Dutch Adult Population Research Articles

Changing Behavioral Lifestyle Risk Factors Related to Cognitive Decline in Later Life Using a Self-Motivated eHealth Intervention in Dutch Adults.

BackgroundOur labor force is aging, but aged workers are not yet coached on how to stay cognitively fit for the job.ObjectiveIn this study, we tested whether a self-motivated, complex eHealth intervention could improve multiple health-related behaviors that are associated with cognitive aging among working Dutch adults.MethodsThis quasi-experimental prospective study with a pre-post design was conducted with employees of Dutch medium to large companies. All employees with Internet access, a good understanding of the Dutch language, and who provided digital informed consent were eligible to participate. In total, 2972 participants (2110/2972, 71.11% females) with a mean (standard deviation, SD) age of 51.8 (SD 12.9) years were recruited; 2305 became active users of the intervention, and 173 completed the 1-year follow-up. This self-motivated eHealth lifestyle intervention stimulates participants to set personally relevant, monthly health behavior change goals using Goal Attainment Scaling and to realize these goals by implementing behavior change techniques grounded in behavior change theory. The primary outcomes were the goal-setting success rate and the change in overall lifestyle score from baseline to the 1-year follow-up; the score was based on physical activity, diet, smoking, alcohol, sleep, and stress scores. The secondary outcomes were the changes in body weight, body mass index, specific lifestyle characteristics, and website usage.ResultsA total of 1212 participants set 2620 behavior change goals; 392 participants assessed 1089 (1089/2288, 47.59%) goals and successfully achieved 422 (422/1089, 38.75%) of these goals. Among the goal-setting participants in follow-up, this led to a +0.81-point improvement (95% CI 0.49-1.13, P<.001) in overall lifestyle (d=0.32) and weight loss of 0.62 kg (95% CI −1.16 to −0.07, P=.03). These participants also showed significant improvement in 8 out of 11 specific lifestyle components.ConclusionsAmong an adult Dutch population, this eHealth intervention resulted in lifestyle changes in behavioral risk factors associated with cognitive decline, and these improvements lasted over the period of 1 year. Given the general aging of our workforce, this eHealth intervention opens new avenues for the widespread use of cost-effective self-motivated prevention programs aimed at prevention of early-stage cognitive decline and more self-management of their risk factors.Trial RegistrationNederlands Trial Register: NTR4144; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4144 (Archived by WebCite at http://www.webcitation.org/6cZzwZSg3).

Dissertations 25 years after date 45. Prevalence and etiology of craniomandibular dysfunction in the Netherlands

The disorders temporomandibular dysfunction and craniomandibular dysfunction are still being discussed intensely in the literature 25 year after the publication of the dissertation 'Prevalence and etiology of craniomandibular dysfunction. An epidemiological study of the Dutch adult population'. Attention is especially being devoted to occlusion and its relationship with this disorder; the conclusions reached are often contradictory. In addition to the definitions of temporomandibular and craniomandibular dysfunction and of occlusion, a possible explanation for this controversy can be found in the methodological shortcomings of the studies. On the basis of the most important results in the dissertation of 25 years ago and the scientific discussion since, 7 guidelines are formulated that are illustrated with clinical examples for an evidence-based treatment of patients with this disorder in a general dental practice.

Exploring individual cognitions, self-regulation skills, and environmental-level factors as mediating variables of two versions of a Web-based computer-tailored nutrition education intervention aimed at adults: A randomized controlled trial

