervention modules and 73% reported to have put the advice into practise. Half and one-third of the students appreciated the tailored advice positively and neutrally, respectively. Students attending vocational training appreciated FATaintPHAT better than students attending university preparation education. No associations were found between behavioural outcomes with appreciation and use. In conclusion, the school-based FATainPHAT intervention was used and appreciated well among adolescents. The fact that the intervention was appreciated better among the lower compared with higher educated students indicates that the technique of computer-tailoring is also suitable for lower educated students.Trial registration: Netherlands Trial Registry, ISRCTN 15743786. [ABSTRACT FROM PUBLISHER]

Introduction. This study investigates the association between ethnic background and overweight (obesity included) among 5 year olds. Methods. We used baseline data from 5 year olds (n = 7801) and their parents collected for the "Be active, eat right" study. A child was considered to be of non-Dutch ethnic background when at least one of the parents was born abroad. Odds ratios (ORs) were adjusted for sociodemographic characteristics. Results. Compared to children of Dutch ethnic background, for children with a Moroccan ethnic background the OR for being overweight (obesity included) was 2.27 (95% CI 1.48-3.47), for Turkish children the OR was 3.63 (95% confidence interval (CI) 2.46-5.35), for Antillean children the OR was 1.97 (95% CI 1.01-3.86), and for Surinamese children the OR was 0.47 (95% CI 0.20-1.06). Addition of parental overweight decreased the ORs for Moroccan and Turkish children by 10.2% and 12.5%, and addition of watching TV and having breakfast by the child decreased the ORs by 7.9% and 12.2%. Conclusion. Already at a young age, children of Moroccan and Turkish ethnic background are at increased risk for being overweight compared to Dutch children. Parental overweight, watching TV, and not having breakfast by the child are contributing factors in this association. [ABSTRACT FROM AUTHOR]

This study was carried out to support and enhance a series of global studies assessing contemporary and future changes in nutrient export from watersheds (Global Nutrient Export from Watersheds (NEWS)). Because hydrography is one of the most important drivers in nutrient transport, it was essential to establish how climatic changes and direct human activities primarily irrigation and reservoir operations) affect the hydrological cycle. Contemporary and future hydrography was established by applying a modified version of a global water balance and transport model (WBMplus) driven by present and future climate forcing, as described in the Millennium Ecosystem Assessment scenarios (1970-2050). WBMplus represents a major upgrade to previous WBM implementations by incorporating irrigational water uptake and reservoir operations in a single modeling framework. Contemporary simulations were carried out by using both observed climate forcings from the Climate Research Unit of East Anglia (CRU) data sets and from Global Circulation Model (GCM) simulations that are comparable to the future simulations from the same GCM forcings. Future trends in three key human activities (land use, irrigation, and reservoirs operation for hydropower) were taken from the Integrated Model to Assess the Global Environment (IMAGE). The reservoir operation required establishing a realistic distribution of future reservoirs since the IMAGE model provided only the hydropower potentials for the different future scenarios. [ABSTRACT FROM AUTHOR]

In 1986, the first nationwide epidemiological survey of adult oral health and attitudes to oral health care was carried out in The Netherlands. One of the aims of this study was to evaluate the prevalence and the quality (in terms of need for replacement) of amalgam and composite restorations in the Dutch adult population. A group of 600 dentate individuals, 20-44 years of age, was examined. Stratified cluster sampling included as factors age, gender, socio-economic status, and area of residence. Two additional parameters were studied: frequency of visiting a dentist and type of health insurance. Oral examinations consisted of direct (mirror and explorer) and indirect (color slides and bite-wing radiographs) observations with use of well-defined criteria. On average, 13.4 restorations per individual were present, of which 23.3% were classified as unsatisfactory. A great difference in prevalence and quality data was found among several types of restorations. Test results (ANOVA) for effects of age, gender, socioeconomic status, area of residence, frequency of visiting a dentist, and insurance on the prevalence of unsatisfactory restorations resulted nearly always in significant effects of only age and frequency of visits to a dentist. There was a tendency (p<0.05) for the prevalence of unsatisfactory restorations to be higher with increasing age. For individuals visiting a dentist infrequently (once or not at all in the past two years), the prevalence of restorations was lower, and the percentage of unsatisfactory restorations was higher, in comparison with individuals visiting a dentist frequently. The two major reasons for the scoring of restorations as clinically unacceptable were approximal ledges (43%) in class II restorations and marginal (secondary) caries (57%) in all other types of restorations. [ABSTRACT FROM AUTHOR]

