“Facilitating Training Transfer Effects; the case of Vietnamese MBA programs”

“Will work for food; a behavioural economic analysis of overeating”

In today’s society it is difficult for many people to resist tasty fattening food. But not everyone is as sensitive to the temptation of, for example, a bar of chocolate. Studies in this dissertation show that people who often say they are following and/or have overweight, will work harder for energy high food (such as chocolate).  Snacks are therefore extra rewarding for these people, which contributes to their tendency to overeat. This dissertation also shows that imposing taxes on high calorie food can limit overconsumption, also for people with a tendency to overeat.

Key words:

psychology; eating; overweight; following a diet

“Aspecten van een beroepscultuur”

“Towards process-oriented care delivery in hospitals”

For years already, long waiting lists for hospital appointments and defective matching between health care providers have been important points for improvement in order to make hospital care more patient-friendly.  This dissertation states that working in a patient-friendly manner and offering good quality and affordable care can be realised if hospitals make the transition from the traditional organisation in specialised departments to a process-oriented organisation. This requires specialisation in a limited number of disorders, which is still an issue in the rules and legislation of health care. The current dbc structure, in which financing is process-oriented, probably does stimulate the cooperation between various specialisations. This research was commissioned by NIVEL.

Key words:

hospital care, patient-friendliness, organisation change

“De advocaat in het Burgerlijk Proces”

“Collusion and Price Wars; a dynamic approach to price competition”

“The regulation of architects kin Belgium and the Netherlands”

This thesis examines the regulation of architects in Belgium and the Netherlands and discusses who is allowed to use the title and practice the profession.  Also the contractual liability of architects is compared. The free movement of architects is analyzed in an EU context. Finally the book contains an economic analysis of the regulation of architects to determine whether the Dutch of Belgian regulation is necessary and proportional to reach the goals set. In this way the thesis aims to determine whether the Dutch or the Belgian combination of regulations and contract law provisions is most cost-efficient from an economic point of view.

Key words:

regulation, architects, Belgium, Netherlands, EU legislation

“HIV/AIDS; STIGMA as a factor that affects care seeking, care and support of PERSONS with HIV/AIDS in Port Harcourt Nigeria”

HIV/AIDS has been identified as one of the major problems facing the global community. This thesis examines the problems of ‘people living with HIV/AIDS’ (PLWHA) in Port Harcourt Nigeria. 
The first part of the study aimes at understanding the HIV-related stigma in Sub-Saharan Africa and the consequences of stigma for care seeking. The second part aimes at understanding stigma and other problems PLWHA in Port Harcourt, Nigeria face in seeking care and support in society and health care institutions. In addition, gender-related power differences in care given to PLWHA were also investigated. This study shows that the stigmatization of PLWHA is still overwhelmingly present and affects their quality of life. This has huge implications for HIV prevention, antiretroviral treatment adherence, care seeking, care and the support they receive. Effective policies backed with practical multi-faceted interventions are important.

Key words:

HIV/AIDS, stigma , gender, society, health care institutions

“Multimodal analysis of neuroimages in Alzheimer’s disease”

Several neuroimaging biomarkers have been identified to diagnose Alzheimer’s disease (AD) since the earliest stages, monitor its progression, and possibly predict its onset. This research shows that structural damage, functional alterations, and protein build-up, characterizing AD, are interrelated but neither concurrent nor co-localized phenomena. This research points out the need of multimodal analysis techniques to further assess the relationship between different biomarkers, in order to better understand the mechanisms that trigger the disease onset and drive its progression, to increase early diagnostic accuracy and to lead to the identification of novel targets for pharmaceutical intervention which could delay disease progression.

Key words:

Alzheimer’s disease, biomarkers, multimodal analysis

“VITALUM; development and evaluation of tailored print communication and telephone motivational interviewing to improve lifestyle behaviors among older adults”

To lower the risk of cardiovascular disease Dutch adults are recommended to eat at least 2 pieces of fruit and 200 grams of vegetables each day, and to exercise moderately intense for a minimum of 30 minutes per day at least 5 days per week.  However, over 80% of the adults eat too few vegetables and fruits, and 40% moves too little.  This dissertation describes the development and evaluation of telephone motivating interviewing and computer-generated tailor-made advice via letters to help adults between the age of 45 and 70 years realise these recommendations. Participants who received these letters, interviewing or a combination of both started to exercise more and eat more vegetables and fruits than participants who did not receive information. These methods can therefore be used to help people to live a healthier life.

Key words:

healthy lifestyle, motivating interviewing, tailor-made advice

“Celdood, een nieuw perspectief op leven”

“The Odyssey to Sustainability of the Universities of Applied Sciences in the Netherlands”

This dissertation is the report of twenty years of practical experiments in HBO (higher vocational education) that were intended to not only provide students with knowledge about and insight in sustainable development, but also the skills and attitude to actually do something with those at a later stage. Roorda focused on various programmes and several aspects of sustainability and worked mainly with teachers, administrators and managers.  
One of the experiments concerned the development of ‘AISHE’, an assessment and policy instrument for sustainable development in HBO. AISHE is now used in seven countries; on the basis of AISHE the ‘Quality Mark Sustainable Higher Education’ was granted to over fifty programmes and schools.   
Each experiment used the change processes that took place at that time in HBO, among which a transition from teacher oriented to student- and competence-oriented education. Therefore, the dissertation also presents a historic overview of twenty years HBO history.

Key words:

sustainable development, higher education, hbo, change processes , transition

“Quality of life assessment in palliative care”

“Psychosocial needs of breast cancer patients and their relatives”

Diagnosis and treatment of breast cancer may cause physical, psychological and social problems which may influence the patients' and their relatives' needs. This dissertation consists of three  quantitative studies on the psychosocial needs of patients and relatives during and after the patients treatment. The patients had unmet psychological needs whereas relatives needed help with access to information and health care professionals. Physical and social impairment, an impaired body image, distress, anxiety, a lack of support and conflicts in their interpersonal relationships were associated with the patients unmet needs. Distress, anxiety and conflicts in the relationships were associated with the relatives' unmet needs. These factors may help to identify patients with a higher need for help and to conduct target support to those who actually need it.

Key words:

breast cancer, psychosocial needs, relatives

“Molecular imaging in the combined modality treatment of lung cancer”

Patients with locally advanced lung cancer receive a combined treatment of radiotherapy and chemotherapy. This dissertation studied how this treatment can be optimized by means of molecular imaging with positron emission tomography (PET). The results show that the radiation area of small-cell lung cancer can be diminished safely by using the PET scan. It is further shown that, 3 months after the treatment, a PET scan can determine the progression of the disease in a stage when re-treatment is still possible. Finally, 2 new PET tracers are evaluated, aimed at specific biological characteristics of cancer cells. The studies show that these tracers can be safely used. Future studies will be necessary to define the optimal imaging circumstances. 

This research received partial support from ‘KWF kankerbestrijding’.

Key words:

lung cancer, PET, radiotherapy

“Intestinal fat and eating behavior: role of the ileal brake”

“Metabolic and genetic aspects of thiopurine”

Side-effects from drugs often have a genetic background. The described PhD research focuses on the causes of side-effects from certain anti-inflammatory drugs, the thiopurines. These are often used to treat (auto) immune diseases. In the case of thiopurine use it is important to determine the activity of the enzymes  thiopurine-S-methyltransferase (TPMT) and inosine trifosfatase (ITPase) to prevent serious side-effects, such as bone marrow suppression and pneumonia and the involved hospitalisation. The research also shows that ITPase plays a role in the progression of pulmonary Langerhans’ cell histiocytosis (PLCH), a serious lung disease. 

Key words:

side-effects thiopurines, enzyme TPMT, enzyme ITPase

“Stock Market Manipulation”

Separation of ownership and management creates an agency conflict between the principal and the agent, who manages. This dissertation sheds new light on the ability of market participants to recognize information which is not equally dis-tributed in financial markets. Causes and consequences of shareholder litigation and their role in corporate governance are critically analyzed and newly inter-preted. Understanding the conflict between managers and shareholders and be-tween firms and financial intermediaries is important academically and profes-sionally. First, investors learn about effective control of managers. Second, the regulator understands the effects of regulation in financial markets and whether it yields expected benefits. The third group of beneficiaries is the managers themselves. They have to be aware of managerial leeway, the risks that they face and the externalities they impose on financial markets. The last group concerns financial intermediaries and their role in the primary securities market.

Key words:

asymmetric information, corporate governance, financial intermediar-ies, financial regulation, executive compensation, shareholder litigation.

“Agonist-induced modulation of glycocalyx barrier properties in the microcirculation”

This dissertation research studies the role of the glycocalyx, a gel layer on the inside of all blood vessels in the heart. The glycocalyx turns out to behave as a thick non-stick layer that prevents damaging parts to stick to the wall and as an extra space for blood when more oxygen needs to be transported from the blood to the heart. Temporary adjustments of this layer appear to positively influence the blood and oxygen supply, but when this layer is damaged, that does not happen. Repair of a damaged glycocalyx  could in the future be a possible therapy for patients suffering from chest pain.

Key words:

glycocalyx, blood vessels

“OxLDL-specific antibodies and neutrophils; their relevance in mouse atherosclerosis”

“Met meer menselijke maat naar een toekomstbestendige zorg voor chronische zieken”

“Essays on Bargaining and Claim Problems”

This dissertation investigates normative, strategic, and psychological aspects of bargaining and bankruptcy problems using theoretical and experimental methods. It shows that in case of bankruptcy and when claims are known, compensations of creditors in proportion to their claims is not only normatively appealing but also a stable outcome when firms can choose the bankruptcy rule to attract investors. However, when claims are unverifiable the equal division of the estate is the stable outcome of a simple allocation problem.  The thesis also shows that bargaining over a jointly produced surplus is strongly affected by information about the relative performance of team members and the randomness in the production process. Importantly, these effects are mediated by immaterial subjective entitlements bargainers derive through the production process.

Key words:

bargaining, bankruptcy 

“Molecular imaging of large arteries by ultrasound; Potentials and pitfalls”

The cause of cardiovascular diseases is often atherosclerosis. A torn atherosclerotic plaque causes thrombi that can lead to a heart or brain infarct. With ultrasound (echography) an atherosclerotic plaque can be made visible. However, it is not yet possible to determine the risk of tearing with ultrasound. A new development uses molecular imaging involving a contrast agent to visualize the presence of atherosclerosis-specific molecules that can play a role in the tearing. This dissertation describes a method to visualize a plaque by means of white blood cells that were charged with an ultra sound contrast agent. It is shown that the cells that were charged with blood cells are detectable in the blood stream and that the contrast agent has no influence on the roll and attachment behaviour on the activated vascular wall. This new acquired knowledge is essential for the development of efficient diagnostics.

