Dutch Women Research Articles

Working conditions in women with multiple pregnancy—the impact on preterm birth and adherence to guidelines: a prospective cohort study

Women with multiple pregnancies are at risk for maternal complications such as preterm birth. Hazardous working conditions, such as physically demanding work and long and irregular working hours, might increase the risk of preterm birth. This study primarily aimed to determine whether certain working conditions up to 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective was to evaluate whether the working conditions of Dutch women with multiple pregnancy have been adjusted to the guidelines of the Netherlands Society of Occupational Medicine. We performed a prospective cohort study alongside the ProTWIN trial, a multicenter randomized controlled trial that assessed whether cervical pessaries could effectively prevent preterm birth. Women with paid work of >8 hours per week completed questionnaires concerning general health and working conditions between 16 and 20 weeks of pregnancy. Univariable and multivariable logistic regression analyses were performed to identify work-related factors associated with preterm birth (32-36 weeks' gestation) and very preterm birth (<32 weeks' gestation). We analyzed a subgroup of participants who worked for more than half of the week (>28 hours). We calculated the proportion of women who reported work-related factors not in accordance with guidelines. We studied 383 women, of whom 168 (44%) had been randomized to pessary, 142 (37%) to care as usual, and 73 (19%) did not participate in the randomized part of the study. After adjusting for confounding variables, working >28 hours was associated with very preterm birth (n=33; 78%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.1), and irregular working times were associated with preterm birth (n=26, 17%) (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.1) and very preterm birth (n=10; 24%) (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-7.3). Within a subgroup of 213 participants working >28 hours per week, multivariable analysis showed that irregular working times (n=16; 20%) (adjusted odds ratio, 3.5; 95% confidence interval, 1.2-10.1) and no/little freedom in performance of tasks (n=23; 28%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.3-7.3) were associated with preterm birth. Irregular working times (n=9; 27%) (adjusted odds ratio, 3.4; 95% confidence interval, 1.0-11.1), requiring physical strength (n=9; 27%) (adjusted odds ratio, 5.3; 95% confidence interval, 1.6-17.8), high physical workload (n=7; 21%) (adjusted odds ratio, 3.9; 95% confidence interval, 1.1-13.9), and no/little freedom in performing tasks (n=10; 30%) (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.6) were associated with very preterm birth. Before 20 weeks of pregnancy, 224 (58.5%) women with multiple pregnancy continued to work under circumstances that were not in accordance with the guidelines. In our cohort study, nearly 60% of women with multiple pregnancy continued to work under circumstances not in accordance with the guidelines to avoid physical and job strain and long and irregular working hours. Irregular hours were associated with preterm and very preterm birth, and long hours were associated with preterm birth.

7955 The Adeno Study: Adenomyosis in Dutch Women and Its Effect of Neonatal and Obstetric Outcomes -a Retrospective Population-Based Study

