International Migration, Integration and Social Cohesion online publications
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Delusion infestation:From definition to treatment
No full textDelusional infestation (DI) is a rare but disabling psychiatric disorder in which patients are convinced they are infested with parasites or other (non-)living organisms, despite the absence of medical evidence. The condition causes severe psychological distress, social isolation, and a markedly reduced quality of life. Patients often present to dermatologists, but effective management requires close collaboration with psychiatry.This thesis explores the clinical variation within DI, the organizational and communicative barriers to care, and strategies for more harmonized and patient-centered management. The findings show that the itch experienced in DI is not associated with immunological abnormalities, suggesting a perceptual rather than inflammatory origin. Triggers such as post-scabies itch, dopaminergic medication, and stimulant use (e.g., cocaine and amphetamines) may precipitate or exacerbate symptoms.The therapeutic section demonstrates that loss to follow-up and poor adherence are common, often related to limited illness insight and mistrust. Moral case deliberation revealed that direct confrontation with delusional beliefs is usually counterproductive; instead, a gradual, symptom-focused approach fosters trust and collaboration.An international survey highlighted major differences in clinical practice across Europe. A subsequent Delphi consensus study established core diagnostic criteria, a stepwise treatment pathway, and recommendations for collaboration between dermatology and psychiatry.In summary, this thesis shows that DI represents a clinical spectrum in which somatic and psychological factors converge, and that effective care requires integration, standardization, and empathic communication
Advancinc gastric cancer care:Insights into staging, preoperative treatment, and surgical techniques
No full textGastric cancer is among the most common malignancies worldwide and remains a leading cause of cancer-related mortality. In the Netherlands, approximately 1,000 patients are diagnosed each year, of whom around 400 are eligible for potentially curative treatment. Managing gastric cancer involves a series of decisions that must balance oncological outcomes with patient resilience, biological variability, safety and practical feasibility. This thesis set out to examine some of the most pressing questions in that continuum: how to stage disease more accurately, how to apply systemic therapy in older patients, and how to refine surgical techniques. In doing so, it highlights the enduring value of staging laparoscopy, but also its potential limitations, calling attention to the need for more sensitive tools, such as fluorescence-guided imaging. It examines real-world treatment allocation in older patients, revealing both the rationale and the potential risks of current clinical decision-making. It challenges the routine practice of omentectomy, arguing for evidence rather than tradition, and demonstrated that while minimally invasive subtotal gastrectomy has matured into a safe and effective approach, minimally invasive total gastrectomy may still require caution and further refinement. Taken together, this thesis offers a contribution to modern gastric cancer care: grounded in clinical reality, informed by evidence, and open to innovations
Improving insomnia care in patients with medical comorbidity:Addressing sleepless nights and fatigued days
No full textThis thesis describes studies investigating insomnia in patients with medical comorbidity, focusing on both sleepless nights and daytime fatigue. In a cross-sectional case-controlled study the prevalence of clinical insomnia and subjective sleep characteristics were examined in patients with post-COVID-19 fatigue. Insomnia was reported by 65% percent of patients. It is important that healthcare providers recognize and address insomnia, particularly when severe fatigue is present. In an observational study it was investigated whether the co-occurrence of fatigue and insomnia influences the outcomes of Cognitive Behavioural Therapy for fatigue (CBT-F) and for insomnia (CBT-I). Symptom-focused CBT was found effective even when insomnia and fatigue co-occur, though both symptoms should be re-assessed post-treatment for possible additional interventions if the co-occurring symptom persist. In the TIMELAPSE study, it was examined if a low dose Amitriptyline (AM), a sedating antidepressant often used off-label as sleep medication, was a safe alternative to CBT-I in treating insomnia in patients with medical comorbidity. TIMELAPSE was a multicenter randomized controlled non-inferiority trial. AM was found to be non-inferior to CBT-I at 12 weeks treatment. However, fewer patients showed clinical improvement with AM, AM had more side-effects and there were indications that it had limited long-term efficacy. CBT-I was also effective in patients who initially preferred pharmacological treatment. Therefore, CBT-I should remain the first-line treatment for patients with insomnia with medical comorbidity. Implementation of the clinical implications of our studies can improve insomnia care for patients with medical comorbidity
The Demon and the Prostitute:Justinian and Theodora in Procopius’s biographical <i>Secret History</i> from sixth-century CE Constantinople
No full textProcopius’ sixth-century Secret History combines biographic material with other literary genres, such as rhetorical invective and political satire. It purports to reveal the ugly truth about Emperor Justinian and Empress Theodora. As such, it is a clear attempt at character assassination. This paper explores (1) how Procopius sought to create a reliable narrator character in order to launch credible character attacks. and (2) how he employed alleged biographic facts to paint extremely hostile portraits of Justinian and Theodora. Specifically, the paper will focus on the emperor’s portrayal as a demonic character and the empress’s association with the lewd world of theatre and prostitution
Oestrogen, the key to a healthy pelvic floor?