This research was financially supported by the ‘Nederlandse Hartstichting’

Key words:

molecular imaging, ultrasound, contrast agents

“Union democracy and the challenge of globalisation to organised labour in Ghana”

In Ghana, trade union strategies to combat globalisation challenges include revamping union structures to enhance the membership of women and informal economy workers. Internal democracy in trade unions relies on the ability of their members, irrespective of their background, to access the power tools offered by unions to defend their working rights. The construction of trade union membership around male formal economy workers offers limited access for women and informal economy members to union power tools like education, sub-group autonomy and participation in union governance. The inability of trade unions in Ghana to foster solidarity between women, informal and formal economy members, was affecting not only members’ access to power resources, but union potential to combat effectively globalisation challenges in the workplace and beyond.       

Key words:

union renewal, internal democracy, globalisation, gender democracy, informal economy 

“Methodological and Conceptual Challenges of Evaluating the Impact of Development Interventions”

In the past years, doubts about the usefulness of development cooperation have led to an increase in rigorous impact evaluation.  Many people, however, wrongly align ‘rigorous’, with the use of randomized experiments. This dissertation distinguishes three important categories of challenges in impact evaluation: delimitation, attribution versus explanation, and practical implementation. A reflection about these issues, and not so much a certain method, forms the basis for rigorous study. Within this framework the various sub-studies illustrate the following aspects: the limitations and the potential of randomized experiments; the importance of a policy-theoretical perspective in impact evaluation, and the importance of combining suitable methods.

Key words:

development cooperation, impact evaluation

“Cognition and depression after stroke; course and interaction”

This research studied depressive complaints and cognition after a stroke, as well as their course in time and interaction with each other. A cohort of 190 patients was followed during a year and examined for depression after 1, 3, 6, 9 and 12 months; another cohort of 194 people was followed during two years and underwent full neuropsychological examination after 1, 6, 12 and 24 months. Depressive complaints after a stroke often turned out to be connected to the stroke. In half of the cases the depression occurred in the first three months after the stroke, and one third of these persons recovered within a few weeks. In more serious cases, complaints can recur of become chronic. Patients with executive function disorders (disorders in behaviour, emotion and thinking) have a worse prognosis.  

Key words:

stroke, depression

“Sacral Neuromodulation in patients with faecal incontinence”

Faecal incontinence is very common but complex disorder involving high costs for the patient and the community.  Besides a considerable psychological burden it has an enormous socially invalidating aspect that has profound consequences for the patient’s well-being. This dissertation summarizes the usability, safety, feasibility and the possible mechanism of action of sacral neuromodulation (SNM) as a treatment for faecal incontinence. After 10 years of clinical experience with SNM in our hospital, we can conclude that SNM is an effective treatment for functional intestinal disorders, particularly in patients with faecal incontinence.  

Key words:

faecal incontinence, treatment, sacral neuromodulation

“Interpretation of diagnostic test results: Pretest expectations, test interpretation and management decisions in routine general practice”

“The European Union and its Member States: Organized Hypocrisy?”

“Virtual Worlds, Real Healing”

The research points to the relevance of understanding the role that traditional habits and practices (i.e., passive acquisition of new technologies, lack of implicit learning efforts, weak investments in machinery and equipment) play in shaping the development of an industry. It also considers how institutions (in the form of policies) can effect changes to (or reinforce) these habits and practices. It shows that without purposeful intervention to support learning, the policy regime is not enough on its own to ensure that technological learning and capacity building takes place. Therefore, building capacity locally and creating an institutional regime that supports innovation appears to be the only way in which learning and capacity development processes can be enhanced.

Key words:

virtual reality, stress, anxiety

“Learning and Innovation under Changing Market Conditions: the Auto Parts Industry in Mexico”

The research points to the relevance of understanding the role that traditional habits and practices (i.e., passive acquisition of new technologies, lack of implicit learning efforts, weak investments in machinery and equipment) play in shaping the development of an industry. It also considers how institutions (in the form of policies) can effect changes to (or reinforce) these habits and practices. It shows that without purposeful intervention to support learning, the policy regime is not enough on its own to ensure that technological learning and capacity building takes place. Therefore, building capacity locally and creating an institutional regime that supports innovation appears to be the only way in which learning and capacity development processes can be enhanced.

Key words:

innovation, auto parts market Mexico, traditions

“Technical Change, Competitiveness and Poverty Reduction: A study of the Ghanaian Apparel Industry”

To guide future technology, industrial and poverty reduction policy planning and formulation, this study offers evidence of widespread technical inefficiencies and technical change among SMEs in apparel manufacturing business in Ghana. A survey of 140 firms shows weak signs of catching-up with the best practice firms even with increasing application of new technologies. Levels of poverty/deprivation remain high among apparel manufacturers, down from 41.8 percent in 2002 to 34.2 percent in 2007. The study linked the drop in poverty to output growth and proposed a more sustained and comprehensive policy measures to boost productivity growth through a better educated workforce and automated production processes to curb technical inefficiencies. Going forward requires good governance and workable international trade rules to change the present levels of performance of textiles/apparel industry in Ghana.

Key words:

Technical Change, Competitiveness, Poverty Reduction, Apparel Industry, Ghana

“Pension rights, human capital development and well-being”

This dissertation studies to which extent pension system reforms have an effect on training participation, the delivered effort at work, the well-being and the mental health of older employees. The study shows that reducing the pension benefits (discontinuance of pension scheme in the public sector) has a substantial and persistent negative effect on the mental health and well-being of employees. Moreover, the work effort is lower among employees with moderated pension benefits, who have a strong urge for retaliation. The decline in well-being is caused by the fact that employees feel they are treated unjustly and strongly compare themselves with those who keep their original entitlement to pension benefits.

Key words:

moderated pension benefits, human capital, well-being

“Innovation in Car Mobility; co-evolution of demand and supply under sustainability pressures”

“On European Antitrust Enforcement”

“Perinatal modulators of respiratory outcome after preterm birth”

Ten percent of all children are born preterm. Preterm birth increases the risk of death and diseases, among which chronic lung damage. In lung fluid of premature infants changes were found that can predict and partly explain lung damage. Furthermore, children were examined that were born after a uterus infection, main cause for preterm birth. There are indications that they can be better treated by raised dosage and more extensive application of medicines that are already used in practice. This can lead to a strong decrease of disease and death. It shows that early prediction of disease and specific treatment can contribute to a better future for premature infants.

Key words:

preterm birth, (chronic) lung damage

“Modelonzekerheid en Waardering”

“Melatonin for sleep problems in individuals with intellectual disabilities: A study into its effectiveness and clinical aspects”

Melatonin is drug that regulates the sleep-wake rhythm. This dissertation studied the working of melatonin in individuals with intellectual disabilities who have long-term sleep problems. In their case, namely, sleep problems are often caused by a disorder in their own melatonin rhythm; in individuals without intellectual disabilities other factors (such as stress) often play a role. Melatonin not only turned out effective in the treatment of problems with falling asleep and continuing to sleep, but it also had a positive effect on behaviour problems during the day. Aggressive behaviour, such as hitting, biting and destroying, was reduced. Remarkably, in some patients the sleep problems recurred during the treatment after a few weeks because the melatonin was too slowly broken down. The advice is to only start a melatonin treatment after (in the saliva) the moment has been determined when the own melatonin production has started.  

Key words:

individuals with intellectual disabilities, sleep problems, melatonin, behaviour problems

“Brain Sterol Metabolism – Modulating Alzheimer’s Disease”

This dissertation shows that stimulating the processing of cholesterol (turnover) in the brains of Alzheimer mice (by means of medication) can turn around the cognitive regression that characterizes the disease. It was also shown that the natural stimulation of the cholesterol turnover with plantsterols leads to an irreversible accumulation of these plantsterols in the brains of mice, which in healthy mice does not influence the normal brain functions. In an Alzheimer cell model, however, was found that plantsterols reduce the production of toxic peptides that characterize Alzheimer’s disease. This dissertation offers a solid foundation for further studies into the modulation of the brains-sterol-metabolism in the prevention and treatment of Alzheimer’s disease. Dietary intervention can play an important role here. 
 
The study was financially supported by a Marie Curie early stage training site fellowship (MEST-CT-2005-02058)

Key words:

Alzheimer, cholesterol, plantsterol, brain, cognition

“Monte-Carlo Tree Search”

“Unity in Diversity: studies on Micro and Macro Panel Data Sets”

Thanks to the progress of information technology, keeping track records of a multitude of people or entities has become a matter of routine. For instance, marketeers keep files of potential customers, employers of employees, insurers of insured, investors of companies etc. The data concern a number of different but qualitatively similar units, which have been observed over some time. The topic of this dissertation is the methodology and practice of the analysis of such multi-unit or panel data. Two micro-economic and two macro-economic applications are presented and discussed; the micro-economic ones use a large sample of households or individuals, the macro-economic ones involve a small or less small number of countries, each observed for a few years. What our results show is that relationships that are often taken for granted are in reality very fragile and may be based largely on preconceptions.

Key words:

methodology, analysis, panel data

“European private international law on legal parentage? Thoughts on a European instrument implementing the principle of mutual recognition in legal parentage”

“Molecular mechanisms of beta-carotene action in the lung”

Beta-carotene is a health improving substance that is often found by nature in vegetables and fruit, and is used as an orange colouring agent in nutrients or as an addition to vitamin preparations.

Intake of an unnaturally high dose of beta-carotene involves an increased lung cancer risk in smokers or in people who are exposed to asbestos. This dissertation describes various mechanisms that could be involved there. It is shown that beta-carotene could have a negative effect on DNA damage caused by inflammations. Research with a unique humanized mouse model also shows that male and female mice react oppositely to beta-carotene. In male mice a new beta-carotene-sensitive process was discovered that could play a role in the origin of lung cancer. Most found effects, however, indicated health protection by beta-carotene. Therefore, the explanation for the negative effects can possibly be found in the presence or absence of chronic infections.

Key words:

Bètacaroteen

“van hard werken is nog nooit iemand dood gegaan”

“Basal cell carcinoma: genetic, diagnostic and therapeutic insights”

This dissertation studies the genetic analysis and treatment of the most common type of skin cancer, the basal cell carcinoma (BCC). The genetic research was performed on the basal cell nevus syndrome (BCNS). Patients with this syndrome develop many BCCS at an early age already. In a patient with BCNS possible causes were found for an extraordinarily aggressive BCC. Another genetic research focused on patients who also had BCCs at an early age, without having BCNS.  It turned out that a badly functioning DNA repair system was not the cause. Two clinical studies into treatment possibilities were performed. The first study showed that Mohs’ micrographic surgery is the preferred treatment for recurring BCCs in the face, i.e. BCCs that came back after earlier surgery. The second study showed that for compactly growing BCCs treatment with standard surgery is preferred over treatment with photodynamic therapy (PDT).  

