Jaap Dronkers

The effects of preoperative exercise therapy on postoperative outcome: a systematic review

Objective: To summarize the current evidence on the effects of preoperative exercise therapy in patients awaiting invasive surgery on postoperative complication rate and length of hospital stay. Data sources: A primary search of relevant key terms was conducted in the electronic databases of PubMed, EMBASE, PEDro and CINAHL. Review methods: Studies were included if they were controlled trials evaluating the effects of preoperative exercise therapy on postoperative complication rate and length of hospital stay. The methodological quality of included studies was independently assessed by two reviewers using the PEDro scale. Statistical pooling was performed when studies were comparable in terms of patient population and outcome measures. Results were separately described if pooling was not possible. Results: Twelve studies of patients undergoing joint replacement, cardiac or abdominal surgery were included. The PEDro scores ranged from 4 to 8 points. Preoperative exercise therapy consisting of inspiratory muscle training or exercise training prior to cardiac or abdominal surgery led to a shorter hospital stay and reduced postoperative complication rates. By contrast, length of hospital stay and complication rates of patients after joint replacement surgery were not significantly affected by preoperative exercise therapy consisting of strength and/or mobility training. Conclusion: Preoperative exercise therapy can be effective for reducing postoperative complication rates and length of hospital stay after cardiac or abdominal surgery. More research on the utility of preoperative exercise therapy and its long-term effects is needed as well as insight in the benefits of using risk models.

Ethnic, religious and economic diversity in Dutch neighbourhoods: explaining quality of contact with neighbours, trust in the neighbourhood and inter-ethnic trust

Several studies conclude that ethnic diversity tends to reduce social capital. There may, however, be other forms of diversity that also affect social capital, and their inclusion might make the negative effect of ethnic diversity spurious. Besides ethnic diversity, we identify economic and religious diversity, as well as language proficiency in the neighbourhood. This study explores data from the Netherlands showing how these four dimensions of diversity in the neighbourhood affect the quality of contact with neighbours, trust in the neighbourhood and inter-ethnic trust for immigrant and native residents. We find that ethnic diversity in the neighbourhood still lowers the quality of contact with neighbours. For natives, ethnic diversity is positively associated with inter-ethnic trust, whereas for immigrants there is no effect. Furthermore, for natives, religious diversity negatively affects the quality of contact with neighbours and inter-ethnic trust, whereas for immigrants this effect is positive. Economic diversity positively impacts on trust in the neighbourhood and inter-ethnic trust. We do not find an effect of language proficiency. We conclude that, besides ethnic diversity, other forms of diversity in the neighbourhood do also affect trust. Furthermore, diversity can undermine, but also build, various aspects of trust. Last, diversity in the neighbourhood does not mean the same for immigrant and native residents.

Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study

Objective: To investigate the feasibility and effects of preoperative inspiratory muscle training on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective abdominal aortic aneurysm surgery. Design: Single-blind randomized controlled pilot study. Setting: Gelderse Vallei Hospital Ede, the Netherlands. Subjects: Twenty high-risk patients undergoing elective abdominal aortic aneurysm surgery were randomly assigned to receive preoperative inspiratory muscle training or usual care. Main measures: Effectiveness outcome variables were atelectasis, inspiratory muscle strength and vital capacity, and feasibility outcome variables were adverse effects and patient satisfaction with inspiratory muscle training. Results: Despite randomization, patients in the intervention group were significantly older than the patients in the control group (70 ± 6 years versus 59 ± 6 years, respectively; P = 0.001). Eight patients in the control group and three in the intervention group developed atelectasis (P = 0.07). The median duration of atelectasis was 0 days in the intervention group and 1.5 days in the control group (P = 0.07). No adverse effects of preoperative inspiratory muscle training were observed and patients considered that inspiratory muscle training was a good preparation for surgery. Mean postoperative inspiratory pressure was 10% higher in the intervention group. Conclusion: Preoperative inspiratory muscle training is well tolerated and appreciated and seems to reduce the incidence of atelectasis in patients scheduled for elective abdominal aortic aneurysm surgery.

Educational performance of native and immigrant children from various countries of origin

Abstract Mostly due to the lack of suitable data, cross-national research on the integration of migrant pupils is still scarce. We aim to fill this gap by addressing the question of the extent to which native and first- and second-generation migrants from various regions of origin, living in thirteen different countries of destination, differ in their scholastic ability. Using the PISA 2003 data, we focus primarily on the impact of origin and destination effects on the scholastic achievement of migrants. The results indicate that family characteristics and origin and destination effects can offer a significant contribution to the explanation of difference in scholastic knowledge between natives and first- and second-generation migrants. However, certain primary origin and destination effects, as well as interactions between these and family characteristics, remain significant and substantive after controlling for family characteristics, suggesting serious integration problems in the case of migrants from a few regions of origin in some European countries of destination.

