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Background: People with chronic conditions have complex healthcare needs that lead to challenges for adequate healthcare provision. Current healthcare services do not always respond adequately to their needs. A modular perspective, in particular providing visualization of the modular service architecture, is promising for improving the responsiveness of healthcare services to the complex healthcare needs of people with chronic conditions. The modular service architecture provides a comprehensive representation of the components and modules of healthcare provision. In this study, we explore this further in a qualitative multiple case study on healthcare provision for children with Down syndrome in the Netherlands. Methods: Data collection for four cases involved 53 semi-structured interviews with healthcare professionals and 21 semi-structured interviews with patients (the parents of children with Down syndrome as proxy). In addition, we gathered data by means of practice observations and analysis of relevant documents. The interviews were audio-recorded, transcribed verbatim and analyzed utilizing the Miles and Huberman approach. Results: Our study shows that the perspectives on healthcare provision of professionals and patients differ substantially. The visualization of the modular service architecture that was based on the healthcare professionals' perspective provided a complete representation of (para)medical outcomes relevant to the professionals' own discipline. In contrast, the modular service architecture based on the patients' perspective, which we define as a person-centered modular service architecture, provided a representation of the healthcare service that was primarily based on functional outcomes and the overall wellbeing of the patients. Conclusion: Our study shows that visualization of the modular service architecture can be a useful tool to better address the complex needs and requirements of people with a chronic condition. We suggest that a person-centered modular service architecture that focuses on functional outcomes and overall wellbeing, enables increased responsiveness of healthcare services to people with complex healthcare needs and provision of truly person-centered care. [ABSTRACT FROM AUTHOR]

Objective: Adaptive cruise control (ACC), a technology that allows for automated car following, is becoming increasingly prevalent. Previous surveys have shown that drivers generally regard ACC as pleasant but that they have to intervene when the ACC reaches its operational limits. The former research has been mostly concerned with specific car brands and does not fully reflect the diversity of ACC types in traffic today. The objective of the present research was to establish the determinants of pleasure in using ACC.Methods: A 55-item online questionnaire was completed by Dutch users of diverse ACC systems.Results: Respondents (N = 182) rated their ACC highly, with a mean score of 8.0 on a scale from 1 (extraordinarily negative) to 10 (extraordinarily positive) and were most pleased with ACC on high-speed roads and in low-density traffic. Moreover, the findings point to specific operational limits such as associated with cut-in situations. Pleasure was greater for the types of ACC that are able to decelerate to a full stop, according to 48% of our sample. An analysis of the free-response items indicated that respondents who were displeased with ACC mentioned its occasional clumsiness and the dangerous situations it may evoke, whereas those who were pleased with ACC valued the complementarity of human and machine and emphasized the roles of responsibility and experience in using ACC.Conclusion: Pleasure in using ACC is a function of both technological advances and human factors. [ABSTRACT FROM AUTHOR]

The article discusses the provisions of the improved corporate governance regulation in Netherlands. It explores the different lapses of the country's current corporate law, which prompted government officials to consider the revisions proposed by the Peters Committee, which suggests the importance of restoring the right and position of shareholders. An overview of the changes in the 2004 version of corporate governance regulation in the country is offered.

Introduction: Despite their important role in the economy, truck drivers face several challenges, including adapting to advancing technology. The current study investigated the occupational experiences of Dutch truck drivers to detect common patterns., Methods: A questionnaire was distributed to professional drivers in order to collect data on public image, traffic safety, work pressure, transport crime, driver shortage, and sector improvements., Results: The findings based on 3,708 respondents revealed a general dissatisfaction with the image of the industry and reluctance to recommend the profession. A factor analysis of the questionnaire items identified two primary factors: 'Work Pressure', more common among national drivers, and 'Safety & Security Concerns', more common among international drivers. A ChatGPT-assisted analysis of textbox comments indicated that vehicle technology received mixed feedback, with praise for safety and fuel-efficiency improvements, but concerns about reliability and intrusiveness., Discussion: In conclusion, Dutch professional truck drivers indicate a need for industry improvements. While the work pressure for truck drivers in general may not be high relative to certain other occupational groups, truck drivers appear to face a deficit of support and respect., Competing Interests: AC is CEO of Transporteffect BV and Chauffeurnieuws. He was not involved in the current analysis and interpretation of the data. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 de Winter, Driessen, Dodou and Cannoo.)

Introduction: In the Netherlands, medical decision-making without parental permission is allowed from the age of 16. The aim of this study was to examine parents' knowledge of this age-based framework to discover potential knowledge gaps that hinder the communication between doctors, parents, and their children., Methods: Survey-based research was conducted to examine parents' knowledge of the age-based framework that applies to minors in Dutch healthcare. The survey was based on 5 topics: medical diagnosis and treatment, medical advice, reproductive and sexual health services, abortion, and euthanasia. The survey was sent to 1,010 Dutch parents, aged 35-55 years, with at least one child. The data were analysed using SPSS. Percentages and means were calculated., Results: Parental knowledge of the age-based framework varied depending on the topic., Conclusion: This study provides insights into parents' current level of knowledge of the age-based framework that applies to minors in Dutch healthcare. This information is useful in the conversation between health care professional, parents, and their children.