Key words:

basal cell carcinoma (BCC), basal cell nevus syndrome (BCNS)

“The quest for the origin and prevention of  postoperative myalgia following succinylcholine – new insights in an old problem”

Muscle relaxants are common drugs in anaesthetics and they are often administered during general narcosis. The popular muscle relaxant succinylcholine is mostly used in short interventions and rush surgery. However, succinylcholine has various side-effects, such as muscular pain after surgery. The origin of that postoperative muscular pain is still not known. The study was meant to gain more insight in the causes, particularly a possible inflammation reaction. The results show that an inflammation reaction does not significantly contribute to the origin. Furthermore, various preventive measures were studied to prevent muscular pain. There are various medicamental possibilities for efficiently preventing the muscular pain, among others by pre-treatment with certain painkillers, local anaesthetics and other muscle relaxants. Unfortunately, the pre-treatment appears not to be without risk for certain side-effects (for example pain during injection), which requires special attention from the practising doctor.

Key words:

succinylcholine, side-effects

“Patient-Specific Cardiovascular Modelling in pulmonary Arterial Hypertension; assessment of hemodynamic and mechanical ventricular interaction”

Pulmonary Arterial Hypertension (PAH), a disorder of the small blood vessels in the lungs, is characterized by a chronic rise of the blood pressure in the pulmonary artery, leading to an increased pump load of the heart. This can lead to heart failure and early death. The mechanisms of heart failure in patients with PAH were studied with a computer model of heart and vessels. Results have led to new and clinically relevant insights, with possible consequences for diagnostics and therapy. Shown was that in the long term PAH leads to a deteriorated cooperation between the left and the right heart. The computer model predicts that this disturbed left-right cooperation can be partly restored by means of a pacemaker. Currently is being investigated if the model can precisely estimate (without catheterisation) the blood pressure in the right heart and the pulmonary artery on the basis of a few simple clinical measurements. That way, in the future the model can contribute to better and less burdening diagnostics in PAH and other patients.

Key words:

Pulmonary Arterial Hypertension (PAH), heart pump function

“Diversiteit als middel tot optimalisatie van de behandeling van longkanker”

“Dietary proteins and body weight regulation”

“The effects of Business Cycle Conditions, Incentives and Disability Benefits on Labour Market Transitions in Spain”

My PhD thesis focuses on the role of institutions, the business cycle and labor demand needs on determining transitions between employment, unemployment and disability pensions in the Spanish labor market.

The focus of this research is to determine and quantify the factors influencing the different evolution in labor market participation, employment and disability pensions in Spain experienced since the 1980's. These factors range from legal and institutional factors to individual-specific determinants to employer, firm and industry characteristics and business cycle conditions. My thesis tries to capture the differential effect of each of these factors on individual transitions between labor market states. 

Key words:

Spanish labor market, differential effect

“Empirical studies of new firms and innovation in Italy”

This thesis focuses on the role of entrepreneurship as a trigger of the growth potential of industries and regions. On one side it assumes that entrepreneurial activity may promote the creation of entirely new sectors, whereas on the other hand that it can exert direct and indirect impacts on economic and employment growth. 

Use of up-to-date statistical tools and unique datasets allows to perform a rigorous analysis of effects and features of entrepreneurship, firm growth, and innovation in Italy. The results give a picture of the Italian economy confirming some of its distinctive features emerged from previous studies while rejecting others.

Key words:

entrepreneurship and innovation in Italy

“Course of disease, farigue and health related quality of life in inflammatory bowel disease”

This dissertation describes the course of disease, fatigue and quality of life in a Group of patients with an inflammatory bowel disease (IBD) in South Limburg. The course of disease was in general mild. It turned out, however, that patients in the first year after the diagnosis or with a more serious course of disease probably need a more intensive check to lower the risk of complications.  

Besides bowel complaints and anaemia, the presence of fatigue had great influence on the quality of life. But even without complaints almost 40% of the patients experience much more fatigue than expected in comparison to the healthy population. A more serious course of disease in the past seems to be of influence here.

Key words:

inflammatory bowel disease (IBD), course of disease

“Clinical evaluation and cost-effectiveness of a community based COPD management program”

COPD is a very common progressive and invalidating lung disease. It is the only chronic disease with a still increasing mortality worldwide. The INTERCOM trial described in the dissertation shows that patients with moderately serious COPD complaints and an effort limitation already in an early stage of the disease benefit from a tailor-made transmural lung rehabilitation program. After two years, the program not only to a better quality of life and effort capacity compared to the usual care, but it was also cost effective. This means a great effect of a limited investment. In COPD patients with a decreased muscular mass the programme costs were entirely earned back, because these patients had to be hospitalized less often

Key words:

COPD, transmural lung rehabilitation program

“False Positives or Hidden Dimensions. The definition and Measurement of Child Poverty”

Poverty is often associated with a shortage of financial means as a result of which basic needs such as food, housing and education cannot be provided. On the basis of Vietnamese data this dissertation shows that children in families with sufficient financial means do not necessarily go to school or drink clean water. Contrarily, children who lack certain basic provisions do not necessarily live in a family with a shortage of financial means. This result has consequences both for the way we can create an adequate image of child poverty, and for the policy that is needed to combat child poverty

Key words:

child poverty, financial means

“Intestinal barrier loss in children and adults in disease and during surgery”

“Aspects of joint protection education in people with rheumatoid arthritis”

“Neural selection of words: we started out with little & still have most of it left”

“The challenges and needs of older people as HIV and aids caregivers in South Africa”

In the past decades, older people have become important caregivers for adult children who are sick due to HIV or AIDS, and for grandchildren that stayed alone after the death or disease of one or both parents. This dissertation gives insight in the burden of care that the older people experience and in the psychosocial and socio-economic factors that influence this. The dissertation also describes the development and evaluation of an intervention programme focused on the support of older people with their tasks as caregivers. The results show that after the workshops older people regard themselves more capable of providing care than they did before. Furthermore, cooperation with relevant stake holders in society is necessary for the improvement of structural needs of older caregivers, such as financial assistance and access to social security.

Key words:

HIV, AIDS, older people, South Africa, care giving

“Improving health literacy, self efficacy and personal skills: towards culturally tailored behavioural interventions for African women”

Black women in South Africa bear the highest burden of HIV and the condom use among this population of women is low. The aims of the research were to examine determinants of condom use among HIV positive and HIV negative isiXhosa speaking women separately. We found that dry sex (e.g. sex  after vaginal treatment with substances that often dry and tighten the vaginal wall) among HIV-negative Xhosa women is primarily determined by the preference for dry sex of a dominant male partner. Women’s motivation for negotiating condom use is primarily influenced by their desire to please their partners For South African HIV-positive and HIV-negative black women the fear of stigma because of HIV/AIDS is the biggest barrier to participate in HIV/AIDS efficacy trials. Interventions to enhance condom use by HIV-positive black South African women need to focus on the reinforcement of self-confidence. HIV behavioural interventions  have to be associated with poverty alleviation initiatives and have to be accompanied by behavioural interventions specific to men.

Key words

HIV, condom use, Xhosa women,  

“Neuromodulation for functional bowel disorders”

“Het opslaan van een oog. Tijdelijkheid en ongelijktijdigheid in hedendaagse kunst”

“Linking Cognitive and Cerebral Aging; evidence from structural and functional MRI”

“Discovery of ligands for Frizzled and their promises for the diagnosis and treatment of cardiovascular disease”

“Involving patients in cardiovascular risk management in general practice – evaluation of a nurse-led intervention”

The IMPALA-project teaches nurse practitioners in the general practice to identify people who run a strongly increased risk of cardiovascular diseases and to work together with these people on a ‘tailor-made’ plan for a healthier lifestyle. Individual freedom of choice is central in this approach. The project distinguishes itself from many other preventative projects because of the emphasis on joint decision-making: the patient’s preference is taken into account in the action plan. This research shows that patients can better assess their risk of developing a cardiovascular disease as a result of IMPALA. Also the lifestyle of patients improves and the risk decreases, although not more than in patients that visited a nurse practitioner who did not use IMPALA. The latter control group was identified in the same way.

“When the brain speaks for itself; exploiting hemodynamic brain signals for motor-independent communication”

Human communication entirely depends on the functional integrity of the neuro-muscular system. In the so-called ‘locked-in’ syndrome, completely paralyzed patients become incapable of interacting with their surroundings – while being fully conscious and awake. Providing such patients with motor-independent means of communication therefore is of high importance. For the last 20 years, related research has focused on developing ‘brain-computer interfaces’ implementing neuroelectric signals for communication. In the studies presented in this thesis, an alternative approach was followed, namely the possibility to exploit hemodynamic brain signals as measured with functional magnetic resonance imaging. The newly developed communication procedures proved to be highly robust and effective. As they are also easy-to-apply they might help affected patients already in the near future.

“La Côte d’Ivoire et la gestion durable des resources naturelles marines”

“Antioxidant activity: from model to man”

Oxygen is toxic. Our cells are continuously attacked by reactive forms of oxygen (oxidants). For our protection we have anti-oxidants, which we extract from food or which the cells produce themselves. Anti-oxidants work in various ways. This dissertation describes a method that allows a good determination of the anti-oxidant activity. To be able to offer protection, the anti-oxidant has to be absorbed by the body. This was tested in test persons who took apples, fruit salad and a fruit drink. It turned out that the fruit salad and the fruit drink protect against the toxicity of oxygen. Apples are less effective.  

Key words:

Antioxidant, radical damage, fruit, oxidants

“Money and Mobility: Migration and Remittances”

In recent years, migration has increased rapidly and become a more prominent feature of the world economy and the public policy debate.  According to the United Nations, there are estimated to be more than 200 million international migrants in 2010. Remittances, the money that the migrants send back to their home countries, reached an estimated $328 billion in 2008.  This dissertation primarily focuses on processes and consequences of economic migration and more specifically of remittance sending/receiving. This dissertation focuses on the determinants of migration that prompt economic migrants to leave their countries of origin, on   how remittances are currently empirically measured and on how migrants send remittances once they have decided to do so. Research was also done on the effect immigrant integration had on the remittance channel decision and on health care spending in the sending country. 

Key words:

migration, immigration, remittances, migrant  

“Misdaad en straf; een herbezinning op het strafrecht vanuit mystiek perspectief”

This book critically discusses both the ruling penal theories and the current criminal procedure and reveals their main limitations and shortcomings. This research particularly critically studies the overestimation of the crime control effect and the supposed moral character of criminal law. Besides fundamental criticism of the criminal law, this book also offers an alternative for today’s cynical crime control. Based on the mysticism and related man and world views, a beginning is made for a mystical criminal law that does not revolve around punishment but around restoration of damage and relations. Important concepts in this context are solidarity, remorse, forgiveness and reconciliation. This book goes against the spirit of the age.  

