A three-component cognitive behavioural lifestyle program for preconceptional weight-loss in women with polycystic ovary syndrome (PCOS): A protocol for a randomized controlled trial

Background: Obesity in women with polycystic ovary syndrome (PCOS) negatively affects all clinical features, and a 5 to 10% weight loss has shown promising results on reproductive, metabolic and psychological level. Incorporating a healthy diet, increasing physical activity and changing dysfunctional thought patterns in women with PCOS are key points in losing weight. The biggest challenge in weight management programs is to achieve a reasonable and sustainable weight loss. The aim of this study is to explore whether Cognitive Behavioural Therap

Exhaled nitric oxide levels to guide treatment for children with asthma.

BACKGROUND: Asthma guidelines aim to guide health practitioners to optimise treatment for patients to minimise symptoms, improve or maintain good lung function, and prevent acute exacerbations. The principle of asthma guidelines is based on a step-up or step-down regimen of asthma medications to maximise health using minimum doses. Fractional exhaled nitric oxide (FeNO) is a marker of eosinophilic inflammation and tailoring asthma medications in accordance to airway eosinophilic levels may improve asthma outcomes such as indices of control or reduce exacerbations, or both. OBJECTIVES: To evaluate the efficacy of tailoring asthma interventions based on fractional exhaled nitric oxide (FeNO), in comparison to not using FeNO, that is, management based on clinical symptoms (with or without spirometry/peak flow) or asthma guidelines (or both), for asthma-related outcomes in children. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and reference lists of articles. The last searches were in June 2016. SELECTION CRITERIA: All randomised controlled trials (RCTs) comparing adjustment of asthma medications based on FeNO levels compared to those not using FeNO, that is, management based on clinical symptoms or asthma guidelines (or both) involving children. DATA COLLECTION AND ANALYSIS: We reviewed results of searches against predetermined criteria for inclusion. Two review authors independently selected relevant studies, assessed trial quality and extracted data. We contacted study authors for further information with responses provided from three. MAIN RESULTS: The review included nine studies; these studies differed in a variety of ways including definition of asthma exacerbations, FeNO cut-off levels used (12 parts per billion (ppb) to 30 ppb), the way in which FeNO was used to adjust therapy and duration of study (6 to 12 months). Of 1426 children randomised, 1329 completed the studies. The inclusion criteria for the participants in each study varied but all had a diagnosis of asthma. There was a significant difference in the number of children having one or more asthma exacerbations over the study period, they were significantly lower in the FeNO group in comparison to the control group (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.45 to 0.75; 1279 participants; 8 studies). The number needed to treat for an additional beneficial outcome (NNTB) over 52 weeks was 9 (95% CI 6 to 15). There was no difference between the groups when comparing exacerbation rates (mean difference (MD) -0.37, 95% CI -0.8 to 0.06; 736 participants; 4 studies; I(2) = 67%). The number of children in the FeNO group requiring oral corticosteroid courses was lower in comparison to the children in the control group (OR 0.63, 95% CI 0.48 to 0.83; 1169 participants; 7 studies; I(2) = 0%). There was no statistically significant difference between the groups for exacerbations requiring hospitalisation (OR 0.75, 95% CI 0.41 to 1.36; 1110 participants; 6 studies; I(2) = 0%). There were no significant differences between the groups for any of the secondary outcomes (forced expiratory volume in one second (FEV1), FeNO levels, symptom scores or inhaled corticosteroid doses at final visit). The included studies recorded no adverse events.Three studies had inadequate blinding and were thus considered to have a high risk of bias. However, when these studies were removed in subgroup analysis, the difference between the groups for the primary outcome (exacerbations) remained statistically significant. The GRADE quality of the evidence ranged from moderate (for the outcome 'Number of participants who had one or more exacerbations over the study period') to very low (for the outcome 'Exacerbation rates'), based on lack of blinding, statistical heterogeneity and imprecision. AUTHORS' CONCLUSIONS: In this updated review with five new included studies, tailoring asthma medications based on FeNO levels (in comparison with primarily guideline management) significantly decreased the number of children who had one or more exacerbations over the study period but did not impact on the day-to-day clinical symptoms or inhaled corticosteroid doses. Therefore, the use of FeNO to guide asthma therapy in children may be beneficial in a subset of children, it cannot be universally recommended for all children with asthma.Further RCTs need to be conducted and these should encompass different asthma severities, different settings including primary care and less affluent settings, and consider different FeNO cut-offs

Long-term scar quality after hydrosurgical versus conventional debridement of deep dermal burns (HyCon trial): Study protocol for a randomized controlled trial

