Dutch Norm Research Articles

Additional Safety Measures for Movable Bridges, A Bridge Too Far? A Calculated Approach on Proportional Safety for Movable Bridges in the Netherlands

This article explores a proportional safety approach for movable bridges, aligning with the core principles of Dutch safety policies: the use of the Dutch norm for an individual risk (IR) of one fatality per hundred thousand people exposed (denoted as IR = 10-5) and a reasonable investment maximum of € 80.000, - per gained disability adjusted life year (DALY). Based on the actual history of accidents the individual risk for people using movable bridges is around 10-7 and thus easily meets the Dutch norm. Movable bridges in the Netherlands are thus more than ‘safe enough’ and do not require extra investments in safety measures. If the municipal and provincial authorities in charge of movable bridges do decide to invest in extra safety measures, a reasonable maximum budget is € 2.2 million a year for all 1.500 movable bridges. Here it is assumed that the newly implemented safety measures verifiably lead to preventing all casualties.

Early Cost-Effectiveness Analysis of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer Patients with Limited Peritoneal Carcinomatosis.

Gastric cancer patients with peritoneal carcinomatosis (PC) have a poor prognosis, with a median overall survival of 10 months when treated with systemic chemotherapy only. Cohort studies showed that cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) might improve the prognosis for gastric cancer patients with limited PC. Besides generating trial data on clinical effectiveness, it is crucial to timely collect information on economic aspects to guide the reimbursement decision-making process. No previous data have been published on the cost(-effectiveness) of CRS/HIPEC in this group of patients. Therefore, we performed an early model-based cost-effectiveness analysis of CRS/HIPEC for gastric cancer patients with limited PC in the Dutch setting. We constructed a two-state (alive-dead) Markov transition model to evaluate costs and clinical outcomes from a Dutch healthcare perspective. Clinical outcomes, transition probabilities and utilities were derived from literature and verified by clinical experts in the field. Costs were measured using two available representative cohorts (2010-2017): one 'systemic chemotherapy only' cohort and one 'CRS/HIPEC' cohort (n=10 each). Incremental cost-utility ratios (ICURs) were expressed as Euros per quality-adjusted life-year (QALY). We performed probabilistic and deterministic sensitivity, scenario, and value-of-information analyses using a willingness-to-pay (WTP) threshold of €80,000/QALY, which reflects the Dutch norm for severe diseases. In the base-case analysis, CRS/HIPEC yielded more QALYs (increment of 0.68) and more costs (increment of €34,706) compared with systemic chemotherapy only, resulting in an ICUR of €50,990/QALY. The probability that CRS/HIPEC was cost effective compared with systemic chemotherapy alone was 64%. To reduce uncertainty, the expected value of perfect information amounted to €4,021,468. The scenario analyses did not alter the results and showed that treatment costs, lifetime health-related quality of life and overall survival had the largest influence on the model. The presented early cost-effectiveness analysis suggests that adding CRS/HIPEC to systemic chemotherapy for gastric cancer patients with limited PC has a good chance of being cost-effectiveness compared with systemic chemotherapy alone when using a WTP of €80,000/QALY. However, there is substantial uncertainty in view of the current available data on effectiveness. Results from the ongoing phase III PERISCOPE II trial are therefore crucial for further decisions on treatment policy and its cost-effectiveness.

Long-term neurodevelopment in children with resected congenital lung abnormalities.

