A Descriptive Mixed-Methods Analysis of Sexual Behavior and Knowledge in Very Young Children Assessed for Sexual Abuse: The ASAC Study.

Child sexual abuse (CSA) is a worldwide problem with serious consequences. We hypothesized that worrisome sexual behavior and knowledge would frequently be reported in children assessed after CSA. We therefore investigated (A) what types of sexual behaviors and knowledge were reported by parents of young children assessed for CSA; (B) in what cases such behaviors and knowledge were worrisome; and (C) how such children responded verbally and non-verbally during child interviews. We conducted a mixed-methods study, including qualitative inductive content analysis and quantitative analysis. It included 125 children (76 boys, 60.8%; median age 3.3 years, age range 0-11), all involved in the Amsterdam sexual abuse case (ASAC) and examined for highly suspected (n = 71) or confirmed CSA (n = 54). We identified themes from (1) the parent reports: sexual behavior (e.g., self-stimulation, touching others, imitation of sexual acts), fears and anxiety with regard to sexuality, and sexual utterances (sexual slang, references to sexual acts); and (2) the child interviews: behavioral reactions (avoidance, distractive behaviors), emotional reactions (anger, aggression), and verbal reactions (conspicuous utterances, refusal to talk about specific subjects). In 37% of the children the sexual behavior was deemed worrisome or very worrisome. Clinicians who assess children for CSA are advised to focus in particular on sexual behavior problems and inappropriate sexual knowledge.

Psychosocial symptoms in very young children assessed for sexual abuse: A qualitative analysis from the ASAC study.

Child sexual abuse (CSA) is a worldwide problem with serious consequences. No recognizable symptom pattern for suspected CSA has yet been identified in very young children. We aim to investigate psychosocial symptoms in a sample of children with confirmed or strongly suspected CSA and the interpretations given to such symptoms by independent clinical experts. Secondly we examined whether experts were able to identify confirmed victims of severe CSA. A qualitative study including inductive content analysis of medical files and focus group discussions with independent experts on the interpretation of psychosocial symptoms was conducted. We included 125 children (76 boys, 60.8%, and 49 girls, 39.2%; median age 3.3 years; age range 0-11) who were involved in the Amsterdam sexual abuse case (ASAC) and had been examined for strongly suspected CSA. We identified four themes among the psychosocial symptoms: problems concerning emotions, behavior, toilet training, and development, whether or not associated with the daycare center or the perpetrator. Clinical experts identified signs of posttraumatic stress disorder (PTSD), regression in continence skills (not otherwise explained), and problems triggered by exposure to the perpetrator or the abuse location as concerning symptoms for CSA. Less concerning symptoms were designated as worrisome if they were numerous and there was no clear explanation for these symptoms. A clear symptom pattern was lacking and about half of the confirmed severe victims of CSA did not display any psychosocial problems. Therefore, it is difficult for experts to identify confirmed CSA victims. Thus, the assessment of suspected CSA should be over time and multidisciplinary.

Optical trapping of interfaces at ultra-low interfacial tension.

We achieve active control of interfacial phenomena by optically trapping the interface using the gradient forces of a strongly focussed laser beam parallel to the interface. We illustrate our technique in a phase separated colloid-polymer mixture by distorting the interface in a very controlled way. The static structure of the manipulated interface as well as its dynamic relaxation behaviour are analysed. Both the statics and dynamics can be related to the capillary wave height-height correlation functions using the fluctuation dissipation theorem up to surprisingly large deformations of the interface. To underline the novelty and potential of our approach we also show multiple interface distortions and the controlled snap-off of liquid droplets.

Comparison of early versus late initiation of GnRH antagonist co-treatment for controlled ovarian stimulation in IVF: a randomized controlled trial.

