Replacing canes with an elasticated orthotic-garment in chronic stroke patients - The influence on gait and balance. A series of N-of-1 trials

Objective:To investigate the effect of replacing canes with an elasticated orthotic-garment on balanceand gait-function in chronic stroke survivors.Design:Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in ahome setting.Participants:Four cane using chronic stroke survivors (P1-4).Interventions:Phase A (9e12 weeks) cane-walking“as usual”to establish baseline values; Phase B (9e16weeks) intervention: orthotic-garment worn throughout the day with maximal cane-use reduction;Phase C (9e10 weeks) participant-determined follow-up: either no walking-aid, orthotic-garment orcane.Outcome measures:Primary: Functional-Gait-Assessment (FGA), Secondary: Trunk-sway during walkingmeasured as Total-Angle-Area (TAA�2) in frontal and sagittal-planes, both measured weekly.Results:Visual and statistical analysis of results showed significant improvements in FGA from phase Ato B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deterioratedin P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2&P4. Trunk-swayreduced during walking, indicating increased stability, in two participants from phase A to B and in threeparticipants from A to C but no TAA changes were statistically significant. In phase C participant-selectedwalking-aids were: P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4e5days.Conclusions:Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke.“Hands-free”assistive-devices may be more effective than canes in improving gait-function in somepatients

Reaching Integrated and Prompt Action in Response to Invasive Alien Species - LIFE RIPARIAS

Reaching integrated and prompt action in response to invasive alien species (RIPARIAS

Design of the New Life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. [ISRCTN85313483]

BACKGROUND: Preventing excessive weight gain during pregnancy is potentially important in the prevention of overweight and obesity among women of childbearing age. However, few intervention studies aiming at weight management during pregnancy have been performed and most of these interventions were not as successful as expected. In this paper the design of the New Life(style) study is described as well as the content of the individually tailored intervention program, which focuses on controlling weight development during pregnancy. METHODS: The effectiveness of the New Life(style) intervention program versus usual care by midwives is evaluated in a randomised controlled trial. Women who expect their first child and visit one of the participating midwifery practices are included. The intervention is standardised in a protocol and executed by trained counsellors with the women who are randomised in the intervention group. During 5 sessions – at 18, 22, 30 and 36 weeks of pregnancy and at 8 weeks postpartum – individual weight gain is discussed in relation to weight gain guidelines for pregnant women of the American Institute of Medicine. Counsellors coach the women to maintain or optimise a healthy lifestyle, in a period of drastic physical and mental changes. Data is collected at 15, 25, 35 weeks of pregnancy and at 6, 26, and 52 weeks after delivery. Primary outcome measures are body weight, BMI, and skinfold thickness. Secondary outcome measures include physical activity, nutrition and blood levels of factors that are associated with energy homeostasis. DISCUSSION: Results of the current RCT will improve the knowledge of determinants of weight gain during pregnancy, weight retention after childbirth and of the effectiveness of the intervention program that is described. Caregivers and researchers in the field of health promotion are offered more insight in specific elements of the New Life(style) intervention program

Quality of reporting according to the CONSORT, STROBE and Timmer instrument at the American Burn Association (ABA) annual meetings 2000 and 2008

