Academic Ceremonies December 2014

“Polyols and polyphenols against glucotoxicity”

This thesis shows that certain food substances can have therapeutic implications for patients suffering from diabetes. One of the substances we studied is erythritol, a naturally-occurring substance which is present in small amounts in some fruits as well as beer and wine. It is shown that erythritol protects blood vessel cells (the lining of our vascular system) and beta cells (cells which produce insulin) against harmful effects of glucose. The substances we studied often had several small effects which together produced a large positive effect on cells. This is beneficial in the management of chronic diseases, because a ‘gentle’ approach is preferable to a ‘harsh’ approach in which a blow is struck, as is often the case with drugs.

Key words:

diabetes, food substances, protective effect

“Inside out; On stereotype awareness, childhood trauma and stigma in psychosis”

This thesis examines the factors in a person’s environment that can play a role in psychotic disorders: stigmatisation and trauma. It looks at data from the GROUP study on the degree to which people are aware of negative, generalised convictions (stereotyping) about people with psychiatric disorders and their families. A higher degree of self-worth is associated with less awareness of stereotyping of people with psychoses. More childhood trauma is associated with more awareness of stereotyping. This thesis contributes towards our knowledge about what makes people vulnerable or non-vulnerable to stigmatisation and provides guidelines for training in clinical practice.

Key words:

stigmatisation, stereotyping, childhood trauma and psychosis

“Extended Psychosis Phenotype  in the wider Social Environment”

In this thesis, psychosis is considered in an extended phenotype including non-clinical experiences without distress or impairment, psychotic experiences with mild to moderate distress but without impairment and help seeking, and full-blown psychotic disorder. An unique methodology to psychometrically measure and to evaluate the whole spectrum is used. One in four individuals in the general population sample at least once experienced a delusional type of thinking or a hallucination. Due to psychotic experiences, a significant proportion of individuals displayed distress, impairment and help-seeking in various forms, and some of them became long-time service users. Risk factors such as cannabis use and familial liability led to disproportionate shift in the severity of the psychosis phenotype. Furthermore, associations between proxy genetic factors and the extended psychosis phenotype were moderated by contextual factors within wider social environment including neighbourhood-level social disadvantage and social capital.

Key words:

Psychosis, continuum, urban environment, social capital, social disadvantage

“Validity and diagnostic value of tests used in thediagnostic work up of haemostatic disorders!”

Medical decisions on diagnosis and treatment depend on laboratory, imaging and other tests, which must be accurate and precise to be of clinical value. Premature application may lead to wrong diagnosis, unnecessary delays in starting appropriate treatment, or even hazardous therapy. We identified major problems in precision and accuracy of tests used in the work-up of patients with a bleeding tendency and thromboembolic disorders. Our results call for concerted efforts to ensure appropriate evaluation studies. The needs we identified may promote a large number of studies, which may bring the development of medical tests further, and subsequently improve patient care.

Key words:

medical tests, evaluation studies, bleeding disor-ders, venous thromboembolism

“Rectal cancer imaging; How about the nodes?”

“Giving maltreated children a voice”

“Stepping Stone Cities?; exploring Urban Greening and Gardening as a Viable Contribution to Global Biodiversity Conservation”

Is the greening of cities a way to contribute to protecting global biodiversity? This question has been researched by looking at worldviews behind nature conservation strategies and organisations and by looking at the public support for urban greenery. Traditional conservation organisations should focus their sights more on the nature in and around cities. This could help increase residents’ practical knowledge of nature. There is a growing focus on collectively making cities greener, but private individuals are choosing more for stones than for biodiversity in their own gardens. There is a lot to be gained in this area. A focus on ‘new’ urban nature, however, can never compensate for the conservation of the ‘old’ wild nature.

