Thromboembolic complications remain a major public health burden, making antithrombotic agents one of the most widely prescribed groups of medication, but the treatment is often challenging as it... Show moreThromboembolic complications remain a major public health burden, making antithrombotic agents one of the most widely prescribed groups of medication, but the treatment is often challenging as it at the same time increases risk of bleeding. With nationwide data from Statistics Netherlands, antithrombotic therapy and relevant clinical outcomes were comprehensively examined in the patient population of atrial fibrillation, overall or among those with comorbid cancer. The results suggest the patient population was increasingly receiving anticoagulants, driven by the newly introduced medication- direct oral anticoagulant and guided by the CHA2DS2-VASc score, and meanwhile the patient population experienced fewer ischemic stroke and major bleeding. In spite of these promising changes, suboptimal medication adherence and potential underuse of anticoagulants remain directions for further improvement. Antithrombotic agent use during pregnancy was also examined in the general Dutch pregnant population, which featured a surge in antiplatelet prescriptions, and risk of preeclampsia/eclampsia decreased and several newborn outcomes improved simultaneously. Together, the studies presented in this thesis provide an overview of antithrombotic therapy in the Netherlands in recent years, providing insights for further improving this treatment and relevant patient outcomes. Show less
This dissertation examines the educational positions of children of immigrants in the Netherlands from 1980 to 2020. In particular, the influence of migration background and socioeconomic factors... Show moreThis dissertation examines the educational positions of children of immigrants in the Netherlands from 1980 to 2020. In particular, the influence of migration background and socioeconomic factors on educational positions is studied. Findings reveal substantial progress in education for migrant children overall, especially among the second generation, younger cohorts, and girls with a migrant background, indicating promising upward mobility within the education system for many of these children. The family environment impacts educational outcomes, with socioeconomic background playing a crucial role. Higher parental incomes correlate with higher education levels for children in both the short and long term. Additionally, the living environment affects outcomes such as school dropout rates, especially among boys from migrant backgrounds in larger cities. They are more prone to leaving education prematurely than their female or non-migrant peers. Despite institutional barriers and discrimination within the education system, these children demonstrate an upward trend in education, highlighting the need for further research incorporating discrimination as a factor. Show less
The African Studies Centre Leiden celebrated its 75th anniversary at Museum Volkenkunde in Leiden on 8 September 2022. It was a festive day with colleagues, students, alumni, and societal partners.... Show moreThe African Studies Centre Leiden celebrated its 75th anniversary at Museum Volkenkunde in Leiden on 8 September 2022. It was a festive day with colleagues, students, alumni, and societal partners. This ASCL Occasional Publication presents the keynote speeches of the day, giving insight into the Centre’s rich past and present research, education, library and societal activities. In addition, it is illustrated with many pictures of the day and showcases the ASCL Library’s special items from the collection that were exhibited. Show less
Since the opening of the first CLIL department in the Netherlands in 1989, tweetalig onderwijs (‘bilingual education’) has expanded into a national network of over 130 secondary schools, serving a... Show moreSince the opening of the first CLIL department in the Netherlands in 1989, tweetalig onderwijs (‘bilingual education’) has expanded into a national network of over 130 secondary schools, serving a population of around 37,000 learners. While academic interest in the field has also seen growth and diversification, the pace of practical developments and the lack of a structured research agenda have led to research becoming fragmented and lagging behind practice. This chapter provides an overview of the Dutch CLIL context followed by a critical review of research into organisation, implementation, outcomes and experiences in Dutch bilingual education. The chapter concludes with a reflection on the ways in which future research could support further developments in practice. Show less
Harkel, A.T. ten; Dierendonck, R. van; Farber, E.; Dee, M.; Doeve, P.; Hamerow, H.; ... ; Deckers, P. 2023
