This study provides insight into factors which were related to a positively or negatively experienced outcome of pain rehabilitation. A good match within the patient-professional interaction seems essential. IMPLICATIONS OF REHABILITATION: Within chronic pain rehabilitation good didactic skills and a client-centered attitude of the professional may be helpful in order to make the patient feel being taken seriously. An assessment of the patient's learning style might lead to a better fit of the patient education and training according to an individual's learning style. Relapse might be prevented by paying special attention to the integration of new behavior within important life areas as work and sports.

Consanguineous couples should be adequately informed about their increased reproductive risk and possibilities for genetic counselling. Information may only be effective if it meets the needs of the target group. This study aimed to gain more insight into: (1) attitudes of people belonging to ethnic groups in Western society towards consanguinity and their understanding of risk for offspring; and (2) their attitudes regarding reproductive information targeted at consanguineous couples. Dutch Moroccans and Turks were invited to complete an online questionnaire by snowball sampling and by placing a link on two popular Dutch Moroccan/Turkish forum websites between September and October 2011. The questionnaire was completed by 201 individuals who were, on average, neither positive nor negative towards consanguinity. Respondents with a consanguineous partner were more positive, estimated the risk for the offspring lower and were less positive about the provision of risk information to consanguineous couples when compared with respondents without a consanguineous partner. Participants of Turkish origin had a more negative attitude towards consanguinity and estimated the reproductive risk higher than Moroccan participants. More than half of the respondents thought that information should be given before marriage, whereas only 10% thought it should never be provided. The general practitioner was most often mentioned (54%) as the designated professional to inform people. Information about genetic risks related to consanguinity should be offered early, preferably before marriage. The diversity of the target population requires various strategies to disseminate information and reach consanguineous couples with the offer of genetic counselling.

BackgroundCousin marriages, in the Netherlands most frequently between Turkish or Moroccan couples, are at higher risk of having offspring with recessive disorders. Often, these couples not perceive or accept this risk, and it is hardly considered a reason to refrain from family marriages. Preconception carrier screening (PCS) is offered to Jewish groups, and more recently in the Netherlands, to genetically isolated communities. In this study, Dutch Moroccan and Turkish women’s perspectives on preconception carrier screening (PCS) and reproductive choices were explored.MethodsIndividual interviews were held with Dutch Turkish and Moroccan consanguineously married women (n = 10) and seven group discussions with Turkish and Moroccan women (n = 86). Transcripts and notes were analyzed thematically.ResultsAll women welcomed PCS particularly for premarital genetic screening; regardless of possible reproductive choices, they prefer information about their future child’s health. Their perspectives on reproductive choices on the basis of screening results are diverse: refraining from having children is not an option, in vitro fertilization (IVF) combined with pre-implantation genetic diagnosis (PGD) was welcomed, while prenatal genetic diagnosis (PND), termination of pregnancy (TOP), in vitro fertilization with a donor egg cell, artificial insemination with donor sperm (AID), and adoption, were generally found to be unacceptable. Besides, not taking any special measures and preparing for the possibility of having a disabled child are also becoming optional now rather than being the default option.ConclusionsThe women’s preference for PCS for premarital screening as well as their outspokenness about not marrying or even divorcing when both partners appear to be carriers is striking. Raising awareness (of consanguinity, PCS and the choice for reproductive options), and providing information, screening and counseling sensitive to this target group and their preferences are essential in the provision of effective health care.

