Academic Ceremonies April 2015

“Out-of-pocket patient payments and vulnerable population groups in Serbia”

The dissertation describes the financial burden provoked by out of pocket patient payments in Serbia. Patients in Serbia pay informally by giving money or gifts to the health care providers. Sometimes they are also asked to bring goods such as food or medicines into the hospital. The results from this dissertation show that all those payments impose a high financial burden for patients, particularly on vulnerable groups such as chronically sick. About 2,3% of the population pays more than 40% of its income on health care. In maternity care, besides the financial burden, we also observe lack of compassion towards women giving birth.

Key words:

payments, health care, Serbia

“Health literacy in the Western Balkans: The example of Albania and Kosovo”

Health literacy (HL), an essential determinant of health, is totally irrelevant to current health policy in Albania and Kosovo, two transitional Albanian speaking countries in South East Europe. Through a series of surveys in both countries, we argue that health literacy could be linked to both health determinants and outcomes with education being the most important modifiable risk factor of limited HL. The observed associations additionally suggest to increase the efficiency of current respective education systems and form a solid basis for the inclusion of HL measurement in the health policy agenda of both countries for guiding interventions to improve the health status of citizens in these communities.

Key words:

Albania, Kosovo, health literacy, socio-demographic factors, socioeconomic

“Self-direction in return-to-work: bottlenecks, facilitators and an intervention”

The Dutch employers’ organisations MKB Nederland and VNO-NCW recently suggested a reduction of wage payments to absent employees from two years to one. It remains to be seen, though, whether this measure will result in an adequate resumption of work, if no investments are being made in improving the collaboration between absent employees and their employers. The results described in this dissertation indicate a strained relationship between absent employees and their employers as a result of divergent goals (employees: recuperation, employers: resumption of work) and mutual distrust. Furthermore, the results show that making investments in a better collaboration between absent employees and their employers is cost-effective.

Key words:

employees, employers, sickness absence, resumption of work

“Credit Ratings & the Auditor’s Going-Concern Opinion”

“Vergeet niet dat je arts bent’; Joodse artsen in Nederland 1940-1945”

‘Do not forget you are a doctor’, a father impressed on his son when they were forced to say goodbye to each other, persecuted by the Nazis. The father referred to the privileges as well as the duties of a doctor. Jewish doctors were indeed privileged considering their relatively high chance of survival. Furthermore, it is shown that they often tried to fulfil their professional duties. Being thrown upon their own resources, they had to solve numerous new ethical dilemmas. They often tried to help others by using medical methods, however unorthodox, and offer resistance.

Key words:

medical history, WWII, Jewish doctors

“De omwenteling die niet kwam; verkenning van het Bestuursbeleid bij het ministerie van Binnenlandse Zaken”

In this book, twenty-four projects carried out during forty years of administrative policy are passed in review. The author evaluates these projects from the perspective of public administration, which expects a change from a more traditional hierarchical administration (government) to a more network-oriented administration (governance). Despite challenges, it was concluded that the administrative theory held by the Ministry of Home Affairs has remained traditional. Furthermore, there was no systematically developed view of the relationship between government and society, necessary for a modern administrative policy, between 1969 and 2009. The researcher compared the Ministry of Home Affairs with parliament and a specialist department, where no breakthrough to another managerial view was achieved either. As a result, Schrijver assumes that chances of introducing more effective managerial processes at government level have been missed.

Key words:

administrative policy, Ministry of Home Affairs

“Is it remotely possible ?; remote supervision of general practice registrars”

GP registrars learning and work in practice is usually supervised by co-located, experienced general practitioners. An alternative is needed in outback Australia and northern Canada for registrars working in solo practice; clinical supervisors use information and communication technology to supervise registrars remotely.  This research demonstrated this approach led to comparable outcomes in national examinations, and considered why it could work and for whom. To our surprise some registrars’ learning accelerated because of their clinical responsibilities, their freedom to choose the timing and resources for learning, and seeing the impact of their work through continuity of care with patients and communities. Continuity of remote supervisor meant their learning efficiently built on prior experience and considered the personal challenges and characteristics at the heart of providing effective health care.  Responsibility, continuity of care and continuity of supervisor, are key factors in effective and efficient postgraduate learning.

Key words:

medical education, General Practice, clinical supervision, rural and remote underserved communities, distance education

“Exercise training and physical activity in patients with mild to moderate COPD in primary care”

“Financial decision making in incomplete markets”

“Parenting across borders; Effects of transnational parenting on the lives of Angolan and Nigerian migrant parents in The Netherlands”

This study is about Angolan and Nigerian parents who live in the Netherlands, but whose children reside in the country of origin. It examines whether this separation effects the wellbeing of the migrant parent. The study reveals that transnational separation can indeed have a negative impact on the wellbeing of the parents. However, this separation does not have to be problematic if good family arrangements are made, such as maintaining regular contact with the child. Furthermore, the context of migration and integration proves a crucial factor. Undocumented migrants and migrants with a low socioeconomic status are particularly prone to reduced wellbeing, partly due to limitations in migration policy that can hinder physical contact with the child..