THIS PAPER ADDRESSES THE QUESTION, who were the people who were buried at the early medievalNorth Sea emporia? Conclusions about the mercantile character of the North Sea emporia are often based on... Show moreTHIS PAPER ADDRESSES THE QUESTION, who were the people who were buried at the early medievalNorth Sea emporia? Conclusions about the mercantile character of the North Sea emporia are often based on portablematerial culture. In recognition of the fact that it is difficult to draw conclusions about the identities of people basedon finds assemblages, two pilot projects have been completed that involved bioarchaeological analyses of cemetery pop-ulations associated with these sites. The first of these, the Investigating the Dead in Early Medieval Domburg project,undertook multi-disciplinary analyses of the (very small) surviving burial population from the mostly destroyed sitesin the Domburg area (Netherlands), combining isotope analysis, radiocarbon dating, biological anthropology, dendro-chronology, and provenancing and study of previous use of coffin wood. The second, the Medieval Migrants of theNorth Sea World project, inventoried available isotopic evidence for human remains from emporia sites in England,the Netherlands and Scandinavia, alongside contextual archaeological information. This paper presents both projects,providing the detailed information from Domburg in its wider, international context, and highlighting the need for acomprehensive research agenda to fill current gaps in our understanding of early medieval emporia populations. Show less
The overall aim of this dissertation was to study the contribution of a syndemics framework to understanding and addressing persistent health disparities. Departing from an interdisciplinary... Show moreThe overall aim of this dissertation was to study the contribution of a syndemics framework to understanding and addressing persistent health disparities. Departing from an interdisciplinary approach, the dissertation attends to research questions on syndemics indicators, contextual drivers for syndemics, the intergenerational nature of syndemics, and possibilities for early public health interventions in Katwijk, a former fishing town in the Netherlands. An epidemiological study described the three most prevalent disease clusters in Katwijk. A qualitative life course study found a first indication that syndemic vulnerability is potentially intergenerational, and that syndemic processes can be countered. A mixed method study showed that while challenging, a family-engagement approach can elicit positive effects on families’ health and wellbeing. The ethnographic study described the hurdles for implementing family-focused health promotion for multifaceted health conditions, such as childhood obesity. This dissertation establishes that the syndemics framework provides tools to identify past and present factors on the complex pathways to persistent poor health, which in turn point at directions for breaking patterns of generational health. The findings highlight a need for multisystem approaches in which stakeholders develop a thorough understanding of a community’s history and past legacies with institutions, and professionals are equipped with the necessary knowledge, attitudes and skills for community-based and family-focused interventions. Show less
This thesis researches the profession of the upholsterer – or ‘kamerbehanger’ in Dutch – and the role they played in the creation of interiors in the Dutch Republic, in the long eighteenth century ... Show moreThis thesis researches the profession of the upholsterer – or ‘kamerbehanger’ in Dutch – and the role they played in the creation of interiors in the Dutch Republic, in the long eighteenth century (1680-1810). Its research centers on the cities of Amsterdam, The Hague and Haarlem. A total of 234 shops or individual upholsterers working there in this period were found. Hopefully, the index of their names included in this thesis will advance future research. The first chapter describes the way the profession developed, as well as how upholsterers learned the trade, worked, kept their shops and advertised. In the following four chapters, the relation between upholsterer and client is explored in-depth through case studies from the period 1680-1810.Upholsterers provided bed and wall hangings, curtains of all sorts, upholstered furniture and other textile wares. They were a relatively small but diverse group working in the luxury industries, with about 10 shops at any one time in Amsterdam and in The Hague, and about 1-5 shops in Haarlem. Some upholsterers did not have a shop but worked their trade from a single room, or worked for others. Most kept a small shop. For some, this was indeed the best profession (‘le meilleur métier’). Upholsterers such as a Pierre Courtonne or Johannes Deel, working for the Stadholders and the elite of their day, were able to amass fortunes of 20,000-50,000 guilders and played a role in designing interiors. Succes was