Netherlands

The dislocated, deterritorialized discourse produced by repatriates from formerly European colonies has remained overlooked in academic scholarship. One such group is the Eurasian “Indo” community that has its roots in the former Dutch East Indies, today’s Indonesia. This article focuses on Tjalie Robinson, the intellectual leader of this community from the 1950s to the mid-1970s. The son of a Dutch father and a British-Javanese mother, Robinson became the leading voice of the diasporic Indo community in the Netherlands and later also in the United States. His engagement resulted in the foundation of the Indo magazine Tong Tong and the annual Pasar Malam Besar, what was to become the world’s biggest Eurasian festival. Robinson played an essential role in the cultural awareness and self-pride of the eventually global Indo community through his elaboration of a hybrid and transnational identity concept. By placing his focus “tussen twee werelden” (in-between two worlds) and identifying “mixties-schap” (mestizaje) as the essential characteristic of Indo identity, Robinson anticipated debates on hybridity, transnationalism, and creolism that only much later would draw attention from scholars in the field of postcolonial studies. This article highlights Robinson’s pioneering role in framing a deterritorialized hybrid alternative to nationalist essentialism in the postcolonial era.

We present results from a genome-wide association study for variants associated with human pigmentation characteristics among 5,130 Icelanders, with follow-up analyses in 2,116 Icelanders and 1,214 Dutch individuals. Two coding variants in TPCN2 are associated with hair color, and a variant at the ASIP locus shows strong association with skin sensitivity to sun, freckling and red hair, phenotypic characteristics similar to those affected by well-known mutations in MC1R.

For more than a decade, criticisms levied against Muslims and Islam in Western European countries such as France and the Netherlands have been shielded under the auspices of a call for increased security and a desire to protect liberal secularism. An example of this can be found in the recent move by the Dutch cabinet to implement legislation to ban the burqa in public places such as schools, hospitals, government buildings, and public transportation. The proposed Dutch ban follows the French parliament who implemented similar legislation in 2011 restricting the presence of discernible religious symbols such as burqas and niqabs from the public sphere. In a statement to the press, Prime Minister Mark Rutte, explains the proposed ban " had nothing to do with religion, " but rather it is intended to help facilitate " recognizable communication " (qtd. in " Netherlands Plans "). He clarifies " In a free country like the Netherlands, everyone has the right to dress how they choose, no matter what others think. That freedom is only limited in situations when it is essential for people to look at each other " (qtd. in " Netherlands Plans "). In this statement the restrictions placed on full face-veils are steeped in concerns of contemporary cultural conflict, inflamed by language that claims that Muslim immigrants to the Netherlands need to be better integrated. In France and the Netherlands, full face-veils have become symbols of " religious extremism " that are actively legislated against. As such they are tied to a series of judgments and evaluations that situate them as objectionable cultural objects and indicative of problematic immigrant groups. Defined as " extremist " or " politically dangerous " this vision of full face-veils is based on normative conceptions of the subject. When considered in relation to the secular, violence is done to those who are visibly different, marked by religious symbols that are understood through binaries such as objectionable/unobjectionable, Western/Eastern, Islamic/Christian, religious/secular further problematizing them. These schisms have intensified in the aftermath of 9/11 and the global war on terror creating a rift between secular and religious worldviews. There is no greater symbolic target of this schism between the secular and the religious than the burqa. The polarization of these two groups, secular and religious has gained further strength when they are posited in relation to the nation state. Within this context secularism is invoked as that which protects the state, defines it, and transforms practices related to public and private life via institutions. This paper explores the invocation of normative dispositions of secularism and security in light of the increasing restrictions placed against Muslim women in the public sphere in France and the Netherlands within dominant discourse. Drawing from the draw work of Saba Mahmood, Judith Butler, and Talal Asad I explore how bodies are marked as " different " within public spaces, through a discussion of the schism between the secular/religious. Such an examination is significant as these legislations are some of the most prohibitive in the West.