Key words:

urban nature; biodiversity; gardening; conservation

“MOVING TEAMS FORWARD; Effects of feedback and team reflexivity on team performance”

Why do smart teams move backwards? Teams can be loaded with exceptionally smart professionals, but may get heavily frustrated because they failed to achieve their objectives or improve their performance. Coordination and reflection seem to explain why some teams move forward while others don't progress.  Prevention of downward spirals in performance is essential to help teams. This research shows that engaging in essential team behaviors such as sharing and building knowledge and reflecting on team functioning will drive them to success. Additionally, it demonstrates that teams can gain substantially when they are provided with accurate and timely feedback and opportunities for guided reflection on why things went right or wrong.

Key words:

team performance, team learning behavior, feedback

“OCD matters in psychosis”

Obsessive-compulsive disorder (OCD) and psychosis co-occur far more often than expected, but the causes and consequences of this remain unclear. This research shows that even before the emergence of a diagnosable disorder, mild features of OCD and psychosis co-occur. This heightens the risk that the severity of the psychotic symptoms – and hence also the care needs – will increase. In addition, the results point to a shared familial vulnerability: brothers and sisters of patients with psychotic disorders also have more obsessive-compulsive symptoms. In practice, people with combined obsessive-compulsive and psychotic symptoms should therefore be monitored particularly closely.

Key words:

early detection, obsessive-compulsive disorder, psychosis, schizophrenia, psychiatry, care needs

“Designing for Success: Investigating Design as a Driver for Innovation”

The success of companies such as Apple or Alessi has pointed to a positive association between companies’ foci on product design and their overall innovation performance. Therefore, the past decade has seen an increased interest among company managers in deciphering the DNA of such design-oriented companies, in order to extract their design related processes, principles and tools, and apply them to various innovation contexts. This thesis frames the overall impact of design and examines its drivers and innovation outcomes on a corporate and on a project level. The results demonstrate that the economic benefits of design efforts can only partially be traced back to tangible outputs; instead a substantial proportion of its success can be ascribed to the managerial, processes technical and cultural aspects of design transcending companies and guiding innovation projects.

Key words:

innovation management, design thinking, design-driven innovation, design orientation 

“Toxicogenomics responses in the in vitro liver; A view on human interindividual variation”

Toxicity for humans often is falsely predicted based on animal tests, possibly amongst others due to human interindividual variation. Human-based alternative screening methods are scarce. The liver, a primary site for toxicity, is a candidate for a human-based alternative model for safety screening. The aim of this study is to evaluate human interindividual variation in several liver-based in vitro cell models. The results show that these models indeed can be used to evaluate interindividual variation, especially when several research techniques are combined. Possibly these models can be used to relieve the burden on animal-testing in the future.

Key words:

Liver, toxicity, interindividual variation, alternatives to animal tests

“THE MULTIDISCIPLINARY TEAM GENODERMATOSIS: a simple strategy to solve  complex cases”

“Carotid baroreflex activation therapy. Potential mechanisms in resistant hypertension”

High blood pressure is a common health problem. Despite the many drugs available to treat it, the blood pressure of roughly 50% of patients remains too high. This not only has serious consequences for patients (such as heart attacks and strokes), but also places a heavy burden on the healthcare system. This thesis investigates a new, pacemaker-like device that stimulates blood pressure sensors in the neck. These sensors lower blood pressure via complex signals to the brain. This treatment has a safe and lasting effect on blood pressure, without exhausting the blood pressure sensors or damaging the kidneys. While further research is needed to fully clarify the underlying mechanisms, the thesis identifies a number of hormones and proteins that could play a role in this process.

Key words:

high blood pressure, pacemaker, mechanisms

“Optimism. The natural placebo. Cognitive, behavioural and motivational mechanisms of resilience towards pain”

Optimism leads to less pain! That is the main conclusion of this thesis in which the causal relationship between optimism and pain is demonstrated experimentally for the first time. The research confirms that positive future expectations are associated with fewer negative thoughts about the significance/impact of pain and with greater flexibility in dealing with life goals. In this way, a positive view of the future leads to a better wellbeing in the now. This knowledge contributes to protecting people from the negative effects of chronic pain. This is especially important because chronic pain does not always have a medical solution.