STUDY QUESTION: What is the impact of initiating GnRH antagonist co-treatment for in vitro fertilization (IVF) on cycle day (CD) 2 compared with CD 6 on live birth rate (LBR) per started cycle and on the cumulative live birth rate (CLBR)? SUMMARY ANSWER: Early initiation of GnRH antagonist does not appear to improve clinical outcomes of IVF compared with midfollicular initiation. WHAT IS KNOWN ALREADY: During ovarian stimulation for IVF, GnRH antagonist co-treatment is usually administered from the midfollicular phase onwards. Earlier initiation may improve the follicular phase hormonal milieu and therefore overall clinical outcomes. STUDY DESIGN, SIZE, DURATION: This open-label, multicentre randomized controlled trial was conducted between September 2009 and July 2011. A web-based program was used for randomization and 617 IVF-intracytoplasmic sperm injection (ICSI) patients were included. PARTICIPANTS/MATERIALS, SETTING, METHODS: Recombinant FSH (150-225 IU) was administered daily from CD 2 onwards in both groups. The study group (CD2; n = 308) started GnRH antagonist co-treatment on CD 2, whereas the control group (CD6; n = 309) started on CD 6. MAIN RESULTS AND THE ROLE OF CHANCE: There were no significant differences in clinical outcomes between the two groups. A non-significant trend towards a higher LBR per started cycle and CLBR was observed in the CD6 group compared with the CD2 group (LBR: 24.0 versus 21.5%, P = 0.5; CLBR: 29.9 versus 26.7%, P = 0.6). LIMITATIONS, REASONS FOR CAUTION: The study was terminated prematurely because no significant difference was observed in clinical outcomes after 617 inclusions. A much larger study population would be needed to detect a small significant difference in favour of either study arm, which raises the question of whether this would be relevant for clinical practice. WIDER IMPLICATIONS OF THE FINDINGS: The present study shows that the additional treatment burden and costs of starting GnRH antagonist on CD 2 instead of on CD 6 are not justified, as early initiation of GnRH antagonist does not improve LBRs. STUDY FUNDING/COMPETING INTEREST(S): This study was partially supported by a grant from Merck Serono. O.H., M.J.C.E, A.V., P.A.D., R.E.B., G.J.E.O., C.A.G.H., G.C.D.M., H.J.V., P.F.M.H. and A.B. have nothing to declare. F.J.B. has received fees and grant support from the following companies (in alphabetic order): Ferring, Gedeon Richter, Merck Serono, MSD and Roche. B.J.C. has received fees and grant support from the following companies (in alphabetic order): Ferring, Merck Serono and MSD. C.B.L has received fees and grant support from the following companies (in alphabetic order): Auxogen, Ferring, Merck Serono and MSD. B.C.J.M.F. has received fees and grant support from the following companies (in alphabetic order): Andromed, Ardana, Ferring, Genovum, Merck Serono, MSD, Organon, Pantharei Bioscience, PregLem, Schering, Schering Plough, Serono and Wyeth. J.S.E.L. has received fees and grant support from the following companies (in alphabetic order): Ferring, Gennovum, MSD, Merck Serono, Organon, Schering Plough and Serono. N.S.M. has received fees and grant support from the following companies (in alphabetic order): Anecova, Ferring, Merck Serono, MSD, Organon and Serono. TRIAL REGISTRATION NUMBER: www.clinicaltrials.gov, no. NCT00866034.

Obesity and cardiovascular disease risk among Turkish and Moroccan migrant groups in Europe: a systematic review.

Migrants from Turkey and Morocco are among the largest ethnic minority groups in several European countries. In this review, we aimed to systematically search, assess and describe the available literature on cardiovascular disease (CVD), obesity and other endogenous cardiovascular risk factors among these groups. Although the number of publications covering this topic among Turkish and Moroccan migrants has increased in the past decades, studies among these groups, especially the Moroccan, are still limited. There is a particular lack of information on CVD mortality and morbidity rates. Furthermore, studies are often hampered by low participation rates, small sample sizes and self-reported data. This further complicates drawing sound conclusions on CVD and risk factors among these migrant groups. The results with regard to CVD morbidity and mortality rates are inconclusive. With regard to CVD risk factors, we tentatively conclude that obesity and diabetes are more common among Turkish and Moroccan migrant groups in Europe than the western European population. In the Turkish population there is also a fair amount of evidence for unfavourable high-density lipoprotein cholesterol levels. However, more research on this topic among these major ethnic minorities is of high importance.

Magnetic-field-induced nematic-nematic phase separation and droplet formation in colloidal goethite.