Background: Deep dermal burns require tangential excision of non-viable tissue and skin grafting to improve wound healing and burn-scar quality. Tangential excision is conventionally performed with a knife, but during the last decade hydrosurgery has become popular as a new tool for tangential excision. Hydrosurgery is generally thought to be a more precise and controlled manner of burn debridement leading to preservation of viable tissue and, therefore, better scar quality. Although scar quality is considered to be one of the most important outcomes in burn surgery today, no randomized controlled study has compared the effect of these two common treatment modalities with scar quality as a primary outcome. The aim of this study is, therefore, to compare long-term scar quality after hydrosurgical versus conventional tangential excision in deep dermal burns. Methods/design: A multicenter, randomized, intra-patient, controlled trial will be conducted in the Dutch burn centers of Rotterdam, Beverwijk, and Groningen. All patients with deep dermal burns that require excision and grafting are eligible. Exclusion criteria are: a burn wound 30%, full-thickness burns, chemical or electrical burns, infected wounds (clinical symptoms in combination with positive wound swabs), insufficient knowledge of the Dutch or English language, patients that are unlikely to comply with requirements of the study protocol and follow-up, and patients who are (temporarily) incompetent because of sedation and/or intubation. A total of 137 patients will be included. Comparable wound areas A and B will be appointed, randomized and either excised conventionally with a knife or with the hydrosurgery system. The primary outcome is scar quality measured by the observer score of the Patient and Observer Scar Assessment Scale (POSAS); a subjective scar-assessment instrument, consisting of two separate six-item scales (observer and patient) that are both scored on a 10-point rating scale. Discussion: This study will contribute to the optimal surgi

Juvenile Crime Monitor 2020 - Developments in juvenile crime during the first two decades of the 21st century

The Juvenile Crime Monitor 2020 provides a broad, multi-method and multi-source overview of juvenile crime developments in the Netherlands from 2000 up to (and sometimes including) 2020, with an emphasis on 2015 and onward. The Juvenile Crime Monitor 2020 uses police data on juvenile suspects, prosecution and court data on convicted offenders and sanctions, and self-report data from a representative Dutch juvenile sample. By using multiple sources, examined developments are less selective and biased, than when only a single source is used. Furthermore, several age groups are distinguished: children aged 10 to 11, minors aged 12 to 17, and young adults aged 18 to 22; most data concerns ages 12 and older. Besides traditional crime, cyber-dependent and cyber-enabled crime is examined as well. Not all sources used are yet able to provide information on 2020, which can be considered a special year due to the start of the COVID-19 pandemic, with only self-report and police data able to provide general data on this year.In de tweejaarlijkse Monitor Jeugdcriminaliteit (MJC) zijn de ontwikkelingen in de jeugdcriminaliteit in de periode 2000 tot 2020 beschreven. Het doel van de MJC is een breed overzicht te geven van de ontwikkelingen in de jeugdcriminaliteit in Nederland en omringende landen, waarbij de nadruk ligt op de jaren 2015 tot 2020. Hiervoor wordt gebruikgemaakt van gegevens uit verschillende bronnen: naast gegevens van politie en justitie over jeugdige verdachten, veroordeelde daders en afdoeningen door politie, het Openbaar Ministerie (OM) en de rechterlijke macht (ZM), bevat deze editie ook gegevens over zelfgerapporteerd daderschap op basis van een representatieve steekproef onder Nederlandse jongeren. De ontwikkelingen worden apart beschreven voor twaalfminners (10- tot 12-jarigen), minderjarigen (12- tot 18-jarigen) en jongvolwassenen (18- tot 23-jarigen), met de nadruk op de oudste twee leeftijdsgroepen. Naast ontwikkelingen in de traditionele criminaliteit worden ook ontwikkelingen in cyber- en gedigitaliseerde criminaliteit beschreven. Daarnaast zijn over zelfgerapporteerd daderschap en geregistreerde verdachten enkele algemene gegevens over (een deel van) 2020 meegenomen, dat vanwege de COVID-19-maatregelen een bijzonder jaar was. Daarmee bestrijkt deze MJC hoofdzakelijk de ontwikkelingen in de periode 2000 tot 2020 met een eerste algemene doorkijk naar het jaar 2020

Verslag van een voorstudie naar de uitvoerbaarheid van metingen op basis van de OBJD

Het huidige onderzoek heeft als doel vast te stellen of op basis van de Onderzoek- en Beleidssdatabase Justitiële Documentatie (OBJD) een volledig dan wel representatief beeld geschetst kan worden van de strafrechtelijke carrières van op OM-niveau verdachte woninginbrekers en gewelddadige overvallers. In dit onderzoek zal onder meer worden gekeken of de gevonden aantallen voldoen voor statistische analyses. Ook zal in de discussie gekeken worden hoe de gevonden aantallen zich verhouden ten opzichte van andere bronnen over dezelfde materie

