Academic Ceremonies March 2008

“The effectiveness of an education and activation program in acute and sub-acute shoulder complaints presented in general practice”

Shoulder complaints appear to still exist in half of the patients six months after the first visit to the general practitioner. A new treatment, given a the start of the complaints, focuses on the one hand on the expectations of patients about their shoulder complaints and on the other hand on how they have dealt with the complaints in daily life (getting dressed, driving a car, cleaning windows). Previous research in people with for example back complaints showed that wrong ways of thinking and acting lead to a longer duration of the complaints. The effect of the new treatment was studies by means of an experiment. This experiment did not show a significant effect after six months. However, it turned out that those patients who expected the worst at the start of the complaints (catastrophize) actually recover less.

Key words:

Shoulder complaints, general practice, catastrophize

“The systematic assessment of the short-term risk for patient violence on acute psychiatric wards”

Violence is a serious problem in health care institutions, having negative consequences for staff and patients. The subject of the dissertation is patient aggression against others in acute psychiatric wards. The studies included in the dissertation are aimed to improve aggression related nursing practice. The studies relate (1) to the scope of the problem in acute psychiatry in Switzerland, and (2) to the development and application of a structured assessment of the short-term risk for violence among acute psychiatric patients. A structured short-time risk assessment proved to be a promising way to reduce violence in this area of care.

“Novel insights in the pathophysiology of insulin resistance; A molecular genetic approach”

The number of people with overweight explosively increases worldwide. Overweight often leads to type 2 diabetes and a disturbed fat metabolism. These are important risk factors for cardiovascular diseases. Because of minor genetic differences some people are more sensitive to developing for example overweight, type 2 diabetes or an increased cholesterol level. In this PhD research we studied among others the ATF6 gene in detail. This gene plays an important role in folding the proteins in the cell. We have shown that small variations in the ATF6 gene increase the risk of type 2 diabetes and a high cholesterol level. 

Key words:

Type 2 diabetes, Cholesterol 

“Hepatic steatosis in familial conmbined hyperlipidemia”

Cardiovascular diseases are the main cause of death in Western society. Well-know risk factors are smoking, high blood pressure and a high cholesterol and fat level. Familial combined hyperlipidemia (FGH) is a common hereditary disorder that is characterized by an increased cholesterol and fat level. In this dissertation we have shown that this hereditary predisposition is partly caused by a (three times) increased sensitivity to the development of liver fattening. The importance of this finding is supported by the appearance of a new medication for the treatment of liver fattening and therefore also possibly for the prevention of cardiovascular diseases.

“SAFE but SORRY; theory, assessment, and treatment of pain-related fear in chronic low back pain patients”

Fear of moving, the fear that activities are damaging for the back, and avoidance of activities contribute to the development and maintenance of chronic back pains. A cognitive-behavioural exposure in vivo treatment can lessen this fear. By carrying out increasingly more threatening activities patients experience they can do these without damaging consequences and in spite of their pain. This first controlled treatment study in four rehabilitation centres shows that exposure in vivo is more effective than a regular treatment in lessening the fear of movement and at least as effective in improving daily functioning. Exposure in vivo is a valuable addition to the existing treatment offer.   

“Prediction of hepatotoxic responses in humans: A toxicogenomics-based parallelogram approach”

Rat studies in vivo are not always representative for the effects that can be expected of hepatotoxic substances in humans. Alternatives for animal tests, in vitro experiments in liver cells, cannot give a complete prediction either.  With toxicogenomics-based techniques these effects can be better shown. In this dissertation on the basis of the so-called parallelogram approach results of rat studies and experiments in liver cells of rats and humans were combined. For this purpose the effects of known hepatotoxic substances on all genes and de resulting biological mechanisms were compared. The use of human liver cells turns out to be essential because rats and humans can react differently to hepatotoxic substances. Rat studies still appear necessary to bridge in vitro-in vivo differences.

Key words:

toxicogenomics, alternatives for animal tests

“Towards restraint-free care for psychogeriatric nursing home residents”

Restraints in freedom of movement, for example by means of bed rails, still often occur in the care for demented nursing home residents, among others to prevent falling incidents. However, freedom restraints have major disadvantages. The main purpose of this dissertation is to make a contribution to restraint-free care for this target group. This research shows that a training programme and the use of a nurse in a consultative function are not enough to decrease as well as prevent the restraint of freedom. It also turns out that the main factor to apply restraint of freedom is the mobility of residents. A connection with work pressure was not found. Therefore, in initiatives to decrease the restraint of freedom characteristics of residents should be at the centre, such as the individual needs and the stimulation of the mobility.

Key words:

restraint of freedom, nursing home care

“Vital imaging of large arteries using two-photon laser scanning microscopy: focus on the arterial wall”

Changes in the qualities of the arterial wall can lead to diseases such as atherosclerosis. In spite of the current knowledge on blood vessels and atherosclerosis the possibilities of studying structural as well as functional qualities at the cellular level are still limited. An improved insight in structural and functional qualities of the arterial wall can possibly lead to more knowledge about (the development of) atherosclerosis. In this dissertation the ‘two-photon laser scanning microscopy (TPLSM)’ was used to visualize at the cellular level structural and functional arterial wall qualities. The described methods offer a new perspective on the qualities of large blood vessels and contribute to new insights in diseases such as atherosclerosis. 

Key words:

arterial wall structure, atherosclerosis, TPLSM

“Adaptive remodeling of cardiomyocytes under stress”

Patients with coronary vascular complaints show a drop of blood flow and a decrease of oxygen transport to the heart muscle tissue. This can lead to a partial return of adult heart muscle cells to an earlier foetal stage. An example of this programmed cell survival is hibernating heart muscle tissue. In this dissertation, detailed information was gathered on the structural changes of heart muscle cells in various models of hibernation. Also specific protein markers were registered that give information about the heart cell function. Important findings are the discovery of a new form of intercellular communication and the influence of passive stretch (stretching of the heart muscle) on the heart muscle cell.

Key words:

hibernation, cell survival

 “The Place of Play; on toys, Technological Innovations and Geographies of Play”

This dissertation studies the changing relations between consumers and producers in the context of toys and play. Players increasingly contribute actively to game worlds and toy products. Players create, for example, new contents for computer games and they make these accessible to other players via the Internet. This participative culture is placed in a historic framework by means of three case studies: LEGO toys, Sim City/The Sims and the citizen participation project Face Your World. The three case studies show how the more or less solitary 19th century game world is transforming into densely populated geographies. The place of the game literally (increasingly indoors) as well as metaphorically (players become producers). Although the participative culture is often regarded as the ultimate form of consumer emancipation, the fact remains that companies decide whether the boundaries between consumers and producers gradually disappear.

Key words:

Computer games, participative cultures

“Proteomics as a tool for biomarker detection; protein profiling in chronic and vascular disease”

“Advanced Thrombinoscopy”

Thrombosis is de second-largest cause of death and disease (stroke, embolism) in the Western world. However, clinicians still do not dispose of a universal test to determine the coagulability of blood.  In the last few years, it has been increasingly recognized that measuring the thrombin generation could fulfil this role. Therefore, various laboratories are searching for ways of determining the thrombin generation. This dissertation shows that the CAT technique (Calibrated Automated Thrombinoscopy) provides more information about the coagulation capacity of blood than all previous tests and that it also is the most accurate (automated) technique that is available at the moment. With this test, defects in the blood coagulation system as well as in the thrombocytes can be traced down and the treatment with for example heparins or oral anti-coagulation medication can be followed up and optimized.

“Challenging the Digital Imperative”