dependent on factors such as seed money, an up-to-date knowledge of current fashions, and maintaining good relations with clients. Most shops went from father to son, and most of the upholsterers working in the Republic were locals. Only a small percentage were foreign-born, and even though France exercised a large influence on the luxury market in the eighteenth century, this is not reflected in the number of French upholsterers settling in the Republic. Only at the end of the century can an increase in their number be seen, and a handful of ‘French upholsterers’ settle in Holland. They seem to have had an advantage over their Dutch colleagues in that they were able to purchase the latest French wares directly through their connections.Regarding the relationship with their clients, it has been found that most upholsterers played the role of advisor and facilitator, when helping their clients buy a new interior or furniture. All-in-all, the case studies show how upholsterers would balance their client’s quest for the newest and most fashionable furniture and interiors with their budget and the available goods. Show less
Background:Identification of risk factors and causes of stroke is key to optimize treatment and prevent recurrence. Up to one-third of young patients with stroke have a cryptogenic stroke according... Show moreBackground:Identification of risk factors and causes of stroke is key to optimize treatment and prevent recurrence. Up to one-third of young patients with stroke have a cryptogenic stroke according to current classification systems (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] and atherosclerosis, small vessel disease, cardiac pathology, other causes, dissection [ASCOD]). The aim was to identify risk factors and leads for (new) causes of cryptogenic ischemic stroke in young adults, using the pediatric classification system from the IPSS study (International Pediatric Stroke Study).Methods:This is a multicenter prospective cohort study conducted in 17 hospitals in the Netherlands, consisting of 1322 patients aged 18 to 49 years with first-ever, imaging confirmed, ischemic stroke between 2013 and 2021. The main outcome was distribution of risk factors according to IPSS classification in patients with cryptogenic and noncryptogenic stroke according to the TOAST and ASCOD classification.Results:The median age was 44.2 years, and 697 (52.7%) were men. Of these 1322 patients, 333 (25.2%) had a cryptogenic stroke according to the TOAST classification. Additional classification using the ASCOD criteria reduced the number patients with cryptogenic stroke from 333 to 260 (19.7%). When risk factors according to the IPSS were taken into account, the number of patients with no potential cause or risk factor for stroke reduced to 10 (0.8%).Conclusions:Among young adults aged 18 to 49 years with a cryptogenic ischemic stroke according to the TOAST classification, risk factors for stroke are highly prevalent. Using a pediatric classification system provides new leads for the possible causes in cryptogenic stroke, and could potentially lead to more tailored treatment for young individuals with stroke. Show less
Jongenelen, R.G.L.; Leighton, T.; Veldkamp, F. 2023
In response to the shortage of nursing staff and the so-called refugee crisis in 2015, two residential homes invited first-generation immigrants with a refugee background to participate in a... Show moreIn response to the shortage of nursing staff and the so-called refugee crisis in 2015, two residential homes invited first-generation immigrants with a refugee background to participate in a project for nursing education, orientation and internships. Between 2015 and 2018, a group of ten immigrants started working in a Dutch residential home and a group of seventeen immigrants in the German home. This dissertation investigates the social processes when these newcomers start working with the established staff, as well as the extent to which their mutual interactions and values of good care influence the enactment of geriatric care. Using ethnographic observations (305 hours), in-depth interviews (44) and six focus groups (24), the established care workers and immigrants were followed in both homes. The empirical data shows that institutional constraints, such as staff shortage, the imposition of professional norms, gossip used as a ‘weapon of the weak’, mutual suspicions of indifference, and collective images of ‘us’ versus ‘them’ affected the enactment of geriatric care. Their habitus stimulated them to tinker among each other as well as with different, sometimes conflicting, values of good care. However, both groups shared the feeling of ignorance by management, a pain of not mattering. Show less