Breaking the stigma : the association between psychological factors and the complex regional pain syndrome

In 1900, Sudeck first described a post-traumatic pain syndrome with edema and trophic changes. This syndrome, known as Sudeck atrophy, was later called sympathetic reflex dystrophy and in 1994 renamed Complex Regional Pain Syndrome (CRPS). CRPS usually develops after a minor trauma such as an injury or fracture or after surgery, but spontaneous development of CRPS type 1 (CRPS1) has also been described. There are two types of CRPS described; CRPS1 arises without an obvious, detectable nerve lesion, and type 2 (CRPS2) manifests with an obvious, detectable lesion. The observation that only certain patients develop CRPS1 after a common trauma has led to the idea that some patients are susceptible to developing CRPS1. There are indications for a genetic susceptibility for CRPS129-33, and there is growing evidence for immunological attainment of this syndrome, but a definitive conclusion cannot yet be made. The International Association for the Study of Pain (IASP) defines CRPS1 as a variety of painful conditions following injury that appears regionally and has a distal predominance of abnormal findings

Mother-to-infant bonding in women with a bipolar spectrum disorder

Purpose Offspring of mothers with a bipolar disorder are at high-risk for impaired developmental outcomes and psychopathology (e. g., mood, anxiety, sleep disorders) later in life. This increased risk of psychopathology is not only because of genetic vulnerability, but environmental factors may play an important role as well. The often long and debilitating mood episodes of mothers with bipolar disorder might hamper their qualities as a caregiver and may impact the child. We examined early mother-to-infant bonding 1 year postpartum in mothers with bipolar spectrum disorder as compared to mothers of the general population. The association between mother-to-infant bonding and the type of bipolar spectrum diagnosis (bipolar I, bipolar II, bipolar Not Otherwise Specified) as well as relapse within 12 months postpartum was also assessed. Methods In total, 75 pregnant women with a bipolar spectrum disorder participated in the current study. The participants were included in a longitudinal cohort study of women with bipolar spectrum disorder and were prospectively followed from pregnancy until 1 year postpartum. Mother-to-infant bonding was assessed using the Pre- and Postnatal Bonding Scale. A longitudinal population-based cohort of 1,419 pregnant women served as the control group. Multiple linear regression analyses were used to assess the association between bipolar spectrum disorder and mother-to-infant bonding scores, controlling for several confounders. Results Women with bipolar spectrum disorder perceived the bonding with their child as less positive compared to the control group. The type of bipolar spectrum disorder was not associated with poorer bonding scores. Relapse during the 1st year after delivery also did not affect bonding scores in women with bipolar spectrum disorder. Conclusions Our findings could imply that women with bipolar spectrum disorder are more vulnerable to impairments in bonding due to the nature of their psychopathology, regardless of the occurrence of postpartum relapse. Careful follow-up including monitoring of mother-to-infant bonding of pregnant women with a history of bipolar spectrum disorder should be a standard to this vulnerable group of women. In addition, regardless of severity and mood episode relapse, an intervention to improve bonding could be beneficial for all mothers with bipolar spectrum disorder and their newborns

Een verkennend onderzoek naar de inzet van voorwaardelijke vrijheidsstraffen

De factsheet beschrijft de ontwikkeling in het aantal en de duur van de voorwaardelijke vrijheidsstraffen die in de achterliggende periode werden opgelegd. Onder meer wordt nagegaan of er sprake is geweest van een toename van (deels) voorwaardelijke straffen en of dat - getalsmatig - ten koste is gegaan van het aandeel celstraffen

Verslag van een voorstudie naar de uitvoerbaarheid van metingen op basis van de OBJD

Van 2012 tot 2016 loopt het actieplan ‘Kinderen Veilig’. In het actieplan worden drie accenten gelegd: 1. Voorkomen; 2. Krachten bundelen door multidisciplinaire aanpak; en 3. Het aanpakken van fysieke mishandeling en seksueel misbruik. Dit onderzoeksproject betreft het derde accent. Dit onderzoek heeft als doel te achterhalen of op basis van de Onderzoek- en Beleidsdatabase Justitiële Documentatie (OBJD) een volledig dan wel representief beeld kan worden verkregen van de strafrechtelijke carrière van persoen die op OM-niveau verdacht worden van kindermishandeling. Naast kindermishandeling wordt in dit rapport ook de aandacht gericht op seksueel geweld tegen kinderen en mensenhandel