Academic Ceremonies May 2015

“From home towards the nursing home in dementia; informal caregivers’ perspectives on why admission happens and what they need”

This dissertation explored reasons for admitting people suffering from dementia to nursing homes from the perspective of caregivers. It also studied the needs perceived by caregivers during this process. Caregivers cite reasons for admission predominantly related to the person suffering from dementia including aggression, wandering, an increased need for help and a deterioration in cognitive function. Reasons related to caregivers themselves are cited as well, although to a far lesser extent. Based on the results, it is recommended that healthcare professionals offer caregivers the support they need during the transition process their relatives go through. This means that caregivers should be eligible for receiving care or support after the admission as well. In addition, it is argued that healthcare professionals should listen carefully to caregivers’ opinions rather than decide what they need without asking them first.

Key words:

dementia, volunteer aid, admission

“Elusive citizenship”

“Making sense of environmental responsibility; Investigating environmental stewardship among retail employees and consumers”

It is not easy to encourage environmentally-friendly behaviour. This is largely due to the personal disadvantages in the short term outweighing the collective advantages in the long term. Creating a strong sense of environmental responsibility can help to encourage environmentally-friendly behaviour, otherwise known as environmental stewardship. This dissertation found that branch managers play a key role in creating environmental stewardship among retailers and explains how this leads to environmentally-friendly sales. It is also possible to encourage environmental stewardship among consumers by stressing an affinity with future generations and by drawing attention to the individual influence they have on the environment.
 

Key words:

environmentally-friendly behaviour, environmental stewardship, responsibility, consumer behaviour, retail

“Risks and Benefits of Regional Anesthesia in the Perioperative Setting”

This dissertation studied various risks and benefits of regional anaesthesia in the perioperative setting. In the Netherlands, the number of operations has increased from 1.1 to 1.4 million a year over the last decade. Therefore, the evaluation of optimal perioperative care including anaesthesia is highly important. Although large studies are needed to show anaesthesia safety, recommendations for practice are often based on small studies. Comparing regional with general anaesthesia is a limited approach which underestimates the potential benefits of combined techniques in high-risk populations. Another aspect is the development of improved postoperative pain management programmes for specific operations. Catheter functioning, for instance, can be affected by material characteristics. Until recently, no systematic studies were needed to obtain a European hallmark (CE hallmark) but the results of this study show the need for these types of studies.

Key words:

anaesthesia, regional anaesthesia

“Credit in the economy: small business default correlation and firms co-movements”

Small businesses play a crucial part in every developed economy. They employ about 50% of the workforce and are the engine of innovation. For this reason policy makers and regulators support financing small businesses’ operations to allow them to grow and show its potential. Through a series of studies about small business credit risk, we show that small business credit risk is predominantly related to firm characteristics rather than to economy or industry wide conditions. We find evidence that distress in a customer industry is linked to higher credit risk among the small business suppliers and that trade credit is an important channel transmitting distress from one firm to another.

Key words:

small businesses, credit risk

“Microvascular dysfunction and diabetes: a vicious cycle?”

“Robotics-assisted treadmill exercise for cardiovascular rehabilitation early after stroke”

“Selective stimulation of the subthalamic nucleus in Parkinson’s disease; dream or near future”

Patients suffering from advanced Parkinson’s disease are treated with deep brain stimulation of the subthalamic nucleus. In addition to favourable effects on movement some patients experience behavioural side effects. The aim of this doctoral research was to attempt to stimulate only the part of the subthalamic nucleus responsible for motor functions. Although the study showed that the motor area could not be strictly divided from non-motor areas, rapid technological progress will allow deep brain stimulation to be further sophisticated, which will lead to a better treatment for patients.

Key words:

Parkinson’s disease, deep brain stimulation

“Preeclampsia is more than a vascular disease”

“Bundle Branch Block and Benefit from Cardiac Resynchronization Therapy”

Heart failure is a common chronic disease caused by reduced pump function. Treatment is expensive and the mortality rate is high, particularly in women. One cause is the nonsynchronous contraction of the heart muscle. This can be corrected with cardiac resynchronisation therapy (CRT) via a pacemaker. This study found that, compared to men, women had a lower threshold criterion for CRT; benefited more from CRT, including fewer symptoms and a lower mortality rate; were offered CRT less frequently than men; and were underrepresented in clinical trials with no mention of gender-specific outcomes.