In this project we examine whether homicide ‘clusters together’ with other adverse health outcomes in the Netherlands, focusing on child mortality, suicide, sexual risk behavior, and substance... Show moreIn this project we examine whether homicide ‘clusters together’ with other adverse health outcomes in the Netherlands, focusing on child mortality, suicide, sexual risk behavior, and substance abuse. We expect moderate-to-strong correlations between homicide and the other adverse health phenomena (hypothesis 1). Further, we expect that these correlations will be reduced when social disorganization is controlled for (hypothesis 2).The study used population-level data between the years 1996 and 2019, for each of the 40 local regions of the Netherlands. We applied a multilevel correlation procedure to evaluate correlations between homicide and the other adverse health outcomes. Correlations between homicide and the other adverse health outcomes were modest. That is, we found only limited evidence for clustering between homicide and the other adverse health outcomes. The patterns of clustering that did occur, suggested that social disorganization in the region promotes risk-taking behaviors in the population, which ultimately increases rates of homicide, abuse of illegal drugs and births to adolescent parents.Project materials, syntax and supplementary information can be found on the Open Science Framework at https://osf.io/jd5yu/. Show less
The aim of this chapter is to contribute to the debate on deconstructing the gender binary, toexplore notions of experiencing shame and violence, and also to identify key points of self-concept... Show moreThe aim of this chapter is to contribute to the debate on deconstructing the gender binary, toexplore notions of experiencing shame and violence, and also to identify key points of self-concept ingenderqueer people, by running a survey in three different countries: Greece, the UK and the Netherlands.The survey is the first to explore the impact of this gender- binary discourse and the experience of shameand violence within this frame, within the genderaqueer community in a comparative perspective. Thechapter contributes to the debate on perceptions of masculinity and femininity in association with shameand violence, while reconnoitring the role of culture as a driver of these perceptions and how that role leadsto the re-evaluation of the self along with the sense and impact of shame as a relational process with the self and the society. The survey approaches shame and violence, not only in terms of how they are perceived by the genderqueer community, but also of how they are expressed, e.g. in a passive way (directed violence against a person) or active way (person as actor engaging in violent behaviour) in everyday life. The application of different perspectives on confronting the binary, power and shame provides a critical take on the gender-based debate and on the crux of self-concept and identifies breaks with existing thinking and practice that are essential to any reform of gender recognition policy. Show less
Jonas, P.; Savigne, E.G.; Koster, M.; Choonara, I. 2022
Over the past ten years, seven Dutch Universities have built a sustainable exchange with seven institutes in Cuban healthcare. The exchange was initiated by the Leiden University Medical Centre and... Show moreOver the past ten years, seven Dutch Universities have built a sustainable exchange with seven institutes in Cuban healthcare. The exchange was initiated by the Leiden University Medical Centre and the University of Medical Sciences of Havana. Cooperation with Cuba was chosen as Cuba has excellent primary healthcare and has a strong focus on prevention and public health. These were considered important due to the major contribution of non-communicable diseases to morbidity and mortality in the Netherlands. Exchanges have occurred with Dutch health professionals and students visiting Cuban healthcare institutions and Cuban postgraduate students studying in the Netherlands. There has been an increased awareness of the importance of public health and prevention in Dutch professional organizations following the exchange. The exchange has also helped to break the scientific and economic US blockade of Cuba and resulted in joint publications. In this review we described the process, key aspects, results and lessons learned in this process. Collaboration between Cuba (a middle income) and the Netherlands (a high-income country) is possible. Show less
