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The article describes the dissemination and implementation of the Aging Well and Healthily (AWH) program in the Netherlands. In the period 1997-1999 this process was monitored by means of telephone interviews with 263 participants, 28 peer educators, and 13 organizers. The program participants were mainly physically active and relatively healthy people in their mid 70s. The peer educators were in their late 50s. The overall satisfaction with the content and delivery of the AWH program was good; 13% of the participants enrolled in related local sports activities. In total, the AWH program was run 57 times, which did not meet the target of 50 times a year. Different factors could have negatively influenced dissemination. In the first place, the organization of the program was perceived to be complex and not compatible with the values of the organizations that were to implement the program. Also, 3 national implementation partners had organizational problems of their own. The results were used to design a new social marketing strategy, which appears to be successful.

Promoting unstructured outside play is a promising vehicle to increase children's physical activity (PA). This study investigates if factors of the social environment moderate the relationship between the perceived physical environment and outside play. Study design: 1875 parents from the KOALA Birth Cohort Study reported on their child's outside play around age five years, and 1516 parents around age seven years. Linear mixed model analyses were performed to evaluate (moderating) relationships among factors of the social environment (parenting influences and social capital), the perceived physical environment, and outside play at age five and seven. Season was entered as a random factor in these analyses. Results: Accessibility of PA facilities, positive parental attitude towards PA and social capital were associated with more outside play, while parental concern and restriction of screen time were related with less outside play. We found two significant interactions; both involving parent perceived responsibility towards child PA participation. Conclusion: Although we found a limited number of interactions, this study demonstrated that the impact of the perceived physical environment may differ across levels of parent responsibility. © Remmers et al.; licensee BioMed Central Ltd.

Background: A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results. Methods: Perinatal deaths between 1993 and 1998 in regions of ten European countries were identified. The categories of death chosen for the study were singleton fetal deaths at 28 or more weeks of gestational age, all intrapartum deaths at 28 or more weeks of gestational age and neonatal deaths at 34 or more weeks of gestational age. Deaths with major congenital anomalies were excluded. An international audit panel used explicit criteria to review all cases, which were blinded for region. Subjective interpretation was used in cases of events or interventions where explicit criteria did not exist. Suboptimal factors were identified in the antenatal, intrapartum and neonatal periods, and classified as 'maternal/social', due to 'infrastructure/service organization', or due to 'professional care delivery'. The contribution of each suboptimal factor to the fatal outcome was listed and consensus was reached on a final grade using a procedure that included correspondence and plenary meetings. Results: In all regions combined, 90% of all known or estimated cases in the selected categories were included in the audit. In total, 1619 cases of perinatal death were audited. Consensus was reached in 1543 (95%) cases. In 75% of all cases, the grade was based on explicit criteria. In the remaining cases, consensus was reached within subpanels without reference to predefined criteria. There was reasonable to good agreement between and within subpanels, and within panel members. Conclusions: The international audit procedure proved feasible and led to consistent results. The results that relate to suboptimal care will need to be studied in depth in order to reach conclusions about their implications for assessing the quality of perinatal care in the individual regions.

Background: During the last decade, a rapid increase of birth locations for low-risk births, other than conventional obstetric units, has been seen in the Netherlands. Internationally some of such locations are called birth centres. The varying international definitions for birth centres are not directly applicable for use within the Dutch obstetric system. A standard definition for a birth centre in the Netherlands is lacking. This study aimed to develop a definition of birth centres for use in the Netherlands, to identify these centres and to describe their characteristics. Methods: International definitions of birth centres were analysed to find common descriptions. In July 2013 the Dutch Birth Centre Questionnaire was sent to 46 selected Dutch birth locations that might qualify as birth centre. Questions included: location, reason for establishment, women served, philosophies, facilities that support physiological birth, hotel-facilities, management, environment and transfer procedures in case of referral. Birth centres were visited to confirm the findings from the Dutch Birth Centre Questionnaire and to measure distance and time in case of referral to obstetric care. Results: From all 46 birth locations the questionnaires were received. Based on this information a Dutch definition of a birth centre was constructed. This definition reads: "Birth centres are midwifery-managed locations that offer care to low risk women during labour and birth. They have a homelike environment and provide facilities to support physiological birth. Community midwives take primary professional responsibility for care. In case of referral the obstetric caregiver takes over the professional responsibility of care." Of the 46 selected birth locations 23 fulfilled this definition. Three types of birth centres were distinguished based on their location in relation to the nearest obstetric unit: freestanding (n = 3), alongside (n = 14) and on-site (n = 6). Transfer in case of referral was necessary for all freestanding and alongside birth centres. Birth centres varied in their reason for establishment and their characteristics.