Lisbon city was the common homeland of many nations in the Early Modern period. This paper studies the signs of the Flemish / Dutch presence in the Portuguese capital, between the fifteenth and eighteenth centuries, a presence with important contributions to Portuguese civil and military technology, cultural life and specially with an active role in the Trade between Portugal and northern Europe of Overseas products (initially sugar, chilli, pastel, and afterwards «Pau-Brasil», tobacco and diamonds), as well as more traditional products, such as wine and salt. It was a community that despite the periods of diplomatic and military contingency in the sixteenth and seventeenth century (after the closure of the Portuguese factory in Antwerp and the religious wars), maintained a continuous presence in Lisbon, becoming noticed either by their wealth, marked by important urban noble houses and countryside manor houses in the outskirts, the direct exploitation of marine salt, their social organization around Lisbon’s Flemish fraternity and the 2nd generation connection with some of the wealthiest local families thus replicating the Portuguese social patterns.

Uma das características da Lisboa do início da Idade Moderna era ser a pátria comum de muitas nações. No presente texto vamos analisar os sinais da presença na capital portuguesa de uma dessas nações, a Flamenga / Holandesa, que entre os séculos XV e XVIII, além das suas importantes contribuições para a tecnologia civil e militar e para cultura, teve um papel activo no comércio de Portugal para o Norte da Europa, não só de produtos do Espaço Ultramarino (numa fase inicial, no açúcar, malagueta, pastel; e depois no pau-brasil, tabaco e pedras preciosas), como também de matérias mais tradicionais, como o Vinho e o Sal. Foi uma comunidade que apesar dos períodos de contingência diplomática e militar, manteve uma presença contínua em Lisboa com maior incidência no século XVII (depois do fecho da feitoria portuguesa de Antuérpia e das guerras religiosas), destacando-se quer pela sua riqueza, assinalada por importantes palácios citadinos e quintas nobres nos arredores, a exploração directa das marinhas de sal, a sua organização social em torno da confraria dos Flamengos, pela ligação da 2.ª geração a famílias locais mais ricas e pela integração nos padrões sociais da época.

Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. To assess national models and methods for financing and reimbursing palliative care. Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Pr...

Background: Ethnic differences in the association between central obesity and raised albumin-creatinine ratio (ACR) have not been investigated. Our aim was to determine whether the association between central obesity, defined by the waist-to-height ratio (WHtR), and ACR differed between subjects of Hindustani-Surinamese, African-Surinamese and Dutch origin. Methods: In total, 334 Hindustani-Surinamese (~South Asian), 589 African-Surinamese (~African), and 493 Dutch (~European) men and women, aged 35-60 years, randomly selected from the municipal register of Amsterdam, participated in an interview and physical examination. We calculated the WHtR by dividing the waist circumference by height and the log ACR (logACR, log mg/mmol) by log-transforming the albumin concentration by the creatinine concentration in urine. The association between WHtR and logACR was studied in the total population and stratified by ethnicity. We also tested for interaction. Results: In the total population, a higher WHtR was associated with a higher logACR, after adjustment for sex, age, and smoking, body mass index and the presence of type 2 diabetes or hypertension. Among the Hindustani-Surinamese, the adjusted association between WHtR and logACR appeared somewhat stronger than among the other ethnic groups: for every 0.1 increase in the WHtR, the log-ACR increased by 0.522 (0.096-0.949) log mg/mmol among the Hindustani-Surinamese, by 0.334 (0.047-0.622) among the African-Surinamese and by 0.356 (−0.010-0.721) among the Dutch. However, the interaction was not statistically significant. Conclusions: WHtR was associated with a higher ACR among populations of Hindustani-Surinamese, African-Surinamese and Dutch origin. Our study seems to support global use of WHtR in relation to ACR across ethnic groups. However, although not significant, the association appeared slightly stronger among the Hindustani-Surinamese than among the other ethnic groups. If confirmed, this could have implications for use of the WHtR across ethnic groups.