The impact of COVID-19 on population health is recognised as being substantial, yet few studies have attempted to quantify to what extent infection causes mild or moderate symptoms only, requires... Show moreThe impact of COVID-19 on population health is recognised as being substantial, yet few studies have attempted to quantify to what extent infection causes mild or moderate symptoms only, requires hospital and/or ICU admission, results in prolonged and chronic illness, or leads to premature death. We aimed to quantify the total disease burden of acute COVID-19 in the Netherlands in 2020 using the disability-adjusted life-years (DALY) measure, and to investigate how burden varies between age-groups and occupations. Using standard methods and diverse data sources (mandatory notifications, population-level seroprevalence, hospital and ICU admissions, registered COVID-19 deaths, and the literature), we estimated years of life lost (YLL), years lived with disability, DALY and DALY per 100,000 population due to COVID-19, excluding post-acute sequelae, stratified by 5-year age-group and occupation category. The total disease burden due to acute COVID-19 was 286,100 (95% CI: 281,700-290,500) DALY, and the per-capita burden was 1640 (95% CI: 1620-1670) DALY/100,000, of which 99.4% consisted of YLL. The per-capita burden increased steeply with age, starting from 60 to 64 years, with relatively little burden estimated for persons under 50 years old. SARS-CoV-2 infection and associated premature mortality was responsible for a considerable direct health burden in the Netherlands, despite extensive public health measures. DALY were much higher than for other high-burden infectious diseases, but lower than estimated for coronary heart disease. These findings are valuable for informing public health decision-makers regarding the expected COVID-19 health burden among population subgroups, and the possible gains from targeted preventative interventions. Show less
Heus, E. de; Duijts, S.F.A.; Zwan, J.M. van der; Kapiteijn, E.; Dijkum, E.J.M.N. van; Herpen, C.M.L. van; Merkx, M.A.W. 2022
Introduction: Epidemiological discrepancies exist between rare and common can-cers. The aim of this population-based study was to compare rare versus common adult solid cancers in the Netherlands,... Show moreIntroduction: Epidemiological discrepancies exist between rare and common can-cers. The aim of this population-based study was to compare rare versus common adult solid cancers in the Netherlands, by providing incidence, prevalence and survival rates, evaluating trends in survival and comparing individual entities within domains and families.Methods: All adult patients with malignant solid cancers in the Netherlands between 1995 and 2019 were identified from the Netherlands Cancer Registry. Data on patient, tumour and treatment characteristics were collected, and relative survival and survival trends were ana-lysed.Results: A total of 170,628 patients with rare adult solid cancers and 806,023 patients with common adult solid cancers were included. Rare cancers accounted for 18% of all cancer di-agnoses (mean incidence), and 15% of the total ten-year cancer prevalence during 2010-2019. Overall 5-year survival was worse for rare cancers than for common cancers (52.0% versus 68.7%). Between 1995-1999 and 2015-2019, 5-year survival rates for rare cancers increased to a lesser extent (from 46.2% to 52.6%, i.e. 6.4%) than for common cancers (56.9% Show less
Osong, B.; Masciocchi, C.; Damiani, A.; Bermejo, I.; Meldolesi, E.; Chiloiro, G.; ... ; Soest, J. van 2022
Background and Purpose: Tumor recurrence, a characteristic of malignant tumors, is the biggest concern for rectal cancer survivors. The epidemiology of the disease calls for a pressing need to... Show moreBackground and Purpose: Tumor recurrence, a characteristic of malignant tumors, is the biggest concern for rectal cancer survivors. The epidemiology of the disease calls for a pressing need to improve healthcare quality and patient outcomes. Prediction models such as Bayesian networks, which can probabilistically reason under uncertainty, could assist caregivers with patient management. However, some concerns are associated with the standard approaches to developing these structures in medicine. Therefore, this study aims to compare Bayesian network structures that stem from these two techniques. Materials and Methods: A retrospective analysis was performed on 6754 locally advanced rectal cancer (LARC) patients enrolled in 14 international clinical trials. Local tumor recurrence at 2, 3, and 5-years was defined as the endpoints of interest. Five rectal cancer treating physicians from three countries elicited the expert structure. The algorithmic structure was inferred from the data with the hill-climbing algorithm. Structural performance was assessed with calibration plots and area under the curve values. Results: The area under the curve for the expert structure on the training and validation data was above 0.9 and 0.8, respectively, for all the time points. However, the algorithmic structure had superior predictive performance over the expert structure for all time points of interest. Conclusion: We have developed and internally validated a Bayesian networks structure from experts' opinions, which can predict the risk of a LARC patient developing a tumor recurrence at 2, 3, and 5 years. Our result shows that the algorithmic-based structures are more performant and less interpretable than expert based structures. Show less