<h3>Study Objective</h3> To retrospectively investigate prevalence of adverse obstetric and neonatal outcomes in women with histopathologically proven adenomyosis compared to the general (Dutch) population. <h3>Design</h3> Retrospective population-based cohort study. <h3>Setting</h3> Population-based national databases. <h3>Patients or Participants</h3> Women with registered pregnancy outcomes in the Dutch national Perined registry, who received a histopathological diagnosis of adenomyosis (post-hysterectomy) between 1995 to 2018, as registered in the Dutch national pathological registry, were included. Pregnancy outcomes of 7,925 women with a histopathological diagnosis of adenomyosis were compared to 4,615,803 women without adenomyosis. Adjusted Odds Ratios (aOR, 95% CI) were calculated. Outcomes were corrected for: maternal age, parity, ethnicity, year of registered birth, induction of labor, hypertensive disorder in previous pregnancy, multiple gestation and low socioeconomic status. <h3>Interventions</h3> Hysterectomy. <h3>Measurements and Main Results</h3> Women with adenomyosis had an aOR of 1.370 (95% CI 1.25-1.498) for hypertensive disorders, an aOR of 1.373 (95% CI 1.248-1.510) for preeclampsia, and aOR of 1.15 (95% CI 1.067-1.248) for small-for-gestational-age. Women with adenomyosis had an aOR of 1.538 (95% CI 1.410-1.679) for emergency caesarean delivery, an aOR of 1.242 (95% CI 1.124-1.373) for failure to progress in labor, an aOR of 1.278 (95% Ci 1.101-1.484) for placental retention and an aOR of 1.232 (95% CI 1.098-1.383) for postpartum hemorrhage. There was no significantly increased risk for HELLP, eclampsia, placental abruption, operative vaginal delivery or need for oxytocin stimulation. <h3>Conclusion</h3> This is the largest study up to now which investigates the impact of adenomyosis on obstetric outcomes and is the first study which uses the golden standard of adenomyosis diagnosis: histopathology. We confirm women with adenomyosis show an increased prevalence of a variety of adverse obstetric outcomes, specifically hypertensive disorders of pregnancy, small-for-gestational age, failure to progress in labor and placental retention. We conclude that uterine placental invasion and contractile function in labor may be impaired in women with adenomyosis.

Young women’s sexual satisfaction in danger: the significance of thin-ideal internalization, positive body image, and appearance-related self-consciousness during physical intimacy

BackgroundPrevious research indicated that a positive body image is indirectly related to young adult women’s sexual satisfaction through protecting them from appearance-related self-consciousness during physical intimacy. The aim of the present study was to investigate thin-ideal internalization as a potential factor associated with positive body image, and subsequently ap-pearance-related self-consciousness during physical intimacy and sexual satisfaction.Participants and procedureUsing a cross-sectional design, 250 young adult Dutch women (age: M = 22.98, SD = 2.98) filled in an online survey measuring the relevant variables.ResultsA path analysis revealed that lower thin-ideal internalization was related to greater sexual satisfaction through a more posi-tive body image and less appearance-related self-consciousness during physical intimacy, and also consecutively via both.ConclusionsThese findings suggest that thin-ideal internalization may trigger processes that are detrimental to sexual satisfaction in women. Consequently, strengthening sociocultural pressure resistance skills in young adult women could facilitate the de-velopment and maintenance of positive sexual experiences.

The co-occurrence of both breast- and differentiatedthyroid cancer: incidence, association and clinical implications for daily practice.

BackgroundBreast cancer (BC) and differentiated thyroid cancer (TC) are two common cancer types with the highest incidence in women. BC and TC can develop synchronous or metachronous and the occurrence of both is higher than expected by chance. This study aimed to examine the association between BC and TC in the Netherlands.MethodsThis is a retrospective cohort study during the period of 1989–2020 retrieved from the Netherlands Cancer Registry (NCR). Patients diagnosed with BC-TC and BC alone as control group and TC-BC and TC alone as control group were included. The primary outcome was the standardized incidence ratio (SIR) of BC-TC and TC-BC. Secondary outcomes included data on the demographics, type of malignancy, treatment and overall survival (OS).ResultsThe incidence of TC among 318.002 women with BC (BC-TC) was 0.1% (423 patients) (SIR = 1.86 (95% CI: 1.40–2.32)) and the incidence of BC among 12,370 patients with TC (TC-BC) was 2.9% (355 patients) (SIR = 1.46 (95% CI: 1.09–1.83)). BC-TC patients were younger compared to the BC alone group at BC diagnosis (55 vs 60 years, p < 0.001). The age-adjusted odds ratio to develop TC was not significantly increased for patients who received chemotherapy and radiotherapy. Most TC cases were synchronous tumors after BC diagnosis (19%) with a TNM stage 1. Only 6% of the BC tumors after TC occurred synchronous with a TNM stage 1 in most cases. The OS of all groups was the most favorable in patients with both BC and TC compared to BC- and TC alone.Conclusion and relevanceThe SIR of TC after BC diagnosis and BC after TC diagnosis was higher than predicted based on the rates of the general population. TC and BC as second primary tumors were diagnosed in an early stage and did not affect overall survival. Therefore, Dutch women who have been treated for BC or TC require no special surveillance for their thyroid- and breast gland.