Key words:

women, cardiology, heart failure, cardiac resynchronisation therapy, death

“Critically III Older Patients Treated in Intensive Care Units: Long-Term Consequences”

This thesis examined the long-term consequences of treatment in an Intensive Care Unit (ICU) on older patients’ quality of life, healthcare resource utilization, and presence of the distressing symptoms of pain, anxiety and agitation. Study findings reveal that up to one year after the ICU stay, older patients report a good quality of life and do not experience increased long-term pain, anxiety or agitation as compared to a sample of age-matched participants. The study concludes that with sufficient healthcare resources for support, such as frequent contact with their general practitioner, easily accessible rehabilitation programs and home healthcare services, older patients  can recover to a level where they can live relatively independently at home and do not require cost-intensive institutionalization. This information justifies treatment of older patients in ICUs, and to plan for the provision of sufficient resources to support older patients living at home.

Key words:

intensive care treatment, older patients, long-term consequences

“Vascular dysfunction: at the heart of cardiovascular disease, cognitive impairment and depressive symptoms”

This dissertation focussed on the damaging effects of deterioration of vascular function on the body. It is shown that deterioration of function of large blood vessels (due to vascular stiffening), small blood vessels (microvascular dysfunction) and the lining of blood vessels (endothelial dysfunction) not only plays an important role in the development of cardiovascular disease, but also in the development of dementia and depression. Vascular dysfunction is therefore an important new lead for preventing and treating cardiovascular disease, dementia and depression. Various studies were used, including the Maastricht Study, the Hoorn Study, the AGES-Reykjavik Study and the Rotterdam Study.

Key words:

blood vessels, vascular dysfunction, cardiovascular disease, dementia, depression

“Methylglyoxal, the glyoxalase pathway and advanced glycation endproducts in type 2 diabetes and cardiovasculair disease”

People suffering from type 2 diabetes are more likely to develop arteriosclerosis and are at sharply increased risk of developing cardiovascular disease. A possible explanation is that in people suffering from diabetes a higher number of sugared proteins (advanced glycation endproducts) accumulate in vascular calcifications, a process with damaging effects. This dissertation describes the relation between higher blood levels of sugared proteins and a higher risk of developing cardiovascular disease in people suffering from type 2 diabetes. Higher levels of sugared proteins in vascular calcifications are linked to a higher degree of inflammation and tissue necrosis from arteriosclerosis. Inhibiting the formation of sugared proteins may prevent cardiovascular disease and measurements of sugared proteins may improve predictions of cardiovascular disease in people suffering from type 2 diabetes.

Key words:

type 2 diabetes, arteriosclerosis, sugared proteins, cardiovascular disease

“Translabial 3D ultrasound for diagnosing levator ani defects in women with pelvic organ prolapse”

“Faculty development for medical professionalism in an Arabian Context”

“Multi-Agent Learning Dynamics”

Within the field of artificial intelligence, multi-agent systems are used to model and solve complex problems in today's society. The complexity of such systems requires that individual agents have the ability to learn to optimise their own behaviour. An important challenge is to gain qualitative and theoretical insight into the dynamics of these learning multi-agent systems, as their results are often hard to predict in advance. This dissertation describes how methods from the field of evolutionary game theory can be used for this. These methods are then applied to systems such as social networks and the stock market.
 

Key words:

artificial intelligence, multi-agent systems, game theory

“Modulation of vascular inflammation; cell type specific effects by ADAMs and HDL”

Atherosclerosis is the main cause of cardiovascular disease. This dissertation focuses on regulating inflammation, a key factor in atherosclerosis, by modulating high density lipoproteins (HDL, or ‘good cholesterol’) and modifying proteins via A Disintegrin And Metalloprotease (ADAM) enzymes. We demonstrated that the presence of ADAM10 in blood cells and endothelial cells has the opposite effect on atherosclerosis. We also found that HDL had cell-specific effects, namely, anti-inflammatory effects on smooth muscle cells and inflammatory effects on macrophages. These cell-specific effects are important for developing targeted and patient-specific therapies.
 

