International Migration, Integration and Social Cohesion online publications
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Preterm birth:Risk recognition and intervention effectiveness
No full textPreterm birth is not a disease; it is a classification used to define the timing of birth relative to gestational age. It reflects when a birth occurs, not why it occurs, and is the outcome of various causes that can disrupt physiological gestation. The heterogeneity in preterm birth causes implies that a one-size-fits-all approach to its screening tools and interventions is not realistic. The dynamic interaction of individual risk factors complicates the prediction which risk factor(s) will exert the greatest impact, while others remain undetected, making a cause-targeted approach more challenging. Not all cases of preterm birth are attributable to cervical dysfunction, nor do they necessarily manifest with cervical shortening. By embracing preterm birth as an outcome with multiple causes, instead of a singular disease entity, universal cervical length measurement should become an essential part in preterm birth prevention as it is a valuable tool to detect cervical dysfunction. This thesis advocates for a comprehensive package of prevention strategies that addresses the full spectrum of biological causes of preterm birth, while acknowledging that many risk factors extend into the environmental and socio-economic domain and require a broader, systemic approach. We need to move away from the pursuit of a single one-tool-predicts all, or one-intervention-prevents all, as this could overlook the true potential of targeted strategies to address specific causes of preterm birth
Pancreatic cancer treatment:A multidisciplinary study towards an evidence-based and patient-centered approach
No full textThis doctoral thesis provides a comprehensive exploration of pancreatic cancer, integrating population-based data, clinical trial data, and patient-reported outcomes to better understand disease patterns, evaluate treatment strategies, and examine the well-being of patients throughout the course of the disease.Chapter 2 analyzes how real-world survival scenarios for pancreatic cancer have evolved over a 16-year period. Chapter 3 investigates the influence of sex and gender on treatment allocation and survival among patients with early-stage (stage I–III) disease in the Netherlands. Chapter 4 presents findings from the international randomized NAPAN trial, which compared second-line treatment strategies for patients with metastatic pancreatic cancer progressing after gemcitabine-based therapy. Chapter 5 describes the study protocol of the PREOPANC-5 trial, designed to improve outcomes for patients with borderline resectable pancreatic cancer. Chapters 6 and 7 focus on patient-reported outcomes. Chapter 6 examines changes in health-related quality of life (HRQoL) over time across different treatment pathways. Chapter 7 assesses the prevalence and development of anxiety and depression and identifies patient and treatment characteristics associated with more severe psychological symptoms.Overall, this thesis demonstrates the evolving landscape of pancreatic cancer, where survival improvements should progress in parallel with attention to quality of life and psychological wellbeing. It reaffirms the clinical value of established regimens, explores novel strategies, and underscores the need to address treatment disparities and ensure equitable access. As survival gains remain modest, integrating the patient perspective into both research and clinical practice should be considered a key priority for future innovation
Democracy, control, legitimacy:Separation of powers and EU trade and investment policy
Full text linkThis thesis examines the institutional framework and practices of negotiation of trade and investment agreements by the European Union (EU) through the lens of separation of powers. Trade policy and trade agreements have the potential to affect the rights and obligations of individuals and generate significant distributive consequences. In addition, the scope of EU trade policy has gradually broadened, and it increasingly deals with non-economic topics, such as industrial and climate policies. In turn, the normative framework of separation of powers developed in this thesis evaluates how EU governance in the field of trade fares against two fundamental objectives: democratic will formation and control. The normative examination carried out in this thesis combines the legal-doctrinal method with case studies dedicated to specific trade or investment agreements that draw on content analysis of various policy documents and expert interviews. This thesis demonstrates that the law and practices of EU trade policy evoke not an ideal of separation, but rather that of confusion of powers. The legal framework and practices in question are consensus-oriented (not agonistic) because of its complexity, the abundance of inputs, and the great number of veto players. At the same time, this framework is arguably well-suited to prevent abuse of power, often precisely for the reasons that make it insufficiently democratic. The thesis also underscores the underexplored role of the Trade Policy Committee of the Council and the European Commission’s framing and agenda-setting powers which translate into a long-term intellectual leadership over trade policy strategy