The Stigma Surrounding Menstruation: Attitudes and Practices Regarding Menstruation and Sexual Activity During Menstruation

This article describes the findings of a mixed-methods study aimed to understand attitudes and practices regarding menstruation and sexual activity during menstruation due to stigma. Findings from the surveys (n = 439), eight in-depth interviews, and four expert interviews show that both men and women hold stigmatizing attitudes toward menstruation and sexual activity during menstruation. Most respondents were not sexually active during menstruation. Stigmatizing attitudes resulted in constant physical and mental menstrual management for women, negatively influencing their lives. Surinamese women displayed significantly more stigmatizing attitudes and practices than Dutch women. Results imply that improving menstrual education could have a destigmatizing effect.

Pregnant Dutch Women Have Inadequate Iodine Status and Selenium Intake.

Iodine and selenium are essential for thyroid hormone synthesis. Iodine and selenium interact. Pregnancy increases the maternal iodine requirement. We previously reported inadequate iodine status in pregnant Dutch women. Since little is known about their selenium intake, we investigated the iodine status and selenium intake in relation to iodine and selenium supplement use during pregnancy. Iodine status was established in 201 apparently healthy pregnant women as 24 h iodine excretion (24H-UIE; sufficient if median ≥225 µg), iodine concentration (24H-UIC; ≥150 µg/L) and iodine/creatinine ratio (24H-UICR; ≥150 µg/g). Selenium intake was calculated from 24 h selenium excretion. Iodine status in pregnancy proved insufficient (medians: 24H-UIE 185 µg; 24H-UIC 95 µg/L; 24H-UICR 141 µg/g). Only women taking 150 µg iodine/day were sufficient (median 24H-UIE 244 µg). Selenium intake was below the Estimated Average Requirement (EAR; 49 µg/day) in 53.8%, below the Recommended Dietary Allowance (RDA; 60 µg/day) in 77.4% and below the Adequate Intake (AI; 70 µg/day) in 88.7%. Combined inadequate iodine status and selenium intake <RDA was found in 61%. Women who want to become pregnant should, consistently with WHO and ETA recommendations, be advised to use a 150 µg iodine-containing supplement. Concomitant selenium supplementation should be added to this advice, at least in The Netherlands.

Concurrent participation in breast, cervical, and colorectal cancer screening in the Netherlands

BackgroundMany European countries offer organised population-based breast, cervical, and colorectal cancer screening programmes. Around age 55 and 60, Dutch women are invited to all three screening programmes. We examined the extent to which participation concurs and identified factors influencing concurrent participation. Materials and methodsIndividual level data from breast, cervical, and colorectal cancer screening invitations between 2017 and 2019 were extracted from the Dutch screening registry. The percentages of women participating in all three, two, one, or none of the programmes around age 55 and 60, and before subsequent round invitation were determined. Multivariate ordinal regression analyses were performed to estimate whether population density, socio-economic status (SES) per postal code area, and time between the three invitations (<3, 3–6, >6 months) were associated with concurrent participation. ResultsData from 332,484 women were analysed. At age 55, 53.7% participated in all three programmes, 22.1% in two, 11.7% in one, and 12.6% did not participate at all. At age 60, a similar participation pattern was observed. Women living in areas with higher population density were less likely (odds ratios 0.75–0.94) and women in higher SES groups were more likely (odds ratios 1.12–1.60) to participate in more screening programmes, although this positive association was smaller for the highest SES group. No substantial association was found between concurrent participation and timing of invitations. ConclusionsMore than half of Dutch women participated in all three screening programmes and around 12% did not participate in any. Concurrent participation was lower in cities and lower SES groups.