To determine whether children who underwent resection of a congenital lung abnormality (CLA) are at higher risk for neurodevelopmental impairments than peers in the general population. The study population consisted of children born between 1999-2018 who underwent resection of a symptomatic CLA. Neurocognitive development (intelligence, memory, attention, visuospatial processing, executive functioning) and motor function of this population are monitored through our structured, prospective longitudinal follow-up program at the ages of 30months, 5, 8, and 12years. We compared study population scores with Dutch norm values using one-sample t-tests and one-sample binominal proportion tests. Forty-seven children were analyzed. The 8-year-olds showed significant impairments in sustained attention through the Dot Cancellation Test (mean z-scores -2.4; [-4.1; -0.8], p = 0.006 and -7.1; [-12.8; -1.4], p = 0.02 for execution speed and fluctuations respectively). Visuospatial memory was impaired at 8years, though only in 1 out of 3 assessment tools (Rey Complex Figure Test z-scores (-1.0; [-1.5; -0.5], p < 0.001). Further neurocognitive outcomes were unimpaired at all tested ages. Regarding motor function outcomes, mean z-scores of total motor functioning were unimpaired across assessed ages. However, at 8years, significantly more children than expected had definite motor problems (18% vs 5%, 95% CI [0.052; 0.403], p = 0.022). Conclusion: This evaluation reveals impairment in some subtests of sustained attention, visuospatial memory and motor development. However, globally, normal neurodevelopmental outcomes were found throughout childhood. We recommend testing for neurodevelopmental impairments in children who underwent surgery for CLA only if associated morbidities are present or if caregivers express doubts about their daily functioning. What is Known: • In general, surgically managed CLA cases seldom suffer from long-term surgery-related morbidity and show favorable lung function. What is New: • Long-term neurocognitive and motor function outcome appear unimpaired within surgically managed CLA cases. We recommend testing for neurodevelopmental impairments in children who underwent surgery for CLA only if associated morbidities are present or if caregivers express doubts about their daily functioning.

Neurodevelopment in patients with biliary atresia up to toddler age: Outcomes and predictability

AimTo assess neurodevelopment in young patients with biliary atresia (BA) and to determine the predictive value of General Movement Assessment (GMA) at infant age for neurodevelopmental impairments at toddler age. MethodInfants diagnosed with BA were prospectively included in a longitudinal study. Neurodevelopmental status was previously assessed before Kasai porto-enterostomy (KPE) and one month after KPE using Prechtl's GMA, including motor optimality scores. At 2–3 years, neurodevelopment was assessed using the Bayley Scales of Infant Development, and compared to the Dutch norm population. The predictive value of GMA at infant age for motor skills and cognition at toddler age was determined. ResultsNeurodevelopment was assessed in 41 BA patients. At toddler age (n = 38, age 29 ± 5 months, 70 % liver transplantation), 13 (39 %) patients scored below-average on motor skills, and 6 (17 %) patients on cognition. Abnormal GMA after KPE predicted both below-average motor skills and cognitive score at toddler age (sensitivity, 91 % and 80 %; specificity 83 % and 67 %; negative predictive value, 94 % and 94 %; and, positive predictive value, 77 % and 33 %, resp.). InterpretationOne-third of toddlers with BA show impaired motor skills. GMA post-KPE has a high predictive value to identify infants with BA at risk of neurodevelopmental impairments.

Barrett Esophagus: Quality of life and factors associated with illness perception

BackgroundHealth‐related Quality of life (HRQoL) in patients with Barrett's esophagus (BE), a premalignant condition, may be influenced by gastroesophageal reflux disease (GERD) symptoms and the risk of developing esophageal adenocarcinoma.MethodsWe aim to investigate HRQoL in non‐dysplastic Barrett Esophagus (NDBE) patients, identify factors associated with a negative illness perception of the diagnosis BE and compare outcomes between patients treated in a specialized BE center with non‐expert centers. In this multi‐center cross‐sectional study, HRQoL of NDBE patients were assessed using the Short Form 36, Hospital Anxiety and Depression Scale, Cancer worry Scale, and Reflux Disease Questionnaire. A multivariable, linear regression analysis was conducted to assess factors associated with illness perception (Illness perception scale) of the BE diagnosis. Outcome parameters of patients from expert centers were compared to non‐expert centers.ResultsA total of 859 NDBE patients (mean age 63.6% and 74.5% male), of which 640 from BE expert centers were included. BE patients scored similar or higher means (i.e. better) on generic HRQoL in comparison with a Dutch norm population. The multivariable regression model showed that cancer worry, GERD symptoms, signs of anxiety and depression, and female gender were associated with a negative illness perception of BE. GERD symptoms were reported in the minority (22.4%) of BE patients. Levels of anxiety symptoms were comparable to a Dutch norm population (mean 3.7 vs. 3.9 p 0.183) and lower for depression symptoms (mean 6.8 vs. 7.6 p < 0.001). Overall, there were no differences found on outcomes between expert centers and non‐expert centers.ConclusionNDBE patients scored similar or better on generic HRQoL, anxiety and depression than an age and gender matched norm population. The presence of cancer worry, gastrointestinal symptoms, anxiety and depression, and female gender are factors associated with a negative illness perception of the diagnosis BE.