Key words:

atherosclerosis, inflammation, enzymes

“Oxidative stress responses in hepatocarcinogenesis; Unravelling the mechanisms using a toxicogenomics approach”

“Clinical evaluation of pulsed electromagnetic field treatment for acute scaphoid fractures”

Scaphoid fractures are relatively frequently occurring fractures among young, active people. Failing treatment or treatment initiated too late may lead to serious health related, economic or social problems. This dissertation describes the effect of pulsed electromagnetic field (PEMF) bone growth stimulation on healing of acute scaphoid fractures. The aim of our study was to determine whether treatment with PEMF bone growth stimulation was better than current plaster treatment.
In conclusion, the use of PEMF bone growth stimulation was found to have no significant benefit and is therefore not recommended as it is more expensive than standard conservative treatment. However, the observed positive effects of PEMF bone growth stimulation on healing time of a subgroup of stable, non-displaced scaphoid fractures show the need to further conduct goal-oriented research into the effect of PEMF bone growth stimulation on the healing process of acute fractures.

Key words:

scaphoid fractures, treatment, PEMF bone growth stimulation

“Health Technology Assessment in Epilepsy; economic evaluations and preference studies”

A proper comparative assessment of costs, clinical effects and quality of life is needed due to an increase in healthcare costs. This dissertation describes research carried out into quality of life of patients suffering from epilepsy, preferences as to epilepsy diagnostics, cost of side effects and cost-effectiveness of the ketogenic diet, a treatment method for children suffering from epilepsy in whom drugs are not sufficiently effective. In order to support parents and children in following the diet a special ‘recipe website’ (ketogeenmenu.nl) was developed. After four months, seizure frequency was reduced by more than 50% in half of the children following the diet. In the control group, this result was achieved in only 18.2% of the children. However, no conclusive evidence was found regarding the cost-effectiveness of the ketogenic diet.

Key words:

cost-effectiveness, epilepsy, ketogenic diet

“Alles draait om de chemie”

“Interictal epileptiform acivity as a marker for clinical outcome”

“Influencing panic; Experimental and clinical studies into determinants of panic severity”

“Proactive coping post stroke: The Restored4Stroke Self-Management study”

In the Netherlands, 40,000 people suffer a stroke each year. After a stroke, people often have problems dealing with the changes they face. The Restore4Stroke Self-Management study examined whether it is helpful to teach people who have suffered a stroke and their partners proactive coping, in other words to teach them to anticipate potential unpleasant consequences of stroke while planning a goal. Although proactive coping was found to be an important indicator of psychosocial functioning after stroke, teaching such strategies to groups of people who have suffered a stroke and their partners did not result in increased proactive coping or fewer participation restrictions. Our results may be explained by the intervention not being implemented optimally or the effects of contextual, personal and therapeutic factors on the outcome of our intervention. Therefore, more research is needed into these factors.

Key words:

stroke, treatment, self-management

“Mineral dust induced pneumoconiosis: a pivotal Role for the inflammasome”

Pneumoconiosis is the world’s most common disease caused by the inhalation of dust. Pneumoconiosis is usually caused by exposure to crystalline mineral fibres and particles. This dissertation explores which genes are activated or eliminated after lung cell exposure to asbestos or coal mine dust and which mechanisms play a role in the development of such diseases. The ‘inflammasome’ protein was found to play an important role in the inflammation underlying this disease. In addition, it was shown that activation of this protein in lung cells in turn triggers reactions associated with tissue stiffening, a feature of occupational asbestosis and silicosis. Furthermore, it was found that this protein can also play a role in the development of the disease in miners suffering from pneumoconiosis. This study may contribute to the development of new drugs.

Key words:

asbestosis, silicosis, pathogenic mechanisms

“Lifestyle and Diabetes Type 2- Closing the evidence gap between research and practice”

“Leer me dansen: de tango tussen bio en materialen”