Objective: Patient trust and consent are complex topics for health care workers in pediatrics, specifically when relating to adolescent's legal status. In the context of medical decisions, not much work has been performed to understand the opinion of parents on health care decision-making, especially on confidentiality concerning their adolescent children. The purpose of this research was to assess the parental opinions on these decisions and the influence of different perspectives., Methods: We used a case-based methodology to assess parental opinions on fictional medical decisions. A survey was provided to parents in 2 pediatric outpatient departments in Belgium and the Netherlands. The survey contained cases regarding medical care related to confidentiality and consent about which participants gave their opinion., Results: In total, 222 surveys were completed. Overall, most parents would allow an adolescent to make his/her own decision (58.6%-70.4%), except in the case of confidentiality on alcohol-related trauma (28.9%). The results show a significant difference in how parents responded when answering from the parental perspective or adolescents' perspective. They granted significantly more authority to the adolescent in the latter view., Conclusion: Our study shows that parents who were confronted with cases from an adolescent perspective were significantly more likely to give the patient authority. In addition, the medical issue and context influence how the parents responded. These data provide insight into the parental opinions and could lead to more evidence-based frameworks for shared medical decision-making of adolescents and their parents., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective : Axial spondyloarthritis (axSpA) is a chronic inflammatory joint disease that usually presents with axial symptoms, but can also present with peripheral and extra-articular manifestations. It occurs equally in females and males. The diagnostic delay for axSpA is 5-7 years, and is significantly longer in females than in males. The aim of this study is to investigate the difference in disease characteristics between females and males with axSpA and to stratify this difference according to human leucocyte antigen (HLA)-B27 status. Method : Clinical characteristics, spondyloarthritis (SpA) features, disease activity parameters, X-rays of sacroiliac joints, and laboratory results were assessed in a real-life cross-sectional cohort of 389 patients with a clinical diagnosis of axial or peripheral SpA, and compared between genders. Results : Of 389 patients included, 313 had a clinical diagnosis of axSpA [females vs males, 131 (42%) vs 182 (58%), respectively]. Females had less radiographic axSpA according to the modified New York criteria (38.9% vs 63.7%, respectively), had a higher erythrocyte sedimentation rate [(median (interquartile range) 11 (5-23) vs 8 (3-16) mm/h), and reported higher disease activity by the Bath Ankylosing Spondylitis Disease Activity Index (mean ± sd 5.2 ± 2.1 vs 4.6 ± 2.2). No differences were found in clinical characteristics or SpA features, or when stratifying for HLA-B27 status. Conclusions : In this real-life cohort of patients with axSpA, although males more often had structural damage on X-rays, females had similar disease with regard to SpA features and at least equal disease activity parameters compared to males.

Vitamin K-deficiency can cause haemorrhage in newborns and infants from the first hours up to several months after birth. These 'vitamin K deficiency bleedings' (VKDB) can be divided into 3 forms: early (occur in the first hours after birth), classic (first week after birth) and late (between the 2nd and the 12th week of life). The current Dutch vitamin K practice guideline consists of prophylactic administration of 1 mg vitamin K orally directly after birth and a daily dose of 25 μg from day 8 onwards. The current prophylactic treatment provides good protection against VKDB for healthy, breastfed infants. However, the current prophylactic treatment provides insufficient protection for a specific group of infants, namely breastfed infants with defective fat absorption (in cholestasis), leading to less efficient absorption of vitamin K by the body. Anually approximately 5 infants from this group suffer serious haemorrhage. After evaluation of current literature and advice from The Health Council of the Netherlands, vitamin K dosage was adapted for all breastfed infants from day 8 to 3 months (12th week of life) following birth: the daily dose was raised from 25 µg to 150 µg per day.

During the summer of 2006 in the paediatric ward of the Spaarne Hospital in Hoofddorp, the Netherlands, a large number of children were admitted with a coxsackievirus type-B infection, one of the enteroviruses. A total of 27 children were diagnosed with this virus. Patient A, a one-month-old boy, was admitted with fever. The spinal fluid showed a high leukocyte count. He was treated with amoxicillin, ceftriaxon and acyclovir, and recovered rapidly. The spinal fluid culture was positive for coxsackievirus type B5. Patient B, a 3-year-old girl, presented with attacks of abdominal pain and groaning respiration. Infection parameters were mildly elevated. The chest X-ray was normal. She was admitted for observation and recovered spontaneously. Viral faeces culture revealed coxsackievirus type B4. Rapid recognition of an enterovirus infection is important to prevent unnecessary diagnostic and therapeutic interventions. PCR is a diagnostic technique of great importance.

Introduction: Gender differences were investigated in a sample of persons (N=34,755) who completed the driver's license theory test in the Netherlands., Results: Contrary to recent findings from Sweden, no gender differences were found., Impact of Industry: The present study signifies the importance of standardization in driver testing.

Three healthy boys, 3.5, 5 and 1.5 years of age, were admitted to hospital with a severe bacterial skin infection, cerebellar ataxia, and pneumonia, respectively, one week after the onset of varicella. They recovered completely after treatment. Studies in Europe report complications from varicella in 2.5% of healthy children. Most of these are neurological complications and secondary bacterial infections of skin and soft tissue. Last year, a European consensus was published that recommended that all healthy children be vaccinated against chickenpox. In The Netherlands, routine varicella zoster virus (VZV) vaccination has not (yet) been implemented. We propose a new discussion on the possible inclusion of VZV vaccination in the national vaccination programme.

With use of a model of the costs and effects of cholesterol lowering therapy in the primary prevention of coronary heart disease, the cost-effectiveness of simvastatin and cholestyramine in the Netherlands have been estimated. Costs per year of life saved by cholestyramine therapy are several times greater than those of simvastatin therapy and compared unfavorably with those of generally accepted health care programs in the Netherlands. Cholesterol-lowering with simvastatin in men can be cost-effective when therapy is initiated at an early age. At cholesterol levels between 6.5 and 8 mmol/l, however, therapy should be restricted to men with at least one, preferably two additional risk factors such as hypertension or diabetes mellitus. Among women, cholesterol lowering can only be cost-effective when therapy is limited to women with diabetes mellitus or severely elevated serum cholesterol levels.