BackgroundThis study explored whether the determinants that were targeted in two versions of a Web-based computer-tailored nutrition education intervention mediated the effects on fruit, high-energy snack, and saturated fat intake among adults who did not comply with dietary guidelines. MethodA RCT was conducted with a basic (tailored intervention targeting individual cognitions and self-regulation), plus (additionally targeting environmental-level factors), and control group (generic nutrition information). Participants were recruited from the general Dutch adult population and randomly assigned to one of the study groups. Online self-reported questionnaires assessed dietary intake and potential mediating variables (behavior-specific cognitions, action- and coping planning, environmental-level factors) at baseline and one (T1) and four (T2) months post-intervention (i.e. four and seven months after baseline). The joint-significance test was used to establish mediating variables at different time points (T1-mediating variables – T2-intake; T1-mediating variables – T1-intake; T2-mediating variables – T2-intake). Educational differences were examined by testing interaction terms. ResultsThe effect of the plus version on fruit intake was mediated (T2–T2) by intention and fruit availability at home and for high-educated participants also by attitude. Among low/moderate-educated participants, high-energy snack availability at home mediated (T1–T1) the effect of the basic version on high-energy snack intake. Subjective norm mediated (T1–T1) the effect of the basic version on fat intake among high-educated participants. DiscussionOnly some of the targeted determinants mediated the effects of both intervention versions on fruit, high-energy snack, and saturated fat intake. A possible reason for not finding a more pronounced pattern of mediating variables is that the educational content was tailored to individual characteristics and that participants only received feedback for relevant and not for all assessed mediating variables. Trial registrationNetherlands Trial Registry NTR3396.

Eye Care by Dutch Nursing Home Physicians: A Descriptive Study

&lt;p&gt;Currently, 4% of older adults reside in long-term care facilities in the Netherlands. Nursing home residents tend to have multimorbidity that is associated with considerable disabilities and a high level of care dependency. In the Dutch adult population the highest estimated prevalence (&amp;gt;40%) of visual impairment (low vision and blindness) was found in the subgroup of residents in nursing homes (NHs). The aim of this study is to describe the current practice of eye care by Dutch nursing home physicians (NHPs).&lt;/p&gt;&lt;p&gt;A digital online survey was developed to describe the eye care activities of nursing home physicians and their cooperation in this perspective with other professionals.&lt;/p&gt;&lt;p&gt;Of 1573 NHPs present in the Netherlands, 125 (8%) responded.&lt;/p&gt;&lt;p&gt;Results show that more than 50% of the NHPs regularly examine ‘distant vision’, ‘near vision’ and ‘the visual field’. However, 23%, 33% and 45% almost never or never examine the ‘visual field’, ‘near vision’ and ‘distant vision’, respectively. Data regarding eye care, regularly recorded in the client files by more than 50% of the NHPs, are medical data involving ‘use of eye medication’, ‘eye disease’, and ‘eye surgery in the past’. Less commonly recorded is ‘the use of reading glasses’ as well as ‘eye pain’.&lt;/p&gt;&lt;p&gt;Inside of the NH, (head) nurses and ward nurses (chi&lt;sup&gt;2&lt;/sup&gt; = 309, df = 5, p = 0.000), and outside of the NH, ophthalmologists and low vision specialists are most frequently contacted about eye related issues (chi&lt;sup&gt;2&lt;/sup&gt; = 224, df = 4, p = 0.000). Opticians are rarely contacted, and optometrists and orthoptists are ‘never’ contacted by more than 50% of the NHPs. Moreover, 50% of the NHPs noted that collaboration with external eye care professionals is ‘not structural’.&lt;/p&gt;&lt;p&gt;This study shows that, according to NHPs, relevant visual aspects are not structurally examined and recorded in the client files. Outside of the NH, NHPs tend to have a less frequent collaborative relationship with optometrists, orthoptists and opticians compared to ophthalmologists and low vision specialists. The NHP’s role in providing eye care can be improved by development of guidelines for structural eye screening, improvement of recording in client files, and exploring plus undertaking collaboration with other eye care professionals.&lt;/p&gt;

Retinal Microvasculature Is Associated With Long-Term Survival in the General Adult Dutch Population.