During a period of 21 months an analysis was made of bacteremia caused by Staphylococcus aureus in a teaching hospital for adults. During the observation period staphylococcal bacteremia was detected in 77 patients, i.e. in 1.83 cases per 1,000 admissions. Not less than 81.8% of staphylococcal bacteremia cases were hospital-acquired. The age-specific attack rate increased consistently from the sixth decade onwards. The male/female ratio was 1.96: 1. If this ratio was related to the sex ratio of patients admitted to the hospital during the observation period, statistical significance was reached for the surplus of males. Staphylococcal bacteremia contributed to death in 14 of 47 patients, i.e. 18.2%. Intravascular infection was the most prevalent source of infection (25 of 77 cases, i.e. 32.5%). Serious complications were observed in 14 cases of staphylococcal bacteremia. Eight of these patients had endocarditis and four died. Tolerance was observed with nine of 77 strains and may have influenced the reaction to antimicrobial therapy in at least one case. Zusammenfassung: Bakteriiimien durch Staphylococcus aureus in einer holliindischen Universitiitsklinik. W~ihrend eines Untersuchungszeitraumes von 21 Monaten traten in einer Universit~itsklinik for Erwachsene 77 F~ille von Bakteri~imie durch Staphylococcus aureus auf (1,83 F~ille auf 1000 Einweisungen). Davon waren nicht weniger als 81,8% Hospitalinfektionen. Die altersbezogene Inzidenz stieg regelm~iBig vom sechzigsten Lebensjahr an. M/inner waren 1,96mal h~iufiger betroffen als Frauen. Dieser h6here Anteil von M~innern war signifikant, wenn man das Ge-schlechtsverh~iltnis aller im Untersuchungszeitraum aufgenommenen Patienten mit beriicksichtigte. Sta-phylokokkenbakteri~imie fiihrte bei 14 von 47 Patienten (18,2%) zum Tode. Die am h/iufigsten vorkommende Infektionsquelle war die intravaskul~ire Infektion (25 von 77 F~illen; 32,5%). Schwere Komplikationen wurden im Verlauf von 14 Bakteri~imien beobachtet. Acht dieser Patienten hatten eine End0carditis und vier verstarben. Toleranz wurde bei 9 von 77 Sta-phylokokkenst~immen gesehen; dies k6nnte das Ansprechen auf die antimikrobielle Therapie in zumindest einem Fall beeinflugt haben.

Advances in pharmacology and technology have sharply reduced mortality of extremely preterm infants at the expense of an increasing number of survivors with handicaps and disabilities. The EURONIC study among neonatal intensive care units across Europe demonstrates that treatment of infants born at the limits of viability raises challenging ethical, moral, legal, and emotional dilemmas among neonatologists, nurses, and parents alike. When is it wise to withhold or withdraw intensive care and, if so, what are the needs of the nonviable or dying infant, family, and neonatal staff to provide a humane and compassionate death? This process begins with a thorough determination of diagnosis and prognosis, followed by decision making on the basis of futility of treatment or quality-of-life issues, and counseling of parents. Withholding or withdrawing of intensive care should be synonymous with palliative care. Perinatal audit and after-care of the family complete the process. The Dutch viewpoint and practice guidelines on withholding and withdrawing of neonatal intensive care are presented.

The Utrecht Diabetes Project (UDP) is a shared-care project providing remote diabetologist support for 85 GPs. In the UDP all examinations, performed by the GP, follow standardized procedures, results being sent to the diabetologist. Laboratory results are sent automatically to both GP and diabetologist. To study the composition of the UDP population; completeness of data recording; changes in biochemical variables of UDP patients; and GPs' motives for enrolling them. Data were extracted from the records of 19 GPs and a questionnaire was sent to all UDP GPs. Of 770 patients with Type 2 diabetes, 44% were treated with UDP support, 29% by their GPs alone, and 27% at out-patient clinics. The 336 UDP patients were representative of all UDP patients. Patients older than 75 years were the greater part of those treated by GPs alone; out-patient clinics had more patients with diabetes > 10 years or with complications. UDP patients' records were the most complete. Diabetes regulation, lipid levels and diastolic blood pressure in the UDP patients improved significantly after inclusion in the UDP. GPs tend to seek UDP aid especially for patients who are young, or of recent onset, at risk of macrovascular complications, or needing insulin. Standardized data transfer between GP, diabetologist and laboratory might establish an effective infrastructure for shared diabetes care. Diabet. Med. 18, 459-463 (2001)

