Background The caesarean delivery (CD) rate has risen in most countries over the last decades, but it remains relatively low in the Netherlands. Our objective was to analyse the trends of CD rates in various subgroups of women between 2000 and 2010, and identify the practice pattern that is attributable to the relative stability of the Dutch CD rate. Methods A total of 1,935,959 women from the nationwide Perinatal Registry of the Netherlands were included. Women were categorized into ten groups based on the modified CD classification scheme. Trends of CD rates in each group were described. Results The overall CD rate increased slightly from 14.0% in 2000–2001 to 16.7% in 2010. Fetal, early and late neonatal mortality rates decreased by 40–50% from 0.53%, 0.21%, 0.04% in 2000–2001 to 0.29%, 0.12%, 0.02% in 2010, respectively. During this period, the prevalence of non-vertex presentation decreased from 6.7% to 5.3%, even though the CD rate in this group was high. The nulliparous women with spontaneous onset of labor at term and a singleton child in vertex presentation had a CD rate of 9.9%, and 64.7% of multiparouswomen with at least one previous uterine scar and a singleton child in vertex presentation had a trial of labor and the success rate of vaginal delivery was 45.9%. Conclusions The Dutch experience indicates that external cephalic version for breech presentation, keeping the CD rate low in nulliparous women and encouraging a trial of labor in multiparous women with a previous scar, could help to keep the overall CD rate steady
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De cd-rom HRM biedt een compleet en actueel overzicht van het totale HRM-gebied. Het bevat een unieke verzameling informatie over personeelsmanagement en sociaal beleid. Deze cd-rom geeft richtlijnen, maatregelen en handige tips op het gebied van personeelsmanagement. Het is samen met het zakboek de vraagbaak bij HRM-vraagstukken
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Deze cd-rom is ontwikkeld onder supervisie van het Transferpunt Vaardigheidsonderwijs. Het bevat een serie oefeningen rond toonhoogte in het algemeen, en toonhoogte van de menselijke stem in het bijzonder. Ze kunnen zonder of met een minimum aan begeleiding worden uitgevoerd. Het programma is in de eerste plaats bedoeld voor logopedisten in opleiding. In logopedisch onderzoek en therapie zit een aantal onderdelen dat een toonhoogte-aspect heeft. Studenten kunnen in het eerste, algemene deel, hun basiskennis t.a.v. toonhoogte op het vereiste niveau brengen. Het tweede deel van het programma is specifieker gericht op stemonderzoek en stemtherapie. Studenten oefenen zich in specifieke onderdelen t.a.v. de menselijke stem. Verschillende onderdelen zijn ook bruikbaar voor andere disciplines. Zo zou het onderdeel `toonhoogte algemeen in het muziekonderwijs gebruikt kunnen worden.
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Het Protocol Hoger Onderwijs is een inhoudelijke handreiking voor HO-instellingen (HBO en WO) om de begeleiding van dyslectische studenten te optimaliseren. Dit Protocol is ontwikkeld in het kader van het door OCW geïnitieerde Impulsproject 2004 onder regie van Handicap + Studie. De ontwikkelaars van dit protocol hebben dankbaar gebruik gemaakt van de praktijkgerichte suggesties van studenten en docenten van Fontys Hogescholen. Primaire doelgroep: studenten, docenten en studieloopbaanbegeleiders van HO-instellingen. Verder: beleidsmakers op instellingsniveau en tweedelijns begeleiders (studentendecanen, studentenpsychologen), raden van bestuur, professionaliseringscoördinatoren, medezeggenschapsraden en studentenfracties. Bij het boek is een dvd ontwikkeld waarin studenten en docenten aan het woord zijn over het omgaan met de belemmeringen die de functiebeperking met zich meebrengt. Op de bijgeleverde cd-rom zijn documenten voorhanden die ingezet kunnen worden bij de begeleiding van dyslectische studenten.
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BACKGROUND: Cervical dystonia (CD) is characterized by involuntary muscle contractions causing abnormal postures and/or twisting movements of the head and neck. These motor symptoms can have a major impact on disability. Treatment with botulinum toxin injections aims to reduce motor symptoms, and therefore disability. Despite motor improvements, many patients still experience difficulties with performing daily life activities. To optimize treatment, other factors that determine disability should be identified.OBJECTIVE: To explore and identify clinical characteristics that relate to disability in CD.METHODS: Data on disability, severity of dystonia, anxiety, depression, pain and quality of life of 96 CD patients was analyzed with a principal component analysis (PCA). Multiple regression analysis was performed to determine which components derived from the PCA explain most of the variance in disability.RESULTS: PCA revealed five components (disability, psychiatric features, pain, physical function and severity of dystonia), explaining 74.4% of the variance in disability. Multivariate association between disability and the other components was statistically significant (R(2) change 0.433, F change (4-86) = 22.39, p = .000). Psychiatric features had the largest contribution to disability (standardized beta = 0.555, p = 0.000) followed by pain (standardized beta = 0.232 p = 0.004). Physical functioning (standardized beta = 0.059 p = 0.507) and severity of dystonia (standardized beta = -0.001 p = 0.991) had no significant contribution.CONCLUSIONS: In CD patients, psychiatric features and pain are important determinants of disability. Interventions to reduce psychiatric problems and pain should have a more prominent role in the treatment of CD patients in order to improve disability levels.