We demonstrate the suitability of polarization microscopy to study the recently discovered (parallel) nematic-(perpendicular) nematic phase separation. This novel type of phase transition is induced by applying an external magnetic field to a nematic liquid crystal of boardlike colloidal goethite and is due to an interplay between the intrinsic magnetic properties of goethite and the collective effect of liquid crystal formation. It is shown that the intense ochre colour of goethite does not preclude the use of polarization microscopy and interference colours, and that dichroism can give valuable qualitative information on the nature of the phases, their anchoring and their sedimentation and order parameter profiles. We also apply these techniques to study 'nematic-nematic tactoids': nematic droplets sedimenting within a nematic medium with mutually perpendicular orientations.

Magnetic field effects on tactoids of plate-like colloids.

We investigate the effect of a magnetic field on the shape and director field of nematic droplets in dispersions of sterically stabilized and charge-stabilized colloidal gibbsite platelets with a negative diamagnetic anisotropy. Depending on the magnetic field strength and tactoid size, we observe with polarized light microscopy several interesting structures, with different shapes and director fields both with and without defects. In particular, our findings provide the first experimental evidence for the existence of the split-core defect structure predicted ten years ago by Mkaddem and Gartland [Phys. Rev. E 62, 6694 (2000)]. The split-core structure is a metastable director-field configuration that can be stabilized by a sufficiently strong externally applied magnetic field but only if the diamagnetic anisotropy of the particles is negative. To account for our observations, we present a calculation of the stability regions of different shapes and director-field structures as a function of tactoid size, anchoring conditions, surface tension, elastic constants, and magnetic field strength. By fitting the experimental data to the theoretically predicted structures, we are able to extract values for the splay elastic constant, interfacial tension, and anchoring strength. Remarkably, we find significant differences between the two systems studied: for sterically stabilized gibbsite in bromotoluene the anchoring strength is one order of magnitude larger than that of aqueous gibbsite, with the latter exhibiting weak and the former strong anchoring of the director field to the interface. The splay elastic constants that we obtain are in agreement with earlier experiments, simulations, and theory, while the interfacial tension and anchoring strength are considerably larger than what was found in earlier experiments.

Tactoids of plate-like particles: size, shape, and director field.

We studied, by means of polarized light microscopy, the shape and director field of nematic tactoids as a function of their size in dispersions of colloidal gibbsite platelets in polar and apolar solvents. Because of the homeotropic anchoring of the platelets to the interface, we found large tactoids to be spherical with a radial director field, whereas small tactoids turn out to have an oblate shape and a homogeneous director field, in accordance with theoretical predictions. The transition from a radial to a homogeneous director field seems to proceed via two different routes depending in our case on the solvent. In one route, the what presumably is a hedgehog point defect in the center of the tactoid transforms into a ring defect with a radius that presumably goes to infinity with decreasing drop size. In the other route, the hedgehog defect is displaced from the center to the edge of the tactoid, where it becomes virtual again going to infinity with decreasing drop size. Furthermore, quantitative analysis of the tactoid properties provides us with useful information on the ratio of the splay elastic constant and the anchoring strength and the ratio of the anchoring strength and the surface tension.

Liquid crystal phase transitions in systems of colloidal platelets with bimodal shape distribution.

We have studied a system of polydisperse, charged colloidal gibbsite platelets with a bimodal distribution in the particle aspect ratio. We observe a density inversion of the coexisting isotropic and nematic phases as well as a three-phase equilibrium involving a lower density nematic phase, an isotropic phase of intermediate density, and a higher density columnar phase. To relate these phenomena to the bimodality of the shape distribution, we have calculated the liquid crystal phase behavior of binary mixtures of thick and thin hard platelets for various thickness ratios. The predictions are based on the Onsager-Parsons theory for the isotropic-nematic (I-N) transition combined with a modified Lennard-Jones-Devonshire cell theory for the columnar (C) state. For sufficiently large thickness ratios, the phase diagram features an I-N density inversion and triphasic I-N-C equilibrium, in agreement with experiment. The density inversion can be attributed to a marked shape fractionation among the coexisting phases with the thick species accumulating in the isotropic phase. At high concentrations, the theory predicts a coexistence between two columnar phases with distinctly different concentrations. In experiment, however, the demixing transition is pre-empted by a transition to a kinetically arrested, glassy state with structural features resembling a columnar phase.

Psychometric properties of an interviewer-administered version of the Kessler Psychological Distress scale (K10) among Dutch, Moroccan and Turkish respondents.

