Introduction

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Introduction: unmarried and unknown: urban men and women in the low countries since the early modern period

This essay introduces a special issue on The Lure of the City that examines the attraction of towns to unmarried men and women in the Low Countries during the early modern period and the nineteenth century. The issue has the relation between singles and cities as its main focus. Singles were present in disproportionately large numbers in urban areas, but the question is why? This essay sets out the historiographical framework for the contributions in the issue, discusses the sources and methodologies used, and provides a brief overview of the evolution of singleness in the Low Countries. The contributions all demonstrate the relevance of a comparative approach. It is revealed that towns and cities not only attracted but also created singles, that they offered different opportunities for different groups of unmarried people and that they affected men and women differently. Finally, it appears that not every town and city was attractive to men and women without a spouse

Rehabilitation for improving automobile driving after stroke

Publisher version made available in accordance with the publisher's policy. This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy. 'This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2014, Issue 2. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’Background Interventions to improve driving ability after stroke, incl uding driving simulation and retraining visual skills, hav e limited evaluation of their effectiveness to guide policy and practice. Objectives To determine whether any intervention, with the specific aim o f maximising driving skills, improves the driving performa nce of people after stroke. Search methods WesearchedtheCochrane Stroke GroupTrialsregister(August 2 013), theCochrane Central Registerof ControlledTrials( The Cochrane Library 2012, Issue 3), MEDLINE (1950 to October 2013), EMBASE (1980 to Octo ber 2013), and six additional databases. To identify further published, unpublished and ongoing trial s, we handsearched relevant journals and conference proceeding s, searched trials and research registers, checked reference lists and conta cted key researchers in the area. Selection criteria Randomised controlled trials (RCTs), quasi-randomised trials and cluster studies of rehabilitation interventions, with t he specific aim of maximising driving skills or with an outcome of assessing d riving skills in adults after stroke. The primary outcome of i nterest was the performance in an on-road assessment after training. Secon dary outcomes included assessments of vision, cognition and dr iving behaviour. Data collection and analysis Two review authors independently selected trials based on pr e-defined inclusion criteria, extracted the data and assessed ri sk of bias. A third review author moderated disagreements as required. T he review authors contacted all investigators to obtain missi ng information. Main results We included four trials involving 245 participants in the revi ew. Study sample sizes were generally small, and interventi ons, controls and outcome measures varied, and thus it was inappropriate to pool studies. Included studies were at a low risk of bias for th e majority of domains, with a high/unclear risk of bias identified in the a reas of: performance (participants not blinded to allocation), a nd attrition (incomplete outcome data due to withdrawal) bias. Interventio n approaches included the contextual approach of driving simula tion and underlying skill development approach, including the ret raining of speed of visual processing and visual motor skills . The studies were conducted with people who were relatively young and the ti ming after stroke was varied. Primary outcome: there was no cle ar evidence of improved on-road scores immediately after trainin g in any of the four studies, or at six months (mean difference 15 points on the Test Ride for Investigating Practical Fitness to Drive - Belgian version, 95% confidence intervals (CI) 4.56 to 34.56, P v alue = 0.15, one study, 83 participants). Secondary outcomes: road sig n recognition was better in people who underwent training comp ared with control (mean difference 1.69 points on the Road Sign Recogn ition Task of the Stroke Driver Screening Assessment, 95% CI 0 .51 to 2.87, P value = 0.007, one study, 73 participants). Significan t findings were in favour of a simulator-based driving rehabil itation programme (based on one study with 73 participants) but these r esults should be interpreted with caution as they were based o n a single study. Adverse effects were not reported. There was insufficie nt evidence to draw conclusions on the effects on vision, other me asures of cognition, motor and functional activities, and driving beh aviour with the intervention. Authors’ conclusions There was insufficient evidence to reach conclusions about the use of rehabilitation to improve on-road driving skills after st roke. We found limited evidence that the use of a driving simulator m ay be beneficial in improving visuocognitive abilities, such as road sign recognition that are related to driving. Moreover, we we re unable to find any RCTs that evaluated on-road driving lesso ns as an intervention. At present, it is unclear which impairments tha t influence driving ability after stroke are amenable to rehab ilitation, and whether the contextual or remedial approaches, or a combinatio n of both, are more efficacious

Spatial disparities at death : age-, sex- and disease-specific mortality in the districts of Belgium at the beginning of the twentieth century

At the beginning of the twentieth century, life expectancy at birth was much lower in Flanders, the northern part of Belgium, than in Wallonia, the southern part of the country. In the literature, this excess mortality is mainly attributed to high levels of infant mortality caused by bad feeding practices and low-quality drinking water. The regional variability of mortality risks at other ages during this period has received less attention. In this article, we reconstruct age-, sex- and disease-specific death rates for the 41 districts of Belgium around the year 1910. To show the mortality variations, we construct maps according to indirect standardised mortality rates that reflect the deviation from the national average. Our spatial analysis shows that there was a clear-cut Flemish-Walloon divide in general mortality only for infants and children under the age of 7. For older children, adolescents, and young and elderly adults, low and high mortality were observed in both regions. For disease-specific mortality, moreover, a geographical pattern was only visible for infants, who consistently had the highest death rates in Flanders. Hence, the spatial disparities in general and disease-specific mortality cannot be simplified according to a Flemish-Walloon divide. Furthermore, we noted large differences among districts belonging to the same province, and in the ranking of the districts by age. In other words, high mortality levels of infants, children, adolescents and adults did not per se appear in the same districts. From adolescent ages onwards, there were also large differences in the ranking of districts by sex- specific mortality. This strongly suggests the importance of sex-specific determinants of health and mortality at these ages