Retinal vascular diameters are associated with (sub)clinical cardiovascular disease and short-term cardiovascular mortality, but their association with long-term mortality is uncertain. We studied the association of retinal vascular diameters with cause-specific mortality in the general adult Dutch population during 25 years of follow-up. From 1990 to 1993, arteriolar and venular diameters were measured semiautomatically on digitized images in 5674 persons (mean age 68.0 years, 59% women) from the population-based Rotterdam study. Follow-up for mortality was complete till March 2015. Associations between vascular diameters and mortality were examined using Cox proportional hazards models, adjusting for age, sex, cardiovascular risk factors, and the fellow vessel diameter. During 85 770 person-years (mean±SD: 15.1±6.67), 3794 (66.8%) persons died, of whom 1034 due to cardiovascular causes. We found that narrower arterioles and wider venules were associated with higher risk of mortality (adjusted hazard ratio [95% confidence interval] per SD decrease 1.04 [1.00-1.08] and increase 1.07 [1.03-1.12], respectively). For arterioles, these associations were strongest for cardiovascular mortality, whereas venules showed consistent associations for cardiovascular and noncardiovascular mortality. Importantly, these associations remained unchanged after excluding the first 10 years of follow-up as immortal person-time. We found evidence for effect modification with stronger associations in persons <70 years (venules only) and smokers (P value for interaction<0.01). We replicated our findings in another independent cohort from the Rotterdam Study of 3106 persons with 19 880 person-years of follow-up and 144 deaths (hazard ratio for venules 1.22 [1.00-1.49]). Markers of retinal microvasculature are associated with long-term mortality in the general adult Dutch population.

Who Follows eHealth Interventions as Recommended? A Study of Participants' Personal Characteristics From the Experimental Arm of a Randomized Controlled Trial.

BackgroundComputer-tailored eHealth interventions to improve health behavior have been demonstrated to be effective and cost-effective if they are used as recommended. However, different subgroups may use the Internet differently, which might also affect intervention use and effectiveness. To date, there is little research available depicting whether adherence to intervention recommendations differs according to personal characteristics.ObjectiveThe aim was to assess which personal characteristics are associated with using an eHealth intervention as recommended.MethodsA randomized controlled trial was conducted among a sample of the adult Dutch population (N=1638) testing an intervention aimed at improving 5 healthy lifestyle behaviors: increasing fruit and vegetable consumption, increasing physical activity, reducing alcohol intake, and promoting smoking cessation. Participants were asked to participate in those specific online modules for which they did not meet the national guideline(s) for the respective behavior(s). Participants who started with fewer than the recommended number of modules of the intervention were defined as users who did not follow the intervention recommendation.ResultsThe fewer modules recommended to participants, the better participants adhered to the intervention modules. Following the intervention recommendation increased when participants were older (χ2 1=39.8, P<.001), female (χ2 1=15.8, P<.001), unemployed (χ2 1=7.9, P=.003), ill (χ2 1=4.5, P=.02), or in a relationship (χ2 1=7.8, P=.003). No significant relevant differences were found between groups with different levels of education, incomes, or quality of life.ConclusionOur findings indicate that eHealth interventions were used differently by subgroups. The more frequent as-recommended intervention use by unemployed, older, and ill participants may be an indication that these eHealth interventions are attractive to people with a greater need for health care information. Further research is necessary to make intervention use more attractive for people with unhealthy lifestyle patterns.

The probabilistic aggregate consumer exposure model (PACEM): Validation and comparison to a lower-tier assessment for the cyclic siloxane D5

