The glass ceiling: A biological phenomenon.

Many brilliant and ambitious young women lose their drive for top careers after childbirth. New maternal impulses are at odds with their original ambitions and for many mothers stress and frustration will be the result as they have to combine child care with workweeks of 60-80h to reach or remain at the top. Pregnancy hormones modify the female's brain as has been demonstrated already for decades in animals.

[Problematic breastfeeding due to a short frenulum].

Ankyloglossia (tongue tie) in the neonate can be a cause of breastfeeding problems. Frenotomy (cutting of the frenulum linguae) had fallen into disrepute, but has regained its place as a standard medical procedure in Anglo-Saxon countries, though not in the Netherlands. We present two neonates, both boys, presenting with breastfeeding problems caused by ankyloglossia.

Developing a brief cross-culturally validated screening tool for externalizing disorders in children.

Objective: Most screening instruments for externalizing disorders have been developed and validated in Western children. We developed and validated a brief screening instrument for predicting externalizing disorders in native Dutch children as well as in non-Dutch immigrant children, using predictors that can be easily obtained from teachers.

Method: Teachers completed the Strengths and Difficulties Questionnaire for an ethnic diverse sample of 2,185 children ages 6 to 10 years.

Swaddling: a systematic review.

Swaddling was an almost universal child-care practice before the 18th century. It is still tradition in certain parts of the Middle East and is gaining popularity in the United Kingdom, the United States, and The Netherlands to curb excessive crying. We have systematically reviewed all articles on swaddling to evaluate its possible benefits and disadvantages.

Quality improvement of paediatric care in the Netherlands.

The development of the quality improvement programme of the Paediatric Association of the Netherlands is described within the setting of the national programme of the Dutch government. The programme is based on four pillars: site visits by peers (visitatie), continuous medical and professional education, development of clinical (evidence based) guidelines and patient safety with complication registration. The site visits by peers play a central role in assessing the quality improvement activities in hospital based paediatric care.

Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD).

Background: The impact of attention deficit hyperactive disorder (ADHD) in the Netherlands on health care utilisation, costs and quality of life of these children, as well as of their parents is unknown.

Objective: The aim of this study was to assess the direct medical costs of patients suffering from ADHD and their quality of life as well as the direct medical costs of their mothers.

Study Design: We selected a group of 70 children who were being treated by a paediatrician for ADHD based on the DSM-IV diagnostic criteria for ADHD.

Prevalence of psychiatric disorders among children of different ethnic origin.

The present study assesses the population prevalence of DSM-IV disorders among native and immigrant children living in low socio-economic status (SES) inner-city neighborhoods in the Netherlands. In the first phase of a two-phase epidemiological design, teachers screened an ethnically diverse sample of 2041 children aged 6-10 years using the Strengths and Difficulties Questionnaire (SDQ). In the second phase, a subsample of 253 children was psychiatrically examined, while their parents were interviewed.

Comparison of behavior modification with and without swaddling as interventions for excessive crying.

Objective: To test the hypothesis that swaddling is an effective method to reduce crying, we compared a standardized approach of regularity and stimulus reduction with the same approach supplemented with swaddling.

Study Design: Healthcare nurses coached 398 excessively crying infants up to 12 weeks of age for 3 months. Outcome measurements were crying as measured by Barr's 24-hour diary and parental perception of crying.

Ethnic differences in parental detection of externalizing disorders.

Background: Previous research has reported lower treatment rates for externalizing disorders among non-Western children as compared to Western children. Ethnic differences in parental detection may be an explanation for this discrepancy.

Aims: In a cross-sectional study among the four largest ethnic groups in the Netherlands, namely Dutch, Moroccan, Turkish and Surinamese, we examined the influence of ethnicity on parental detection of behavioural disorders.

Different treatment thresholds in non-Western children with behavioral problems.

Objective: First, to investigate whether non-Western children in the Netherlands are less likely to be treated for behavioral problems than Western children; second, to examine whether discrepancies in treatment status are related to differences in level of problem behavior and impairment.

Method: The study included 2,185 children of the four largest ethnic groups in the Netherlands, namely, 684 Dutch, 702 Moroccan, 434 Turkish, and 365 Surinamese children from grades three to five of elementary school. Teachers completed the Strengths and Difficulties Questionnaire and five DSM-IV items on externalizing problems.

Infant mortality, ethnicity, and genetically determined disorders in The Netherlands.

Background: Infant mortality of ethnic minorities in The Netherlands (10% of the population) is twice as high as in the indigenous Dutch population. Causes of death are different for the diverse migrant groups.

Methods: Hospital records of nearly 600 infants who died in the four major cities between 1995 and 1998 were analysed according to the cause of death, ethnicity, and possible heredity.

Value of routine chest radiography in the medical screening of internationally adopted children.