Key words:

criminal procedure, penal theory, crime control

“Global rebalancing: Cultures of Crisis”

“On the role of superoxide radicals (O2*) in fibrosis”

“Understanding social interaction in computer- supported collaborative learning”

In this dissertation, we focus on understanding social interaction of learners in authentic and relevant settings, who worked and learned together in virtual teams for an extended period of time. The findings indicate that differences in academic motivation influences the type of contributions to discourse as well as the position a learner takes within the social network in our setting. Extrinsically motivated learners had a preference to connect to highly intrinsically motivated learners. Our findings might explain why in distance learning large differences in participation are found and why certain learners are more inclined to drop-out in class.

Key words:

distance learning, social interaction

“Public Health implications of the Mediterranean diet; its interaction with active and passive smoking”

“The effects of metformin on metabolism and cardiovascular disease in type 2 diabetes”

Patients with diabetes type 2 benefit from continuing the metformin treatment when the moment has come that insulin administering becomes necessary. This is shown by this research that studied the long-term (4.3 years) effects of metformin on among others cardiovascular diseases. The metformin induced improvement in cardiovascular diseases was partly explained by weight loss and improvement in endothelial function in the metformin group, but not by lower insulin levels. Finally, long-term metformin treatment turned out to considerably decrease the risk of developing a vitamin B12 deficiency. The present guidelines, however, don’t make recommendations for the prevention and detection of vitamin B12 deficiencies during the metformin treatment. This research presents strong arguments for the routine determination of vitamin B12 during the metformin treatment.

Key words:

metformin, cardiovascular diseases, endothelial dysfunction, inflammation, vitamin B12

“Towards better diagnosis and monitoring of asthma and cystic fibrosis in children; the value of non-invasive inflammometry”

Asthma and cystic fibrosis (CF) are very common chronic (children’s) lung diseases. Although chronic inflammation of the bronchial tubes is at the centre of the pathophysiology of asthma and CF, this inflammation does not hold a place in the diagnostics, treatment and monitoring of these disorders. The reason for this is that the current methods of measuring inflammation, such as broncoalveolar lavage or biopsy, are too invasive to be used as a routine. New non-invasive methods concern the analysis of exhaled air by measuring nitrogen monoxide or volatile organic components (VOCs) in exhaled air and analysis of biomarkers in exhaled air condensate.  The research shows that exhaled air analysis is a good addition to conventional parameters such as symptoms, physical examination and lung function. This can improve the diagnostics and treatment of children with asthma and CF.

Key words:

asthma, cystic fibrosis, non-invasive methods

“Hemodialysis Access-Induced Distal Ischemia (HAIDI); diagnosis and surgical management”

“Bioactive compounds in whole grain wheat”

Bread can be healthier! Consuming whole-grain foods can prevent cardiovascular diseases, type-2 diabetes and metabolic syndrome. This is due to bioactive compounds in whole grain, such as antioxidants and anti-inflammatory compounds. We found that the different fractions of a wheat grain vary much in their content. The external fractions of the grain, the bran and specially the aleurone, are the richest. We observed that processing the bran in whole-grain breads increased three times the levels of bioactive compounds in blood and urine in humans. This thesis shows that a daily consumed food like bread can be improved to deliver beneficial compounds.

Key words:

whole-grain bread, bran, bioactive compound, antioxidant, inflammation

“Chirurg: van dokter tot jongleur”

“The protective effect of Moderate Alcohol Consumption against Cardiovascular disease and total Mortality: Epidemiological evidence”

“A nutritional approach to prevent cardiovascular disease: from single foods to complex dietary pattern”

Nutrition plays a crucial role in prevention of cardiovascular disease (CVD). In this thesis, two approaches were followed. One regards single foods and nutrients: one study shows that regular intake of small quantities of dark chocolate might have benefits in primary prevention of CVD. Another one shows how alcohol and wine polyphenols are capable, in moderate drinkers, of modulating omega-3 polyunsaturated fatty acids in blood, a cardioprotective effect referred to as ‘‘fish-like”. The second approach regards dietary patterns and has explored ongoing modifications in adhesion to Mediterranean diet. This thesis highlights the need of parallel research in nutrition, exploring the role of single foods/nutrients as well as embracing a “pattern” vision, focusing on real life combination of elements in diet.

Key words:

nutrition, cardiovascular disease, diet

“Modulation of tissue factor expression in vascular cells”

Tissue factor (TF) is the trigger of blood coagulation. Although TF duty is to limit the loss of blood following vessel damage, it has been shown that its aberrant expression could play a key role in pathological conditions such as cardiovascular diseases and cancer. This thesis explores the role of TF in various scenarios. It shows that leptin, an hormone released form of adipose tissue, upregulates TF in blood monocytes, a phenomenon which may account for the thromboembolic episodes frequently associated with obesity. By contrast, a downregulation of TF was observed in cells exposed to drugs such as angiotensin converting inhibitors or clopidogrel, suggesting an additional mechanism by which these compounds exert their protective effect against cardiovascular diseases. Not only drugs but also natural substances, namely polyphenolic compounds found in grapes and red wine, could downregulate TF expression, a new mechanism to explain their role in prevention of cardiovascular disease.

Key words:

tissue factor, cardiovascular diseases

“The what and when in brain stimulation.Studying language production and deception with optimised neuronavigated transcranial magnetic stimulation”

“Online flow measurement in hemodialysis”

For haemodialysis patients there is always a risk of a blockage of the access to the bloodstream. Periodical measuring of the blood flow can timely signal an imminent blockage, upon which a dotter procedure can prevent complete blockage. This strategy is already successfully applied at the MUMC+, although the available scientific literature does not confirm this success yet. The described strategy could possibly be improved by increasing the measuring frequency by means of using innovative, in the dialysis equipment integrated techniques. Two techniques were studied: one of these turned out comparable to the present golden standard measuring method with regard to reliability.  

Key words:

haemodialysis, bloodstream, blockage, monitoring

“Remodeling of intracellular calcium handling in fibrillating atria”

“Earnings dynamics in Europe”

“Multispecies probiotics and antibiotic-associated side effects – pathophysiological and clinical evidence”

“Costs and effects of implementation of a short admission programme following breast cancer surgery in the Netherlands”

This dissertation investigates if short-stay breast cancer surgery (day or 24 hour case) is safe and efficient, studying the experiences of patients. A short stay programme was implemented in four Dutch hospitals. The proportion of patients who had short-stay treatment significantly increased after implementation from 45% to 82%, while the number of complications, rehospitalisation, reoperations or number of visits to the emergency department did not increase.  The programme is less expensive than the usual care, even if the costs of implementation are taken into account.  Research into the experiences of patients showed that especially the information provision needed to be improved. On the basis of these research results large-scale implementation of the programme is recommended.

Key words:

breast cancer surgery, short hospitalization, quality care

“Innovatief Onderwijs Ontwerpen in het Gezondheidsdomein”

“Het inzagerecht; Artikel 843a van het Wetboek van Burgerlijke Rechtsvordering”

In a civil procedure, documents that can allow party A to prove that he/she is right, can be in the hands of someone else.  Article 843a of the Code of Civil Procedure offers A, under certain conditions, the possibility to copy those documents. This dissertation studies the question of how strictly these conditions should be taken. It turns out that this also depends on the fundamental question to what extent finding the truth is important. Sijmonsma thinks that finding the truth is important and therefore pleads that these conditions in article 843a are generously applied for A. An amendment of the law should be recommended.  

Key words:

article 843a, truth finding 

“Cognitive Aging and Functional Compensation; Evidence from Brain Imaging Studies”

When people age, their cognition starts to decline. Elderly people can get round these unfavourable effects by functional compensation, which means by adjusting the way they use their brains. When in elderly people brain activity is perceived in brain areas that are specific for the function they perform and in extra brain areas in the prefrontal cortex, this has a positive effect on cognitive task performance.  These types of activity patterns indicate functional compensation. When the cognitive task becomes very difficult (for example when they have to memorize 7 to 10 items in the short term), elderly people show no longer an increased brain activity and they perform less well. This indicates that elderly people can no longer compensate. Remarkable is furthermore that elderly people with strong fibre tracts in the brains are best capable of compensating the effects of aging. 

Key words:

aging, cognition, brain activity

“Chemotherapy dose-intensification in breast cancer: is more better?”

“Kidney transplantation from donors after cardiac death; studies on the pathophysiology and prevention of ischemic acute kidney injury and on the long-term outcome after transplantation”

Kidney transplantation is the best treatment for patients with terminal kidney insufficiency, but due to a shortage of donor kidneys many people are deprived from this optimal care. Organ donation after a cardiac arrest can make the number of kidney transplantations rise and shorten or even eliminate the waiting list for kidney transplantations. However, because these donor kidneys are damaged by ischemia in the period between the cardiac arrest and organ preservation, there is a reticence to accept these donor kidneys.  For this reason this dissertation closely studies the entire transplantation process from donor to receiver to find clinically usable methods that can prevent this primary non-function of donor kidneys after a cardiac arrest. The research shows that kidney transplantations from donors after cardiac arrest lead to a longer life expectancy. Furthermore, in the transplantation process a series of clinically usable methods was found to lower the risk of non-functional transplantation kidneys.

“Bridging boundaries: Transnationalism and migrants’ lives in a globalizing world”

“Chlamydia trachomatis; identifying women with tubal factor subfertility”

“Home or home-like hospital birth for low-risk nulliparae: does it matter?”

The organization of obstetrics has been under great pressure for a number of years. This dissertation gives insight in differences between women who are pregnant with their first child and their partners with regard to the location of the delivery (at home versus polyclinic) and the effectiveness and efficiency of the care. Both pregnant women and their partners find it important that they can influence the decision process. Women, on the other hand, value a home-like environment for the delivery and partners prefer the possibility of pain reduction. Women who wish to give birth at home have a lesser chance of being referred and an unplanned caesarian, without a difference in neonatal outcomes and total costs of the care.

Key words:

home delivery versus policlinic, efficiency of care

“Positieve maar ook negatieve effecten van etnische diversiteit in scholen op onderwijsprestaties?”

“In search of neurobiological intermediate phenotypes of aberrant information processing in psychosis”

In the case of a psychosis the information processing is deregulated. This dissertation studies how disturbed information processing is related to psychotic symptoms, genetic influences and brain processes. It turns out that delayed information processing is related to so-called negative symptoms and that genetic influences underlie this. In people with an increased genetic risk of psychosis (relatives of patients) there are indications at the brain level that the auditory information processing is delayed. A bad memory turns out to be a risk factor for depressive symptoms. It was also shown that genetic variation in the COMT gene is involved in mild psychotic reactions to ordinary stress. Moreover, the research provides indications for deregulated processing of inner speech in the brains of schizophrenia patients. 