Long-term neurodevelopmental outcome in children after antenatal intravenous immune globulin treatment in fetal and neonatal alloimmune thrombocytopenia

Children with fetal and neonatal alloimmune thrombocytopenia face increased risk of intracranial hemorrhage potentially leading to developmental impairment. To prevent intracranial hemorrhage, pregnant women with alloantibodies against fetal platelets are often treated with intravenous immunoglobulin. Intravenous immunoglobulin seems effective in vastly reducing the risk of fetal or neonatal bleeding complications. However, information on long-term neurodevelopment of these children is lacking. This study aimed to evaluate long-term neurodevelopmental outcome in children with fetal and neonatal alloimmune thrombocytopenia who were treated with intravenous immunoglobulin antenatally. An observational cohort study was performed, including children of mothers treated with intravenous immunoglobulin during pregnancy because a previous child was diagnosed with fetal and neonatal alloimmune thrombocytopenia. Children were invited for a follow-up assessment including standardized cognitive and neurologic tests. The parents were asked to complete a behavioral questionnaire and school performance reports. The primary outcome was severe neurodevelopmental impairment, defined as severe cognitive impairment (intelligence quotient <70), cerebral palsy with Gross Motor Function Classification System Level ≥3, bilateral blindness, and/or bilateral deafness (requiring amplification). The secondary outcome was mild to moderate neurodevelopmental impairment, defined as either mild to moderate cognitive impairment (intelligence quotient <85), cerebral palsy with Gross Motor Function Classification System Level ≤2, minor neurologic dysfunction, vision loss, and/or hearing loss. Between 2003 and 2017, 51 children were live-born after antenatal intravenous immunoglobulin treatment. One family moved abroad and was therefore not eligible for inclusion. In total, 82% (41/50) of the eligible cases were included for neurodevelopmental assessment at a median age of 9 years and 8 months. Severe neurodevelopmental impairment was not detected. The incidence of mild to moderate neurodevelopmental impairment was 14% (6/41; 95% confidence interval, 6%-29%). The children's mean cognitive score, behavioral scores, and academic achievement were not different from those observed in the Dutch norm groups. Neuroimaging was performed in 90% (37/41) of cases. Severe intracranial hemorrhage was diagnosed in 2 cases (5%), one antenatally before the start of intravenous immunoglobulin and the other case 1 day after birth. Both cases had a normal neurodevelopmental outcome. The risk of neurodevelopmental impairment in children whose mothers were treated for fetal and neonatal alloimmune thrombocytopenia with antenatal intravenous immunoglobulin is comparable to that reported in the general population.

Assessing social-emotional development in infants and toddlers using parent-reports: Comparing the ASQ-SE-NL to the Social-Emotional Scale of the Bayley-III-NL

BackgroundThe Ages and Stages Questionnaire Social-Emotional (ASQ-SE) is a parent-report screening instrument designed to assess children's social-emotional development and detect those at risk for delay or problems. Psychometric properties of this questionnaire have been studied before, but the ASQ-SE has never been compared to the Social-Emotional Scale of the Bayley-III (Bayley-III-SE). AimTo compare the Dutch ASQ-SE (ASQ-SE-NL) to the Dutch Bayley-III-SE (Bayley-III-NL-SE; criterion measure). MethodA Dutch community sample of mothers with children aged 3–41 months (n = 1014) filled out both questionnaires. Cut-off scores for the ASQ-SE-NL were determined using: 1) >1 SD above the mean and 2) ROC curves. For the Bayley-III-NL, Dutch norm scores were used. ResultsSpecificity (70.8% and 88.5%) and screen-out accuracy (0.65 and 0.77) of the ASQ-SE-NL were good. Sensitivity was only sufficient (70.6%) when using ROC curves and only for the ASQ-SE-NL ≥18 months age versions. Screen-in accuracy was insufficient (<0.49). Positive predictive value was 34.7% and 32.7%, and negative predictive value was 87.5% and 92.3%. False positive cases on the ASQ-SE-NL scored significantly lower on the Bayley-III-NL-SE than true negative cases. ConclusionUsing the Bayley-III-NL-SE as the criterion, the ASQ-SE-NL performed well in identifying children not at risk for delay or problems. The ASQ-SE-NL sufficiently detected children at risk for delay or problems in the ≥18 months ASQ-SE-NL age versions when cut-off scores were determined by ROC curves. The ASQ-SE-NL can be used in a monitoring routine, but early rescreening is advised after a positive test result, given the number of false positive results.