Paediatric post-COVID condition, different faces of a new disease
Full text linkAt the beginning of the COVID-19 pandemic we were confronted with Paediatric Post-COVID Condition (PPCC). This thesis describes our first insights into this new phenomenon. Our first study focused on children hospitalized for acute COVID-19 or MIS-C, in which pulmonary sequelae did occur frequently four to twelve months after hospital admission. It showed that CPET testing is frequently abnormal and helpful to provide insights into pathophysiology of sequelae. In the beginning of the COVID-19 pandemic PPCC was still an unknown entity. We described the experience of Dutch paediatricians with PPCC end of 2020 and demonstrated both the high burden of disease, and the need to both organize care and research focusing on PPCC. To inform organization of care, we first investigated the prevalence of PPCC in a Dutch low and high risk setting, compared to a negatively tested group. PPCC prevalence was respectively 14.6, 29.2 and 2.3% three months after acute infection, and did decrease over time. Children with PPCC had lower physical health-related quality of scores and higher fatigue scores. Definitions used clearly influence PPCC prevalence, demonstrating the importance of data harmonization tools. Second, we examined international care PPCC care programs and their patients, and highlighted the broad symptomatology of PPCC, and heterogeneous diagnostic and therapeutic approach. The International Post-COVID-Condition in Children Collaboration (IP4C) published an overview of priorities to accelerate and improve PPCC care. These combined findings demonstrate the urgent need for further scientific substantiation of PPCC care programs to improve PPCC outcomes
Water and ion dynamics at interfaces
No full textThis thesis explores the ultrafast dynamics of interfacial water using time-resolved vibrational sum-frequency generation (TR-vSFG) spectroscopy, with a focus on triggering and monitoring transient electric fields at the air-water and water-water interfaces.First, the effect of temperature on the vibrational lifetimes of hydrogen-bonded and free OD stretching modes in D2O is studied. The results show that the hydrogen-bonded OD stretching mode relaxes independently of temperature, while the free OD relaxes faster at higher temperatures. These results highlight the similarity between the interfacial and bulk relaxation dynamics of the hydrogen-bonded OD stretching mode. Additionally, we show that intramolecular energy transfer dominates the reorientation relaxation mechanism for free OD.Next, TR-vSFG is used as a contactless T-jump method to study electric double layer (EDL) dynamics at the air-DCl/water interface. The interfacial hydrated proton population is found to be thermally modulated, and the EDL rearrangement occurs within tens to hundreds of picoseconds. Simulations combined with analytical modeling using a modified Poisson-Nernst-Planck equation confirm that electrostatic interactions govern these dynamics. This aligns with the Debye-Falkenhagen theory, even at high ion concentrations.Finally, we investigate the electrolyte's electrical response to the IR-induced shock wave following the T-jump. The measured TR-vSFG signal reveals interference between two SFG signals generated at the air-water and traveling water-water interface, respectively. Strong chemical specificity is observed, and its causes are discussed.These findings deepen our understanding of ultrafast aqueous interfacial phenomena and offer pathways for tuning interfacial ionic behavior relevant to technologies such as electrochemical capacitors and ion-based transistors
Can teachers promote students' self-regulated learning in elementary schools?:The role of teacher–student interactions and teacher skills
Full text linkSelf-regulated learning (SRL) is widely recognized as a crucial skill that influences various educational outcomes, including students’ academic success, student engagement, and lifelong learning capabilities. It involves a cyclical process in which students actively regulate various components of their learning, including cognition, metacognition, motivation, emotions, and behavior. Despite its significance, many educators struggle to effectively teach SRL in their students, which may be due to a lack of knowledge and practical tools to guide them. This lack of knowledge and tools stems in part from the traditional belief that SRL starts to develop after elementary school. Additionally, much of the existing theoretical models of SRL are grounded in research primarily focused on secondary school and university students. As a result, there is still a knowledge gap concerning how SRL may be best promoted in younger children. To address this gap, this dissertation explored the extent to which teacher and classroom factors are associated with students’ SRL-skills during the upper elementary school years. Three aims were addressed. The first aim was to synthesize the current empirical literature on classroom processes that may promote students’ SRL. The second aim was to examine the dimensions that underlie individual differences in SRL among elementary school students. The third and final aim was to investigate the extent to which teacher and classroom processes are associated with SRL-skills in elementary school classes, including daily interactions between teachers and students, and specific teacher skills