Key words:

optimism, chronic pain, positive psychology

“NOXious oxidative stress: from head to toe and back”

In many cardiovascular diseases, reactive oxygen species cause irreparable organ damage. Inhibition of NOX, an important source of such oxygen species, could be a possible treatment method. This thesis shows that certain forms of NOX play a key role after a stroke has occurred in mouse models. The inhibition of NOX4 results in less brain damage, whereas the activation of NOX5 causes more damage (the latter only goes for female mice). Furthermore, elevation of the blood pressure was observed as a result of NOX5 activation.
The effects found in this study are shown to be exclusively related to brain disease, as no effects were found in models of myocardial infarction or peripheral vascular disease.

Key words:

cardiovascular diseases, oxygen species, NOX, stroke

“In vitro assay systems in the development of therapeutic interventions strategies for neuroprotection and repair”

“Health Benefits of Epicatechin and other flavonoids”

Flavonoids are substances found in various food products. This study focusses on flavonols, a subgroup of the flavonoid family. Tea and cacao contain relatively high concentrations of one of these flavonols, epicatechin. The antioxidant and anti-inflammatory effects of epicatechin can have important implications for chronic inflammatory diseases such as rheumatoid arthritis, chronic enteritis, asthma and COPD. Our study results also show that flavonols have a positive effect on vascular health. During an eight-week period of flavonol intake from grape seeds vascular function in test subjects improved and blood markers of oxidative stress and inflammation were reduced. In addition, our findings suggest that epicachetin and other flavonoids counteract the effects of anti-inflammatory drugs. Therefore, it is conceivable that both will be prescribed simultaneously in the future.

Key words:

flavonols, epicatechin, anti-inflammatory

“Preterm birth after antenatal inflammation as underlying cause of bronchial hyperreactivity”

Preterm birth is often caused by an intrauterine infection (chorioamnionitis). As these children grow older, they more frequently develop bronchial hyperreactivity (asthmatic symptom). This thesis gives insight into how lung development and airway function were influenced by antenatal inflammation as gestation advances and during the first period after birth. For this a sheep model was used. This thesis has identified a potential link between activation of the prenatal immune status and impaired lung development, resulting in altered airway reactivity postnatal. This should provide a basis for future research towards the understanding and treating of asthma in early childhood after preterm birth.

Key words:

preterm birth, lung development, antenatal inflammation, asthma

“International Aspects of the CCCTB in Europe”

On 16 March 2011, the European Commission proposed a Council Directive on a common consolidated corporate tax base (CCCTB). The purpose of this research was to analyse specific international aspects of the CCCTB, which in the opinion of Tiiu Albin Pereira, form the necessary basis for the possible introduction of a common European corporate tax system. While the author believes that the CCCTB can function well in parallel to the current international framework of corporate tax systems, as follows from the research, some of the provisions of the proposed CCCTB Directive as well the policy behind them should be carefully reconsidered. In addition, the current research highlights the likely conflicts arising from the potential introduction of the CCCTB among a number of Member States in the future and proposes solutions.

Key words:

Corporate tax; EU tax harmonization

“Diabetes care and the introduction of a new standard in the Netherlands; A closer look from the perspectives of health care professionals and patients”

This thesis shows that the introduction of the Care Standard for diabetes (supported by the National Diabetes Action Programme) has made a positive contribution to the improvement of care given to patients suffering from diabetes in the Netherlands. The National Diabetes Action Programme has resulted in the implementation of the Care Standard for diabetes into the Dutch health care. Studies on patients suffering from diabetes show that support of autonomy and strategies designed to improve perceived patient competencies are important factors in future interventions aimed at the improvement of self-management and quality of life. In the future, an integrated multidisciplinary patient-focused approach to chronic diseases is needed.