School performance and behavioral functioning in children after intrauterine transfusions for hemolytic disease of the fetus and newborn

AimTo investigate the school performance and behavioral difficulties in children with hemolytic disease of the fetus and newborn (HDFN) treated with intrauterine transfusion (IUT) compared to Dutch norm data. Study designCros-sectional cohort study. SubjectsChildren who received one or multiple IUTs for severe Rh- or K (Kell)-mediated HDFN between January 2008 and January 2015 at the LUMC. Outcome measuresSchool performance reports were assessed as well as behavioral difficulties as assessed with the Dutch child behavioral checklist (CBCL) by parents and caregivers and the Teacher Report Form (TRF) completed by teachers. ResultsA response rate of 56% (70 children, aged 5–12 years) was obtained. Grade repetition occurred in 13 cases (19%), 16 children (23%) received some form of additional help, most often support by a speech therapist (n = 8), but also support for dyslexia (n = 4), physical therapy (n = 2) and social-emotional support (n = 2). None of the children in our study group attended special-needs education. School performance levels for reading comprehension, spelling and mathematics according to the Dutch National Pupil Monitoring System were similar for the study population and Dutch norm data. The incidence of behavioral problems as reported by parents was similar to the Dutch norm data, teachers reported less behavioral difficulties in the study group. ConclusionThis study shows favorable and reassuring school development in children treated with IUT in an experienced fetal-therapy center. A normal distribution in school and behavioral development is to be expected for children with HDFN treated with IUTs.

Health-related quality of life of perinatally HIV-infected young people: a longitudinal study

ABSTRACT Young people perinatally infected with HIV (pHIV) are at risk of a lowered health-related quality of life (HRQOL). Previous evaluation of the NeurOlogical, VIsual and Cognitive performance in HIV-infected Children (NOVICE)-cohort showed no difference in HRQOL between pHIV and matched HIV-uninfected controls (HIV-), yet a higher percentage of pHIV had impaired HRQOL. The aim of this study is to compare the change over time in HRQOL of pHIV to HIV- over a 5-year period. We used the Pediatric Quality of Life Inventory (PedsQL)™ 4.0 to repeat HRQOL assessment. High PedsQL scores indicate good HRQOL. Fifteen/33 (45.5%) pHIV and 17/37 (45.9%) HIV- completed both assessments. At the first assessment, the mean age was 13.1 years (range 8.0–18.4). PHIV scored higher than HIV- on Emotional functioning and on Total scale score. After five years, the mean age was 17.6 years (range 12.1–22.8). PHIV scored higher than HIV- on all scales, except Social functioning. PHIV did not differ significantly from the Dutch norm on either time-point. LMEM showed no difference in change over time for any of the PedsQL scales. In this study, young people with pHIV receiving high-quality health care, including monitoring of HRQOL, remain to experience a good HRQOL.

Methodology to Prioritize Chilean Tailings Selection, According to Their Potential Risks.

For centuries, Chile has been a territory with significant mining activity, resulting in associated social benefits and impacts. One of the main challenges the country faces today is the presence of a great number of mine tailings containing heavy metals, such as Cu, Cr, Ni, Zn, Pb, As, Cd, and Fe, which make up a potential risk for the population. This study is intended to develop a methodology for determining tailings requiring urgent treatment in Chile, based on risks associated with heavy metals. Geochemical data from 530 Chilean tailings were compared to the Dutch norm and the Canadian and Australian soil quality guidelines for residential use. Additionally, criteria about residents and water bodies were used, considering a 2-km area of influence around tailings. To do this, QGIS (Böschacherstrasse 10a CH-8624 Grüt (Gossau ZH), Zurich, Switzerland), a geospatial tool, was used to geolocate each deposit, considering regions, communes, rivers, lakes, and populated areas. To evaluate potential ecological contamination risks, Hakanson’s methodology was used. Results revealed the presence of 12 critical tailings in Chile that require urgent treatment. From the 530 tailings evaluated, 195 are located at less than 2 km from a populated area and 154 at less than 2 km from a water body. In addition, 347 deposits require intervention: 30 on Cu, 30 on Cr, 13 on Zn, 69 on Pb, 138 on As, 1 on Cd, and 5 on Hg.