The Kessler Psychological Distress scale (K10) is an instrument that is widely used to screen for mental disorders, but information is lacking on its psychometric qualities in non-Western samples. This study used a population-based sample (N = 725) to assess the reliability and validity of the K10 across ethnic groups in an urban area. The results were generally supportive of the K10 as a reliable and valid instrument to screen for anxiety and depression in all three groups. Cronbach's alpha was high (0.93) and the results indicated the existence of a solid single factor structure. Item bias in relation to ethnic background was minor. In each group, there was good criterion validity with respect to one-month DSM-IV diagnosis for depressive and/or anxiety disorder. The results nevertheless highlight the importance of cross-cultural validation, as we found different cut-off values for ethnic subgroups to obtain optimal sensitivity and specificity for detecting depressive and/or anxiety disorders.

Devitrification of the glassy state in suspensions of charged platelets.

Colloidal suspensions of charged gibbsite platelets at salt concentrations of 10(-2) M and below and with a sufficiently high particle concentration form a kinetically arrested, glassy state. We study the evolution of the glassy state in suspensions of three different gibbsite systems. Despite differences in size and polydispersity, we observe small, iridescent grains of the hexagonal columnar phase, for all these systems after periods of months to years. The connections between this devitrification phenomenon and the structure of the glassy state are discussed.

Orientation dependent Stokes drag in a colloidal liquid crystal.

Stokes drag on the (sub)micrometre scale plays a key role in phenomena ranging from Brownian motion to the rheology of particulate suspensions. We report the first measurement of the direction dependent Stokes drag in a nematic liquid crystal of colloidal rods, where the viscous forces are of equal importance to the elastic forces. By tracking a sedimenting sphere with combined fluorescence confocal microscopy and polarization microscopy we find that the Stokes drag for motion along the director is two times larger than for motion perpendicular to the director. This brings the unique viscoelastic properties of a colloidal liquid crystal into focus.

Prevalence and risk-factors for depression in elderly Turkish and Moroccan migrants in the Netherlands.

BACKGROUND: Western societies host increasing number of elderly labour migrants from Turkey and Morocco. The article studied the prevalence of clinically significant depressive symptoms among elderly Turkish and Moroccan migrants compared with native Dutch elderly and if differences in prevalence rates were explained by known risk factors for depression and/or ethnic, migration-related factors. METHODS: 330 Turkish, 299 Moroccan, and 304 Dutch elderly (55-74 years) were interviewed (cross-sectionally) using the Center for Epidemiologic Depression Scale (CES-D). Potential risk factors included sex, income level, marital status, ethnic origin, chronic physical illnesses, limitations in daily functioning, migration and acculturation questions. RESULTS: The prevalence of self-reported depressive symptoms (CES-D>or=16) was very high in elderly migrants, 33.6% for Moroccan and 61.5% for Turkish elderly. The prevalence of depressive symptoms in the native Dutch sample was similar to earlier studies in the Netherlands and abroad: 14.5%. Among migrants education and income level was very low and they had a high number of physical limitations and chronic medical illnesses. This only explained part of the ethnic differences found. In all three samples, depressive symptoms were associated with sex, chronic physical illness and physical limitations. In multivariate analysis, ethnic origin was uniquely associated with the presence of clinically significant depressive symptoms. Only a small number of remigration and acculturation items were associated with depressive symptoms in bivariate analysis. CONCLUSIONS: The prevalence of clinically significant depressive symptoms among elderly migrants from Turkey and Morocco in the Netherlands is very high. Ethnicity was a strong independent risk factor.

Dampness in buildings as a risk factor for health effects, EUROEXPO: a multidisciplinary review of the literature (1998-2000) on dampness and mite exposure in buildings and health effects.

UNLABELLED: The scientific literature on health effects from dampness in buildings, including mite exposure over the period 1998-2000 has been reviewed by an European group (EUROEXPO) of eight scientists in experience from medicine, epidemiology, toxicology and engineering. Forty studies deemed relevant have been the foundation for the conclusions. Dampness in buildings is a risk factor for health effects among atopics and non-atopics both in domestic and in public environments. However, the literature is not conclusive in respect of causative agents, e.g. mites, microbiological agents and organic chemicals from degraded building materials. There is a strong need for more multidisciplinary studies including expertise from all relevant areas. A general conclusion from the work was that there is a strong need for multidisciplinary reviews in scientific journals of articles dealing with associations between indoor environmental factors and health effects. PRACTICAL IMPLICATIONS: There is good evidence for a true association between dampness in buildings and health. As the causative factors behind this association are not known, the main focus in practical investigations should be on finding out and remediate the reasons for the humidity problem.