We examined possible explanations for the underrepresentation of women among university faculty, in two different national contexts. In the Netherlands, a sample of doctoral students (N = 132) revealed no gender differences in work commitment or work satisfaction. Faculty members in the same university (N = 179), however, perceived female students to be less committed to their work and female faculty endorsed these gender-stereotypical perceptions most strongly. A second study, in Italy, replicated and extended these findings. Again no gender differences were obtained in the self-descriptions of male and female doctoral students (N = 80), while especially the female faculty (N = 93) perceived female students as less committed to their work than male students. Additional measures supported an explanation in social identity terms, according to which individual upward mobility (i.e. of female faculty) implies distancing the self from the group stereotype which not only involves perceiving the self as a non-prototypical group member, but may also elicit stereotypical views of other in-group members.

Objective. To evaluate the risk of severe acute maternal morbidity (SAMM) related to mode of delivery. Design. Prospectively nationwide population based cohort study. Setting. All 98 maternity units in the Netherlands. Population. All pregnant women in the Netherlands. Methods. Cases were collected during a 2-year period. Incidence was assessed for all cases and for a subgroup of cases in which a direct relation between SAMM and mode of delivery was possible. In the latter group, all cases not clearly related to mode of delivery were excluded. Incidence of cesarean section (CS) compared to (attempted) vaginal delivery was calculated, and risk of SAMM after previous CS was assessed. Main outcome measures. Incidence of SAMM by mode of delivery; odds ratios (OR). Results. The incidence of SAMM possibly related to mode of delivery was 6.4/1,000 during elective CS compared to 3.9/1,000 during attempted vaginal delivery (OR 1.7: 95% CI 1.4-2.0). Women with a previous CS were at increased risk for SAMM in their present pregnancy (OR 3.0: 95% CI 2.7-3.3). Conclusion. CS in a previous as well as present pregnancy increased the risk of SAMM. The risk remained increased after excluding those cases where SAMM was not clearly related to mode of delivery.

Background: Departing from the hypotheses that over the past decades patients have become more active participants and physicians have become more task-oriented, this study tries to identify shifts in GP and patient communication patterns between 1986 and 2002. Methods: A repeated cross-sectional observation study was carried out in 1986 and 2002, using the same methodology. From two existing datasets of videotaped routine General Practice consultations, a selection was made of consultations with hypertension patients (102 in 1986; 108 in 2002). GP and patient communication was coded with RIAS (Roter Interaction Analysis System). The data were analysed, using multilevel techniques. Results: No gender or age differences were found between the patient groups in either study period. Contrary to expectations, patients were less active in recent consultations, talking less, asking fewer questions and showing less concerns or worries. GPs provided more medical information, but expressed also less often their concern about the patients' medical conditions. In addition, they were less involved in process-oriented behaviour and partnership building. Overall, these results suggest that consultations in 2002 were more task-oriented and businesslike than sixteen years earlier. Conclusion: The existence of a more equal relationship in General Practice, with patients as active and critical consumers, is not reflected in this sample of hypertension patients. The most important shift that could be observed over the years was a shift towards a more businesslike, task-oriented GP communication pattern, reflecting the recent emphasis on evidence-based medicine and protocolized care. The entrance of the computer in the consultation room could play a role. Some concerns may be raised about the effectiveness of modern medicine in helping patients to voice their worries.