Current practice of chemical risk assessment for consumer product ingredients still rarely exercises the aggregation of multi-source exposure. However, focusing on a single dominant source/pathway combination may lead to a significant underestimation of the risk for substances present in numerous consumer products, which often are used simultaneously. Moreover, in most cases complex multi-route exposure scenarios also need to be accounted for. This paper introduces and evaluates the performance of the Probabilistic Aggregate Consumer Exposure Model (PACEM) applied in the context of a tiered approach to exposure assessment for ingredients in cosmetics and personal care products (C&PCPs) using decamethylcyclopentasiloxane (D5) as a worked example. It is demonstrated that PACEM predicts a more realistic, but still conservative aggregate exposure within the Dutch adult population when compared to a deterministic point estimate obtained in a lower tier screening assessment. An overall validation of PACEM is performed by quantitatively relating and comparing its estimates to currently available human biomonitoring and environmental sampling data. Moderate (by maximum one order of magnitude) overestimation of exposure is observed due to a justified conservatism built into the model structure, resulting in the tool being suitable for risk assessment.

Gastrointestinal symptoms in low-dose aspirin users: a comparison between plain and buffered aspirin

BackgroundAspirin is associated with gastrointestinal side effects such as gastric ulcers, gastric bleeding and dyspepsia. High-dose effervescent calcium carbasalate (ECC), a buffered formulation of aspirin, is associated with reduced gastric toxicity compared with plain aspirin in healthy volunteers, but at lower cardiovascular doses no beneficial effects were observed.AimTo compare the prevalence of self-reported gastrointestinal symptoms between low-dose plain aspirin and ECC.MethodsA total of 51,869 questionnaires were sent to a representative sample of the Dutch adult general population in December 2008. Questions about demographics, gastrointestinal symptoms in general and specific symptoms, comorbidity, and medication use including bioequivalent doses of ECC (100 mg) and plain aspirin (80 mg) were stated. We investigated the prevalence of self-reported gastrointestinal symptoms on ECC compared with plain aspirin using univariate and multivariate logistic regression analyses.ResultsA total of 16,715 questionnaires (32 %) were returned and eligible for analysis. Of these, 911 (5 %) respondents reported the use of plain aspirin, 633 (4 %) ECC and 15,171 reported using neither form of aspirin (91 %). The prevalence of self-reported gastrointestinal symptoms in general was higher in respondents using ECC (27.5 %) compared with plain aspirin (26.3 %), but did not differ significantly with either univariate (OR 1.06, 95 %CI 0.84–1.33), or multivariate analysis (aOR 1.08, 95 %CI 0.83–1.41). Also, none of the specific types of symptoms differed between the two aspirin formulations.ConclusionsIn this large cohort representative of the general Dutch population, low-dose ECC is not associated with a reduction in self-reported gastrointestinal symptoms compared with plain aspirin.Electronic supplementary materialThe online version of this article (doi:10.1007/s12471-014-0522-3) contains supplementary material, which is available to authorized users.

Antidepressants and Gastrointestinal Symptoms in the General Dutch Adult Population

Gastrointestinal symptoms are frequently reported adverse effects of antidepressants, but antidepressants are also a treatment modality in functional gastrointestinal disorders. We aimed to assess the association between antidepressant use and gastrointestinal symptoms in the general adult population. We assessed gastrointestinal symptoms, medication use, and comorbidity through structured questionnaires in randomly selected individuals. We compared presence of gastrointestinal symptoms in respondents who reported antidepressant use with those who did not. We used multivariable regression analysis to verify the association between antidepressant use and gastrointestinal symptoms. In total, 16,758 questionnaires were returned and eligible for analysis. Antidepressant use was reported by 701 respondents (4.2%). Gastrointestinal symptoms were more frequently reported by antidepressant users compared with nonusers (40% vs 25%, P < 0.01). This apparent association between antidepressant use and gastrointestinal symptoms did not remain after adjusting for demographic factors, comorbidity, and use of other medications (adjusted odds ratio, 0.94; 95% confidence interval, 0.74-1.18). In our cross-sectional population-based study, we did not find an association between antidepressant use and gastrointestinal symptoms.