The impact of type 1 diabetes on young adults\u2019 health-related quality of life

BackgroundYoung adulthood is a challenging period for people with diabetes mellitus type 1 (T1DM) as they are facing multiple life transitions while managing a demanding disease. This poses a risk for impaired health-related quality of life (HRQOL). We assessed HRQOL in a cohort of young adults with T1DM in the Netherlands, and compared outcomes with those of Dutch norm groups of healthy young adults and young adults with a chronic disease.MethodsWe analyzed data collected in a larger evaluation study on transitional care for young adults with T1DM in a nationwide sample in the Netherlands, including twelve participating hospitals. These data had been obtained from online questionnaires completed by young adults with T1DM after they had transferred to adult care. HRQOL was self-reported with the Pediatric Quality of Life Inventory for young adults (PedsQL-YA).ResultsOne hundred and sixty-five young adults with T1DM participated (44.2% response); and they scored significantly worse than did healthy peers on all domains of HRQOL, except social functioning. Particularly, functioning at school or work was worse than that of the norm group. The study group’s HRQOL-scores were comparable to norm scores of young adults with chronic diseases, although the physical and social functioning of young people with T1DM was better. One quarter (26.1%) of all young adults with T1DM reported fatigue.ConclusionsDuring transition to adulthood, young adults with T1DM struggle to maintain a balance between the demands of managing a disease and their life. Many of them encounter problems at work or school, and suffer from fatigue. These findings underscore the need to regularly assess HRQOL, and to discuss work- and education-related issues in clinical practice.

Long-Term Neurodevelopmental Outcomes in Children with Biliary Atresia

To assess long-term neurodevelopmental outcomes in school-aged children with biliary atresia. All Dutch children (6-12years of age) diagnosed with biliary atresia were invited to participate in this study. We used validated neurodevelopmental tests to assess motor skills and cognition, and questionnaires to assess behavior. Scores were compared with the Dutch norm population, by means of 1-sample tests. Results are given as number and percentage or mean±SD. We included 46 children, with a median age of 11years (range, 6-13years); 36 children had undergone a liver transplantation (78%). Twelve children (26%) received special education (vs 2.4% in the norm population; P<.01). Motor outcomes were significantly affected compared with the norm population (P<.01), with 25% normal (vs 85%), 25% borderline (vs 10%), and 50% low scores (vs 5%). Total IQ was lower in patients with biliary atresia, compared with the norm population (91±18 vs 100±15; P<.01). There were no significant differences in test scores between children with native liver and after liver transplantation. School-aged children with biliary atresia show neurodevelopmental impairments compared with the norm population, especially in motor skills. Our data strongly warrant evaluation of neurodevelopmental intervention programs to assess whether long-term outcomes could be improved.

Psychometric properties and norm scores of the sleep self report in Dutch children