Key words:

psychosis, information processing

“Ethics at the interface of reproductive medicine and genetic technology: the case of mitochondrial disorders”​

“R&D alliances, knowledge flows, and innovation: Three studies on the value of collaborative R&D”

“screenen? Ja, maar hoe?”

“Capturing the dynamics of commitment”

“To drain or not to drain; quantification of drainable intravascular venous volume during extracorporeal life support”

“Motor learning in neurological rehabilitation: practicing skills with movement imagery”

For decades already, athletes have been improving their performance by practicing movements in imagination (movement imagery).  This research studied if this ‘dry exercise’ also has an effect in rehabilitation. Physiotherapists and occupational therapists have examined this in patients with Parkinson’s disease and in patients after a stroke (CVA). In our (relatively small) studies we could not show that the use of movement imagery is better than regular therapy. Patients indicated, however, that exercising in imagination motivated them and made them less afraid. They also liked being able to exercise safely whenever they wanted. More research and larger studies are necessary to investigate if there are groups of patients that possibly will benefit from movement imagery and to find out the physical, emotional and cognitive effects.

Key words:

movement imagery, rehabilitation, neurological disorders

“Fact-finding in civil litigation; a comparative perspective”

In civil procedures, the facts are often decisive. During a legal procedure the facts are collected, principal and secondary issues are separated and proof is brought forward.  The procedure often ends with a final judgement. This dissertation compares civil procedures in the Netherlands with those in Austria and the United States. It also discusses the historical background of the regulations regarding the investigation of the facts.  Striking is that there are very big differences between the Austrian and the Dutch system on the one hand, and the American system on the other hand. This partly is a result of the different demands that are made on the civil jurisdiction. The use of trial by jury in the United States, for example, explains many differences between jurisdictions. 

Key words:

civil procedure, comparative law, Netherlands, Austria, US.

“Promoter methylation based biomarkers for the detection of colorectal cancer”

Colorectal cancer is a very common health problem. In an early stage, this disease can be easily treated and often be cured by surgery. Currently, colonoscopy and the detection of blood in the faeces are used to detect colorectal cancer. The first method has high sensitivity, but is invasive and expensive, whereas the second is simple to use, but not sensitive enough. The limitations of these techniques initiated the development of new non-invasive biomarkers for colorectal cancer. This dissertation describes various new potential non-invasive epigenetic biomarkers (DNA markers) in faeces and blood for the detection of intestinal cancer. Also, the biological relevance of these biomarkers in intestinal cancer was studied. From these data we conclude that promoter methylation can be used for the non-invasive detection of intestinal cancer.

Key words:

detection colorectal cancer, biomarkers

“From algorithms to interactions; an Investigation of effective communication and design of Interactive decision Aids”

“Dikke kinderen, uitgebluste werknemers en vreemde virussen. Filosofie van de publieke gezondheidszorg in de 21e eeuw”

“Imaging in Oncology, a new beginning has just begun …..”

“Essays on international financial integration”

This dissertation studies the effects of international financial integration.  The research shows that because of growing international trade as well as financial integration the probability of a joint crash of international stock markets has strongly increased. This makes effective international stock diversification more difficult.  Results from study into the investors’ true stock positions show that investors do not move out of markets that jointly crash with their domestic market. Surprisingly enough, they do move out of those markets that jointly boom with their domestic market. Another effect of international financial integration is that value changes in private properties have effect on the trade balance. A value increase of, for example, the house, leads to an increase in consumption.  When foreign acquisitions rise, there is an increasing import of goods and services. This explains, for example, the trade deficits in the United Kingdom and the United States. Finally, the dissertation shows how migrant remittances to their family in the home country positively influence the financial policy of the migrant’s home country.

Key words:

financial markets, international trade, effects of globalisation 

“The elusive particle hazard; inflammatory and Oxidative stress responses”

Inhalation of fine dust particles creates a health danger. Two central, mutually connected phenomena that are assumed to play an important role here are (1) inflammation and (2) oxidative stress. This dissertation shows that the ‘dusty danger’ cannot be so easily defined: particles can cause inflammation related effects without causing oxidative stress or activating the main inflammation switch NF-κB. Indirect effects via stimulation of immune cells appear to be important. Moreover, this dissertation shows that fine dust particles can cause effects in the brains. This has consequences for the risk assessment of fine dust particles.  

Key words:

dust particles, immune cells, risk assessment

“Risk and Return Dynamics”

Research among clients of a large online broker shows that the results of the average Dutch private investor are very disappointing. The feeble performance of internet investors is mainly the consequence of investing in options and of high transaction costs as a result of excessive dealing. Investors with small portfolios and low incomes appear to mainly use options for a gamble on the stock market.  These findings have important implications for policymakers because people become more and more personally responsible for their financial future. Governments should therefore try to increase the financial knowledge of the population by setting up training programmes.

Key words:

private investment results

“Griezelig gewoon. Gotieke verschijningen in Nederlandse romans, 1980-1995.”

This dissertation analyses six Dutch gothic novels by Frans Kellendonk (Letter en Geest), Gerard Reve (De vierde man), Thomas Rosenboom (Vriend van verdienste), Renate Dorrestein (Noorderzon en Het perpetuum mobile van de liefde) and Vonne van der Meer (Spookliefde). Andeweg interprets the gothic as a comment on the fast modernization of the Dutch society in the sixties. By means of gothic elements, such as ghosts and look-alikes, ambivalences about new man-woman relations and sexual emancipation are expressed.  Based on these novel analyses the existing image of the Dutch novel in the eighties can be adjusted. Literature from that period is regularly accused of lack of engagement. Read through the lens of the gothic, the analysed novels turn out to be not unsocial, but very involved in frictions about new definitions of gender, sexuality, social mobility, friendship and religiosity.

Key words:

Dutch novel analysis, gender studies, sexual emancipation, gothic

“Recurrent preeclampsia; prediction, risk counseling and methodological challenges”

Women, who suffered from preeclampsia during an earlier pregnancy, run a strongly increased risk of developing this disorder also in the next pregnancy. The dissertation emphasizes the importance of a correct estimation of the recurrence risk and the related counselling of the women and their partners. An accurate prediction of the recurrence risk requires a combination of several risk factors. By means of relatively simple factors in a so-called predictive model it turned out possible to identify 94% of the women who develop preeclampsia again in the following pregnancy.  The realization of this kind of model involves various challenges, some of which are discussed from a new perspective in this dissertation.

Key words:

preeclampsia, recurrence risk, prediction

“The acute and longer-term effects of different glycemic index carbohydrates on metabolic risk markers in lean and obese subjects”

“Outcome following ten years coronary artery bypass surgery; risk factors for early and late mortality and morbidity”

In a group of 10626 coronary bypass operation patients, who were operated over a period from 1998 through 2007, various risk factors for early and late mortality were studied. Early mortality means less than thirty days after the operation, late mortality is after thirty days. An important conclusion was that the much used EuroSCORE as a risk calculation method is not accurate in predicting early mortality. Patients who had several blood transfusions run a higher risk of dying within thirty days after the operation. An important finding was that patients who were administered plasma with a conservation time of over 320 days showed a 3 times higher mortality than patients who received plasma with a shorter conservation time. Patients without additional risk factors live just as long as the regular Dutch population.

Key words:

coronary bypass, risk factors, mortality

“The introduction of the nurse practitioner in general practice”

The general practice care is under pressure because of in increasingly growing care demand. Because highly qualified nurses take over tasks from GPs and support the practice organization, more patients receive care of the same quality at lower costs. This also improves the process of care provision in the general practice. Thanks to the Nurse Practitioners in the care for people with common complaints GPs can concentrate on the care for patients with complex health problems. Important in this respect is that the financing of general practice care is adjusted.

Key words:

general practice care, nurse practitioner, care demand

“Beauty Pays”

“Fall prevention among people who have sustained an injurious fall: a multidisciplinary approach”

“Macular pigment; In the healthy and diseased retina”

This dissertation studies the central part of the macula, also called ‘yellow spot’ that allows us to see in great detail and in colour. The macular pigment (MP), the substance that colours the yellow spot yellow, has a central role here. A large quantity of MP appears to lower the age-related macular degeneration. This retina disorder is the main cause of visual handicap in industrialized countries. MP consists of substances that are absorbed from food. This dissertation focuses on measuring the MP in an objective, reproducible way so that research into the role of MP and retina disorders can be conducted in a reliable way. Among others, it turns out that people with much MP have a more sizeable retina. Also an abnormal MP distribution was found in two rare retina disorders. 

Key words:

ophthalmology, macula pigment, age-related macular degeneration

“State of the (he)art: prikkelen, rekken en samentrekken”

“Cognitive dynamics of fluent reading and spelling development”

Fluent reading is essential for good functioning in our knowledge society. This dissertation studied how the reading system develops, and whether the reading development depends on the orthographic structure of a language. Some languages namely have a much more distinct relation between writing and pronunciation than others, and this could influence the reading development. However, research showed that the reading system develops in a universal manner, and that in all studied languages the same processes underlie the process of learning to read. The speed at which a child learns to read, however, is in fact influenced by the orthographic structure of the language.

Key words:

reading development, dyslexia, orthographics

“Loss and risk aversion in games and decisions”

“Perinatal mortality in the Netherlands: perinatal audit and fetal biometry”

In the Netherlands, almost 1 out of 100 children dies before, during or in the first four weeks after birth. This is more than in most other EU countries. This dissertation outlines the causes of perinatal mortality, describes the possible factors that might play a role here, as well as the avoidability of perinatal mortality in the Netherlands. It turns out that growth delay, premature birth and multiple pregnancies contribute importantly to the perinatal mortality. By means of fetal growth curves for skull and belly perimeter based on echography the fetal growth at the beginning of the third pregnancy quarter can be assessed more accurately in the regular midwife practice than before. This could lead to timely referral in case of disorders in fetal growth and a decrease of perinatal mortality. 

Key words:
Perinatal mortality, perinatal audit, fetal biometry, substandard care, avoidability..

“Distributional choices in EU climate change law and policy. Towards a principled approach?”

This thesis analyses, from the perspective of legal principles, choices made in EU law concerning the distribution of benefits and costs arising from climate change policies. It recommends making a number of changes to EU climate change law, to reduce tensions between choices and principles. Examples are: review EU policy on biofuels, particularly in relation to imported biofuels; review the approach of the EU to burden sharing between Member States, to ensure that old Member States do not profit from past inactions; monitor closely the interactions that may take place among mitigation measures recently adopted, in order to swiftly correct undesired (distributional) impacts; reconsider the EU approach to burden sharing at international level, in particular the equal per capita approach, and start considering at theoretical level the feasibility of EU-wide personal carbon trading.