EPA-0548 - Assessment of the psychometric properties of the raads-r and two abridged versions of the autism spectrum quotient (AQ-10 and AQ-28) in a dutch adult outpatient population

The increased demand for assessment and treatment of Autism Spectrum Disorders in adults has caused long delays in mental health services. There is currently no diagnostic tool available to assess the urgency of the autistic symptoms, preventing a prioritization in the waiting lists. Promising new instruments are the 80-item Ritvo Autism Asperger Diagnostic Scale-Revised, (RAADS-R)(Ritvo et al., 2010) and abridged forms of the 50-item Autism Spectrum Quotient (AQ-10 and AQ-28). To determine the ability of the RAADS-R and the abridged versions of the AQ to predict a clinical diagnosis of ASD in an adult outpatient population. RAADS-R and abridged AQ versions will be completed by 250 normally intelligent adults, sequentially recruited from new referrals for ASD assessment in six outpatient settings in the Netherlands. Assessing clinicians are blind to the RAADS-R and AQ scores. At the end of the study, the clinical diagnosis (ASD or no ASD) will be related to the RAADS-R and AQ-scores collected prior to the assessments At present 198 adults have been included in the study, as well as 50 normal controls. The average age is 39 years (SD 13.2), and 80% is male. In March 2014 we will be able to present preliminary data on the predictive values of the RAADS-R, the AQ-10 and the AQ-28. Ritvo, R. A., et al. (2010). The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): A Scale to Assist the Diagnosis of Autism Spectrum Disorder in Adults: An International Validation Study. J. Autism Dev. Disord.

Effect of Aging on Healthcare Costs of Inflammatory Bowel Disease

Population aging is expected to result in a substantial additional burden on healthcare resources in the near future. We aimed to assess the current and future impact of aging on direct healthcare costs (DHC) attributed to inflammatory bowel disease (IBD). Patients with IBD from a Dutch multicenter cohort filled out 3-monthly questionnaires for 2 years. Elderly (≥60 yr) and younger patients (18-60 yr) IBD were analyzed for differences in 3-monthly DHC, productivity losses, and out-of-pocket costs. Prevalence rates were obtained from a health insurance database. Estimates of annual DHC and prevalence rates were applied to the total Dutch adult population in 2011 and then projected to 2040, using predicted changes in population demography, prices, and volume. IBD-attributable DHC were lower in elderly than in younger patients with IBD with respect to 3-monthly DHC (&OV0556;359 versus &OV0556;978, P < 0.01), productivity losses (&OV0556;108 versus &OV0556;456, P < 0.01), and out-of-pocket costs (&OV0556;40 versus &OV0556;57, P < 0.01). Between 2011 and 2040, the percentage of elderly IBD patients in the Netherlands has been projected to rise from 24% to 35%. Between 2011 and 2040, DHC of the total IBD population in the Netherlands are projected to increase from &OV0556;161 to &OV0556;661 million. Population aging accounted for 1% of this increase, next to rising prices (29%), and volume growth (70%). Population aging has a negligible effect on IBD-attributable DHC of the IBD population in the near future, because the average costs incurred by elderly patients with IBD are considerably lower than those incurred by younger patients with IBD.

Verzuim door psychische en somatische aandoeningen

Work loss due to mental and physical disorders Work loss due to mental and physical disorders Work loss due to mental and chronic physical disorders in a nationally representative survey including 4.715 workers was estimated using data of Nemesis-2 (Netherlands Mental Health Survey and Incidence Study-2), a study about psychiatric disorders among the Dutch adult population. Both absenteeism and presenteeism were asked for and also chronic physical disorders were assessed.A mental disorder was associated with 8,7 additional absent days per year, 7,7 days of reduced qualitative functioning and 9,9 total work loss days (days of reduced functioning were counted as half). For a chronic physical disorder, the number of days was 9,9, 2,6 and 9,9, respectively. No significant associations were found for reduced quantitative functioning. Adjusted for comorbidity, drug abuse, bipolar disorder, major depression, digestive disorders and panic disorder were associated with the highest number of additional total work loss days. Annual total work loss costs per million workers were estimated at € 360 million for any mental disorder; and € 706 million for any physical disorder.It can be concluded that policies designed to prevent, cure and lessen the impact of commonly occurring disorders will contribute to a reduction in absenteeism and presenteeism. If one keeps in mind that the indirect costs of (mental) disorders are often much higher than their medical costs, prevention and treatment of these conditions may be cost-effective.