171P Association of breast cancer therapy with cognitive decline in older women with early breast cancer: Findings from the CLIMB study

Studies investigating the long-term effects of breast cancer treatment on cognition in older breast cancer survivors are lacking, even though intact cognition is a highly valued outcome by the older population. Specifically, concern has been raised about detrimental effects of endocrine therapy (ET) on cognition. Therefore, we aimed to investigate longitudinal cognitive functioning and predictors of cognitive decline in older women treated for breast cancer. We prospectively enrolled Dutch women aged 70 years or older with stage I-III breast cancer in the CLIMB study. The Mini-Mental State Examination (MMSE) was performed at baseline, and 9, 15 and 27 months. Longitudinal trajectories of MMSE scores were analyzed for the minimal clinically important difference (2.3 points) in the whole cohort and in women treated with ET. To compare MMSE scores between patients with impaired and normal cognition and to identify the association between possible predictors and cognitive decline, linear mixed models were estimated. Among the 273 participants, mean age was 75.8 years (standard deviation (SD) 5.2) and 48% received adjuvant ET. Mean MMSE at baseline was 28.24 (SD 1.95). Cognition did not decline over time to clinically important differences in the whole cohort or in women receiving ET. MMSE scores of women with pretreatment cognitive impairments improved over time (significant interaction terms) in the whole cohort and in women receiving ET. Older age, lower education level and impaired mobility were independently associated with cognitive decline, but this decline was not clinically significant. Cognition of older women with early breast cancer did not decline up until two years after treatment initiation, irrespective of endocrine therapy. Our findings might indicate that fear of declining cognition does not justify de-escalation of breast cancer treatment in older patients.

Trends in long-term care use among Dutch older men and women between 1995 and 2016: is the gender gap changing?

AbstractThis study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social resources, and care provision. This raises the question of whether gender differences in care use have also changed over time. The Longitudinal Aging Study Amsterdam (LASA) involved respondents aged 70–88 in seven waves: 1995/96, 1998/99, 2002/03, 2005/06, 2008/09, 2011/12 and 2015/16 (N = 6,527 observations). Generalised estimating equations (GEE) were used to analyse changes in the impact of gender on the use of informal and formal home care, residential care and private home care, and the non-use of care. Men used more informal care provided by a partner than women, but women used other sources of care more than men. Individual social resources explained the gender gap in informal and formal home care use, and health and social resources explained the gap in residential care. In the non-use of care and, to some extent, in residential care use, the gender gap widened over the years to the disadvantage of men and was not explained by health and social resources. The persistent and even increasing gender gap in the non-use of care over time warrants an exploration of the role of gender in seeking care and access to care, and a closer examination of the role of long-term care policies in maintaining this gap.

Planning is not equivalent to preparing, how Dutch women perceive their pregnancy planning in relation to preconceptional lifestyle behaviour change - a cross-sectional study

BackgroundUnhealthy prenatal lifestyle behaviours are associated with adverse pregnancy outcomes, but little is known about what motivates women to comply with preconceptional lifestyle recommendations or consciously plan their pregnancy. Therefore, the objective of this study is to explore the associations between preconceptional lifestyle behaviours, health beliefs and pregnancy planning among Dutch pregnant women.MethodsIn this cross-sectional study based on the data of the APROPOS-II study, 1,077 low-risk pregnant women were eligible for inclusion. Preconception lifestyle behaviours and actively preparing for pregnancy were assessed in relation to planned pregnancies (based on the London Measure of Unplanned Pregnancies) and health beliefs (14 statements). The following preconceptional lifestyle behaviours were assessed through a self-administered questionnaire in the first trimester of pregnancy: fruit intake, vegetable intake, caffeine intake, (second-hand)smoking, alcohol intake, folic acid supplement use and exercise. Data were analysed using multivariate logistic regression analyses.ResultsA total of 921 (85.5%) women in our cohort had a planned pregnancy. However, of these women, 640 (69.5%) adequately used folic acid supplements and 465 (50.5%) women consumed alcohol at any point during pregnancy. Of the women considering themselves ‘healthy enough and not needing preconception care’, 48 (9.1%) women had an adequate vegetable intake, 294 (55.6%) women consumed alcohol at any point during pregnancy and 161 (30.4%) women were either over-or underweight.ConclusionDespite consciously planning their pregnancy, most women did not adhere to preconceptional lifestyle behaviour recommendations. Women’s health beliefs and overestimation of their health status seem to interfere with actively planning and preparing for pregnancy. Findings from our study may encourage the development of prospective health-promoting interventions that focus on health beliefs and actively preparing for pregnancy, to improve preconceptional lifestyle behaviours, thereby optimizing the health of future generations.