Key words:

climate change policies, EU law

“Compensating catastrophe victims; a comparative law and economic approach”​

“Sociaal-Psychiatrische verpleegkunde: de ontwikkeling van een verpleegkundig specialisme in het domein van de Nederlandse sociale psychiatrie”

“Toll-like receptors in development, health and disease”

“Replicating DNA at Top Speed – Chromatin at Risk”

“Understanding fatigue in multiple sclerosis. From a psychological perspective”​

“Immunosuppressive and anti-proteolytic therapy in vascular diseases”

“Modest expectations; causes and effects of migration on migrant households in source countries”

This research, mainly looking at Albania and Moldova, investigates the reasons why people migrate internationally and send remittances. It also analyses the consequences of internal migration on the wellbeing of migrants and their family and how it affects the relationship between family members. It shows that migrant households earn higher incomes after migration, but are worse off in many aspects, e.g. housing. This is because they live in poor, semi-legal conditions and because migration is an expensive investment. Consequently, family solidarity remains high after migration, especially financial and good transfers.

Keywords:

Migration, remittances, Albania, Moldova, family, transfers

“Stroke survivors with aphasia and their social participation”

“Preventing Irreparable Harm Provisional Measures in International Human Rights Adjudication”​

“Carotid baroreflex activation; a novel method to treat resistant hypertension”

“Molecular Genetic Analysis of Patients with Rare Bleeding; disorders in South Iran”

“Modeling asymmetric and time-varying dependence”

This research is concerned with developing and extending models for dependencies between economic variables. Many techniques exist to capture such co-movements and this thesis focuses on a class of functions called copulas or dependence functions. Although with the help of copulas one can model and capture very distinct forms of dependence, most of the literature assumes that the type and degree of dependence remains constant over time. This research shows how one can relax this restriction, and it shows the usefulness of these so called time-varying copulas for investment decisions and by studying the contagion of financial crisis.

Key words:

economic variables, copulas

“Molecular and cellular alterations in the aging and Alzheimer’s disease brain: implications for therapeutic and preventative strategies”

“Climate change and tourism”

“The impact of supervised exercise therapy on intermittent claudication”​

“Waarom sommigen liever leraar worden en anderen beter geen bankier kunnen worden”

“The chicken embryo as a model for ductus arteriosus developmental biology”

“Oxygen Stress; effect on pre- and perinatal development and vascular reactivity”

“Network Formation Games”

“Macroeconomic Forecasting using Business Cycle Leading Indicators”

“Cortical processing of pain: a bridge between experimental findings and clinical applications”

Pain is a subjective experience. This means that not only psychical factors but also psychological, cognitive, social and environmental factors influence the way pain is perceived. This subjective character makes direct measurement of pain impossible. Pain Event-Related Potentials (pain-ERP) represent the cortical response to pain and are thought to be a more objective measure compared to self-report measures such as Visual Analogue Scales. However, the pain-ERP is a rather complex measure which contains considerable variability. This variability most probably is caused by other (pain-related) information which needs to be identified. This thesis discusses the use of Event-Related Potentials in pain research. More specifically, it discusses methodological concerns and ideas about unravelling the pain-ERP.

“Towards an inclusive society; healthcare for people with intellectual disability”

“The nucleus accumbens: stimulate your impulse”

“Onset, course and comorbidity of bipolar symptoms and treatment setting”

Manic, depressive and psychotic symptoms can be part of the bipolar disorder, also called manic depression. The seriousness, the tempo of improvement and the impact of these symptoms turn out to be influenced by various factors, such as the use of cannabis or other drugs, or the simultaneous occurrence of the symptoms. Also an unfavourable social context, such as not having a relationship or being in a dependent living situation, appears to have a negative effect on the seriousness and impact of these symptoms. Furthermore, the research provides indirect indications of a general deviation in dopamine activity in the brain of patients with a bipolar disorder.

Key words:

bipolar disorder, cannabis, dopamine activity

“Fetal asphyxia: Friend or foe?”

Asphyxia before, during or shortly after birth is worldwide one of the most common problems in obstetrics. It is the most common cause of death of newly born children. The cause is mostly defective oxygen supply, for example because of a detaching placenta or pinched umbilical cord. Depending on the seriousness of the lack of oxygen this can lead to brain damage. Little or nothing is known about the long-term effects of asphyxia. It could possibly be an important factor that contributes to neurodegenerative diseases (for example Parkinson). This dissertation shows that serious fetal asphyxia leads to disorders in the motor activity and anxiety behaviour, along with the loss of the accompanying brain cells. Also the number of connections between brain cells changes. The second part of this dissertation shows that asphyxia, when it is sufficiently mild, can also offer protection, because it makes the tissue more resistant against the damaging effects of long-term asphyxia (asphyctic preconditioning).

Key words:

asphyxia, brain damage, newly born children

“Sexual risk behavior and mental health of young gay men”

Men who have sex with men continue to run a risk of getting a HIV infection as a result of unprotected anal sex. Research shows that sexual risk behaviour occurs among young men. This dissertation describes among others longitudinal studies into the sexual risk behaviour of gay young men during their coming out. The results show that a substantial part of the gay young men uses no condoms during their first anal sex experience and during consecutive episodes of anal sex. This requires HIV preventive interventions so that this target group is urged to always use condoms during anal sex. 
(This dissertation was realized with the support of the Aids Fund)

Key words:

HIV infection, young gay men, sexual risk behaviour

“Quantitative contrast-enhanced MRI of the microvasculature”

The growth of new, microscopically small blood vessels plays an important role in a series of very common diseases, such as cancer and heart attacks. Currently, for example, new therapies are being developed that can inhibit vessel growth in malignant tumours, or that can in fact stimulate vessel growth in the heart after an infarct. However, to be able to evaluate and direct these therapies at an early stage non-invasive techniques are required. This dissertation describes the application of new MRI techniques that allow the selective imaging of vessel growth in tumours and in the heart muscle.  This is an important step towards early diagnostics of vessel growth and therapy-monitoring of these patients.

Key words:

blood vessel growth, MRI, diagnostics

“Prognosis in complex regional pain syndrome 1”

Complex Regional Pain Syndrome 1 (CPRS-1) is een chronische aandoening, gekarakteriseerd door pijn, pathologische veranderingen in bot en huid, overdadig zweten, zwellingen en extreme gevoeligheid voor aanraken. Symptomen treden meestal op in een van de ledematen, na verwonding of chirurgische ingrepen. Hoewel CPRS-1 in de klinische praktijk betrekkelijk vaak voorkomt, is er nog weinig bekend over deze aandoening. De diagnose wordt meestal laat gesteld, omdat de symptomen overeenkomen met normale posttraumatische verschijnselen. Het proefschrift bestaat uit een serie onderzoeksprojecten, waaronder het ontwerp van een prospectieve cohortstudie om een prognostisch risicoprofiel voor deze patiënten te ontwikkelen. De bedoeling is om een klinische database aan te leggen van patiënten die twee jaar lang worden gevolgd.

Key words:

Complex Regional Pain Syndrome 1, post-traumatic phenomena

“Multinational Subsidiary Evolution: corporate change in new EU member states”

“Technology transfer and learning under the Kyoto regime: Exploring the technological impact of  CDM projects in developing countries”

“Genetic determinants of emotional processing in anxiety and depression – some implications for treatment response”

“Efficacy of macronutrients on targeting Obesity and beyond”

This dissertation shows that weight loss is efficiently achieved with a daily protein intake of 0.8-1.2g/kg bodyweight, while the fat and carbohydrate intake is drastically lowered. Loss of weight is followed by maintaining the obtained weight: that requires a daily protein intake of 1.2g/kg bodyweight, again with a low fat and carbohydrate intake. This results in a lasting lower bodyweight, with a lower fat content and favourable metabolic profile, without negative consequences for the kidney function. So, 0.8g/kg is sufficient, but 1.2g/kg bodyweight is more efficient in the long term. These findings can be implemented in professionally supervised diet programmes.

Key words:

obesity, overweight, diets, body composition, macronutrients, protein intake

“Financial Risk Management”

With newly discovered data this dissertation provides insight in the dynamics of the bubble and crash in the year 1720. Although for many years this bubble was regarded a classic example of speculative mania and irrational behaviour, we show that innovation in the Atlantic trade and the birth of a new business organization for insurance companies played an important role in the investors’ enthusiasm. For example, in 1720 the insurance company Stad Rotterdam was established and it still exists as a division of Fortis. The dissertation shows also that the cost levels of pension funds are considerably lower than those of investment funds and that there are important scale economies in costs of pension funds. We also show that the risk adjusted returns of pension funds on average and after deduction of costs are higher than those of investment funds.

Key words:

speculative mania, pension funds, investment funds

“Molecular Imaging of Atherosclerosis and Thrombus Formation”

Cardiovascular diseases are an important cause of death in the Netherlands. The underlying cause of these diseases is often atherosclerosis. When atherosclerotic plaques tear, this can lead to thrombi that can lead to a heart or brain infarct.  This dissertation describes various contrast agents for molecular imaging, a new research area which allow the visualization of specific molecules or processes for certain diseases by means of, for example, Magnetic Resonance Imaging (MRI). It turned out possible, among others, to detect fresh thrombi. In the future, molecular imaging can possibly play a role in the clinical assessment of atherosclerosis and thrombus formation. 
(This research was partly financed by the Nederlandse Hartstichting.)

Key words:

atherosclerosis, thrombus formation, molecular imaging

“Cell-type specific CD40-CD40L interactions in atherosclerosis”

Atherosclerosis is a chronic inflammatory disease of the large arteries, characterized by the build-up of fat, inflammatory cells and connective tissue (plaques). Earlier research showed that inhibition of the molecule CD40 leads to smaller and more stable plaques. However, the specific function of the CD40(L) per cell type in atherosclerosis is not yet known. Therefore in this dissertation the underlying mechanism was unravelled. Binding two types of proteins (TRAFs) to CD40 turns out to play an important role there. Blocking the binding place for TRAF-6 to CD40 appears an effective way of inhibiting plaque formation. This research provides important new insights in the role of the immune system, and of CD40-CD40L interactions in particular, in the pathogenesis of atherosclerosis. This newly acquired knowledge can contribute to the development of more purposeful treatment. 
(This dissertation was also realized with financial support of the Nederlandse Hartstichting.)

Key words:

atherosclerosis, plaques, CD40, TRAF-6

“Economic evaluation in fertility research”

About 10-15% of the people who want to become pregnant face fertility problems. It is important to determine the cause of the fertility problem as fast as possible, so that the right treatment can be quickly applied. This dissertation describes the efficiency of various techniques for the treatment of lower fertility. For this purpose, the study particularly investigated which embryo transferral strategy in IVF is the most cost effective. The transferral of two embryos has in all cases the best chance of being successful, but it is the most expensive. With regard to cost effectiveness the preferred strategy depends on what the society is prepared to pay for one extra successful pregnancy.