Gastrointestinal Symptoms are Still Prevalent and Negatively Impact Health-Related Quality of Life: A Large Cross-Sectional Population Based Study in The Netherlands

BackgroundOver the last decades important risk factors for gastrointestinal symptoms have shifted, which may have changed its population prevalence. The aim of this study was to assess the current prevalence of gastrointestinal symptoms, appraise associated factors and assess health-related quality of life in the general population.MethodsA total of 51,869 questionnaires were sent to a representative sample of the Dutch adult general population in December 2008. Demographic characteristics, gastrointestinal symptoms, health-related quality of life, medication use and co-morbidity were reported. We used multivariable logistic regression analysis to determine factors associated with gastrointestinal symptoms.ResultsA total of 18,317 questionnaires were returned, and 16,758 were eligible for analysis. Prevalence of gastrointestinal symptoms was 26%. Most frequent symptoms were bloating (63%), borborygmi (60%) and flatulence (71%). Female gender (adjusted OR (aOR) 1.59, 95% CI 1.43–1.77), asthma/COPD (aOR 1.47, 95% CI 1.21–1.79), use of paracetamol (aOR 1.33, 95% CI 1.20–1.47), antidepressants (aOR 1.56, 95% CI 1.22–2.00) and acid-suppressive medication were independently associated with presence of gastrointestinal symptoms. Age over 65 years (aOR 0.75, 95% CI 0.65–0.87), and use of statins (aOR 0.75, 95% CI 0.61–0.93) were associated with a lower prevalence of gastrointestinal symptoms. Respondents with gastrointestinal symptoms had a lower mean health-related quality of life of 0.81 (SD = 0.21) compared to 0.92 (SD = 0.14) for persons without gastrointestinal symptoms (P<0.01).ConclusionsPrevalence of gastrointestinal symptoms in the Dutch community is high and associated with decreased health-related quality of life.

Daily Life Physical Activity in Long-Term Survivors of Nephroblastoma and Neuroblastoma

The risk of metabolic late effects after childhood cancer, such as obesity, hypertension, and diabetes, can be positively influenced by a healthy lifestyle with sufficient physical activity. Nevertheless, studies on physical activity in adult survivors of childhood cancer are scarce and involve different and often nonvalidated questionnaires. We used the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH), which was developed and validated to assess daily life physical activity in the Dutch adult population. The aim of the study was to assess daily life physical activity in Dutch adult long-term nephroblastoma and neuroblastoma survivors. Sixty-seven nephroblastoma and 36 neuroblastoma survivors (median age, 30 y; range, 18 to 51 y) and 60 sociodemographically similar healthy control subjects (median age, 32 y; range, 18 to 62 y) were asked to complete the SQUASH during their regular follow-up visit. The adjusted mean physical activity score in male neuroblastoma survivors (mean, 7155; P=0.004) was significantly lower than in male controls (mean, 10,574), whereas it was not significantly lower in male nephroblastoma survivors (mean, 9122; P=0.108). Adjusted means for physical activity scores in females were not different from their controls. In conclusions, male neuroblastoma survivors were identified as performing less daily physical activity.