Key words:

diabetes, implementation care standard, autonomy support

“Uitkeringen aan aandeelhouders in het nieuwe BV-recht; besluitvorming, vertegenwoordiging en vereenzelving”

“Gout, uric acid, and cardiovascular disease; know your enemy”

“Interaction of dietary protein with energy balance”

This thesis studied the effects high-protein and low-protein diets have on food intake and energy consumption. In the laboratory restaurant, test subjects had daily low-protein, normal-protein or high-protein meals, each taken for twelve days. They spontaneously ate less during high-protein meals than during low-protein and normal-protein meals. In a study which was carried out later, this satiating effect of proteins was reduced in test subjects who had high-protein or low-protein meals for twelve weeks while having to maintain their weight. The energy consumption was maintained in test subjects having high-protein meals, whereas it was reduced in test subjects having low-protein meals. Therefore, it was concluded that a high-protein diet may prevent weight gain due to its impact on satiation and food intake as well as energy consumption.

Key words:

diet, proteins, intake, energy consumption

“A cutting Culture: gender and identification in the figured world of surgery”

“The Role of Mood, Habitual Goals and Primed Goals in Painful and Non-Painful Task Persistence”

“Molecular studies of FLCN-related diseases”

Birt-Hogg-Dubé syndrome (BHD) is a rare genetic disorder in which patients are at an increased risk of developing benign facial tumours, pneumothorax and cancer of the kidneys. Understanding of the pathogenic mechanisms underlying these symptoms is necessary for improving treatment options as they also occur in the general population. This thesis examined the function of folliculin (FLCN), the protein which is damaged in BHD patients, and its interacting partner folliculin-interacting protein 1 (FNIP1). It was shown that both proteins are found in cilia, a sort of cellular antennae, and BHD symptoms are caused by a disruption of these structures. Furthermore, it was shown that both proteins play an important role in the development of the zebrafish embryo. These laboratory animal models may be used to screen drugs against BHD.

Key words:

Birt-Hogg-Dubé syndrome, cancer of the kidneys, cilia, zebrafish

“Epidural analgesia during labour: choices and consequences”

Given the fact that an increasing number of women are requesting an epidural when giving birth, it is important to examine the adverse effects associated with this. A quadrupling in the use of epidurals (on request) in the Netherlands over the last ten years has not resulted in a greater number of assisted deliveries (caesarean section or forceps delivery/vacuum-extractor assisted delivery). The probability of needing an assisted delivery is not affected by the degree of cervical dilation at the time of giving the epidural. The effect of a standard or routine epidural on the birth has never before been examined. Our study shows that routinely giving epidural results in a greater number of side effects such as low blood pressure, limited leg movement and indeed more assisted deliveries, and is therefore not recommended. 

Key words:

epidural, birth, complications

“Visual field progression in patients with open-angle glaucoma”

Open-angle glaucoma is a lifelong, chronic eye disease causing deterioration of the field of vision. This thesis shows that in 15% of patients, this condition results in severe visual impairment by the end of the patient’s life. Specific patient characteristics can help determine which patients require ophthalmological treatment to reduce eye pressure. This thesis shows how these can be used to predict future deterioration of the field of vision. It has also been shown that many different methods with varying results exist to measure visual deterioration. A guideline is provided for deciding which method to use.

Key words:

eye disease, glaucoma, eye pressure, therapy

“Over gewichtige zaken”

“The danger of Innocence; common sense beliefs and misconceptions about false confessions”

In the last decade, overturned wrongful convictions have shown that false confessions are not a rare phenomenon.  Admitting to a crime one has not committed is seen as counter-intuitive by many people and studies have shown that the average person is not well informed about the possibility (and risk) of a false confession. The present dissertation demonstrates that misbeliefs and misconceptions about false confessions are a threat to innocent suspects and that there is a demand for changes in the process of police custody to make interrogations a safer place.