Aim: To assess the value of the routine chest radiography as part of the medical evaluation of newly arrived, internationally adopted children.

Methods: We evaluated the use of routine chest radiography (CXR) in the medical screening of 1598 internationally adopted children.

Results: CXR showed abnormalities in 128 cases: 38 of these findings were already known and/or consistent with obvious clinical signs or symptoms, and 54 had no clinical relevance.

Bridging the gap between doctors and policymakers: the use of scientific knowledge in local school health care policy in The Netherlands.

Background: The decentralization of school health care policy in The Netherlands was followed by an increase in diversity, which was most often not evidence-based. This study aims to clarify the use of scientific knowledge in school health care policy-making processes: multi-actor processes in networks, trying to solve certain problems.

Methods: Case-study design in four Municipal Health Service regions, using documents and half-structured interviews as data sources.

Infant care practices related to cot death in Turkish and Moroccan families in the Netherlands.

From 1979 to 1993 Turkish infants had a significantly higher cot death risk compared to Dutch infants. In contrast Moroccan infants had a risk of cot death that was approximately three times lower compared to Dutch infants during the same period. This study shows that these differences have disappeared, while differences still exist in infant care practices between these ethnic groups.

[Medical education in the Netherlands: little attention paid to the cultural diversity of patients].

Objective: To ascertain how much attention is given to cultural diversity in the eight medical faculties in Dutch universities.

Design: Interviews.

Method: In the period January-June 2001 interviews were held with 76 people in medical faculties: policy makers, teachers and students.

Immunisation status of children adopted from China.

Many children adopted from China have antibody titres that do not correlate with those expected from their medical records. We have compared the concentrations of antibodies to poliomyelitis, diphtheria, and tetanus in children adopted from China, those adopted from other countries, and those vaccinated in the Netherlands and the UK. About 30% of children adopted from China did not have adequate protection from tetanus, diphtheria, or poliomyelitis, despite having complete vaccination recorded in their vaccination documents.

Religious circumcision under local anaesthesia with a new disposable clamp.

Objective: To compare the results using a new disposable clamp (the Taraklamp Circumcision Device, TCD, Taramedic Europe BV, Bilthoven, The Netherlands), used since 1998 in one clinic, and the conventional dissection technique (CDT) in another clinic, for religious circumcision in infants.

Subjects And Methods: The TCD and CDT were compared prospectively; the duration of the procedure, complications and postoperative pain were recorded. The cosmetic result and the degree to which the parents were satisfied were evaluated after 6 weeks.

Gonadotrophin releasing hormone agonist treatment with or without recombinant human GH in adopted children with early puberty.

Background: Early onset of puberty is frequently observed in adopted children. During treatment with a gonadotrophin releasing hormone agonist (GnRHa), a decrease in height velocity (HV) precludes height gain.

Objective And Design: We studied the effect of the addition of GH to GnRHa treatment in a 3-year prospective randomized trial in 30 adopted children with early puberty.

Results of group-circumcision of Muslim boys in Malaysia with a new type of disposable clamp.

This study evaluates the safety and results of surgery usingTaraKlamp Circumcision Device during a group circumcision. Atotal of 64 circumcisions of Muslim boys were performed by Medical Assistants supervised by Medical Doctors in a hall in Kuala Lumpur, Malaysia. A new type disposable clamp was used, which was removed 4 days after the operation.

Intercultural training of medical students.

Until recently the Utrecht Medical School had a traditional curriculum with a predominantly biomedical orientation and strong emphasis on curative medicine. In 1997 an experimental 'Multi-cultural Family Attachment Course' started at the Utrecht Medical School with 20 second-year medical students. Each student was attached to a native Dutch and an ethnic minority family with a newborn or chronically ill child.

[Ethical shortcomings of skeletal age determination to establish minority for single young asylum seekers].

Each year tens of thousands of asylum seekers from all over the world come to the Netherlands. Amongst them are minors who come alone. They are eligible for a separate, less severe, admittance procedure than for adults and their under-age children.

Influences of ethnicity on perinatal and child mortality in the Netherlands.

Aims: To investigate the differences in perinatal death and child mortality between different ethnic groups in the Netherlands.

Methods: Retrospective analysis of data collected between 1990 and 1993 in the national obstetric registry comprising 569 743 births. Retrospective analysis of all death certificates of 0 to 15 year old children routinely collected between 1979 and 1993, comprising 20 211 deaths.

[Medical care of underage refugees].

The growing number of people seeking asylum in the Netherlands compromises the provision of adequate medical services to all. This development may have a negative impact on refugee children especially. International literature indicates that many children, especially the ones coming from tropical areas or the ones who resided in refugee camps, are suffering from diseases such as tuberculosis, hepatitis B, anaemia, parasitic diseases, caries, malnutrition, hearing and seeing impairments.