Background: Communication is a necessary tool for ensuring the provision of quality patient-centered care for patients who have life-threatening illnesses, and discussing all relevant end-of-life issues should not be limited to cancer patients. Objective: To examine the incidence and timing of general practitioners (GPs) discussing end-of-life issues with patients whose deaths were expected, and to identify the factors associated with them discussing these issues. Methods: Between January and December 2008, GPs participating in a nationally representative sentinel surveillance network of GPs were asked to register, using standardised forms, the extent of discussing 10 end-of-life issues with patients. Results: We examined 252 patients who died nonsuddenly, 38% of whom died of cancer, and 86% of whose treatment goal was palliative care. Our findings show that GPs often waited until very close to death before they discussed end-of-life issues with patients, and discussed spiritual and social issues less than physical symptoms, diagnoses, and psychological problems. In 74% of cases, the GPs were informed of their patients' preferred place of death; and 8 out of 10 patients with known preferences for place of death, died there. Being diagnosed with cancer was associated with a higher frequency of discussing all 10 end-of-life issues than diagnosis with other (noncancer) conditions, but this is a state of mind we did not explore in this study. Conclusion: Promotion of timely discussion of all relevant end-of-life issues, in patients with cancer and noncancer diagnoses, is advisable based on systematic needs assessment.

Background: In 2008, the Netherlands Psychiatric Association authorized a guideline "consultation psychiatry." Aim: To set a standard for psychiatric consultations in nonpsychiatric settings. The main objective of the guideline is to answer three questions: Is psychiatric consultation effective and, if so, which forms are most effective? How should a psychiatric consultations be performed? What increases adherence to recommendations given by the consulting psychiatrist? Method: Systematic literature review. Results: Both in general practice and in hospital settings psychiatric consultation is effective. In primary care, the effectiveness of psychiatric consultation is almost exclusively studied in the setting of "collaborative care." Procedural guidance is given on how to perform a psychiatric consultation. In this guidance, psychiatric consultation is explicitly looked upon as a complex activity that requires a broad frame of reference and adequate medical and pharmacological expertise and experience and one that should be performed by doctors. Investing in a good relation with the general practitioner, and the use of a "consultation letter" increased efficacy in general practice. In the hospital setting, investing in liaison activities and an active psychiatric follow-up of consultations increased adherence to advice. Conclusion: Psychiatric consultations are effective and constitute a useful contribution to the patients' treatment. With setting a standard consultations will become more transparent and checkable. It is hoped that this will increase the quality of consultation psychiatry.

This study addresses the potential risks to the aquatic ecosystem posed by pesticides currently used in The Netherlands. The study used a novel method to predict aquatic exposure to pesticides based on a geographic information system (GIS) map of agricultural land use, comprising 51 crops used in open-canopy areas. Through the application of species-sensitivity distributions for aquatic organisms, in combination with rules for mixture-toxicity calculation, the modeled exposure results were transformed to risk estimates for aquatic species. The majority of the predicted risks were caused by pesticides applied to potato cropland, and approximately 95% of the predicted risk was caused by only 7 of the 261 pesticides currently used in The Netherlands. For risk verification, local toxic-risk estimates were compared with observed species composition in field ditches. The field verification study was not able to draw firm conclusions regarding the predicted impact of pesticide use on overall biodiversity. A toxicity-related shift from sensitive to more tolerant or opportunistic species could be observed for a few species.

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is the neuropsychologist.

Background This study evaluated the effects of a combination of three ergonomic measures designed to reduce the risk of low back complaints among gypsum bricklayers. The measures focused on optimizing working height and reducing carrying distances. Methods A within-subjects (N ¼ 10) controlled field study was used to compare the effects of working with the ergonomic measures with those of working with conventional working methods at the worksite during the course of a full working day. Productivity, work demands, and workload were assessed.

Drug treatment and reimbursement is an area of ever growing complexity in health priority setting. This paper assesses the National Registry of Growth Hormone Treatment (LRG) responsible for making prioritisation decisions in the Dutch drug reimbursement system in the treatment of growth hormone, using the framework for fairness. We used qualitative research consisting of semi-structured interviews and focus group sessions combined with quantitative methods to audit the decisions of the forum.