Key words:

false confessions, misbeliefs, misconceptions, wrongful convictions

“De stilte en de storm; 4 en 5 mei sinds 1945”

For almost 70 years, the Netherlands has remembered the end of the Second World and its victims War on 4 and 5 May. Despite the ideal of solidarity and unanimity that characterises these days, they often also include discussions and conflicts. What do we commemorate on 4 and 5 May and how do we do that? This historical study is about the ever-recurring discussions regarding the form content of these memorial days since 1945. It shows that 4 and 5 May have no intrinsic meaning. To this day, every generation has had to rediscover or reinterpret the significance of 4 and 5 May.

Key words:

Second World War, commemoration

“Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: Optimization of Technique, Perioperative Measures, and Outcome”

“On Inner Warfare, the Host and the Adversary: Public Health Genomics of Chlamydia trachomatis and Human papillomavirus”

“Public Health genomics of infectious diseases – Insights gained from Chlamydia trachomatis infertility diagnostics”

“Molecular signatures and prognosis of HPV-positive head and neck lesions”

The increase in tonsil cancer in the US and Europe is attributed to infection with the human papilloma virus (HPV), especially HPV type 16. This thesis shows that roughly 35% to 40% of tonsil cancers are HPV positive, and that a specific protein, p16INK4A, is a good surrogate marker for the presence of HPV16. Previous research has revealed clinical differences between this and other tumour types; the present results show that at molecular level, too, these tumours should be considered a separate entity. HPV-positive tumours display fewer genetic abnormalities and a different expression of several key proteins involved in the regulation of cell division and cell death. Further, patients with HPV-positive tonsil cancer have better prognoses, with the exception of patients with HPV-positive tumours with genetic instability and over-expression of the protein EGFR. At present there is debate as to whether patients with HPV-positive tumours should be treated differently – in particular, less intensively – than patients with HPV-negative tumours. This thesis shows that caution is indeed advisable.

Key words:

tonsil cancer, human papilloma virus, prognosis

“SELF-MONITORING OF PHYSICAL FRAILTY: A proactive approach in community-dwelling elderly people”

Independent and healthy aging is important for many people. Preventing a decline in physical functioning can make a positive contribution to this. With this thesis, a monitoring and feedback system has been developed and evaluated, along with the elderly and care professionals, in which the elderly themselves can monitor changes in their physical functioning. The system consists of a scale that measures weight and balance, a grip ball that measures grip strength, and a mobile phone that can measure activity. Through a user-friendly application on the mobile phone, the system gives the elderly instant feedback when a decline is indicated. Steps can then be taken to prevent further deterioration or other negative health outcomes (such as falls, mobility problems or reduced autonomy).

Key words:

elderly; eHealth; self-management; physical vulnerability

“Towards a new, dynamic concept of health”

The WHO’s definition of health as a condition of ‘complete well-being’ is no longer sufficient for modern times. Therefore, Maggie Huber, together with ZonMw and the Dutch Health Council, developed a new definition of health as ‘the ability to adapt to and be able to independently manage the physical, emotional and social challenges of life’. Stakeholders such as patients, clinicians and policymakers provided feedback, and it seems that patients define health in very broad terms; social participation for them is just as important as physical symptoms. Based on this, Huber introduced the concept of ‘positive health’, charted along six key dimensions, including the spiritual/existential dimension and quality of life. The Dutch Community Health Services (GGD) is going to work with ‘positive health’, for instance, with measurement instruments and practical advice.

Key words:

WHO, health, new definition, nutrition research

“Collaboration in innovation: studies on the impact of collaborative innovation on firm performance”

“Islamic divorces in Europe; bridging the gap between European and Islamic legal orders”

This thesis addresses the issue of the recognition of Islamic divorces in European states.
Repudiation-based divorces are particularly notorious for their presumed violation of
fundamental rights of women and are consequently often not recognized. The resulting limping of legal relationships affects other fundamental rights of the persons involved, such as the right to marry and the right of free movement. For this reason, the author scrutinizes classical Islamic divorce law and the contemporary divorce laws and practices of Egypt, Iran, Morocco and Pakistan, as well as the Dutch, English and French recognition policies and relevant EU (case) law. By introducing various soft and hard law solutions, it provides legal practitioners with the information and tools to tackle major shortcomings in the recognition of Islamic divorces. This thesis is therefore a must-read for legal practitioners such as registrars, notaries and members of the judiciary, as well as academics.

