Peter Scholten

Long-term esophageal cancer risk in patients with primary achalasia: a prospective study.

OBJECTIVES:Achalasia patients are considered at increased risk for esophageal cancer, but the reported relative risks vary. Identification of this risk is relevant for patient management. We performed a prospective evaluation of the esophageal cancer risk in a large cohort of achalasia patients with long-term follow-up.METHODS:Between 1975 and 2006, all patients diagnosed with primary achalasia in our hospital were treated and followed by the same protocol. After graded pneumatic dilatation, all patients were offered a fixed surveillance protocol including gastrointestinal endoscopy with esophageal biopsy sampling.RESULTS:We surveyed a cohort of 448 achalasia patients (218 men, mean age 51 years at diagnosis, range 4–92 years) for a mean follow-up of 9.6 years (range 0.1–32). Overall, 15 (3.3%) patients (10 men) developed esophageal cancer (annual incidence 0.34 (95% confidence interval 0.20–0.56)). The mean age at cancer diagnosis was 71 years (range 36–90) after a mean of 11 years (range 2–23) following initial presentation, and a mean of 24 years (range 10–43) after symptom onset. The relative hazard rate of esophageal cancer was 28 (confidence interval 17–46) compared with an age- and sex-identical population in the same timeframe. Five patients received a potential curative treatment.CONCLUSIONS:Although the gastro–esophageal cancer risk in patients with longstanding achalasia is much higher than in the general population, the absolute risk is rather low. Despite structured endoscopical surveillance, most neoplastic lesions remain undetected until an advanced stage. Efforts should be made to identify high-risk groups and develop adequate surveillance strategies.

The Role of Narratives in Migration Policy-Making: A Research Framework

While debates on migration policy often revolve around rival values and interests, they also invoke knowledge claims about the causes, dynamics and impacts of migration. Such claims are best conceptualised as ‘policy narratives’, setting out beliefs about policy problems and appropriate interventions. Narratives are likely to be more successful where they meet three criteria: they are cognitively plausible, dramatically or morally compelling and, importantly, they chime with perceived interests. Increasingly, such narratives are also expected to draw on expert knowledge, although knowledge is often deployed to legitimise particular actors or preferences rather than to enhance the cognitive plausibility of the narrative. The series of articles in this issue explore how narratives are developed, codified, revised and diffused in policy debates and policy-making. We hope that they contribute not just to understanding migration policy, but also to wider debates on the role of ideas and knowledge in public policy.

Two Worlds Apart

Immigrant integration has become an intractable policy controversy in the Netherlands. One facet of this controversy involves the different ways in which immigrant integration has been framed by national and local governments. National government has formulated a “citizenship approach” to immigrant integration, whereas local governments often chose a more accommodative approach to migrant groups. In this article, the authors argue that this discrepancy originates from the divergent institutional logic of national and local integration policies. National integration policies have resulted from belief in strong central policy coordination, a sharp turn from depoliticization to politicization, responsiveness to a series of focus events, and mood swings during the past decades. Local integration policies, in contrast, are characterized by a considerable degree of pragmatic problem coping, in particular, the instrumental use of migrant organizations. As such, the divergent logics of national and local integration policies seem to represent two different worlds of problem framing.

Constructing Dutch Immigrant Policy: Research–Policy Relations and Immigrant Integration Policy-Making in the Netherlands

The development of Dutch immigrant policy over the past decades has been characterised by the rise and fall of several policy frames. The role that social researchers and research institutes have played in these frame shifts has changed significantly. This article reveals that there was a clear relation between the structure of the policy-making process in the Netherlands, including the division of labour between social research and policy-makers therein, and the culture of policy-making or how immigrant integration was framed. A trend was discerned from a technocratic policy structure with a very direct role of researchers in depoliticised processes of policy-making to more engineering-like policy structures with a strong political primacy and a more selective approach to using scientific expertise for legitimating policy discourse. This article argues that these structural changes provided an important condition for the rise of a more assimilationist frame of immigrant policy in the Netherlands.

The political flow of wisdom: science institutions as policy venues in The Netherlands

Abstract This paper deals with the different roles that scientific knowledge can play in shaping and redefining policy images, focusing on two quite distinct policy fields in The Netherlands: immigrant policy and assisted reproductive technology policy. Interactions between policy-makers and scientific experts are linked to processes of negative and positive feedback in which a policy monopoly is maintained or attacked. We show how science and the structural arrangements through which it is produced and disseminated can truly be a ‘venue’ for depoliticization or for fuelling emerging policy disputes. The two cases of immigrant integration and reproductive medicine show variation in topic, tone and tempo, but we also consider points of similarity that may stem from broader features of the system. We conclude with a discussion of institutional conditions for the nexus of science and politics, and point a way for further investigating this subject in cross-national comparative research.