Objectives To study the relationship between the prevalence of depressive symptoms in newly admitted nursing home residents and their previous place of residence. Methods In 65 nursing homes in the Netherlands trained physicians assessed 562 residents (mean age 78.5, range 28-101, 64.6% female) within 10 days after admission. Depressive symptoms were assessed with the Minimum Data Set (MDS) Depression Rating Scale (DRS), and the MDS items: 'diagnosis of major or minor depression', 'change in depression' and 'indicators of persistent depressed, sad or anxious mood disorder present'. Previous place of residence was categorized as 'own home', 'hospital' or 'sheltered living facility'. Adjustments were performed for demographic and health related factors measured with the MDS. Results The prevalence of depressive symptoms (DRS ! 3) for all 562 residents was 26.9%; it was higher in residents admitted from their own home (34.3%) than in residents admitted from the hospital (19.7%) (p ¼ 0.002). Residents who were admitted from the hospital have an adjusted Odds Ratio for having many depressive symptoms of 0.54 (95% CI 0.31-0.94) compared to residents admitted from their own home. There is, after adjustment, no statistical significant difference between residents admitted from their own home, or residents admitted from a sheltered living facility. Conclusions Depressive symptoms are very prevalent in nursing homes. Residents who are admitted from their own home, or from a residential facility, have more depressive symptoms than residents admitted from the hospital. This may reflect different conceptualizations or different adjustment patterns for those groups. For a better understanding of the factors associated with nursing home depression, future studies in detection, prevention and management of depressive symptoms should start prior to or directly after admission, especially for those who have no prior institutional history.

The Dutch multidisciplinary guideline on 'Polypharmacy in older people' advises performing an annual medication review for patients aged 65 or older who use five or more drugs and have at least one risk factor for negative outcomes of their drug usage. We describe a 79-year-old male patient with an indication for a medication review and identified drug-related problems (DRPs). Furthermore, we describe two female patients aged 97 and 91 who use fewer than five drugs, dispensed via an automated system, and also have DRPs. We suggest adding the use of a multidose drug-dispensing system as an indication for a medication review. This will also help to identify patients with undertreatment. In addition, we recommend improving collaboration with pharmacists, which may enhance the effect of a medication review by increasing the number of drug changes.

The Health Insurance Board (CVZ) initiated a study of the functioning of the dental care system for mentally disabled people in the Netherlands.Two independent samples were used for the study, each drawn from a subpopulation of people with a mental disability in the age-group 15-45: people who have always lived at home (n = 60) and people who have been at some time been institutionalized and as a result of decentralization now live outside of the institution (n = 52). Dental visits were in both samples remarkably frequent (95-100%) and relatively few problems with daily dental care were identified. However, the health insurance regulations were unclear to many parents and carers, and there were doubts regarding dentists' specific expertise. At first sight the results of this study do not give cause to assume that there are special barriers to access to professional dental care for adult people with special needs. For a definitive conclusion regarding the long-term effects of the...

This article presents a new Dutch multicenter study ("PKU-COBESO") into cognitive and behavioral sequelae of early and continuously treated Phenylketonuria (PKU) patients. Part of the study sample will consist of young adult PKU patients who have participated in a large neuropsychological study approximately 10 years ago, when they were 7-to-15-year-olds (Huijbregts et al., 2002 [1]). Their neurocognitive development will be mapped in association with their earlier and continued metabolic history, taking into account possible changes in, for instance, medication. A second part of the sample will consist of PKU patients between the ages of 7 and approximately 40 years (i.e., born in or after 1974, when neonatal screening was introduced in The Netherlands), who have not participated in the earlier neuropsychological study. Again, their cognitive functioning will be related to their metabolic history. With respect to aspects of cognition, there will be an emphasis on executive functioning. The concept of executive functioning will however be extended with further emphasis on the impact of cognitive deficits on the daily lives of PKU patients, aspects of social cognition, social functioning, and behavior/mental health (i.e., COgnition, BEhavior, SOcial functioning: COBESO). In addition to a description of the PKU-COBESO study, some preliminary results with respect to mental health and social functioning will be presented in this article. Thirty adult PKU patients (mean age 27.8, SD 6.4) and 23 PKU patients under the age of 18years (mean age 11.0, SD 3.3) were compared to 14 (mean age 26.9years, SD 5.9) and 7 matched controls (mean age 10.5, SD 2.6) respectively, with respect to their scores on the Adult Self-Report or Child Behavior Checklist (measuring mental health problems) and the Social Skills Checklist or Social Skills Rating System (measuring social skills). Whereas there were very few significant group differences (except for mental health problems in the internalizing spectrum for adult PKU patients), possibly due to the small control groups, several significant associations between mental health problems and Phe levels were observed for the PKU patients. Childhood Phe levels and internalizing problems for adult PKU patients were related; concurrent Phe was associated with both internalizing and externalizing behavioral problems for those under the age of 18. These preliminary results underline the importance of early dietary adherence.

