A Coaching Program for Recently Licensed Young Drivers in the Netherlands: Which Drivers are Attracted?

In line with European developments, a Dutch second phase coaching program was developed for young novice drivers to counteract their high accident risk. In this paper the design principles of the program are described. The empirical study focused on the entry characteristics of the participating young drivers (n=3117) as compared to a reference group of young drivers (n=345). Results show that the DX program attracted young drivers that in some respects showed a more risky profile than average young drivers in terms of speed violations, anger and the number of fines. In addition, four groups of participants with sharply differing driving styles could be distinguished

Validity of an On-Road Driver Performance Assessment Within an Initial Driver Training Context

Based on a competence-oriented view of driving a driver performance assessment (DPA) has been developed to inform learner drivers about their progress in acquiring driving proficiency. An initial validation study was carried out to evaluate the adequacy of inferences based on DPA-scores assigned by driving instructors. The results of two pilots are presented. Implications for driving performance assessment within driver training programs are discussed

Kansen voor meer groenten en fruit in zorginstellingen

Dit rapport verkent de mogelijkheden om de inname van groenten en fruit in zorginstellingen teverhogen. Met aanvullend de vraag of (i) de biologische variant en/of (ii) de regionale herkomstmeerwaarde biedt. Er zijn mogelijkheden om de consumptie van groenten en fruit te vergroten, vooralwanneer er meerdere eetmomenten ontwikkeld worden. Producten uit de streek bieden meerwaardevanwege de (verse) smaak en leiden ertoe dat de zorginstellingen goed ingebed raken in de regionaleeconomie

Nailfold capillary scleroderma pattern may be associated with disease damage in childhood-onset systemic lupus erythematosus:important lessons from longitudinal follow-up

OBJECTIVES: To observe if capillary patterns in childhood-onset SLE (cSLE) change over time and find associations between a capillary scleroderma pattern with disease activity, damage or scleroderma-like features. METHODS: Clinical and (yearly) capillaroscopy data from a longitudinal cohort of patients with cSLE (minimum of four Systemic Lupus International Collaborating Clinics (SLICC) criteria, onset <18 years) were analysed. Disease activity was measured by Systemic Lupus Erythematosus Activity Index (SLEDAI) and disease damage by SLICC Damage Index. A scleroderma pattern was defined according to the ‘fast track algorithm’ from the European League Against Rheumatism Study Group on Microcirculation in Rheumatic Diseases. An abnormal capillary pattern, not matching a scleroderma pattern, was defined as ‘microangiopathy’. RESULTS: Our cohort consisted of 53 patients with cSLE with a median disease onset of 14 years (IQR 12.5–15.5 years), median SLEDAI score at diagnosis was 11 (IQR 8–16), median SLEDAI at follow-up was 2 (IQR 1–6). A scleroderma pattern (ever) was seen in 18.9%, while only 13.2% of patients had a normal capillary pattern. Thirty-three patients had follow-up capillaroscopy of which 21.2% showed changes in type of capillary pattern over time. Type of capillary pattern was not associated with disease activity. Raynaud’s phenomenon (ever) was equally distributed among patients with different capillaroscopy patterns (p=0.26). Anti-ribonucleoprotein antibodies (ever) were significantly more detected (Χ(2), p=0.016) in the scleroderma pattern subgroup (n=7 of 10, 70%). Already 5 years after disease onset, more than 50% of patients with a scleroderma pattern had SLE-related disease damage (HR 4.5, 95% CI 1.1 to 18.8, p=0.034), but they did not develop clinical features of systemic sclerosis at follow-up. Number of detected fingers with a scleroderma pattern was similar between cSLE, juvenile systemic sclerosis and juvenile undifferentiated connective tissue disease. CONCLUSION: This longitudinal study shows that the majority of capillary patterns in cSLE are abnormal and they can change over time. Irrespective of disease activity, a capillary scleroderma pattern in cSLE may be associated with higher risk of SLE-related disease damage

Radiotherapie bij patiënten met parkinsonisme en ernstige speekselvloed

Rationale: Drooling (sialorrhoea) in patients with parkinsonism causes physical and emotional problems, impairing the quality of life. Current therapies have several disadvantages. In literature is increased viscosity of saliva an inconvenient complication in several patients who received radiotherapy to mainly the parotid glands. Both from a theoretical (submandibular saliva is the main source of resting saliva) and clinical view (submandibular saliva is viscous, parotid saliva is watery), radiotherapy to submandibular glands instead of parotid glands may reduce this complication and may show to be more effective in treating drooling. Unfortunately, no placebo-controlled studies on the efficacy and safety of radiotherapy to the salivary glands for this humiliating problem in patients with parkinsonism are yet available in the literature. Objective: To study efficacy and safety of radiotherapy to major salivary glands as a treatment of sialorrhoea in patients with parkinsonism; thereby determining the optimal type of gland for treatment. Methods: A prospective, double-blind, randomised, placebo-controlled trial is performed; forty-five patients with parkinsonism suffering from severe sialorrhoea will be divided into three equally sized groups treated by, respectively, placebo- radiotherapy (1), radiotherapy to both parotid glands (2) and radiotherapy (3) to both submandibular glands. The severity of sialorrhoea will be evaluated at the baseline and 1, 3, 6 and 12 months post-treatment. The score on item 6 of the ADL-section of the Unified Parkinson’s Disease Rating scale (UPDRS) will be used as primary endpoint. The Clinical Global Impression scale (CGI), the Drooling Quotient (DQ) and measuring the salivary flow with Lashley-cups will serve as secondary endpoints, as well as a validated adverse event questionnaire. Results: Of the twelve included patients, two could be irradiated. Conclusions: Unfortunately due to external factors, there was not enough time to obtain some results after the irradiation. This trial can not yet confirm a significant improvement in sialorrhoea after radiotherapy or determine the optimal gland for treatment.

Behandeling van overmatige speekselvloed bij patiënten met parkinsonisme

Between 50% and 60% of patients with parkinsonism suffer from severe drooling (sialorrhoea). Sialorrhoea is a major social problem with medical risks as well, e.g. aspiration pneumonia. Sialorrhoea is not caused by increased production of saliva, but by impaired swallowing, leading to storage of saliva in the anterior part of the mouth. Sialorrhoea can be treated by anticholinergics, botulinum toxin injections, surgery and radiotherapy of the salivary glands. The optimal treatment of sialorrhoea needs to be determined individually, for which a decision tree is availabl