Key words:

divorce, Islamic Law, (European) International Civil Law, European Law 

“The Impact of Brands on Innovation and Firm Performance - Empirical Evidence from Germany”

“Clinical and echocardiographic parameters to characterize atrial fibrillation”

Atrial fibrillation is the most common cardiac arrhythmia in the world. This type of arrhythmia can have serious consequences such as heart failure or cerebral infarction. This thesis describes new cardiac echo measurements which enable us to predict more accurately which patient will develop atrial fibrillation in the future, allowing early treatment to be started. If atrial fibrillation is already present, these measurements can indicate the stage of the arrhythmia and the chance of a certain treatment option being successful. Furthermore, an easy-to-use score has been developed which enables us to calculate the risk of worsening atrial fibrillation by using patients characteristics. 

Key words:

atrial fibrillation, echo measurements, predictions

“Electro-responsive hydrogels for vascular tissue engineering”

“Satellite cells in skeletal muscle atrophy and hypertrophy”

Ageing is accompanied by loss of muscle mass and muscle strength. This results in limitations in daily life, less independence and reduced quality of life. Muscle stem cells (also called satellite cells) are essential for muscle tissue growth and maintenance. This thesis shows that a reduction in the number of satellite cells and/or their function may play an important role in the loss of muscle mass associated with ageing. Long-term strength training helps increase muscle mass/muscle strength and is associated with an increase in the number of satellite cells. Strength training should be an important part of intervention programmes to prevent loss of muscle mass with ageing. 

Key words:

ageing, muscle mass, muscle strength, satellite cells

“Meat consumption and cancer risk; an epidemio-logical analysis from multiple perspectives”

Research shows that a high consumption of meat may increase the risk of certain types of cancer. To get as complete of a picture of this relationship as possible, this research looked at the effect of a vegetarian lifestyle on the development of cancer as well as at the mechanisms through which the consumption of meat possibly affects the risk of cancer. This dissertation shows that the complete exclusion of meat in our diet does not lower the risk of cancer. However, it also shows that it is important to make an informed choice regarding the type of meat consumed. For instance, heme iron, the substance that turns meat red, has been associated in our study with the development of colon cancer.

Key words:

meat consumption, cancer

“Cardiovascular drugs and the risk of systemic autoimmune diseases: Pharmacoepidemiological and experimental approaches”

“Managing anticoagulant therapies using innovative thrombin generation assays”

Thrombosis (undesired coagulation) can be treated with different types of anticoagulants. This thesis examines the effect anticoagulants have on the thrombin generation test, which registers the formation of thrombin. This enzyme is one of the key factors in the coagulation process. The more thrombin is formed, the higher risk of thrombosis; the less thrombin is formed, the higher risk of bleeding. One of the findings of this thesis shows that the whole-blood test has a predictive value for bleeding in patients taking oral anticoagulants. The results indicate that the thrombin generation test can be used to study anticoagulants and that more information is gained from this test compared to conventional tests.