Young handicapped citizens in the Netherlands have increasingly been receiving social benefits or special services during the last five years. Dutch governmental departments have therefore commissioned an applied social policy research. We analyzed six benefits (for example special education, psychological healthcare, and Wajong benefits for young disabled). The usage of all these provisions is increasing. In particular we focus on "Wajong" (a sort of pension for Dutch young disabled people) and its social consequences. The number of Wajong benefits is growing strongly. In 2006 every 22nd person aged 18 (4.5%) claimed and received this disability benefit. Also, the statistical trend is that people with a handicap are less often employed and are more often unemployed. So there is an ongoing political discussion about these provisions with special attention to Wajong. © Georg Thieme Verlag KG.

Introduction: In the Dutch maternity care system, the role division between independently practising midwives (who take care of normal pregnancy and childbirth) and obstetricians (who care for pathologic pregnancy and childbirth) has been established in the so-called " List of Obstetric Indications" (LOI). The LOI designates the most appropriate care provider for women with defined medical or obstetric conditions. Methods: This descriptive study analysed the evolution of the concept of " normality" by comparing the development and the contents of the consecutive versions of the LOI from 1958 onwards. The results were related to data from available Dutch national databases concerning maternity care. Results: The number of conditions defined in the successive lists increased from 39 in 1958 to 143 in 2003. In the course of time, the nature and the content of many indications changed, as did the assignment to the most appropriate care provider. The basic assumptions of the Dutch maternity care system remained stable: the conviction that pregnancy and childbirth fundamentally are physiologic processes, the strong position of the independently practising midwife, and the choice between home or hospital birth for low-risk women. Nevertheless, the odds of the obstetrician being involved in the birth process increased from 24.7% in 1964 to 59.4% in 2002, whereas the role of the primary care provider decreased correspondingly. Discussion: Multidisciplinary research is urgently needed to better determine the risk status and the optimal type of care and care provider for each individual woman in her specific situation, taking into account the risk of both under- and over-treatment. Safely keeping women in primary care could be considered one of a midwife's interventions, just as a referral to secondary care may be. The art of midwifery and risk selection is to balance both interventions, in order to end up with the optimal result for mother and child. © 2010 American College of Nurse-Midwives.

Aims: This study was undertaken to estimate the effect of hip protectors on the incidence of hip fracture when introduced into nursing homes as a regular part of the healthcare for all residents. Methods: A pre-test/test design was used. The pre-intervention period lasted 18 months from May 1996. The intervention period lasted 18 months from May 1998. During the intervention period all residents (965 beds) in nursing homes in two municipalities in Norway were offered free use of hip protectors. The project manager provided motivational activities in the nursing homes during the whole period, aimed at increasing the participation rate. Results: The intervention period showed a 39% reduction in the hip fracture incidence when compared with the pre-intervention period (p = 0.003). The percentage of daily users of the protector varied from 35% during the first months to 22% at the end of the period. Among the 61 persons who suffered a hip fracture 31 were registered as daily users. Fourteen of the 31 users were not wearing the protector when the hip fracture occurred, while five of the 31 had the protector on their knees. Twelve of the 31 suffered a hip fracture while properly wearing the protector. Conclusions: This non-randomized study showed that hip protectors introduced to all residents in nursing homes considerably reduced the incidence of hip fracture. It may be possible to achieve higher compliance and a further reduction in the incidence of hip fractures if the producers of hip protectors increase the comfort of the protector without reducing its effect. In addition, it is important that health workers encourage more individuals at high risk to use the protector. © Taylor & Francis 2003.

Background: The MEDICOM (Medical Products Electronic Commerce) Portal provides the electronic means for medical-equipment manufacturers to communicate online with their customers while supporting the Purchasing Process and Post Market Surveillance. The Portal offers a powerful Internet-based search tool for finding medical products and manufacturers. Its main advantage is the fast, reliable and up-to-date retrieval of information while eliminating all unrelated content that a general-purpose search engine would retrieve. The Universal Medical Device Nomenclature System (UMDNS) registers all products. The Portal accepts end-user requests and generates a list of results containing text descriptions of devices, UMDNS attribute values, and links to manufacturer Web pages and online catalogues for access to more-detailed information. Device short descriptions are provided by the corresponding manufacturer. The Portal offers technical support for integration of the manufacturers' Web sites with itself. The network of the Portal and the connected manufacturers' sites is called the MEDICOM system. Objective: To establish an environment hosting all the interactions of consumers (health care organizations and professionals) and providers (manufacturers, distributors, and resellers of medical devices). Methods: The Portal provides the end-user interface, implements system management, and supports database compatibility. The Portal hosts information about the whole MEDICOM system (Common Database) and summarized descriptions of medical devices (Short Description Database); the manufacturers' servers present extended descriptions. The Portal provides end-user profiling and registration, an efficient product-searching mechanism, bulletin boards, links to on-line libraries and standards, online information for the MEDICOM system, and special messages or advertisements from manufacturers. Platform independence and interoperability characterize the system design. Relational Database Management Systems are used for the system's databases. The end-user interface is implemented using HTML, Javascript, Java applets, and XML documents. Communication between the Portal and the manufacturers' servers is implemented using a CORBA interface. Remote administration of the Portal is enabled by dynamically-generated HTML interfaces based on XML documents. A representative group of users evaluated the system. The aim of the evaluation was validation of the usability of all of MEDICOM's functionality. The evaluation procedure was based on ISO/IEC 9126 Information technology - Software product evaluation - Quality characteristics and guidelines for their use. Results: The overall user evaluation of the MEDICOM system was very positive. The MEDICOM system was characterized as an innovative concept that brings significant added value to medical-equipment commerce. Conclusions: The eventual benefits of the MEDICOM system are (a) establishment of a worldwide-accessible marketplace between manufacturers and health care professionals that provides up-to-date and high-quality product information in an easy and friendly way and (b) enhancement of the efficiency of marketing procedures and after-sales support.