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tion programmes, which are based on physical training and behavioural cognitive training, is to improve the health-related quality of life of patients by coaching them to cope with their pain and its consequences (1). Drop-out from low back pain rehabilitation of non-native patients (28.1%) in the Netherlands has been reported to be twice as high as in native Dutch patients (13.7%); the overall drop-out rate is 18.7% (2). The higher drop-out rate of non-native patients is consistent with a study conducted in mental healthcare. In that study the drop-out rate was significantly higher in ethnic minority patients (52%) compared with native patients (30%) (3). Furthermore, the overall drop-out rate in patients with low back pain (18.7%) (2) is consistent with those of previous studies in patients with (low back) pain, which found drop-out rates ranging from 10% to 42% (4-6).There is, however, limited knowledge of the causes of this higher drop-out rate in non-native patients. In a qualitative study, sources of tension in the interaction between non-native patients and native Dutch physicians in chronic non-specific low back pain rehabilitation treatment have been identified (7). These sources of tension, found directly after the first consultation with the rehabilitation physician, were: patients expecting a specific diagnosis and pain relief as the primary aims of treatment; more explicit symptom presentation of patients; different views on responsibilities with regard to the rehabilitation treatment (physicians implied that patients expected more responsibility to be taken by the physician); lack of trust in the rehabilitation physician; contradicting views given by physicians from the patients' country of origin with regard to the cause and treatment of pain; and communication problems, partly due to shame and embarrassment about patients' limited language proficiency in Dutch. These sources of tension potentially lead to future drop-out.More sick leave days (4, 8, 9), higher pain severity (9, 10), being less active in sports (4), a lower age (9) and the idea that exercise did not help or aggravated pain (11) have been identified as predictors of drop-out in low back pain rehabilitation programmes. A systematic review of qualitative and quantitative studies in patients with low back pain regarding INTRODUCTIONPatients with chronic non-specific low back pain can benefit from rehabilitation programmes. The aim of these rehabilita- 567Reasons for drop-out from rehabilitation their expectations and satisfaction with treatment (12) showed that patients in general (i.e. not specifically selected for a non-native background) are dissatisfied with low back pain treatment for a number of reasons, including: not obtaining a specific diagnosis of the pain; pain relief not being the main aim of treatment; lack of physical examination and diagnostic tests; lack of referrals to other therapy or specialists for further treatment; no possibility of sickness certification. This review study seems to show that patients with low ...

Dropout from a rehabilitation programme often occurs in patients with chronic nonspecific low back pain of non-native origin. However, the exact dropout rate is not known. The objective of this study was to determine the difference in dropout rate between native and non-native patients with chronic nonspecific low back pain participating in a rehabilitation programme in The Netherlands. A retrospective study (n = 529) of patient files was performed in two rehabilitation centres and two rehabilitation departments of general hospitals in The Netherlands. Patient files were checked for diagnosis, status of origin, sex, age and outcome, that is, reason for finishing treatment. The difference in dropout rate between patients of Dutch and non-Dutch origin was tested by chi tests and logistic regression-analysis, controlling for age, sex, type of rehabilitation institute and phase of the rehabilitation programme. Dropout occurred among one fifth (18.7%) of the total patient population. Dropout among patients of non-Dutch origin was twice as high as among native Dutch patients (P < 0.001). In regression analyses dropout was related to status of non-Dutch origin, treatment in a rehabilitation centre and the diagnostic phase of a rehabilitation programme. In conclusion, patients of non-Dutch origin drop out considerably more frequently than native Dutch patients. Dropout is higher in the diagnostic phase than in the treatment phase and in rehabilitation centres than in hospitals. Future research should clarify the reasons for the high dropout rate in patients of non-native origin.

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Encouraged by the uprisings in Tunisia and Egypt, and the Arab Spring, young Moroccans began to organise huge demonstrations across the country demanding more democracy, social justice and anti-corruption measures. The 20 February movement, named after the first demonstration held on that date in 2011, is a good illustration of one of the new social movements characterized by an intense use of technology and their diffuse membership. This article explores how protesters challenge the dominant institutions and norms in society through their struggle and how they try to create new meanings for these institutions, not only by protesting but also by using social media. We argue that using new social media is not only a vehicle for the mobilisation of activists, but also represents a form of new meaning-making for them: they participate, not only in a local sense, but also globally. Their online activities intersect and influence of ine practices and vice versa, creating a continuous interaction which exerts an influence on both worlds. It is precisely this interconnectedness of offline and online worlds that is the decisive force in these movements and creates new meaning-making. Key words: Morocco, Arab Spring, new social movement, social media, meaning-making