BackgroundPsychometrically robust questionnaires to assess self-reported sleep problems in children are important since sleep problems can have a major impact on child development. The Sleep Self Report (SSR) is a 26-item self-report tool measuring different sleep domains in children aged 7–12 years. This study aims to evaluate the psychometric properties of the SSR and to provide Dutch norm scores.MethodsChildren aged 7–12 years from the general population were recruited through a professional market research agency. In this population, structural validity was assessed with confirmatory and exploratory factor analyses, internal consistency was assessed with the Cronbach’s alpha coefficient and norm scores were provided. Additionally, children attending outpatient sleep clinics (clinical population) were invited to participate. SSR scores of the general population and the clinical population were compared to establish discriminative validity.ResultsIn total, 619 children (mean age: 9.94 ± 1.72 years) from the general population and 34 children (mean age: 9.21 ± 1.63 years) from sleep clinics participated. The 1-factor structure of the SSR was not confirmed with factor analysis. Exploratory analyses did also not yield an appropriate multidimensional structure. Internal consistency of the total score was adequate (Cronbach’s alpha: 0.76). The total score distinguished the clinical population from the general population (39.07 ± 5.31 versus 31.61 ± 5.31; P < 0.01).ConclusionsAn appropriate structure of the SSR was not found with factor analyses in this Dutch population. The adequate internal consistency indicates that the total score can be interpreted as a measure of overall sleep problems. The SSR also shows good discriminative validity. We recommend the total score to assess overall sleep problems and item scores to evaluate specific sleep issues and to follow up children’s sleep longitudinally, as opposite changes in different item scores may not reflect in the total score. Further research on the development of multidimensional psychometrically sound pediatric sleep self-reports is of major importance.

Separated by the same language: Intralingual translation between Dutch and Dutch

ABSTRACTFlanders and the Netherlands have a long history of intralingual translation. By looking at the different aspects of this intralingual translation we can gain insight into the evolving power relations between both regions. In the long nineteenth century [1800-1914] and the decades after the Second World War the Netherlandic Dutch norm was prevalent and the Flemings translated their texts into Netherlandic Dutch. During the World Wars there were efforts to change the direction of the intralingual translation in favour of Flemish Dutch. From the 1990s onwards Dutch can be considered a pluricentric language with more or less equal power balance. Intralingual translation often goes both ways: from Flemish Dutch into Netherlandic Dutch and vice versa.The case of Dutch can teach us something about the remit of intralingual translation. In my research I defined seven relevant research angles: the orientation of the translation flows, the field where translation takes place, the medium of the translated language, the stakeholders involved in the translation process, the textual elements that undergo translation, the reception of the intralingual translation and finally, and most importantly, the function of the intralingual translation between languages that do not need translation to understand each other.

Dutch Norms for the Eyberg Child Behavior Inventory: Comparisons with other Western Countries

The Eyberg Child Behavior Inventory (ECBI) is one of the most widely used and well-validated parent rating scales for children’s disruptive behavior. This screening instrument is a short, targetted and easy to implement inventory with good psychometric properties and is normed for different countries, among which the United States, Spain, Sweden and Norway. The ECBI has been successfully used for research and clinical purposes, in several countries including The Netherlands. To date, Dutch studies have relied on Scandinavian or US norm scores. However, this may be problematic because of cross-cultural differences in the degree to which certain behaviors are seen as problematic by parents. The main goal of this paper therefore was to obtain norm scores for The Netherlands among 6462 Dutch children aged 4 to 8 years (Mage = 6.37 years; SD = 1.32; 50.6% boys). In line with previous research, we found small differences on the mean sum scores across children of different ages (intensity scale) and gender (intensity and problem scale). Therefore, Dutch norm scores were provided age- and gender specific. Our results showed that disruptive behavior of children in the most rural areas was reported as occurring less frequently and was seen as less problematic by parents compared to the disruptive behavior of children in less rural areas. Finally, we found that Dutch norm scores on the ECBI were significantly lower than US norm scores, and significantly higher on the intensity scale (but not the problem scale) than Norwegian and Swedish norm scores.

The Start2Bike program is effective in increasing health-enhancing physical activity: a controlled study