<p>Abstract</p> <p>Background</p> <p>The quality of oral and poster conference presentations differ. We hypothesized that the quality of reporting is better in oral abstracts than in poster abstracts at the American Burn Association (ABA) conference meeting.</p> <p>Methods</p> <p>All 511 abstracts (2000: N = 259, 2008: N = 252) from the ABA annual meetings in year 2000 and 2008 were screened. RCT's and obervational studies were analyzed by two independent examiners regarding study design and quality of reporting for randomized-controlled trials (RCT) by CONSORT criteria, observational studies by the STROBE criteria and additionally the Timmer instrument.</p> <p>Results</p> <p>Overall, 13 RCT's in 2000 and 9 in 2008, 77 observational studies in 2000 and 98 in 2008 were identified. Of the presented abstracts, 5% (oral; 7%(n = 9) vs. poster; 3%(n = 4)) in 2000 and 4% ((oral; 5%(n = 7) vs. poster; 2%(n = 2)) in 2008 were randomized controlled trials. The amount of observational studies as well as experimental studies accepted for presentation was not significantly different between oral and poster in both years. Reporting quality of RCT was for oral vs. poster abstracts in 2000 (CONSORT; 7.2 ± 0.8 vs. 7 ± 0, p = 0.615, CI -0.72 to 1.16, Timmer; 7.8 ± 0.7 vs. 7.5 ± 0.6,) and 2008 (CONSORT; 7.2 ± 1.4 vs. 6.5 ± 1, Timmer; 9.7 ± 1.1 vs. 9.5 ± 0.7). While in 2000, oral and poster abstracts of observational studies were not significantly different for reporting quality according to STROBE (STROBE; 8.3 ± 1.7 vs. 8.9 ± 1.6, p = 0.977, CI -37.3 to 36.3, Timmer; 8.6 ± 1.5 vs. 8.5 ± 1.4, p = 0.712, CI -0.44 to 0.64), in 2008 oral observational abstracts were significantly better than posters (STROBE score; 9.4 ± 1.9 vs. 8.5 ± 2, p = 0.005, CI 0.28 to 1.54, Timmer; 9.4 ± 1.4 vs. 8.6 ± 1.7, p = 0.013, CI 0.32 to 1.28).</p> <p>Conclusions</p> <p>Poster abstract reporting quality at the American Burn Association annual meetings in 2000 and 2008 is not necessarily inferior to oral abstracts as far as study design and reporting quality of clinical trials are concerned. The primary hypothesis has to be rejected. However, endorsement for the comprehensive use of the CONSORT and STROBE criteria might further increase the quality of reporting ABA conference abstracts in the future.</p

Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

<p>Abstract</p> <p>Background</p> <p>It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.</p> <p>Methods</p> <p>Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.</p> <p>Results</p> <p>Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.</p> <p>Conclusions</p> <p>We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.</p

Pregnancy and maternal weight change

Mechelen, W. van [Promotor]Delemarre-van De Waal, H.A. [Promotor]Poppel, M.N.M. van [Copromotor

Scheve ogen in de Lage Landen : de functie en betekenis van afgunst en jaloezie in Middelnederlandse teksten

Research has shown that emotions don't change, but that the behavior used to express them and value them changes over time. According to social mores, communities may differ in their expressions and acceptance of emotions. This study shows that this also applies to the late Middle Ages. In total, more than fifty Middle Dutch texts were searched for words expressing envy (invidia) and jealousy (zelotypia), including didactic-moralistic, religious, historical and allegorical texts, chivalric romances, songs, plays and stories about animals. The Middle Dutch texts show that the Christian faith had a major influence on the perception of envy. In the course of the fourth century Christian ideas transformed envy from a bad emotion into one of the seven cardinal sins. Christian writers of Middle Dutch texts make clear that envy comes from the devil. The devil is held directly responsible for the envy of man. It was not seen that man had no influence at all on his own behavior, for when he was strong enough, the devil could not tempt him to envy. The envy of virtue, a common form of envy in the examined texts, is rooted in the Christian faith. Envy of virtue was perceived as envy of the true Christian faith. Inequality appears again and again to be the reason for envy; inferiority and the associated fear and shame of dishonor or loss of reputation. Being inferior in the medieval culture was a major disgrace. Envy is presented in the medieval culture as a negative emotion in all its forms. Envy arises out of fear of judgment by the outside world and is a sin against God. Christian ideas and the importance of honor have clearly made their mark on the Middle Ages. On the medieval concept of jealousy, the Christian faith is less well represented. People were familiar with the concept of ‘good’ jealousy. This emotion should be felt when others spoke wrongly about God, the Christian faith, or when friends have been wronged. Among the positive qualities of jealousy, the ones we still know today, are the preventive and protective forms of jealousy. Preventive jealousy makes a spouse think twice before jumping into an extramarital relationship and protective jealousy ensures that a spouse fights for the relationship. Conceptions of jealousy have changed much less through the centuries than conceptions of env