Born Traitors：Abe Tomoji’s Reconstruction of “The Treason of Pieter Elberveld” and the Image of Eurasians

This article aims to clarify Japanese South-commissioned writers’ perception of Eurasians in 1940s Indonesia on the basis of Abe Tomoji’s retelling of a tale of treachery in his essay “Chi to Tsuchi to Kokoro— Eruberuferuto no koto nado” (1944.7). The treachery in question is that of Pieter Elberfeld, a Eurasian man accused of plotting a rebellion against Dutch East Indies Company authorities with Javanese assistance, who was then brutally executed. In 1930s Japan, this story was symbolically employed by the “anti-Western” movement. Abe portrays Eurasians as people who act without clear reasons because of their mixed-blood nature, and he represents them as “born traitors.” By employing the notion of the “contact zone” as a conceptual framework through which to interpret Abe’s essay, this article argues that this portrayal of Eurasians is related to the Japanese military policy towards enemy aliens in Indonesia. This policy exempted Eurasians from internment in camps alongside Europeans if they could prove their Asian descent. As a result, many Eurasians who once prided themselves on their European ancestry began to identify themselves as Indonesians. This article’s findings fill the void in previous research on Abe as a South-commissioned writer, which primarily focuses on Indonesian scenic beauty and the eroticization of Dutch women there.

Effects of Galacto-Oligosaccharides Supplementation on Gut Comfort and Fecal Microbiota in Female Adults With Gut Complaints

ObjectivesThe prevalence of gastrointestinal (GI) discomfort is widespread and quality of life is strongly linked to a well-functioning GI tract. Over the years, many (dietary) solutions have been developed but the prevalence remains high. Prebiotic galacto-oligosaccharides (GOS) have been shown to support gut health in various target groups. Therefore, the objective of this study was to investigate the effect of 21 days consumption of 5.5g GOS on gut comfort in women (25–45 years old) with self-reported gut comfort complaints in a double blind randomized placebo controlled trial.MethodsHealthy Dutch women (n = 65) with a self-reported gut comfort component score (consisting of bloating, flatulence, stomach ache, constipation, and diarrhea, range: 0–15) of at least 6 were enrolled. For three weeks, participants received a daily powder with either 5.5g BiotisTM GOS or maltodextrin to be taken during the first meal of the day. Weekly, validated questionnaires were conducted to study the effect on gut comfort score, sleep, stress, and product tolerance. Furthermore, at start and after the intervention, stool samples were taken to study faecal microbiota.ResultsThis study demonstrates that on group average the daily consumption of 5.5g GOS as well as maltodextrin, for 3 weeks in healthy females (average age: 34 yrs) with self-reported gut comfort complaints, improved the gut comfort component score. No differences were found between the two interventions, which indicates that a large placebo-effect was in place. However, the consumption of GOS did result in a 3 times higher odds to improve the gut comfort component score after three weeks. Daily consumption of 5.5g GOS resulted in a shift in the overall microbiota composition, with a clear 85% increase of faecal Bifidobacterium, which was not observed for the control group. Finally, posthoc analysis showed that GOS tends to decrease flatulence and to improve quality of sleep at 21 days of consumption.ConclusionsDaily consumption of 5.5g GOS for 21 days among adult women 25–45 years with non-medical diagnosed gut complaints improved the gut comfort component score, but was not different from the control. However, consumption of GOS resulted in a higher odds to improve this score. Furthermore, the daily intake of 5.5g GOS significantly increased fecal Bifidobacterium.Funding SourcesFrieslandCampina, The Netherlands.