BackgroundThe sports club is seen as a new relevant setting to promote health-enhancing physical activity (HEPA) among inactive population groups. Little is known about the effectiveness of strategies and activities implemented in the sports club setting on increasing HEPA levels. This study investigated the effects of Start2Bike, a six-week training program for inactive adults and adult novice cyclers, on HEPA levels of participants in the Netherlands.MethodsTo measure physical activity, the Short QUestionnaire to ASsess Health-enhancing physical activity was used (SQUASH). Start2Bike participants were measured at baseline, six weeks and six months. A matched control group was measured at baseline and six months. The main outcome measure was whether participants met the Dutch Norm for Health-enhancing Physical Activity (DNHPA: 30 min of moderate-intensity activity on five days a week); Fit-norm (20 min of vigorous-intensity activity on three days a week); and Combi-norm (meeting the DNHPA and/or Fit-norm). Other outcome measures included: total minutes of physical activity per week; and minutes of physical activity per week per domain and intensity category. Statistical analyses consisted of McNemar tests and paired t-tests (within-group changes); and multiple logistic and linear regression analyses (between-group changes).ResultsIn the Start2Bike group, compliance with Dutch physical activity norms increased significantly, both after six weeks and six months. Control group members did not alter their physical activity behavior. Between-group analyses showed that participants in the Start2Bike group were more likely to meet the Fit-norm at the six-month measurement compared to the control group (odds ratio = 2.5; 95% confidence interval (CI) = 1.1–5.8, p = 0.03). This was due to the Start2Bike participants spending on average 193 min/week more in vigorous-intensity activities (b = 193; 95% CI = 94–293, p < 0.001) and 130 min/week more in sports activities (b = 130; 95% CI = 82–178, p < 0.001) than control group members.ConclusionsStart2Bike positively influences HEPA levels of participants by increasing participation in sport. A relatively short sporting program, offered by a sports club, can be used to encourage less active people to engage in and continue sport at HEPA levels. Overall, sport can contribute to health through increased HEPA and the sports club can serve as a setting to stimulate this.

Evaluación del ambiente aledaño a un expendio de com­bustible dentro del Parque Nacional Morrocoy, Venezuela. II: Calidad de aguas, sedimentos y biota

This paper is the second part of a baseline study carried out in the coastal region near a marine ser­vice station located in Morrocoy National Park, Venezuela. Results from a physical and chemical characteriza­tion of the water and sediments of four sites located around the service station are presented. The physical and chemical factors measured in water included: temperature, salinity, specific conductance, dissolved oxygen, sat­uration percentage of dissolved oxygen, pH, total suspended solids, transparency, oil and grease, total residual petroleum hydrocarbon, vanadium and lead, total coliform bacteria, and the presence of coliform bacteria. The factors measured in sediments include: granulometry, organic material, total carbonates, vanadium, lead, oil and grease, and total hydrocarbons. In addition, the amount of vanadium and lead in sample tissue from three species which are abundant and widely distributed in each site was measured in order to evaluate the potential of these species as bio-indicators. The water in the area where this study was conducted is shallow, warm, and thermally homogeneous, with high salinity and normal pH and dissolved oxygen, and supersaturated with oxygen in cer­tain hours in sites adjacent to abundant underwater vegetation. The water is moderately turbid with a tendency towards less dissolved oxygen with increased depth. The estimated values of NMP/100 ml of the coliform fecal organisms is within legal limits even though the total number of water coliforms measured in Site 2 was ten times higher than in Site 1. This increase is associated with the proximity of Site 2 to an outflow of pre-treated sewage. The values of TRPH in the water collected from each site were low and very dose to the detection limit (O.5/ml). Vanadium was no! found, while lead was detected in 11 of the 12 samples. Compared to the values measured for Site 1, which was the local reference, only one sample had a concentration of three times the maximum baseline. The amount of lead found in all analyzed samples was acceptable, according to the standards set by the State of Washington (maximum value: 292 mg/kg), while the concentration of lead in the sediments around the supply dock were 1.5 to 3.4 times greater than the Dutch norm. It can be concluded that there is no evidence of an accu­mulation of Va or Pb in the species selected as bioindicators. An observation program is proposed in which vari­ables similar to those measured for this characterization will be studied with some modifications. A more intense sampling of some variables is recommended (lead in water and sediments, total coliform and fecal matter in con­secutive samples and in days following a high concentration of visitors) as is the elimination or minimization of other variables.