N-6 and N-3 Fatty Acid Cholesteryl Esters in Relation to Fatal CHD in a Dutch Adult Population: A Nested Case-Control Study and Meta-Analysis

BackgroundDietary polyunsaturated fatty acids (PUFA) are inversely related to coronary heart disease (CHD) in epidemiological studies. We examined the associations of plasma n-6 and n-3 PUFA in cholesteryl esters with fatal CHD in a nested case-control study. Additionally, we performed a dose-response meta-analysis of similar prospective studies on cholesteryl ester PUFA.MethodsWe used data from two population-based cohort studies in Dutch adults aged 20–65y. Blood and data collection took place from 1987–1997 and subjects were followed for 8–19y. We identified 279 incident cases of fatal CHD and randomly selected 279 controls, matched on age, gender, and enrollment date. Odds ratios (OR) were calculated per standard deviation (SD) increase of cholesteryl ester PUFA.ResultsAfter adjustment for confounders, the OR (95%CI) for fatal CHD per SD increase in plasma linoleic acid was 0.89 (0.74–1.06). Additional adjustment for plasma total cholesterol and systolic blood pressure attenuated this association (OR:0.95; 95%CI: 0.78–1.15). Arachidonic acid was not associated with fatal CHD (OR per SD:1.11; 95%CI: 0.92–1.35). The ORs (95%CI) for fatal CHD for an SD increase in n-3 PUFA were 0.92 (0.74–1.15) for alpha-linolenic acid and 1.06 (0.88–1.27) for EPA-DHA. In the meta-analysis, a 5% higher linoleic acid level was associated with a 9% lower risk (relative risk: 0.91; 95% CI: 0.84–0.98) of CHD. The other fatty acids were not associated with CHD.ConclusionIn this Dutch population, n-6 and n-3 PUFA in cholesteryl esters were not significantly related to fatal CHD. Our data, together with findings from previous prospective studies, support that linoleic acid in plasma cholesteryl is inversely associated with CHD.

Subjective Oral Health in Dutch Adults

Aim: To determine whether the subjective oral health (SOH) of the Dutch adult population was associated with clinical and demographic variables. Methods: A clinical examination was conducted in a sample of 1,018 people from the Dutch city of ‘s-Hertogenbosch. SOH was measured using the Dutch translation of the short form of the Oral Health Impact Profile (OHIP-NL14). Results: The average score on the OHIP-NL14 was 2.8 ± 5.9 and 51% of the respondents had a score of 0. Dental status was the most important predictor of SOH. Conclusions: The SOH in the Dutch adult population was much better than in groups of adults in Australia, the United Kingdom and New Zealand. Nevertheless, there were important variations in SOH related to dental and socio-economic status.

Non-Occupational Sedentary Behaviors

Evidence is accumulating that sedentary behaviors have detrimental health effects. Comprehensive data on population changes in various sedentary behaviors over time are scarce. This study aimed to determine changes in non-occupational sedentary behaviors in the Dutch adult population between 1975 and 2005. The National Time Use Survey of the Netherlands was used, which has been collected in 5-year intervals since 1975 (seven time points, n range=1017-2845). Adult participants completed a 7-day time-use diary in which they recorded their primary activity in 15-minute intervals throughout or at the end of the day. A validated method was used to determine time spent in various non-occupational sedentary behaviors. Population-weighted analyses determining changes over time in various sedentary behaviors were carried out in 2011 and 2012. Between 1975 and 2005, the proportion of non-occupational time spent sedentary remained relatively constant at ~60%. However, absolute time decreased, because of a 4.7-hour/week increase in occupational time. Sedentary occupational time could not be studied but has likely increased over these 3 decades. Most non-occupational sedentary behavior was during leisure, and the proportion of sedentary leisure time that comes from screen time increased from 26% in 1975 to 43% in 2005. Between 1975 and 2005, sedentary transport increased by 2 hours/week. The nature and distribution of sedentary behaviors in the Dutch adult population changed substantially over 3 decades. Screen-based activities are playing an increasingly dominant role.