Key words:

migrant parents, transnational separation

“Technology-based measurement of arm-hand skill performance in daily life conditions”

Stroke patients and children with cerebral palsy tend to experience severe arm-hand problems in their daily lives. This dissertation aims to develop a tool to measure arm-hand performance in the home. The tool must be able to measure a) the activities to be performed, b) how often the arms and hands are used, and c) the quality of these movements. This measurement tool is important for evaluating patient progress, detecting arm-hand problems, adapting treatment to the patient’s needs, and assessing the effectiveness of new treatments.

Key words:

rehabilitation, measurement tool, arm-hand problems

“Abdominal Wall Hernia Repair; intraperitoneal Mesh and Adhesions”

One in five patients develops an incisional hernia after having undergone abdominal surgery. Such hernias are abdominal muscle defects allowing intestines to protrude. Hernia repair is performed by placing synthetic woven meshes. Adhesions are being formed between intestine and mesh in reaction to the placement of intraperitoneal meshes. These adhesions can lead to serious problems which are underestimated by surgeons. Experiments showed that mesh coatings can largely prevent this problem. Furthermore, three pills taken prior to surgery could halve the number of adhesions formed between intestine and mesh. Finally, a patient model was developed to further confirm our results.

Key words:

incisional hernias, postoperative adhesions

“Protective and adaptive responses by antioxidant flavonoids”

Radicals are harmful due to their potentially damaging effect on DNA and proteins, which causes ageing and cardiovascular disease. Antioxidants protect against radicals. A surplus of radicals results in adaptation, which means the body will produce more antioxidants. Flavonoids, antioxidants obtained from the diet or dietary supplements, can neutralise radicals. Flavonoids could increase the damaging effects of radicals as this neutralisation process could reduce the adaptation made by the body. This study shows that a product of the flavonoid formed during the neutralisation process also induces adaptation. Therefore, flavonoids protect against the damaging effects of radicals and cause adaptation to be maintained.

Key words:

radicals, antioxidants, flavonoids

“Prevention of obesity in childhood”

This dissertation examines whether the current rise in childhood obesity starts in the prenatal period and whether a secular trend in height can help explain why children have become heavier over the past eighty years. No prenatal secular trend was identified in this dissertation. A postnatal secular trend, however, was evident in terms of weight, height, and BMI. Small for gestational age (SGA) infants are more likely to develop obesity than normal birth weight infants. Furthermore, data on height and weight in a healthy Dutch population were used to develop a prediction model to determine the risk of developing childhood obesity in infants born at a healthy weight. This prediction model is an important tool that can be used in child healthcare to prevent obesity later in life.

Key words:

obesity, children, height, weight, prevention

“How humans economize; energy restriction and end energy expenditure”

“Essays on Working Hours”

“Tissue Distribution and Function of Arginase I: an experimental study”

“Failure to adapt”

The current dynamic social and economic context places additional demands on both the employee and employer. Workplaces require continuous adaptation. 6,6 % of employees are in job lock. 61,4 % of those employees stay in a long term job lock. Job lockers experience more physical and mental health problems compared to those employees who successfully adapt. For the companies job lock leads to increased costs due to withdrawal behaviours and decreased productivity and job attachment. The results from the dissertation are useful to HRMs and reintegration companies for detecting employees at risk to become job locked and building preventive and curative programs.

Key words:

adaptation, job lock, reintegration

“Cardiac Adaptation during and after hypertensive gestation”

“Small fibers, big troubles; diagnosis and implications of small fiber neuropathy”

“The Role of Incentives, Preferences and Personality in Decision Making”

“Tussen wiskunde en werkelijkheid”

“Mesenchymal stromal cells to induce tolerance to solid organ transplantation”

“Psychological adjustment to stress and trauma; Hippocampal configuration learning, cognitive emotion Regulation, and frontal brain asymmetry, as predictors of Resilience”

“Market Reactions to management earnings forecasts”

“Macrophages in Colorectal Cancer: proof of principle for diagnostic application”

“Orthopaedic Infections: pre-clinical models, diagnostic tools and novel coatings”

“Extra articular manifestations and comorbidities in spondyloarthritis: epidemiological and clinical aspects”

“Lokale overheid en populatiegericht gezondheidsbeleid”

“Zooming into the micro-level of experience: An approach for understanding and treating psychopathology”

“Poor Lending”

Why is it hard for the rich to lend to the poor? Mainly because it is costly and risky. This thesis addresses, in the context of microfinance, the challenges faced by financial intermediaries that lend to low income clients. Microfinance institutions can improve their efficiency by concentrating their efforts on their core mission, and find investors that share the same preferences with respect to social and financial objectives. Regulation aimed at facilitating the sharing of information between lenders can significantly reduce the risk of over-borrowing and thus reduce the risk of both lenders and borrowers.

Key words:

microfinance, risk, efficiency