The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection.

To determine the association of parent, family, and adolescent variables with adolescent mental health service need and utilization. Method: Correlates of adolescent mental health service utilization, self-perceived need and unmet need were investigated in a general population sample of 1,120 Dutch adolescents aged 11 to 18 years (78% response rate). Results: 3.1% of the sample had been referred for mental health services within the preceding year, and 3.8% reported unmet need. 7.7% of adolescents at risk for psychopathology, and 17.8% of those indicating a need for help, had been referred. Family stress and adolescent's self-reported problems were most strongly associated with service need and utilization. Internalizing problems, female gender, and low education level were associated with self-perceived unmet need.

In 2002, the Dutch Euthanasia Act came into effect, which made euthanasia available to individuals from the age of 12 and above. The objective of our study was to gain insight into how Dutch paediatricians and other physicians treating children feel about the regulation of physician-assisted dying. We interviewed 63 paediatricians, 125 general practitioners and 208 clinical specialists about their views on physician-assisted dying and the Euthanasia Act. Of the paediatricians, 44% agreed with the age limit of 12 years, and 52% agreed with the requirement that parents be involved. Somewhat more than half thought the Act could contribute to the disclosure of end-of-life practices (52%), the quality of the review procedure (61%), careful decision making (54%) and the reporting rate (65%). These percentages were comparable for other physicians. A minority of the physicians in all groups indicated that, with this Act in place, they would be more willing to report such practices. The most optimistic in this respect were the paediatricians, of whom 39% expected such an effect. About half of Dutch paediatricians support the Euthanasia Act and expect it to achieve its aims, which is the same percentage as was found for other clinical specialists and general practitioners. However, most physicians do not foresee an increase in willingness to report cases of physician-assisted dying.

We examined possible explanations for the underrepresentation of women among university faculty, in two different national contexts. In the Netherlands, a sample of doctoral students (N = 132) revealed no gender differences in work commitment or work satisfaction. Faculty members in the same university (N = 179), however, perceived female students to be less committed to their work and female faculty endorsed these gender-stereotypical perceptions most strongly. A second study, in Italy, replicated and extended these findings. Again, no gender differences were obtained in the self-descriptions of male and female doctoral students (N = 80), while especially the female faculty (N = 93) perceived female students as less committed to their work than male students. Additional measures supported an explanation in social identity terms, according to which individual upward mobility (i.e. of female faculty) implies distancing the self from the group stereotype which not only involves percei...

To report the vitamin D status in adults from seven European countries and to identify behavioural correlates. In total, 1075 eligible adult men and women from Ireland, Netherlands, Spain, Greece, UK, Poland and Germany, were included in the study. Vitamin D deficiency and insufficiency, defined as 25-hydroxy vitamin D3 (25-OHD3) concentration of <30 and 30-49.9 nmol/L, respectively, were observed in 3.3 and 30.6% of the participants. The highest prevalence of vitamin D deficiency was found in the UK and the lowest in the Netherlands (8.2 vs. 1.1%, P < 0.05). In addition, the prevalence of vitamin D insufficiency was higher in females compared with males (36.6 vs. 22.6%, P < 0.001), in winter compared with summer months (39.3 vs. 25.0%, P < 0.05) and in younger compared with older participants (36.0 vs. 24.4%, P < 0.05). Positive dose-response associations were also observed between 25-OHD3 concentrations and dietary vitamin D intake from foods and supplements, as wel...