MO504: Urinary Albumin Excretion and Cancer Risk

Abstract BACKGROUND AND AIMS Accumulating evidence has shown that chronic kidney disease (CKD) is associated with cancer development. However, the main focus in these studies was on patients with moderately or severely impaired kidney function, rather than on patients with milder CKD defined by higher albuminuria. We hypothesized that albuminuria may have an association with cancer risk that is independent of kidney function. This study examined therefore the association between urinary albumin excretion (UAE), considered the gold standard for albuminuria assessment, and the risk of cancer incidence, independent of estimated glomerular filtration rate (eGFR). METHOD We included 8490 subjects in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, population-based cohort of Dutch men and women. UAE was measured in two 24-h urine specimens at baseline (1997–8). Cancer incidence was ascertained by record linkage with the nationwide network and registry of histo and cytopathology in the Netherlands (PALGA). Non-melanoma skin cancer was excluded from analyses. eGFR was calculated by the 2012 CKD-EPI creatinine-cystatin C equation. Cox proportional hazards regression models were used to calculate hazard ratios [HRs, [95% confidence intervals (95% CIs)] crude and additionally adjusted for age, sex, BMI, smoking, alcohol, educational level, diabetes and baseline eGFR. To detect potential reverse causation, we excluded subjects with a follow-up time of &amp;lt;1 year and recalculated the fully adjusted models. RESULTS Overall, 50% of the included subjects were female, and the mean age was 49.8 ± 12.7 years old. Median baseline UAE was 9.4 (IQR: 6.3–17.8) mg/24 h, and the mean baseline eGFR was 94.6 ± 17.3 mL/min/1.73 m2. At baseline, subjects who had higher UAE were more likely to be male, older, have lower eGFR and to have hypertension or diabetes. During a median follow-up of 17.7 (IQR: 17.67–17.71) years, 1789 subjects developed a de novo cancer. In the age- and sex-adjusted model, every doubling of UAE was associated with a 7% (HR: 1.07, 95% CI 1.04–1.10) higher risk of overall cancer. This association remained essentially unchanged after additional multivariable adjustments, including eGFR (HR: 1.06, 95% CI 1.02–1.09). UAE was also independently associated with an increased risk of development of several site-specific cancers including urothelial cell carcinoma (HR: 1.13, 95% CI 1.02–1.25), as well as lung cancer (HR: 1.13, 95% CI 1.04–1.22), haematological cancer (HR: 1.12, 95% CI 1.00–1.25), and head and neck cancer (HR: 1.29, 95% CI 1.06–1.57). We did not observe significant associations of UAE with melanoma, breast, prostate and colorectal cancers. Additionally, the associations of UAE with overall cancer, UCC, lung cancer and head and neck cancer remained significant in the fully adjusted models after we excluded subjects with a follow-up time of &amp;lt;1 year. CONCLUSION Higher albuminuria, assessed in 24-h urine, is associated with an increased risk of overall cancer and several site-specific cancers, independent of baseline eGFR. Future studies are warranted to corroborate these findings and to examine mechanisms underlying these associations.

The social conception of space of birth narrated by women with negative and traumatic birth experiences

BackgroundMany women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth. AimTo explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth. MethodsA feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic. FindingsThree themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror. Discussion/conclusionThe findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.

Attitudes towards cosmetic surgery among women in China and the Netherlands.