The aim of the study was to estimate the prevalence of probable food allergy in adolescents aged 11-20 and to examine the frequency of epinephrine autoinjector (EAI) ownership among high-risk individuals. Adolescents were screened followed by a more detailed telephone questionnaire inquiring about suspected food(s), symptoms, diagnosis, and use of an EAI. The participating adolescents were classified as probably or unlikely to be food-allergic. The need for an EAI was assessed. In total, 2284 adolescents completed the screening questionnaire, of which 396 indicated food to be a problem and 168 agreed to be interviewed. Forty-eight adolescents were classified as probably food-allergic, of which eight were not aware of their food allergy. Twenty-three adolescents were considered candidates for an EAI, whereas only two of them had been prescribed this medication. The calculated questionnaire- based prevalence of EAI need was 3.0% (minimal prevalence at least 1.0%), whereas the EAI ownership was 0.09%. In conclusion, we found an alarming under prescription of EAIs in school-going adolescents. [ABSTRACT FROM AUTHOR]

This paper presents emissions estimates of nitrous oxide (N2O) from The Netherlands (1980-2015), investigates technical mitigation options and compares results to possible goals. Projections based on reference policies result in increasing emissions: by 2000, 2010, and 2015 Dutch N2O emissions will exceed the 1990 level by 1%, 6% and 10%, respectively. This is a net effect of decreasing agricultural and "other" emissions, and increasing emissions from energy, industry, and waste. In particular, emissions from transport increase due to introduction of 3-way catalytic converters. The results indicate that implementation of National Environmental Policy Plan 2 (NEPP-2) will not result in stabilization of emissions at the 1990 level after 2000. Additional policies are calculated to reduce Dutch emissions to about 25% below the 1990 level, most of which results from catalytic N2O reduction in industrial nitric acid production. A much further reduction, in line with long-term policy targets, would require new technologies, or reductions in energy use, transportation, and fertilizer use. [ABSTRACT FROM AUTHOR]

A six-step methodology for estimating use (Steps 1-5) and emissions (Step 6) of fluorocarbons not regulated under the Montreal Protocol and SF6 has been described, to improve insight into emissions in the Netherlands. The last step is largely in line with methods applied in the annual AFEAS reports and under discussion within the IPCC, and estimates HFCs, PFCs, FICs and SF6 released as the sum of (1) emission from compounds used as substitutes for ozone-depleting compounds (2) emissions due to SF6's historical market and (3) emissions from otherindustrial processes. Emissions in the Netherlands were estimated for scenarios assuming that the Montreal protocol will be implemented. Without additional measures (reference scenario emissions of HFCs, PFCs, FICs and SF6 increase from 878 (metric) tons in 1990 to 6983 tonsin 2020. In 2020 emissions are estimated to be about 21 Mt CO2 equivalents, or 13% of the CO2 target for that year (i.e. stabilization at the 2000 level). Assuming maximum emission control through good housekeeping, recycling and waste destruction, emissions are 40-50% lower than in the no-control scenarios. The closed applications only scenario assumes use of these compounds to be restricted to stationary cooling and closed-foam blowing. In this scenario,emissions are 15-25% (no-control case) and 50-60% (maximum emission control case) lower than in the reference scenario. Reductions up to 90% are found in the low-GWP scenario, assuming an average Global Warming Potential of the mix of compounds used of 250 or less. [ABSTRACT FROM AUTHOR]