Psychometric properties and Dutch norm values of the Children's Sleep Habits Questionnaire in toddlers

ObjectiveThe Children's Sleep Habits Questionnaire (CSHQ) was developed in the USA for children aged 4–10 years. The Dutch CSHQ has been validated for this age group, but not yet for toddlers. Furthermore, Dutch norm values for toddlers are unavailable. This study aimed to investigate the psychometric properties and collect norm values of the Dutch CSHQ in toddlers. MethodsData collection was conducted by Taylor Nelson Sofres Netherlands Institute for Public Opinion (TNS-NIPO), a Dutch market research agency. The TNS-NIPO provided access to the TNS-NIPO base, which comprises a panel of respondents who have indicated that they are willing to regularly participate in research. Parents of children aged 2–3 years were invited to complete the CSHQ. The CSHQ is a multidimensional questionnaire to detect sleep problems in children. It is a 33-item, one-week retrospective (parent-)proxy survey. A higher score indicates more sleep problems. ResultsThe response rate was 61% (n = 201). The original eight-factor structure did not fit well in this population and a more appropriate structure could not be achieved with explorative factor analyses. The mean total score was 41.9 (SD 5.6), and was higher (indicating more sleep problems) compared to Dutch school-aged children. ConclusionsThe one-dimensionality of the subscales of the CSHQ could not be confirmed in Dutch toddlers. Clinicians and researcher should be aware of the difficulty of reliably measuring sleep in this age group when using the CSHQ. For research purposes, it is therefore recommended to only use the total score.

Health-related quality of life in children with Robin sequence.

This patient-reported outcome (PRO) study reports on 102 children with Robin sequence (RS) and their parents. There has been differentiated between those with isolated RS and those with RS as part of a syndrome, and take various treatments into account. All RS families from an earlier described cohort were invited to participate. Parents and RS children completed online questionnaires regarding health-related quality of life (HRQoL), satisfaction with appearance, parental distress, and RS specific topics. Results were compared with the Dutch norm population if available. There was no major difference in HRQoL in RS children and the Dutch norm population, nor between children with isolated RS and those with RS as part of a syndrome. The latter is likely due to the large percentage of children with Stickler syndrome, and small number of RS children with intellectual disability. Parental distress was higher in RS children with syndromes compared to parents of isolated RS children. When comparing various treatments, the subgroup treated by mandibular distraction showed a tendency of lower HRQoL scores, less satisfaction with appearance, and more parental distress. Also in the NPA group parents showed a tendency of more parental distress. Subgroups for each treatment were very small, however, and firm conclusions cannot be drawn. In this study, HRQoL in RS children is demonstrated comparable to the norm population, despite variations in treatment, possibly with less favorable outcome for children who received mandibular distraction. Markedly larger studies are needed to allow more reliable comparison of PROs in various treatments, and to incorporate PROs in management guidelines to obtain optimal patient care. © 2016 Wiley Periodicals, Inc.

Acoustic Measurements in Retrofit Buildings Lead to a Sustainable Design of a (Semi-) Open Plan Office

Working in an office environment entails various activities. Communication on the phone, social interaction and meetings produce not only sound, but are also in need of a good speech intelligibility and therefore in need of good room acoustics. Difficult performance tasks are in need of different acoustic conditions. Areas with a more silent environment are needed with a minimised level of distraction from surrounding activities. Areas with a high level of interaction provide workspace for the purpose of teamwork. Different activities require unique acoustic conditions.Before creating a new activity based design in retrofit buildings, the existing acoustic environment is carefully measured. The acoustic qualities of the existing facilities as well as the actual behaviour of the existing population of the building are both measured. The sound insulation of the existing walls is defined as A-weighted standardized level difference DnT,A, measured according to the Dutch norm NEN 5077 (similar to ISO 140-4). The room acoustic parameters are defined by the reverberation time T, measured according to ISO 3382, and the spatial decay rate of A-weighted SPL of speech D2,S measured according to the norm ISO 3382-3 for room acoustics in open plan offices. The level of speech privacy is interpreted out of the combination of A- weighted sound pressure levels of speech Lp,A,S and the average A-weighted background noise level Lp,A,B per position. During a representative week of working hours the sound levels are being measured on different locations in the open plan office. The sound levels are measured in equivalent sound levels Leq, 5min and maximum sound levels Lmax, 5min. To gather information about the character of the sound, sound fragments are also recorded based on a trigger level.Defining the acoustic environment of (semi-)open plan offices based on building measurements and noise level measurements produces a solid foundation for designing a more sustainable office environment. Often the new design leads to activity based office plans where diverse activities are projected in a (semi-) open plan office. This is illustrated with a practical example of an engineering project.