Measuring local autonomy: A decision-making approach

In studies on central-local relations it is common to assess local autonomy in a deductive way. The extent of local autonomy is determined by measuring the central legal and financial competence, after which the remaining room for local decision-making is determined. The outcome of this indirect method is that the autonomy of local government tends to be systematically underestimated. As an alternative this paper introduces a decision-making approach in which local decisions are systematically weighed on three dimensions: Agenda setting, freedom in choices, and dependency. Using Dutch data, the authors come to the conclusion that a locally oriented perspective leads to a more accurate and positive judgement of the autonomy of local government. © 2006 Taylor & Francis

Nausea and nausea-related symptoms in children with cancer: Presence, severity, risk factors and impact on quality of life during the first year of treatment

Aims: Identify 1) presence of nausea and nausea-related symptoms and its relationship with health-related quality of life (HRQoL), and 2) severity of nausea and associations with patient-related factors in children with cancer during the first year of treatment. Methods: A historical cohort study of 781 patients with cancer (2–21 years) was conducted. Presence and severity of nausea were assessed at 3, 6, 9, and 12 months after diagnosis using the nausea scale of the PedsQL3.0 Cancer Module, comprising 5 symptoms, using proxy-report (2–7 years) or self-report (8–21 years). Multivariable multilevel analyses were performed to evaluate the association between patient-related factors and nausea. Overall HRQoL (generic PedsQL) was compared between children with presence and absence of nausea related-symptoms. Results: The presence of nausea during medical treatment was highest at 6 months after diagnosis (42.9 %). Highest symptom presence was seen on the item “food not tasting good” (range 51.6 %−62.8 %). For all nausea-related symptoms, average HRQoL scores were 9.9–14.4 points lower for patients with symptoms compared to patients without symptoms.Pain, treatment anxiety, and worry were significantly associated with nausea in all children. In patients aged 8–21 years, male gender, a solid tumor, and BMI were associated with nausea. Patients with solid tumors were at higher risk of nausea compared to patients with hematological malignancies or brain/CNS tumors. Patients with a high BMI reported less nausea compared to patients with a normal BMI. Conclusion: Nausea is still a major problem in children with cancer and has a negative impact on HRQoL