The field of minimally invasive therapy (MIT) raises many important issues for the future of health care. It seems inevitable that MIT will replace much conventional surgery. This trend is good for society and good for patients. The health care system, however, may find the change disruptive. The need for hospital beds will shrink. Day surgery and community care will grow. Physicians will have to have special training in doing the new procedures. New organizational forms of care will evolve. Quality assurance procedures will be needed to assure that out-of-hospital care is safe and effective. One negative consequence of MIT is that the indications broaden, so that many 'preventive' procedures may be carried out. Societies are doing little to face up to these changes. The potential of MIT could be enhanced by active policy interventions, including evaluation and attention to the organization and financing of health care.

Objective. As part of the Models of Child Health Appraised (MOCHA) project, this study aimed to answer the following research questions: 1) How do European citizens perceive the quality of primary health care provided for children? And 2) What are their priorities with respect to quality assessment of primary health care aimed at satisfying children’s needs? Methods. Nine potential attributes of quality of primary care were operationalized in 40 quality aspects. An online survey was used to elicit opinions in a representative sample of citizens of Germany, the Netherlands, Poland, Spain, and the United Kingdom. Data collection comprised: background characteristics; perceived quality of primary health care for children; and priority setting of quality aspects. Descriptive analysis was performed and differences between groups were tested using Chi-Square test and ANOVA. Results. Valid results were obtained from 2403 respondents. Mean satisfaction with quality of primary care ranged from 5.5 (Poland) to 7.2 (Spain). On average, between 56% (Poland) and 70% (Netherlands) of respondents had a positive perception of the primary health care system for children in their country. The ability of a child to limit their parents’ access to the child’s medical records was judged most negatively in all countries (average agreement score 28%, range 12–36%). The right of a child to a confidential consultation was judged most differently between countries (average agreement score 61%, range 40–75%). Overall top-10 priorities in ensuring high quality primary care were: timeliness (accessibility); skills/competences, management, facilities (appropriateness); no costs (affordability); information, dignity/respect (continuity); and swift referrals, collaboration (coordination). Discussion. Between countries, significant differences exist in the perceived quality of primary care and priorities with regard to quality assessment. Taking into account the citizens’ perspective in decision-making means that aspects with low perceived quality that are highly prioritizedwarrant further action.

Background: As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods: Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC - Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem) between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG) is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results: Twenty four percent of children older than 3 years were inappropriately referred (NCR). Of the correctly referred children 74-88% were short corrected for parental height, 40-61% had a height SDS <-2.5 and 21% showed height deflection (Δ HSDS < -0.25/yr or Δ HSDS < -1). In none of the children a complete detailed routine diagnostic work up was performed and in more than 30% no routine laboratory examination was done at all. Pathologic causes of short stature were found in 27 children (5%). Conclusion: Existing guidelines for workup of children with suspected growth failure are poorly implemented. Although poorly implemented the DCG detects at least 5% pathologic causes of growth failure in children referred for short stature. New guidelines for referral are required with a better sensitivity and specificity, wherein distance to target height should get more attention. The general diagnostic work up for short stature should include testing for celiac disease in all children and for Turner syndrome in girls. © 2008 Grote et al; licensee BioMed Central Ltd.

Objective: : The effectiveness of use of migrant health educators in the general practitioners' care for female migrants with psychosomatic problems was evaluated to contribute to the improvement of the care for these patients. Methods: : A randomised controlled trial (RCT) design was used. A total of 104 patients (75%) agreed to take part in the intervention study. The patients were from Turkish and Moroccan immigrant groups living in The Netherlands. The intervention group received counselling and education from the migrant health educators as adjuncts to the GPs' care. Special attention was given to the patient's cultural background, supporting the communication between GP and patient. The control group received regular treatment from their GPs. Results: : A significant improvement of perceived general health, psychological health and reported ability to cope with pain was observed among the intervention group. No effects were found for social support and the perceived burden of stressful life-events. Conclusion: : The patients' perceived health and coping abilities improved through the intervention as a whole. Not all outcome measures had been affected due to among others the diversity of physical and psychological complaints the patients suffered from, non-compliance and a perceived decrease of disability over time. Practice implications: : The intervention methods should be integrated in the patient care delivery for migrants in general practice. Further development of intervention methods to address the patients' social support is recommended. © 2007 Elsevier Ireland Ltd. All rights reserved.