Key words:

fertility problems, cost effectiveness, IVF

“Intermittent Claudication”

“Genetics in the news; studying the effects of Mass media genetic health messages on health cognitions and behaviour”

The social value of technological applications of genetics, such as genetic screening, can be enormously improved by informing the public about them.  Mass communication, however, is too general and can at best indicate possible individual differences in DNA structure. Mass media genetic health messages often lead to denial of susceptibility and do not motivate to change of unhealthy behaviour. Because of the lack of personal relevance the mass media therefore do not appear to be the ideal communication channel for the improvement of preventive behaviour on the basis of genetic information. Recommended is specifically aimed communication explaining the meaning of the message for the recipient, and additional advice about changes in lifestyle.

Key words:

genetics, mass communication, prevention

“Politics of Provision; the co-production of Genetic technologies and health care arrangements in Germany, the Netherlands, and the United Kingdom”

Genetic research for the determination of a genetic predisposition for a disease is not covered by the health care insurance in everyone’s case. This dissertation studies the procedure of selection for participation and coverage in Germany, the Netherlands and the United Kingdom. It turns out that differences in the organisation of health care and the stand towards genetics lead to the use of different criteria in these countries. In the Netherlands, for example, the criteria are focused on the coverage of various patients and risk groups, whereas the United Kingdom wants to reach the largest possible percentage of the total population. Exclusion from research then has mainly to do with the way health care systems deal with new technologies (such as genetics). This is a reason for a broad political discussion about the coverage of new health care technologies.

Key words:

genetic research, health care system

“Herordening van het sacrale. Religie, ethiek en zorginnovatie”

“Noninvasive imaging of hypoxia, hypoxia response and drug delivery”

Imaging (PET/CT scan) in cancer patients is an increasingly important element in both diagnosis and treatment. Hypoxia (lack of oxygen) is an important characteristic of tumours that causes resistance against cancer treatments. For efficient treatment of hypoxia it is important to know to which extent and where hypoxia is present in a tumour. This dissertation shows the possibility of determining hypoxia and the reaction of the cell to that low oxygen tension in a non-invasive way.  We also proved that imaging is useful to follow the absorption of medication against cancer. Imaging will ultimately lead to an increased chance of survival by quicker and better selection of patients for specific treatments. 

Key words:

cancer, imaging, hypoxia

“Interactive Epistemology and Reasoning: On the foundations of Game Theory”

This PhD thesis is about epistemic game theory, which is a field that studies how people reason about their opponents before making a decision. So we are interested in what is going on in a person’s mind before he comes to choose. The analysis consists of two steps: First we try to describe the person’s way of reasoning by means of a formal mathematical model. Then, we ask which patterns of reasoning seem reasonable, and try to find out the choices that can be made under such natural ways of reasoning. The field of epistemic game theory is thus on the interface between psychology, philosophy, mathematics, economics, and decision theory.

Key words:

game theory, epistemic approach

“Thrombin generation and fibrin formation in dilutional coagulopathy; towards improved peri-operative transfusion protocols”

“Impression Management in Consultancy: Behavior tendencies, processes, and effectiveness”

People are able to select the information they display to others in order to make a desired impression and thereby change others’ thinking and subsequent behavior. This so-called impression management (IM) is expected to make a difference for consultants’ performance. This dissertation deals with the question whether and how IM can have such an influence. The results indicate that certain IM behaviors positively influence consultants’ performance. However, IM can as well lead to the experience of stress and deteriorate consultants’ performance levels. It was found that personal characteristics, as e.g. age and cultural background were found to have an effect on IM choice. Moreover, it was learned that the IM effect vanishes over time. The results lead to the conclusion that IM should be seen as an integral part of a consultant work performance. Selection processes and training sessions are seen as possible ways to find and train not only good consultants but also good impression managers.

Key words:

impression management, behavior, consultant

“Prevalence and Factors Associated with Depressive Morbidity in Women Visiting Perinatal Primary Health Care Settings of Dar es Salaam, Tanzania”

“Heart failure self-management: balancing between medical and psychosocial needs; evaluation of a cognitive-behavioural self-management group programme”

Self-management plays an important role in dealing with chronic heart failure in day-to-day life. In the American ‘Chronic Disease Self-Management Programme’ (CDSMP) people learn to handle the medical, social and emotional consequences of their chronic disease. Effectiveness and applicability of this group programme was investigated in a randomized study on heart failure patients. The meetings (2.5 hours) every six weeks were presided by a trained pair, consisting of a specialized nurse and a heart failure patient. The programme turns out to be usable and effective in the short term. However, earlier shown long-term effects fail to appear. This can possibly be explained by differences in health care, where the CDSMP in its present form possibly adds too little to the existing health care offer for heart failure patients in the Netherlands. 
(This research was financially supported by the ‘Nederlandse Hartstichting’ and the ‘Profileringsfonds’ University Hospital Maastricht.)

Key words:

zelfmanagement, hartfalen, evaluatieonderzoek

“Immune modulation by dietary glucans from oat and mushrooms; results from in vitro, animal and human studies”

There is more and more evidence that the immune reaction, and along with that the risk of certain diseases, is influenced by nutrients. Examples of such a nutrient are glucans that are found in oats and mushrooms. Therefore, in this dissertation we studied the effects of alfa- and bèta-glucans on immune reactions in the intestine and to a lesser degree in the entire body (systemic immune reactions). Our studies showed that the consumption of bèta-glucan from oats advance the immune reaction in the intestine in vitro (“in the test-tube”) in people and in vivo (“in the body”) in mice, while it does not stimulate the systemic immune reaction. Consumption of both alfa- and bèta-glucans from mushrooms stimulate the systemic immune cells of mice in vitro but the alfa-glucans had no clear effect on the systemic immune response in people.

Key words:

immune system, nutrition, glucans

“Gut feelings in General Practice”

Reason and feeling closely cooperate in general practitioners’ diagnostic thinking. GPs sometimes experience gut feelings in the patient contact. Researchers from the universities of Maastricht and Antwerp showed that most GPs take those feelings seriously and that these feelings can direct their diagnostic actions. Also medical disciplinary committees take the gut feelings seriously, witness the fact that in the Netherlands they reproached GPs en specialists regularly in the past ten years for not listening to their gut feelings. The researchers have established an international research agenda to further study and improve the diagnostic meaning of the gut feelings.

Key words:

general practitioner, diagnostics, gut-feeling

“The regulation of protein synthesis by mTOR signaling: a potential target for cancer treatment?”

During the development of cancer, the activity of the protein kinase mTOR is often elevated, leading to increased proliferation and survival of tumor cells. It is thought that mTOR does this by influencing protein synthesis. This thesis describes how mTOR inhibits protein synthesis under reduced oxygen levels (hypoxia), a common feature of solid tumors. Furthermore, the results show that blocking mTOR activity with a drug called rapamycin slows tumor growth, but that it also increases the amount of hypoxic tumor tissue, an undesirable effect that can make tumors more aggressive and resistant to conventional therapy.

Key words:

cancer, mTOR, hypoxia, rapamycin

“Respiratory tract infections in general practice – enhanced communication skills and C-reactive protein testing to optimize management”

Many Dutchmen visit their general practitioner each year with serious complaints about coughing that can restrict their daily occupations. Usually, antibiotics don’t work in the case of coughing complaints that are caused by respiratory tract infections. But still, they are often prescribed and used. This dissertation studied the treatment methods for 659 patients of 70 general practitioners with a view to make the antibiotics use for coughing complaints more adequate. When general practitioners used a short-term test to exclude serious infections (the so-called C-reactive protein test on one single drop of blood) or gave their patients the necessary explanation after training in communication skills, they prescribed considerably fewer antibiotics, while the patients recovered just as quickly. (Funding: ZonMW).

Key words:

respiratory tract infections, cough, antibiotics, general practice, common complaints

“The realities of life for people with severe and profound intellectual disabilities and mental health problems”

“The role of haptoglobin phenotype and 24-hour blood pressure characteristics in cerebral small vessel disease”

“Exercise training in cancer survivors”

At the end of the nineties, rest was regarded the best approach for patients who recovered from treatment after cancer. In her dissertation, however, Ingrid De Backer shows that in fact an intensive training programme strongly improves the physical condition and quality of life of these patients. Such training programmes should be individually oriented by means of reliable and valid effort tests. A highly intensive power and interval training turns out possible for almost all patients provided they receive good support. The result is a substantial improvement of muscular strength, condition, fatigue and quality of life. These positive effects remain up to a year after the end of the training programme. Compared to a patient group that received no training there was a difference in muscular strength of approximately 65 % about 18 months after treatment.  Finally a considerable part (20%) of quality life of cancer patients can be explained by physical variables among which muscular strength and permanent shape.

“WIRED for learning. How computers can support interaction in small Group learning in higher education”

“The Tension between Rules Regulating the (Liberal) Professions and EC Competition Law – Reason and Passion in discussing professional regulation in EC competition law”

This dissertation studies the classic liberal professions, i.e. the legal, medical, technical and accountancy professions. In spite of the fact that the modus operandi of the free professions limits the access and practice of them, these professions are traditionally regarded to be in the general interest because – besides their economic interest – they assume a public role.  This dissertation examines the public interest of having an effective system for, for example, health care and administration of justice, and relates it to the European Competition Law with its guarantees for the functioning of the rule of law.

“Knowledge, Learning, and Teaching: Studies on the application of constructivist principles in higher education”

“The interstitial cells of the urinary bladder”

“Why stress causes psychosis and psychosis causes stress”

Stress plays an important role in the development of a psychosis. This dissertation studies the underlying mechanisms of this stress sensitivity. It turns out that trauma in childhood leads to greater stress sensitivity in adulthood, which in turn is a risk for the development of psychosis. People with sensitivity to psychosis also appear to show deviations in the stress hormone cortisol. Moreover, psychotic symptoms themselves also cause stress with which patients sometimes find it difficult to cope. Bases on these results it appears important to attune the treatment of psychosis more to this underlying stress sensitivity. 

Key words:

psychose, stress, stressgevoeligheid, trauma, cortisol, coping

“Evaluation of the Primary Mouse Hepatocyte Model for the Prediction of Genotoxicity”

“New approaches for immune modulation in Myasthenia Gravis”

“Biomechanical Analysis for Abodominal Aortic Aneurysm Risk Stratification”

The aorta is the biggest coronary artery in the body. Infections and weakening of the aorta wall can cause a widening in the aorta, a so-called aneurysm. Aneurysms occur the most often in the abdominal aorta in the navel area (then it is called an AAA). About 4% of the men over 55 years old have an AAA, and 1% of the women. AAA’s become increasingly wide and the risk of aorta wall rupture increases. Whether the wall will rupture not only depends on the maximum diameter, as is assumed in current diagnoses. A better risk prediction can be made by calculating the wall tension. In this dissertation these calculations were optimized and standardized for future diagnoses.