An Agent-Based Social Network Model of Binge Drinking Among Dutch Adults

Binge drinking is a complex social problem linked to an array of detrimental health effects. While binge drinking in youth has been analyzed extensively using traditional methods (e.g., regressions analyses), the adult population has received less attention, and recent work has exemplified the potential for simulations to help scholars and practitioners better understand the problem. In this paper, we used agent-based social network models to test a number of hypotheses on important aspects of binge drinking in a sample representative of the adult Dutch population. In particular, we found that a combination of simple social rules (choosing peers who are similar, being prompted to drink if at least a fraction of them drinks, and incorporating the context) was sufficient to correctly predict the behaviour of half of the binge drinkers and 4 out of 5 non binge drinkers. Furthermore, we used factorial analyses to examine the contribution and combination of hypotheses in predicting the behaviour of individuals, with results indicating that who we interact with may not matter so much as how we interact. Finally, we evaluated the potential for interventions that mediate interactions between people in order to reduce the prevalence of binge drinking and found that the impact of such interventions was non linear: moderate interventions would yield benefits, but stronger interventions may only be of limited further benefit.

Risks of Nocturia in Patients with Chronic Kidney Disease—Do the Metabolic Syndrome and its Components Matter?

We evaluate the risk factors for nocturia in patients with chronic kidney disease, and determine whether the metabolic syndrome and its components aggravate nocturia in these patients. We enrolled patients with chronic kidney disease who had regular followup at nephrology clinics, and excluded from study those patients undergoing dialysis, and those with neurogenic bladder or active urinary tract infection. Patients were asked to complete a questionnaire including medical history, clinical parameters and times of nocturnal voids in the last month. Laboratory parameters were checked when the questionnaire was completed. Clinically significant nocturia was defined as voiding 2 or more times per night. The metabolic syndrome was defined according to the ATP III (National Cholesterol Education Program Adult Treatment Panel III) guidelines. Chronic kidney disease was divided into 5 stages (based on National Kidney Foundation guidelines). Multivariate logistic regression was used to evaluate the risk factors for clinically significant nocturia. A total of 202 men and 234 women were eligible for analysis (mean age 68.4 years). The prevalence rate of clinically significant nocturia in patients with chronic kidney disease was 64.0%. Statistically significant risk factors for clinically significant nocturia were patient age (OR 1.02, 95% CI 1.003-1.04) and chronic kidney disease stage (OR 1.47, 95% CI 1.19-1.81) but not gender. Although 53.9% of our patients with chronic kidney disease had the metabolic syndrome, the metabolic syndrome (adjusted OR 0.96, 95% CI 0.64-1.44) and its components had no significant correlations with clinically significant nocturia. Clinically significant nocturia is prevalent in patients with chronic kidney disease, and the severity increased with chronic kidney disease stage and patient age. Contrary to previous reports, the metabolic syndrome did not increase the risk of clinically significant nocturia in patients with chronic kidney disease.

The Disadvantaged Among the Dutch: A Survey Approach to the Multidimensional Measurement of Social Exclusion

While combating social exclusion has been a key target of the European Union’s social policy in recent years, the concept remains contested and various ways of measuring its prevalence have been proposed. In the Netherlands a survey-based method has been in use since 2004, which refers to four theoretical elements of social exclusion: material deprivation, limited social participation, inadequate access to basic social rights and a lack of normative integration. In this article we propose an improved and more concise version of the instrument. Using focus groups and cognitive tests, the study first examined whether it adequately covers the different elements of social exclusion. Based on the results, the existing items were reformulated and supplemented. A revised questionnaire was then submitted to a new stratified sample of 650 respondents, randomly drawn from an online panel and a database of people without access to the Internet. The weighted outcomes may be regarded as representative for the entire adult Dutch population, although some caveats apply. Using nonlinear canonical correlation analysis, we identified a single underlying dimension in our new data set. This contains 15 items, with three to four indicators for each of the theoretical elements of social exclusion. According to our general index, just under 5 % of the Dutch population aged 18 years or older are faced with a serious degree of social exclusion. On the four subscales the figure ranges from 7 % (social rights) to 22 % (material deprivation).