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Objective: To explore driving performance and driving safety in patients with cervical dystonia (CD) on a simulated lane tracking, intersections and highway ride and to compare it to healthy controls. Design: This study was performed as an explorative between groups comparison. Participants: Ten CD patients with idiopathic CD, 30 years or older, stable on botulinum toxin treatment for over a year, holding a valid driver's license and being an active driver were compared with 10 healthy controls, matched for age and gender. Main outcome measures: Driving performance and safety, measured by various outcomes from the simulator, such as the standard deviation of the lateral position on the road, rule violations, percentage of line crossings, gap distance, and number of collisions. Fatigue and driving effort were measured with the Borg CR-10 scale and self-perceived fitness to drive was assessed with Fitness to Drive Screening. Results: Except for a higher percentage of line crossings on the right side of the road by controls (median percentage 2.30, range 0.00-37.00 vs. 0.00, range 0.00-9.20, p = 0.043), no differences were found in driving performance and driving safety during the simulator rides. Fatigue levels were significantly higher in CD patients just before (p = 0.005) and after (p = 0.033) the lane tracking ride (patients median fatigue levels before 1.5 (range 0.00-6.00) and after 1.5 (range 0.00-7.00) vs. controls median fatigue levels before and after 0.00 (no range). No significant differences were found on self-perceived fitness to drive. Conclusion: In patients with CD there were no indications that driving performance or driving safety were significant different from healthy controls in a simulator. Patients reported higher levels of fatigue both before and after driving compared to controls in accordance with the non-motor symptoms known in CD.
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Cervical dystonia (CD) is a movement disorder which affects daily living of many patients. In clinical practice, several unmet treatment needs remain open. This article focuses on the four main aspects of treatment. We describe existing and emerging treatment approaches for CD, including botulinum toxin injections, surgical therapy, management of non-motor symptoms, and rehabilitation strategies. The unsolved issues regarding each of these treatments are identified and discussed, and possible future approaches and research lines are proposed.
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interne publicatie; CD-ROM Professional in Beeld, aanbod aan scholenveld
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Cervical dystonia (CD) is a neurological movement disorder characterized by involuntary muscle contractions causing abnormal postures and/or twisting movements of the head and neck.Patients may also experience non-motor symptoms including pain, anxiety and depression. The main treatment option is botulinum toxin (BoNT) injections in affected muscles to improve head postures and reduce pain. In addition to BoNT treatment, patients are often referred for physical therapy (PT), but there is little evidence regarding the long-term effectiveness.Despite remarkable improvements during the last decades, there are still many unmet needs that remain open in the treatment of cervical dystonia (CD). The first goal of this thesis was to assess clinical issues in BoNT treatment that need further improvement and to define clinical recommendations for clinicians. The second goal was to explore which determinants play an important role in disability of CD patients and the third goal was to develop a specialized PT program and to evaluate its effects on disability.Results showed that BoNT treatment can be further improved despite all the evidence for its effectiveness. Further research is needed towards optimal treatment intervals, dose equivalence between different BoNT formulations, the use of supportive techniques like electromyography or ultrasound and managing side effects. Secondly, we found that psychological factors are important determinants of disability. Finally, we found that PT is a valuable addition to BoNT treatment to improve disability and pain. Based on these findings, a multidisciplinary treatment approach to further improve the treatment and quality of life for CD patients is recommended.
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Onderwijs van eigen makelij bestaat uit twee delen: een procesboek en een cd-rom. Beide gaan over de concrete uitvoering en begeleiding van actieonderzoek. Actieonderzoek is een benadering, waarmee docenten (c.q. schoolleiders leerlingbegeleider, mentoren, docenten-in-opleiding, et cetera) zich kunnen professionaliseren. In het procesboek wordt door de auteur uitvoerig aandacht besteed aan de werkwijze bij actieonderzoek, de achtergronden van actieonderzoek en de begeleiding van docenten die actieonderzoek uitvoeren. Bovendien bevat het boek tal van concrete hulpmiddelen die bij de uitvoering en de begeleiding gebruikt kunnen worden. Op de cd-rom zijn artikelen opgenomen met voorbeelden van actieonderzoek in scholen en opleidingen. Docenten schrijven over de concrete vormgeving en opbrengsten van hun eigen actieonderzoek. Opleiders geven een beeld van hun ervaringen met de begeleiding van actieonderzoek. Voorts bevat de cd-rom informatie over nationale en internationale ervaringen met actieonderzoek in initikle en postinitikle lerarenopleidingen, c.q. nascholing.
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