Depression in first generation labour migrants in Western Europe: the utility of the Center for Epidemiologic Studies Depression Scale (CES-D).

OBJECTIVE: The number of elderly migrants from Turkish and Moroccan descent in Western Europe will increase sharply in the coming decades. Identifying depressed elderly migrants necessitates a screening instrument that is both acceptable and has good psychometric properties. This study examines the utility of Turkish and Arabic translations of the Center for Epidemiologic Studies Depression Scale (CES-D) among elderly labour migrants from Turkish and Moroccan descent in the Netherlands. METHOD: The data were derived from a community based health survey among 304 native Dutch, 330 Turkish and 299 Moroccan migrants, aged 55-74 years, living in Amsterdam, the Netherlands. Acceptability, reliability, convergent and construct validity were studied. RESULTS: Acceptability of the CES-D was satisfactory, although Moroccan migrants and Turkish females had difficulty answering one or more of the (interpersonal) items from the CES-D. Translated versions of the CES-D proved to be highly internal consistent and have good convergent validity in both Turkish and Moroccan elderly. Depressed and somatic items were much more intermingled in Turkish and Moroccan elderly compared to earlier studies and native Dutch elderly. This fits to the hypothesis that Turkish and Moroccan elderly migrants tend to somatize their depressive symptoms much more than native Western elderly. CONCLUSION: The utility of the CES-D for elderly migrants of Turkish and Moroccan descent was found to be satisfactory.

Air pollution and mortality in The Netherlands: are the elderly more at risk?

The association between daily mortality and short-term variations in the ambient levels of ozone (O3), black smoke (BS), sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and particulate matter was studied in The Netherlands. Daily total and cause-specific mortality counts (cardiovascular, chronic obstructive pulmonary disease (COPD) and pneumonia), air quality, temperature, relative humidity and influenza data were obtained from 1986-1994. The relationship between daily mortality and air pollution was modelled using Poisson regression analysis. All pollution mortality associations were adjusted for potential confounding due to long-term trends, seasonal trends, influenza epidemics, ambient temperature, ambient relative humidity, day of the week and holidays, using generalised additive models. Statistically significant associations were mostly found in the elderly, that is the age categories of 65-74 and > or = 75 yrs for the pollutants PM10 (particles with a 50%, cut-off aerodynamic diameter of 10 microm), BS, SO2, NO2 and CO. This may partly be due to a better precision of relative risk (RR) estimates for the larger numbers of deaths in these age groups. Significant associations for those < 65 yrs were found for O3 (total and COPD mortality), PM10 (pneumonia), NO2 (pneumonia) and CO (pneumonia). RR estimates for deaths between 45-65 yrs tended to be smaller than those in > 65 yrs, with the exception of ozone; for cardiovascular mortality the RR for PM10, O3 and CO were similar in these age groups. In conclusion, larger relative risks for air pollution were mostly found in the elderly except for ozone and for death-cause pneumonia which showed larger relative risk in younger age groups.

[Travel advice on the prevention of infectious diseases insufficiently obtained by indigenous and non-native inhabitants of Amsterdam, the Netherlands]. / Onvoldoende bereik van reizigersadvisering over infectieziektepreventie onder autochtone en allochtone Amsterdammers.