Around the world, an increasing number of people, predominantly women, are choosing to undergo cosmetic surgery—despite the associated health risks. This study aimed to promote a better cross-cultural understanding of the correlates and predictors of favorable attitudes toward cosmetic surgery among women in China (an Eastern country where cosmetic surgery is increasing most rapidly) and the Netherlands (a Western country). Questionnaire data were obtained from 763 adult women; 245 were Chinese women in China (Mage = 29.71), 265 were Chinese women in the Netherlands (Mage = 25.81), and 253 were Dutch women (Mage = 29.22). Facial appearance concerns and materialistic belief were significant predictors of favorable attitudes towards cosmetic surgery for all three cultural groups. Body appreciation was a significant positive predictor among Chinese women in both China and the Netherlands, whereas age and beauty-ideal internalization were significant positive predictors only among Chinese women in China. The findings and their implications are discussed with respect to the characteristics of Chinese culture that could explain the identified differences between Chinese and Dutch women.

A better but persistently low health status in women with fibromyalgia during the COVID-19 pandemic: a repeated cross-sectional data analysis

Multiple overlapping and complementary theoretical arguments suggest that the COVID-19 pandemic could worsen health in fibromyalgia. The aim of this study was to determine mental and physical health in women with fibromyalgia before and during the pandemic. In a 3-sample, repeated cross-sectional design, we analyzed questionnaire data from Dutch women with fibromyalgia, collected in three independent samples: before the COVID-19 pandemic (2018; n = 142) and during the first acute (2020; n = 304) and prolonged (2021; n = 95) phases of the pandemic. Eight dimensions of mental and physical health were assessed using The RAND 36-Item Short Form Health Survey (RAND SF-36). Compared to norm group data, both before and during the pandemic, women with fibromyalgia showed high levels of fatigue and pain and low levels of general health, social functioning, physical functioning, role physical functioning (d > 1.2, very large effect sizes), role emotional functioning, and mental health (0.71 < d < 1.2, medium to large effect sizes). Contrary to theoretical expectation, levels at five health variables before vs. during the pandemic did not differ (p > 0.05), and levels of pain (p < 0.001), role physical functioning (p < 0.001), and physical functioning (p = 0.03) (0.014 ≤ pη2 ≤ 0.042, small effect sizes) reflected a healthier status during than before the pandemic. These findings indicate a somewhat better but persistently low health status in women with fibromyalgia during the pandemic. This suggests that the pandemic may include changed circumstances that are favorable for some women with fibromyalgia.

Het laatste woord in Uphoffs ‘Rotte Boek’

Imagology studies the representation of national identities in (literary) texts, but is usually limited to a cultural-historical and intertextual focus. Hence the textual, ‘aesthetic function’ of literature is often neglected. In this article we argue that the textual analysis of literary techniques, specifically metafiction, can be a useful theoretical impulse for the premises of imagology. This proposed focus also does more justice to (metafictional) literature’s critical capacities regarding the representation of national identities and ‘the other’. This ‘textual’ form of imagology, focused on metafiction, will be applied to the literary representation of a specific European region, the Balkans, in De spelers [The players] (2009) by Manon Uphoff. This novel deals with a love affair between a Dutch woman and a man who fled his native country in response to the violent conflicts that resulted from the disintegration of Yugoslavia in the 1990’s. The representation of Bosnia and Herzegovina in De spelers could be typified as stereotypical or balkanist discourse – a view that was articulated by reviewer Elsbeth Etty in the national paper NRC Handelsblad. We will argue, however, that the self-referential elements of Uphoffs novel have (self-)critical potential with regard to its balkanist representation of Bosnia and Herzegovina.