Key words:

thrombosis, thrombin generation, anticoagulants 

“INNOVATIVE OPTICAL TECHNIQUES FOR INTRAOPERATIVE ANATOMICAL GUIDANCE; Surgical navigation beyond the limits of the human eye”

Innovative optical techniques can improve the intraoperative identification and characterisation of vital anatomical structures, such as nerves, ureters, arteries and bile ducts. This is crucial in all sorts of surgical procedures, as misidentification of these structures can lead to iatrogenic injury. This thesis focuses on two optical techniques: near-infrared fluorescence imaging using exogenic contrast for the identification of bile ducts, arteries and ureters; and diffuse reflection spectroscopy using endogenic contrast for the identification of new spectral contrasts of ureter, artery, parathyroid and nerve tissues that are invisible to the eye. While both techniques are subject to limitations, they have the potential to improve surgical care through better anatomical recognition. In addition, the newly discovered endogenic spectroscopic tissue contrasts provide insight into the development of a new generation of surgical cameras.

Key words:

surgery, optical techniques, navigation, anatomy, iatrogenic injury, safety

“Punitive Damages; The Civil Remedy in American Law, Lessons and Caveats for Continental Europe”

This thesis considers whether the civil law sanction of punitive damages has a future in continental Europe. To date, this form of civil damages has only been recognised in legal systems in the common law tradition, such as the USA, England, Wales, Australia and New Zealand. In these countries, the defendant in a civil procedure can face punitive damages in addition to compensatory damages. The functions of this private law penalty go beyond mere punishment and prevention; they also include protecting the public interest, facilitating private vindication and compensating costs borne by the plaintiff, such as legal fees. In recent years there seems to have been a change of direction in the European debate, with widespread reluctance increasingly giving way to new, less negative views on punitive damages. This thesis aims to contribute to this debate by enhancing insight into the operation, scope and significance of punitive damages.

Key words:

civil law, compensatory damages, punitive damages

“Sociale epidemiologie: schipperen tussen upstream en downstream”

“Pakistani Marriages and the Private International Laws of Germany and England”

The last decades, migrants entering Europe, brought their language, their culture and habits, but also their legal traditions with them. 
This thesis explores Pakistan, a country whose legal system raises many questions with respect to international family law matters, in particular in relation to marriages celebrated in Pakistan. 
The past and future migration of Pakistanis to Germany and England has inspired the interest in the topic of this thesis and the ambition to undertake an analysis of how the private international law of England and Germany deals with marriages celebrated in Pakistan. Next to its theoretical and scientific contribution, this thesis provides an essential resource of information for professionals that deal with Pakistani marriages, like barristers, civil servants and the judiciary. 

Key words:

Pakistan, marriage, international law

“The relationship between avoidable hospitalisation and primary care”

The aim of this study was to analyse the role of Primary Care (PC) in preventing hospital admissions for some types of conditions and the factors influencing the relationship between Avoidable Hospitalisation (AH) and Primary Care. The factors we found to play a role in the relationship between AH and PC were: the epidemiology of the conditions, the propensity to seek hospital care and the socioeconomic status of patients. Such factors were already known in the scientific literature, we also found that the organisational aspects of Primary Care have a crucial role. This study also permitted the estimation of the cost of avoidable admissions. When one considers the cost of these avoidable admissions, there is a clear need to better understand the factors that predict hospitalisation, especially in individuals with chronic disease. 

Key words:

Primary Care, hospital admissions

“Add-on ablation surgery in patients with atrial fibrillation; Drivers for Intervention”

Atrial fibrillation (AF) is the most commonly occurring cardiac arrhythmia in the Western world. Some patients who undergo open heart surgery have AF, and an additional procedure can be performed during surgery to relieve the AF. This thesis describes the effect of the additional surgical ‘microwave’ ablation technique on the various reasons or ‘drivers’ for treating AF. The study examined the influence of this additional surgical procedure on recovering normal cardiac rhythm following surgery, on the quality of life, cost-effectiveness, electrical cardioversions in cases of recurrent AF, and on the prescription of anticoagulant drugs. The treatment was shown to have no significant positive influence on any of these aspects. The new hybrid procedure, in which the electrophysiologist and the cardiac surgeon work in close collaboration, appears highly promising with regard to the future treatment of AF.

Key words:

atrial fibrillation, cardiac surgery

“Mechanisms and Imaging of myocardial injury and repair”