“Quality of life and criminal recidivism in forensic outpatients with personality disorders. A good live approach”

In the treatment of patients with a personality disorder who committed an offence the emphasis is on reducing the risk of offence repetition. Until recently, there was hardly any attention for risk factors that can have a protective effect. This dissertation focuses on the possibly protective effect of certain factors, namely the life conditions of the patient and the degree of satisfaction about these conditions, outlined in the concept quality of life. The results show that participation in social institutions, and particularly organized recreation, can have a protective effect. Moreover it turned out that satisfaction with various domains and general satisfaction, as well as the way a person feels in life, can be protective for criminal behaviour. Quality of life is a subject that deserves attention in the treatment of forensic patients, with a view to reduce the risk of offence repetition.

Key words:

forensic psychiatry, quality of life, protective factors

“Use of tacrolimus in Chinese renal transplant recipients”

“Dietary Determinants of Obesity”

In this thesis we investigated the associations of dietary glycemic index (GI), glycemic load (GL), energy density (ED) and fiber intake with change of body weight and waist circumference, using data from a large cohort study with participants from five European countries. We found a beneficial effect of low GI, high fiber, low ED diet in the prevention of weight and waist gain, in spite of the small effect sizes. In addition, a significant interaction between dietary GI and a genetic variant was observed. Our results suggest that it may be appropriate to recommend a low ED, high fiber and low GI diet for the prevention of (abdominal) obesity

Key words:

obesity, diet, glycemic index, glycemic load, energy density

“Mechanisms of Vasidilation in early pregnancy. Studies in instrumented consciousrats and isolated rat arteries”.

“A molecular basis for the loss of muscle oxidative phenotype: Implications for COPD”

Chronic obstructive pulmonary disease (COPD), associated with smoking behaviour of years, is characterized, not only by a loss of lung function, but also by deviations in the metabolism of the leg muscles which causes the muscles to acidify more quickly. Because of this, the patients tires quickly and he is restricted in his daily functioning. This dissertation shows that important regulators of muscle metabolism are less present in the leg muscles of COPD patients. This reduction of the protein content is inversely related to the quantity of inflammatory substances in the blood. Moreover, we show that the inflammations in the muscle can be directly involved in deviations in the muscle metabolism. This opens new perspectives for the use of anti-inflammatory substances in the treatment of these deviations.

Key words:

COPD, spiermetabolisme, ontsteking

“Toddling ‘long the River Meuse. Integrated Assessment and participatory Agent Based Modelling to support River Management”

“Role of Neutrophils in Pulmonary DNA damage and repair”

Chronic pneumonia is an important risk factor for the development of pulmonary cancer. This dissertation studied the infiltration of neutrophils in the bronchial tubes as a possible cancer enhancing mechanism of inflammation. Neutrophils form an important source of oxygen radicals (RZS) in the inflamed lung. The release of these RZS increases the damage to the genetic material (DNA) in the lung and obstructs its recovery. The inhibition of the DNA recovery can anchor the DNA damage and thus initiate cancer. Of course, these findings are also important for other organs in which the development of cancer can be associated with a previously existing inflammation.

Key words:

pulmonary cancer, neutrophils, oxygen radicals, DNA

“Monotonicity and Bayes-Nash Implementation”

“A wavelet approach to cardiac signal processing for low-power hardware applications”

The number of deaths caused by hearth diseases has been reduced among others by implantable applications such as pacemakers. The better we can inform the pacemaker about what goes on in the heart, the better it can do its job. By using so-called wavelets measured heart signals are reproduced differently so that they can be filtered and show specific characteristics of the heart, for example the heartbeat. The dissertation describes a design procedure for wavelets, linked to a specific task. It also describes how these wavelets can be incorporated in analogue chips, as a result of which they use little power and are suitable for use in implantable applications.

Key words:

heart, signal processing, analogue, wavelet, wavelet design, ECG, L2 approach

“Cerebral microembolic signals in cardiac interventions”

The quantity of microembolisms in the brain is an indication of possible neurologic complications. A comparison in the number of cerebral microembolisms shows that in a minimal invasive surgical intervention for cardiac arrhythmias (pulmonary vein ablation -PVI) there is less risk of postoperative neurologic complications than in the standard cardiologic therapy. In the cardiologic therapy, where a catheter is brought into the heart, the quantity of cerebral microembolisms depends on the type of catheter. During open-heart surgery the formation of microembolisms is inevitable. A new technology can prevent that they end up in the brain vessels. By placing an ultrasound transducer on the aorta during open-heart surgery, microembolisms can be deflected under the emission of ultrasound in the direction of the aorta descendens.

Key words:

cerebral microembolisms, cardiac arrhythmias, neurological complications

“Hormone-induced changes in the coagulation system”

The hormonal changes during pregnancy and contraceptive use are risk factors for venous thrombosis. In this thesis the effects of oral contraceptives on coagulation were compared with that of hormonal contraceptives with alternative (transdermal, vaginal, intrauterine) routes of administration. Furthermore, we studied the underlying mechanisms of the hormone-induced prothrombotic changes in a mouse model. The results of the studies indicate that the hormone-induced risk of venous thrombosis can at least partially be explained by a decrease of the plasma levels of natural anticoagulants, i.e. tissue factor pathway inhibitor and protein S. A better understanding of the hormone-induced changes in coagulation may help to reduce the incidence of thrombosis during hormonal contraception or pregnancy.

Key words:

hormonal contraception, venous thrombosis, coagulation system

“VEGFR-1 function and dysfunction in monocytes”

Monocytes are white blood cells that are involved in wound healing and the growth of blood vessels. Monocytes migrate to the location where new blood vessels are formed because they are drawn by the growth factors VEGF-A and PIGF (via stimulation of VEGF receptor-1). This ‘chemotactic’ response is weakened in diabetes patients. This dissertation studied the monocyte migration at the molecular level and investigated how this process is disturbed in diabetics. This research found indications that the weakened chemotactic response is caused by an increased RAGE expression and increased oxidative stress, leading to desenzitation of the VEGRF-1 responses. These findings can be regarded as a new molecular concept for diabetes-related cellular dysfunction.

Trefwoorden:

monocyten, diabetes

“Gait and balance characteristics in patients with diabetes type 2. Evalaution and treatment efficacy”

The World Health Organization has described type 2 diabetes as an international epidemic. This PhD project showed that the gait capacity of diabetic individuals decreases and fall risk increases at an early stage of the disease. In addition the effect of a specific training (physiotherapeutic group training including gait and balance exercises with function-orientated strengthening) on patients’ gait and balance was tested. The specific training could improve diabetic patients’ gait speed and balance and increase muscle strength and joint mobility. Further studies are needed to explore these improvements’ influence on the number of reported falls, patients’ physical activity level and quality of life.

“Epidemiological studies into prodromes and risk factors for cognitive decline and dementia”

“Doing Artworks”

During the last three decades, installation artworks have become mainstream in contemporary artistic practices. Acquiring and displaying such works, however, implies that curators and conservators have to deal with obsolete technologies, ephemeral materials and other problems concerning the care and management of these artworks. Installation artworks challenge traditional museum practices of collecting and conservation. How do museums approach these challenges and how to understand the role of conservation theory and ethics in these practices? Drawing on fieldwork in contemporary art museums, this thesis explores how key concepts such as authenticity and artist’s intention figure in day-to-day museum work. Moreover, the study shows how conservation practices behind-the-scenes play an important role in the perpetuation of installation artworks. Consequently, it argues that the common distinction between front (presentation and display) and back (conservation and collection management) is particularly untenable in the case of installation artworks. 

Key words:

contemporary art, conservation and restoration, museums, cultural heritage

“Lumbar extensor training in low back pain management”

“A dynamic Model of the Qnset of Clinical Psychosis from an Epidemiological Perspective”

Although psychosis has been commonly considered a rare phenomenon outside the range of normal human experience, psychotic experiences have been shown to be expressed at levels well below its clinical manifestation. This thesis examines how the psychosis phenotype exists in nature and investigates the dynamic process driving psychosis expression from mental wellness to onset of clinical psychosis within the general population. Ten percent of the general population have attenuated psychotic experiences which are mostly transitory. When influenced by stress-related environmental risk factors these experiences become abnormally persistent, with an increasing risk of becoming clinically relevant over time. Both the individual’s developmental liability and the context of affective deregulation play a roll driving psychosis expression to the onset of clinical psychosis.

Key words:

psychosis, emotional disadjustment, adolescents

“Modulation and Adaption in the Normal and Obstructed Urinary Bladder”

Patients with an Overactive Bladder (OAB) syndrome suffer from uncontrollable urge to urinate, incontinence and frequent urinating. In the Netherlands 12% of the people suffer from the OAB syndrome. It occurs among others in men with an enlarged prostate. This dissertation discusses bladder disorders as a consequence of a narrowing of the guinea-pig urethra, a simulation model for prostate enlargement. Our hypothesis is that an increased bladder muscle activity stimulates sensory nerves in the bladder wall which can cause urinary complaints. Particularly investigated was the role that interstitial cells, prostaglandins and oxidative stress play here. A better understanding of changes in the bladder wall contributes to more effective treatment methods for patients with overactive urinary complaints.

Key words:

bladder, obstruction, urinary incontinence.

“Embryological and surgical aspects of the tethered cord”

In a tethered cord, the spinal marrow because of a development disorder, that is always part of the spina bifida spectrum, fixed at a certain point in the vertebra channel. In many cases this leads to neurological failure. This dissertation describes the neurosurgical treatment of several rare innate disorders of the central nervous system, associated with a tethered cord. The emphasis is on the embryological origin, the clinical and radiological diagnostics and the neurosurgical treatment. The new insights into the embryological development and detailed descriptions of the surgical anatomy are guidelines for the treatment of patients with these rare disorders. Some of these new insights were recently incorporated in an international study book on paediatric neurosurgery.

Key words:

spina bifida, tethered cord, neurosurgery, embryology

“On Regional Differences in Sick Leave. The role of work, individual and health characteristics and socio-cultural environment”

This dissertation concludes that – besides sickness or type of work – region-bound socio-cultural factors influence sick leave. For reducing sick leave in certain regions on the national level, regional socio-cultural differences must be taken into account, because they can cause a different effect from sick leave determinants per region that are known in the literature. In this research that is, for example, the sick leave determinant autonomy on the work floor. Among others (inter)nationally operating companies and safety, health and welfare services have to be aware of that. The propositions with the dissertation among others discuss the lack of a legal regulation for the assessment of applications in the domain ‘care and wellbeing’ (AWBZ and Wmo), which puts the implementation quality of these laws under pressure. 

Key words:

sick leave, region-bound

“More bang for your Buck. The effects of consumer experience, multiple brand association types, and brand alliance form on the perceived value of education”