The role of perceived ethnicity in speech processing: Insights from diverse populations and methods

In this talk, I will discuss behavioral and electrophysiological studies that examine the extent to which perceived talker identity influences speech comprehension and evaluation. Two frequently discussed theoretical accounts lead to different predictions. Bias-based accounts assume conscious misunderstanding of a standard variety in the case of a speaker classification as nonnative, resulting in negative ratings and poorer comprehension. Exemplar-based models suggest that such effects arise only when a contextual cue to the social identity is misleading, i.e., when ethnicity and speech clash with listeners’ expectations. To address these accounts, and to assess ethnicity effects across different groups and methods, diverse non-university populations (172 monolinguals, 58 bilinguals, age range 12–92) were primed with photographs of Asian and white European women and asked to repeat and rate utterances spoken in three accents (Korean-accented German, a regional German accent, standard German), all embedded in background noise. In three electrophysiological studies, students (106 monolinguals, age range 18–30) passively listed to utterances in two accents (Turkish-accented and standard Dutch) and were either primed or not with photographs of a Turkic or a Dutch woman. The findings suggest that theoretical contradictions are a consequence of methodological choices, which reflect distinct aspects of social information processing.

Sexual Self-Concept in Women with Disorders/Differences of Sex Development

Many women born with disorders or differences of sex development (DSD) report sexual problems, in particular women who have undergone extensive genital reconstruction. Examining cognitions and emotions that hinder or promote sexuality may facilitate understanding these sexual problems and may contribute to the development of specific interventions. In this study, sexual self-concept, body image, and sexual functioning were investigated in relation to genital surgery. To conduct the study, the women’s Sexual Self-Concept Scale was translated to Dutch. Evaluation of psychometric properties was conducted in a sample of healthy Belgian and Dutch women participating in an anonymous web-based survey (N = 589, Mdn age, 23 years). The resulting three-factor structure corresponded largely to that of the original version. Compared to control women, women born with a DSD who were included in the Dutch DSD study (N = 99, Mdn age, 26 years) described themselves as being less interested in sex and less sexually active. These women also harbored more negative emotions and cognitions regarding their sexuality and were less satisfied with their external genitalia. In women with a DSD, sexual self-concept was associated with compromised outcomes on sexual functioning and distress. Women who were in a steady relationship, and/or had been sexually active in the past 4 weeks had a more positive sexual self-concept, took a more active role in their sexual relationship, experienced more sexual desire and arousal and less sexual distress than women who were not involved in a partner relationship. Findings in this study indicate that cognitions and emotions related to sexual self-concept play a role in sexual functioning of women with a DSD. A cognitive behavioral counseling approach with focus on coping and exploration of their own sexual needs could prove useful in this group.

Differences in the prevalence of intermediate hyperglycaemia and the associated incidence of type 2 diabetes mellitus by ethnicity: The HELIUS study

AimsWe aimed to describe differences in the prevalence of intermediate hyperglycaemia (IH) between six ethnic groups. Moreover, to investigate differences in the association of the classifications of IH with the incidence of T2DM between ethnic groups. MethodsWe included 3759 Dutch, 2826 African Surinamese, 1646 Ghanaian, 2571 Turkish, 2691 Moroccan and 1970 South Asian Surinamese origin participants of the HELIUS study. IH was measured by fasting plasma glucose (FPG) and HbA1c. We calculated age-, BMI and physical-activity-adjusted prevalence of IH by sex, and calculated age and sex-adjusted hazard ratios (HR)for the association between IH and T2DM in each ethnic group. ResultsThe prevalence of IH was higher among ethnic minority groups (68.6–41.7%) than the Dutch majority (34.9%). The prevalence of IH categories varied across subgroups. Combined increased FPG and HbA1c was most prevalent in South-Asian Surinamese men (27.6%, 95 %CI: 24.5–30.9%), and in Dutch women (4.2%, 95 %CI: 3.4–5.1%). The HRs for T2DM for each IH-classification did not differ significantly between ethnic groups. HRs were highest for the combined classification, e.g., HR = 8.1, 95 %CI: 2.5–26.6 in the Dutch. ConclusionWe found a higher prevalence of IH in ethnic minority versus majority groups, but did not find evidence for a differential association of IH with incident T2DM.