OBJECTIVE: To determine the travel behaviour of inhabitants of Amsterdam, the Netherlands, with respect to age and ethnicity, as well as the impact of travel advice, in particular regarding hepatitis A vaccination of Turkish and Moroccan children. DESIGN: Descriptive. METHOD: In a sample of 2000 inhabitants of Amsterdam, a survey was carried out during the period October 1999-November 2000 on seeking medical advice prior to travelling. In addition, 429 Turkish and Moroccan parents were questioned about hepatitis A vaccination of their children when travelling to their country of origin. RESULTS: In the three years preceding the survey one third of the Amsterdam population travelled to a country where infectious diseases such as malaria and hepatitis A were endemic. Many travellers (18%) went to Asia, Central or Latin America and Africa. Others (12%) travelled to the Middle-East or North Africa. One third of the travellers had sought advice from the Municipal Public Health Service of Amsterdam. Other travellers were advised by their general practitioner (10%). A large group (38%) did not seek any advice at all. Almost one third of the travellers went to their country of origin, particularly Turkish and Moroccan inhabitants of Amsterdam. Seventy percent of Turkish and Moroccan travellers had not sought travel advice. More than half the Turkish and Moroccan parents did not have their children vaccinated against hepatitis A when travelling to their country of origin. CONCLUSION: One fifth of the indigenous Dutch population received no travel advice. More than half of Turkish and Moroccan children travelling to their country of origin were not vaccinated against hepatitis A.

Indicators without a cause. Reflections on the development and use of indicators in health care from a public health perspective.

Indicators have a long history in public health. Since the end of the 18th century information on the health of communities has been gathered on a health system level and public health indicators have become more sophisticated over the vears. However, in many modern health care systems there is a separation between public health and health services. This paper discusses the need for integration and promotes a stronger public health orientation of health services. This has consequences for the nature of indicators on the health services level. The methodological problems of turning epidemiological data into management information for health services are discussed. The key message is that the health of the community should be the ultimate cause of all indicators.

[Increased proportion of elementary school children with asthmatic symptoms in the Netherlands, 1984/85-1994/95; a literature review]. / Toegenomen percentage basisschoolkinderen met astmatische klachten in Nederland, 1984/'85-1994/'95; een literatuuronderzoek.

OBJECTIVE: To investigate whether the prevalence of asthmatic symptoms among children in the Netherlands has changed. DESIGN: Literature study. METHOD: Investigations into the prevalence of children with asthmatic symptoms were collected from Medline, Embase and various libraries if they had been performed between 1984/'85 and 1994/'95 and had used the so-called WHO or Region list. 23 studies were selected with data on 76,353 elementary school pupils. Linear regression analysis, weighed for the number of children, was used to determine if the proportions of children with asthmatic symptoms had increased over the years. RESULTS: In 10 years the prevalence of recent shortness of breath had increased by 107% (from 4.16 to 8.63%), that of recent wheeze by 16% (from 10.64 to 12.35%), that of recent attacks of breathlessness with wheezing by 17% (from 5.29 to 6.19%), and for chronic cough by 259 (from 1.05 to 3.77%) to 272% (from 3.14 to 11.68%). The prevalence of doctor-diagnosed asthma had increased by 120% (from 2.82 to 6.19%). CONCLUSION: There had been a pronounced increase in the percentage of primary schoolchildren with asthmatic symptoms between 1984/'85 and 1994/'95. The prevalence of doctor-diagnosed asthma increased faster then did key symptoms of asthma.

Daily mortality and air pollution in The Netherlands.

We studied the association of daily mortality with short-term variations in the ambient concentrations of major gaseous pollutants and PM in the Netherlands. The magnitude of the association in the four major urban areas was compared with that in the remainder of the country. Daily cause-specific mortality counts, air quality, temperature, relative humidity, and influenza data were obtained from 1986 to 1994. The relationship between daily mortality and air pollution was modeled using Poisson regression analysis. We adjusted for potential confounding due to long-term and seasonal trends, influenza epidemics, ambient temperature and relative humidity, day of the week, and holidays, using generalized additive models. Influenza episodes were associated with increased mortality up to 3 weeks later. Daily mortality was significantly associated with the concentration of all air pollutants. An increase in the PM10 concentration by 100 micrograms/m3 was associated with a relative risk (RR) of 1.02 for total mortality. The largest RRs were found for pneumonia deaths. Ozone had the most consistent, independent association with mortality. Particulate air pollution (e.g., PM10, black smoke [BS]) was not more consistently associated with mortality than were the gaseous pollutants SO2 and NO2. Aerosol SO4(-2), NO3-, and BS were more consistently associated with total mortality than was PM10. The RRs for all pollutants were substantially larger in the summer months than in the winter months. The RR of total mortality for PM10 was 1.10 for the summer and 1.03 for the winter. There was no consistent difference between RRs in the four major urban areas and the more rural areas.