No full textThis thesis integrates both clinical and preclinical research to investigate the therapeutic potential of oestrogen therapy and vaginal CO2 laser therapy for postmenopausal conditions such as pelvic organ prolapse (POP) and genitourinary syndrome of menopause (GSM). It explores the role of oestrogen therapy in vaginal wound healing and its impact on surgical outcomes following POP surgery, addressing the ongoing debate on its clinical benefits. Additionally, this thesis validates the ovariectomised ewe as a model for GSM by assessing serum oestrogen levels, histological parameters, and vaginal microcirculation. Furthermore, it evaluates vaginal CO2 laser therapy as a non-hormonal alternative to oestrogen, and comparing its effects to vaginal oestrogen therapy. By integrating preclinical and clinical findings, this research enhances our understanding of postmenopausal vaginal health and informs evidence-based therapeutic strategies for both surgical and non-surgical management of POP and GSM
Variation and stability in variants of heritage Dutch
No full textThis chapter provides an overview of linguistic variation and stability of heritage Dutch in seven parts of the world. In the context of research on first and second language acquisition strategies in Dutch as well as on other heritage languages, we contextualize and interpret observations taken from existing research gathered using diverse methods such as the analysis of letters, recordings, and standardized tests. The chapter ends by discussing the implications of the results for the study of contact linguistics in general and for Dutch in particular and by identifying loose ends and directions for future research
Bridging oral health and youth health care:A novel approach to early oral health prevention in Dutch well-baby clinics
Get PDFThis thesis examines early oral health promotion in well-baby clinics, focusing on the global issue of early childhood caries (ECC) affecting approximately one-third of Dutch five-year-olds, predominantly from lower socio-economic backgrounds. It examines the challenges Dutch oral health professionals face in providing early oral health prevention. The thesis finds that although over 90% of children under four get preventive care at these clinics, oral health promotion often gets less attention due to other health issues being prioritised. It also looks into how willing parents are to invest in their children’s oral health, noting less willingness among those from lower socio-economic groups. These findings indicate a gap in early oral health promotion and stress the need for more awareness and education on preventing oral health issues from the start.To address these challenges, this thesis introduces the Toddler Oral Health Intervention (TOHI), implemented in well-baby clinics. This starts oral health promotion as soon as the first tooth appears. TOHI involves sessions with trained oral health coaches for children up to 48 months old, focusing on caries risk assessment and tailored oral health promotion, incorporating the Non-Operative Caries Treatment and Prevention program, Health Action Process Approach, and Motivational Interviewing (MI). The intervention's impact on children’s oral health and behaviour was evaluated in a pragmatic randomised controlled trial at age four, demonstrating a reduction in caries incidence and improved oral health behaviour in the intervention group. Additionally, an observational study on MI's application in TOHI revealed varying levels of proficiency among coaches, emphasising the importance of ongoing training and monitoring
Adverse effects of infusion therapy in anesthesia and intensive care
Get PDFIn this thesis we investigated adverse events following transfusion and infusion therapy during anesthesia and intensive care. We focussed on a selection of different aspects in patients in the operation room, intensive care and on the ward. First, we sought to provide insights for which patients the risk of a common transfusion complication, transfusion-associated circulatory overload (TACO), outweighs the potential benefit of a transfusion. Second, we explored possible mechanisms underlying the development of TACO. Third, we searched for ways to optimize infusion therapy in the perioperative period. Our research suggests alternative mechanisms than just hydrostatic pressure overload for the development of TACO. Risk factors for TACO in comparison to patients developing circulatory overload without receiving transfusion products, COP of transfusion products, and clinical research on the effect of transfusion on hydrostatic pressure support a different pathogenesis. Our data helped put together one part of the puzzle. Future studies on TACO pathogenesis should focus on the effect of transfusion products on the endothelial barrier, and how an inflammatory process is part of this effect. Furthermore, we aimed to optimize perioperative infusion therapy. We showed a restrictive infusion regimen is associated with a reduction in complications. We developed a novel method of non-invasive CO monitoring derived from CCA flow. However, this method is not accurate and not precise
In search of protein biomarkers in ovarian cancer and Gaucher disease
Get PDFIn this thesis we used proteomic technologies to identify biomarkers for two very different types of disease, i.e., ovarian cancer and Gaucher disease. In order to obtain reliable and reproducible classification of different sample groups in large datasets, we first experimented with optimizing study protocols and data acquisition. In chapter 2 we evaluated different pre-processing and classification methods in search of methods best suited for discovering (multivariable) biomarkers from large proteomic datasets. Using these results we showed that surface-enhanced laser desorption/ionization-time-of-flight-mass spectrometry (SELDI-TOF-MS) can produce reliable classification results in serum and tissue samples of ovarian cancer patients in chapter 3. Chapter 4 gives an overview of the existing literature describing the research on biomarkers in Gaucher disease such as chitotriosidase and the search for novel markers. It also highlights research using novel techniques such as SELDI-TOF-MS for the discovery of CCL18.Label-free liquid chromatography mass spectrometry (LC-MSe) in combination with laser capture microdissection of macrophages from spleen of Gaucher disease patients resulted in the discovery of glycoprotein nonmetastatic melanoma protein B (gpNMB) as a new marker in Gaucher disease. The results of which are presented in chapter 5.A label-free LC-MS approach was also used on serum and tissue of patients with an ovarian tumor identifying proteins which were significantly differentially expressed between benign and malignant samples in chapter 6. In chapter 7 we used LC-MSe on ovarian tumor tissue of patients with a difference in disease-free survival in an attempt to find biomarkers predicting patient survival and chemoresistance