Oesophagitis is common in patients with achalasia after pneumatic dilatation

Background  Achalasia, an oesophageal motor disease, is associated with functional oesophageal obstruction. Food stasis can predispose for oesophagitis. Treatment aims at lowering of the lower oesophageal sphincter pressure, enhancing the risk of gastro‐oesophageal reflux. Nevertheless, the incidence of oesophagitis after achalasia treatment is unknown.

Policy Analysis and Europeanization: An Analysis of EU Migrant Integration Policymaking

Abstract This article analyses EU-level research–policy infrastructures and their role in the Europeanization of migrant integration policies at a time of perceived crisis and policy failure. Rather than focusing on either knowledge utilization or knowledge production, it focuses on what we call “knowledge infrastructures” or different ways of mobilizing research with specific purposes of knowledge utilization. Rather than finding one dominant configuration of research–policy relations, various infrastructures that co-exist and sometimes even overlap were found. Besides EU-sponsored infrastructures aimed primarily at horizontal exchange of knowledge and information between countries and between cities, there were also infrastructures that were more directly related to EU policy goals as well as an infrastructure that mobilized research as an informal tool to monitor policy compliance. This shows that the use of research in Europeanization does not always mean “going technical”, but that precisely when the EU lacks formal competencies such as in the area of migrant integration policies, mobilizing specific types of research can form part of a political strategy designed to reinforce policy objectives.

The coproduction of immigrant integration policy and research in the Netherlands: The case of the Scientific Council for Government Policy

The Dutch Scientific Council for Government Policy (WRR) is centrally positioned within the Dutch research-policy nexus. In particular, it has developed a tradition of involvement in the field of immigrant integration. This paper analyses the role of the WRR as a ‘boundary organisation’ in the development of both immigrant integration research and policy in the Netherlands. It shows that the WRR not only plays a role in the diffusion of scientific knowledge to policy, but also in negotiating the boundaries and the division of labour between research and policy. It operates on the research-policy nexus, but also contributes to the shaping of this nexus. Studying the ‘boundary work’ of the WRR therefore allows us to develop a better understanding of how and why the relationship between immigrant integration research and policy in the Netherlands has evolved from a symbiotic relationship in the 1970s and 1980s to a more antithetical relationship in recent decades. Copyright , Beech Tree Publishing.

A Local Dimension of Integration Policies? A Comparative Study of Berlin, Malmö, and Rotterdam

This study examines three theses on local integration policies by a qualitative comparative case study of integration policies in three cities in three different countries (Berlin, Malmö, and Rotterdam). We found little evidence of a congruent local dimension of integration policies. Local policies resemble their national policy frameworks fairly well in terms of policy approaches and domains. Our multi-level perspective shows that this is not the result of top-down hierarchical governance, but rather of a multilevel dynamic of two-way interaction. Local policy legacies and local politics matter and national policies are also influenced by local approaches of integration.

The multilevel governance of migration and integration

This chapter focuses on migration and integration as multilevel policy issues and explores the consequences in terms of multilevel governance. Immigration policymaking has been characterized by continued struggle between national governments and the EU about the amount of discretion states have in interpreting EU directives. The involvement of local and regional governments in debates about intra-EU migration, particularly East–west migration from new member states, has further complicated the situation. Regarding integration, even more complex relations have emerged between local, regional, national, and EU institutions. The superdiverse cities of Europe, such as Barcelona, London, Berlin, and Rotterdam, have taken policy directions very different from their national governments, effectively “decoupling” national and local policies. While politicization of migrant integration continues to drive policies in many countries, the EU has developed various soft governance measures to promote policy learning between local governments. This chapter examines the recent evolution of migration and integration policies at the EU, national, and local levels, as well as the regional level. This enables us to understand the factors that drive policies at the different levels and the extent that these lead to convergence or divergence between the levels. Also analysed are the relations—or absence of relations—between levels of government. To make sense of these relations, a framework is applied that allows for different arrangements of relations. The notion of “multilevel governance” provides one possible way of structuring relations between various government levels.