The intergenerational transmission of divorce in cross-national perspective: Results from the Fertility and Family Surveys

We used data on womens first marriages from the Fertility and Family Surveys to analyse the intergenerational transmission of divorce across 18 countries and to seek explanations in macro-level characteristics for the cross-national variation. Our results show that women whose parents divorced have a significantly higher risk of divorce in 17 countries. There is some cross-national variation. When compared with the USA, the association is stronger in six countries. This variation is negatively associated with the proportion of women in each cohort who experienced the divorce of their parents and with the national level of womens participation in the labour force during childhood. We conclude that differences in the contexts in which children of divorce learn marital and interpersonal behaviour affect the strength of the intergenerational transmission of divorce.

Unemployment among immigrants in European labour markets: an analysis of origin and destination effects

This article presents a multilevel analysis of 1363 male and female first- and second-generation immigrants’ unemployment rates. In addition to individual characteristics, the effects of macro-characteristics of 13 destination countries in the EU and of more than 100 origin countries of the immigrants are analysed. Immigrants are found to be more often unemployed in countries where natives have higher unemployment rates. Immigrants’ unemployment rates are lower in countries with a larger segment of low-status jobs, with higher immigration rates and with a higher GDP per capita. Destination countries’ integration policies and welfare state regimes do not affect the unemployment risk of immigrants. At the level of origin countries, immigrants from more politically stable and free, more developed and more wealthy societies are found to be less often unemployed. Immigrants coming from Islamic countries have higher rates of unemployment, while those originating from Western Europe are less likely to be unemployed.

School Achievement Of Pupils From The Lower Strata In Public, Private Government-Dependent And Private Government-Independent Schools: A Cross-National Test Of The Coleman-Hoffer Thesis.

We consider the question whether pupils from the lower social strata perform better in private government-dependent schools than in public or private-independent schools, using the Programme for International Student Assessment (PISA) 2000 data on European high schools. In the 1980s, Coleman and Hoffer (1987) found in the USA that the performance of these pupils was better at religious schools than at comparable public schools. Dronkers and Robert (2003) found in PISA data for 19 comparable countries that private government-dependent schools are more effective than comparable public schools, also after controlling for characteristics of pupils and parents and the social composition of the school. The main explanation appeared to be a better school climate in private government-dependent schools. Private independent schools were less effective than comparable public schools, but only after controlling for the social composition of the school. As a follow-up we now investigate, again with the PISA data of these 19 countries, whether this positive effect of private government-dependent schools differs between pupils from different strata. We use various indicators to measure social strata: social, cultural, and economic. We expect that the thesis of Coleman and Hoffer does hold for private government-dependent schools because in these 19 countries they are mostly religious schools, which have more opportunities to form functional communities and create social capital. But for private independent schools, which because of their commercial foundation are less often functional communities, this relation is not expected to hold. However, the results show that public and private schools have mostly the same effects for the same kind of pupils and thus mostly do not favor one kind of pupils above another kind of pupils. But private government-dependent schools are slightly more effective for pupils with less cultural capital and private independent schools are also more effective for pupils from large families or low status families.

The Existence of Parental Choice in the Netherlands

Parental choice of a private or public school for children has existed in the Netherlands since the start of this century. All school sectors (public, Protestant, Catholic) are subjected to strong control of equal examinations, salary, capital investments, and so forth by the national government. In the start of this century, parental choice of a school was mostly dominated by religious ties, but in the second half of this century, the Dutch society became more or less irreligious. At least nine mechanisms can explain the existence of religious schools in a less religious society: (a) community of churches, (b) educational administration, (c) student intake, (d) financial differences, (e) deliberate educational choice, (f) educational conservatism, (g) religious values, (h) political protection, and (i) refusal of certain pupils.

A cross-national analysis of the relations between school choice and effectiveness differences between private-independent and public schools

We apply propensity score matching to the estimation of differential school effectiveness between the publicly funded private sector and the public sector in a sample of 26 countries. This technique allows us to distinguish between school choice and school effectiveness processes and thus to account for selectivity issues involved in the comparison of the 2 sectors. Concerning school choice, we found 2 patterns: a choice of upwardly mobile parents for private schools and a preference for segregation by (lower) middle-class parents. As regards school effectiveness, our results indicate that, after controlling for selectivity, a substantial advantage in reading achievement remains among students in publicly funded private schools in 10 out of the 26 countries.

Explaining access to citizenship in Europe: How citizenship policies affect naturalization rates

In Europe, a variety of national policies regulate access to citizenship. This article analyses how citizenship policies affect naturalization rates among immigrants. Our analysis confirms that favourable citizenship policies positively affect naturalization rates, especially among first-generation immigrants with more than 5 but fewer than 20 years of residence. However, most variation is explained by other factors. Immigrants from poor, politically unstable, and non-EU countries are more likely to be a citizen of their European country of residence. Other important predictors of the citizenship status of immigrants are language, years of residence (first generation), and age (second generation). Explanations of naturalization rates in Europe should not only take into account institutional conditions but also include other destination and origin country factors and individual characteristics of immigrants.