Effective adaptation to sea-level rise is critical to protect people and their livelihoods from floods in the future. One solution to mitigate the threat of sea-level rise is to utilise the natural sedimentation in coastal wetlands as a sustainable resource to reinforce the dikes. A wide, gently sloping grass-covered dike known as a 'wide green dike' can be constructed out of the locally accreted material. However, this system of dike and wetland not only needs to provide sufficient protection against floods but also ensure enough sediment remains available for the wetland to restore itself and grow in conjunction with the uncertain sea-level rise. This study investigates the sustainability of the multifunctional use of wetlands as a resource for flood protection against sea-level rise.This study looks at a wetland-dike system in the Ems-Dollart estuary, the Netherlands, as a case-study where pilots are being conducted by multiple parties within the Dutch high water protection program with the aim to convert local sediment and dredge spoil into clay. The objective of the pilots is that the wetland-dike system is safe enough to satisfy the Dutch national safety standard (the Ultimate Limit State). This study also incorporates the sustainability aspect of maintaining sufficient sedimentation within the wetland for future reinforcement measures (Serviceability Limit State). The failure probabilities of both limit states are evaluated to determine the safety provided by the wide green dike and its sustainability. To this end we combine a basic sedimentation model and a probabilistic assessment of dike failure under multiple sea-level rise scenarios. By assessing both wave impact on the grass revetment and overtopping over the dike crest the optimal design for a coastal grass dike that requires the least amount of clay under these scenarios is determined and compared with the availability of sediment that can be expected from sedimentation in the wetland. [ABSTRACT FROM AUTHOR]

Abstract: Agriculture contributes to global warming through emissions of nitrous oxide, and methane, and to acidification mainly through emissions of ammonia. Measures to reduce one of these gases may affect emissions of others. Policies neglecting these interrelations may be sub_optimal. This study investigated interrelations between abatement of ammonia, nitrous oxide, and methane from European agriculture. We first studied how emission reduction technologies simultaneously affect the emissions of these three gases. Next, we analyzed for the Netherlands how the costs of emission reduction are affected when these interrelations are included in the analysis. Cost_effectiveness analysis of emission reductions in agriculture in the Netherlands indicates that increased nitrous oxide emissions due to ammonia abatement can be avoided at low cost. Finally we calculated at the European level the side_effects on ammonia emissions and the greenhouse gases nitrous oxide and methane of various emissions scenarios for European agriculture. We estimated that nitrous oxide emissions from European agriculture may increase as a side_effect of ammonia abatement, whereas ammonia emissions may decrease due to nitrous oxide and methane mitigation. The conclusion is that simultaneous reductions in emissions can be realized at lower overall costs using an integrated approach. [Copyright &y& Elsevier]

Context: Reducing health inequalities is a policy priority in many developed countries. Little is known about effective strategies to reduce inequalities in obesity and its underlying behaviors. The goal of the study was to investigate differential effectiveness of interventions aimed at obesity prevention, the promotion of physical activity or a healthy diet by SES. Evidence acquisition: Subgroup analyses in 2010 and 2011 of 26 Dutch studies funded by The Netherlands Organization for Health Research and Development after 1990 (n=17) or identified by expert contact (n=9). Methodologic quality and differential effects were synthesized in harvest plots, subdivided by setting, age group, intensity, and time to follow-up. Evidence synthesis: Seven lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. One study in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES. Individually tailored and workplace interventions were either more effective in higher-SES groups (n=4) or no differential effects were demonstrated (n=9). School-based studies (n=7) showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups. Conclusions: Although for the majority of interventions aimed at obesity prevention, the promotion of physical activity, or a healthy diet, no differential effectiveness could be demonstrated, interventions may widen as well as reduce socioeconomic inequalities in these outcomes. Equity-specific subgroup analyses contribute to needed knowledge about what may work to reduce socioeconomic inequalities in obesity and underlying health behaviors. [Copyright &y& Elsevier]