Dramaturgie van het antropoceen:Theatraliteit in transitie(s)
No full textIn dit proefschrift heb ik onderzocht wat theater kan betekenen in een tijd van (klimaat)crises. Theatraliteit en dramaturgie staan centraal als creatieve concepten en praktijken om de kritiek op het antropoceen te doordenken. In vier hoofdstukken analyseer ik hoe vijf hedendaagse Nederlandse performances toekomstscenario’s voor leven en sterven in – en na - een instabiele en onzekere tijd vormgeven en aldus alternatieve narratieven voor klimaatverandering presenteren. De hoofdstukken verbind ik door drie Interludes, waarin als tussenspel theatraliteit en dramaturgie ingezet worden om te oefenen met een andersoortige taal voor een verstrengeld tijdperk
Mind the gap!:Inequalities in democratic support among adolescents
Full text linkInequalities in democratic support are undesirable. When certain groups are less engaged in democracy, their interests will be underrepresented, leading to suboptimal democratic outcomes for these groups. However, large inequalities in democratic support are found, especially based on educational attainment. In order for governments to design and time policy interventions that are aimed at mitigating these inequalities more effectively, it is important to have a better understanding of their origins and the way they develop. This dissertation therefore studies the origins of inequalities in democratic support among young people. The results show that Dutch adolescents generally support democracy, reject non-democratic alternatives, endorse core democratic values and intend to participate in the political process. It is quite worrisome, however, that the educational gap in democratic support that is observed among adults is already present from a young age, and proves to be quite stable and persistent. The findings in this dissertation show that these inequalities originate at least to some extent in the period before secondary education, and are not easily remedied by (on-site) citizenship education
Convergence and divergence:Comparing symptom expression of and treatment for (parents of) children with ASD and those with ADHD
Full text linkAutism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) appear to have several overlapping features in terms of etiology, underlying mechanisms, and symptom expression. This raises the question of whether it is relevant to distinguish these classifications in school-aged children. Therefore, in this dissertation, differences between core and comorbid problems of school-aged children with ASD and those with ADHD – as well as their parents – were explored. Also, it was investigated whether (parents of) children with ASD and those with ADHD differed with respect to received treatment. Furthermore, a subscale to screen for ASD – consisting of separate items of the school-age version of the Child Behavior Checklist (CBCL) – was constructed and validated. Finally, it was examined whether it is feasible to provide a transdiagnostic Social Skills Training (SST) to a group of middle school-aged children and their parents. The results of this dissertation revealed that, statistically, school-aged children with ASD and those with ADHD can be distinguished with reference to their core symptoms. Both groups experienced relatively high levels of comorbid problems, although children with ASD seemed to be somewhat more impaired. Regarding their parents, hardly any group differences were found. Besides, the types and hours of treatment for the ASD and ADHD group largely overlapped. Additionally, the groups seemed to benefit equally from this treatment. Moreover, the results showed that the constructed ASD subscale had a similar screening potential to that of the existing DSM-oriented subscales. Also, the preliminary effects of the SST were promising, confirming its feasibility. <br/
Prevention of surgical site infections
Full text linkSurgical site infection (SSI) is a common and concerning healthcare-associated infection. The first part of this thesis explored the impact of SSI on both patient health and economic burden. Specifically, it evaluated the impact of SSI and anastomotic leakage on cost and quality of life. In addition, a qualitative study investigated the physical and emotional experiences of patients with negative pressure wound therapy with instillation. Last, a cross-sectional study examined patients’ experiences and preferences regarding surgical wound care education at discharge in the Netherlands.The second part of this thesis investigated the efficacy of individual interventions aimed at reducing SSI risk, addressing gaps in existing knowledge, and highlighting discrepancies in current guidelines. Systematic reviews and (network) meta-analyses were conducted to assess the effects of different preoperative skin antiseptics, incisional wound irrigation solutions, and incisional negative pressure wound therapy on SSI. Additionally, the potential effect of operating room door openings on SSI rates was investigated in a systematic review and individual patient data meta-analysis. The findings from four chapters of Part II have contributed to the development of recommendations for the Dutch guideline for the prevention of SSI, which was published in 2024