Long-term follow-up data on the effects of screening are scarce and debate exists on the relative contribution of screening versus treatment to breast cancer mortality reduction. Our aim was therefore to assess the long-term effect of screening by age and time of implementation. We obtained data on 69,630 breast cancer deaths between 1980 and 2010 by municipality (N=431) and age of death (40-79) in the Netherlands. Breast cancer mortality trends were analysed by defining the municipality-specific calendar year of introduction of screening as year 0. Additionally, log-linear Poisson regression was used to estimate the turning point in the trend after year 0, per municipality, and the annual percentage change (APC) before and after this point. Twenty years after introduction of screening breast cancer mortality was reduced by 30% in women aged 55-74 and by 34% in women aged 75-79, compared to year 0. A similar and significant decrease was present in municipalities that started early (...

In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U-PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse-led care program. Examination of treatment fidelity is critical to successful translation of evidence-based interventions into practice. To assess treatment delivery, dose and content of nursing care delivered within the nurse-led care program, and to explore if the delivery may have influenced the trial results. A mixed-methods study was conducted. Type and dose of nursing care were collected during the trial. Shortly after the trial, a focus group with nurses was conducted to explore reasons for the observed differences between the type and dose of nursing care delivered. A total of 835 older persons were included in the nurse-led care program. The mean age was 75 years, 64% were female and 53.5%...

Gomez's account of the Dutch ex-perience is largely accurate and his analysis is searching, cogent, and per-suasive. Indeed, there are five ways in which it could have been even more so. First, his analysis of jurisprudential developments could have been deeper. He could, ...

Incontinent patients are at risk for incontinence-associated dermatitis. Prolonged exposures of the skin to urine and/or stool are causal factors but the exact aetiology and pathophysiology are not fully understood. The aim of the current investigation was to identify person and health-related variables most strongly associated with incontinence-associated dermatitis development. Secondary data analysis of a multicentre-prevalence study in 2012. Hospitals, nursing homes, home care in Austria and the Netherlands. Nursing home residents, hospital patients, home care clients who completed an incontinence assessment and who were incontinent (n = 3713). Mean age 81.2 (SD 11.2) years. Demographic, functional and physiological parameters were compared between subjects with incontinence-associated dermatitis and without. A logistic regression model predicting incontinence-associated dermatitis was build. Subjects with incontinence-associated dermatitis were statistically significantly more ...

We used extensive data from a long-term study of great tits (Parus major) in the United Kingdom and Netherlands to better understand how genetic signatures of selection translate into variation in fitness and phenotypes. We found that genomic regions under differential selection contained candidate genes for bill morphology and used genetic architecture analyses to confirm that these genes, especially the collagen gene COL4A5, explained variation in bill length. COL4A5 variation was associated with reproductive success, which, combined with spatiotemporal patterns of bill length, suggested ongoing selection for longer bills in the United Kingdom. Last, bill length and COL4A5 variation were associated with usage of feeders, suggesting that longer bills may have evolved in the United Kingdom as a response to supplementary feeding.

Background & aims: Disease related malnutrition (under-nutrition caused by illness) is a worldwide problem in all health care settings with potentially serious consequences on a physical as well as a psycho-social level. In the European Union countries about 20 million patients are affected by disease related malnutrition, costing EU governments up to V 120 billion annually. The aim of this study is to calculate the total additional costs of disease related malnutrition in The Netherlands. Methods: A cost-of-illness analysis was used to calculate the additional total costs of disease related malnutrition in adults (>18 years of age) for The Netherlands in 2011 in the hospital, nursing-and residential home and home care setting, expressed as an absolute monetary value as well as a percentage of the total Dutch national health expenditure and as a percentage of the total costs of the studied health care sectors in The Netherlands. Results: The total additional costs of managing adult patients with disease related malnutrition were estimated to be V 1.9 billion in 2011 which equals 2.1% of the total Dutch national health expenditure and 4.9% of the total costs of the health care sectors analyzed in this study.