This thesis evaluated the efficacy of elective abdominal aortic aneurysm repair. The first part of this thesis evaluated the presumed long-term survival differences of endovascular aneurysm repair ... Show moreThis thesis evaluated the efficacy of elective abdominal aortic aneurysm repair. The first part of this thesis evaluated the presumed long-term survival differences of endovascular aneurysm repair (EVAR) versus open repair. Thereby, it evaluated the impact of developments in AAA management (i.e. the introduction of EVAR and cardiovascular risk management) on the long-term life-expectancy after repair. The second part of this thesis focused on other outcomes important in the evaluation of AAA care. It evaluated the presumed long-term cost difference of EVAR and open repair. In addition, it investigated how the patient perspective is currently embedded in AAA research.The five main conclusions of this thesis are that I) long-term (relative) survival between open versus endovascular aneurysm repair is equal; II) AAA patients remain a persistently high long-term (10-year) excess mortality after elective repair, with no change in mortality rates over the past 25 years; III) women have a notably higher short-and long-term mortality; IV) endovascular and open repair are considered cost equivalent; V) and the evaluation of the patient perspective/quality of life of AAA patients needs improvement. Show less
Land holds immense economic, cultural, religious, and political significance for most sub-Saharan African countries. However, customary patriarchal norms restrict land ownership to the male lineage... Show moreLand holds immense economic, cultural, religious, and political significance for most sub-Saharan African countries. However, customary patriarchal norms restrict land ownership to the male lineage, while women typically access land through relationships with men. Women’s land rights thus remain weak and vulnerable to disputes, particularly when these relationships are severed. Despite legal reforms aimed at enhancing women’s land rights in Kenya, customary norms remain deeply entrenched. This book examines the experiences of women entangled in land disputes. It illustrates women’s vulnerability to land disputes and demonstrates how men exploit their positions of authority to manipulate existing institutions to deprive women of their land rights. These women contend with violence and social exclusion in unclear land dispute resolution structures. While formal courts are more likely to safeguard women’s land rights, the process is often arduous, costly, and often tainted by corruption. Show less
Lennep, J.E.R. van; Tokgözoglu, L.S.; Badimon, L.; Dumanski, S.M.; Gulati, M.; Hess, C.N.; ... ; Benn, M. 2023
Cardiovascular disease is the leading cause of death in women and men globally, with most due to atherosclerotic cardiovascular disease (ASCVD). Despite progress during the last 30 years, ASCVD... Show moreCardiovascular disease is the leading cause of death in women and men globally, with most due to atherosclerotic cardiovascular disease (ASCVD). Despite progress during the last 30 years, ASCVD mortality is now increasing, with the fastest relative increase in middle-aged women. Missed or delayed diagnosis and undertreatment do not fully explain this burden of disease. Sex-specific factors, such as hypertensive disorders of pregnancy, premature menopause (especially primary ovarian insufficiency), and polycystic ovary syndrome are also relevant, with good evidence that these are associated with greater cardiovascular risk. This position statement from the European Atherosclerosis Society focuses on these factors, as well as sex-specific effects on lipids, including lipoprotein(a), over the life course in women which impact ASCVD risk. Women are also disproportionately impacted (in relative terms) by diabetes, chronic kidney disease, and auto-immune inflammatory disease. All these effects are compounded by sociocultural components related to gender. This panel stresses the need to identify and treat modifiable cardiovascular risk factors earlier in women, especially for those at risk due to sex-specific conditions, to reduce the unacceptably high burden of ASCVD in women. Show less
BackgroundLoss of epigenetic control is a hallmark of aging. Among the most prominent roles of epigenetic mechanisms is the inactivation of one of two copies of the X chromosome in females through... Show moreBackgroundLoss of epigenetic control is a hallmark of aging. Among the most prominent roles of epigenetic mechanisms is the inactivation of one of two copies of the X chromosome in females through DNA methylation. Hence, age-related disruption of X-chromosome inactivation (XCI) may contribute to the aging process in women.MethodsWe analyzed 9,777 CpGs on the X chromosome in whole blood samples from 2343 females and 1688 males (Illumina 450k methylation array) and replicated findings in duplicate using one whole blood and one purified monocyte data set (in total, 991/924 females/males). We used double generalized linear models to detect age-related differentially methylated CpGs (aDMCs), whose mean methylation level differs with age, and age-related variably methylated CpGs (aVMCs), whose methylation level becomes more variable with age.ResultsIn females, aDMCs were relatively uncommon (n = 33) and preferentially occurred in regions known to escape XCI. In contrast, many CpGs (n = 987) were found to display an increased variance with age (aVMCs). Of note, the replication rate of aVMCs was also high in purified monocytes (94%), indicating an independence of cell composition. aVMCs accumulated in CpG islands and regions subject to XCI suggesting that they stemmed from the inactive X. In males, carrying an active copy of the X chromosome only, aDMCs (n = 316) were primarily driven by cell composition, while aVMCs replicated well (95%) but were infrequent (n = 37).ConclusionsOur results imply that age-related DNA methylation differences at the inactive X chromosome are dominated by the accumulation of variability. Show less
Aims/hypothesisObesity is a major risk factor for type 2 diabetes. However, body composition differs between women and men. In this study we investigate the association between diabetes status and... Show moreAims/hypothesisObesity is a major risk factor for type 2 diabetes. However, body composition differs between women and men. In this study we investigate the association between diabetes status and body composition and whether this association is moderated by sex.MethodsIn a population-based cohort study (n=7639; age 40–75 years, 50% women, 25% type 2 diabetes), we estimated the sex-specific associations, and differences therein, of prediabetes (i.e. impaired fasting glucose and/or impaired glucose tolerance) and type 2 diabetes (reference: normal glucose metabolism [NGM]) with dual-energy x-ray absorptiometry (DEXA)- and MRI-derived measures of body composition and with hip circumference. Sex differences were analysed using adjusted regression models with interaction terms of sex-by-diabetes status.ResultsCompared with their NGM counterparts, both women and men with prediabetes and type 2 diabetes had more fat and lean mass and a greater hip circumference. The differences in subcutaneous adipose tissue, hip circumference and total and peripheral lean mass between type 2 diabetes and NGM were greater in women than men (women minus men [W–M] mean difference [95% CI]: 15.0 cm2 [1.5, 28.5], 3.2 cm [2.2, 4.1], 690 g [8, 1372] and 443 g [142, 744], respectively). The difference in visceral adipose tissue between type 2 diabetes and NGM was greater in men than women (W–M mean difference [95% CI]: −14.8 cm2 [−26.4, −3.1]). There was no sex difference in the percentage of liver fat between type 2 diabetes and NGM. The differences in measures of body composition between prediabetes and NGM were generally in the same direction, but were not significantly different between women and men.Conclusions/interpretationThis study indicates that there are sex differences in body composition associated with type 2 diabetes. The pathophysiological significance of these sex-associated differences requires further study. Show less
Voluntary associations played a role in processes of politicisation that are visible in Europe in the nineteenth century. This is not in itself a new insight, but we lack a good understanding of... Show moreVoluntary associations played a role in processes of politicisation that are visible in Europe in the nineteenth century. This is not in itself a new insight, but we lack a good understanding of how and why this was the case. In my contribution I will reflect on various ways in which associational life broadened popular participation as well as broadened people’s understandings of politics between 1820-1860. Middle-class reformers of all sorts and stripes played an important role in reinventing voluntary associations as tools for political pressure. Using examples from such organizations as the Irish Catholic Association and British antislavery societies in the 1820s, and from a Dutch temperance society in the 1840s and 1850s, it will become clear that mass organization in politics could be very attractive, and was sometimes successful. Show less
Slam poets in Africa are part of an emerging social movement. In this article, the focus is on women in this upcoming slam movement in francophone Africa. For these women, slam has meant a change... Show moreSlam poets in Africa are part of an emerging social movement. In this article, the focus is on women in this upcoming slam movement in francophone Africa. For these women, slam has meant a change in their lives as they have found words to describe difficult experiences that were previously shrouded in silence. Their words, performances and engaged actions are developing into a body of popular knowledge that questions the status quo and relates to the ‘emerging consciousness’ in many African urban societies of unequal, often gendered, power relations. The women who engage in slam have thus become a voice for the emancipation of women in general. Show less
Ritter, R. de; Sep, S.J.S.; Kallen, C.J.H. van der; Greevenbroek, M.M.J. van; Jong, M. de; Vos, R.C.; ... ; Stehouwer, C.D.A. 2021
Background Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal... Show moreBackground Women with type 2 diabetes are disproportionally affected by macrovascular complications; we here investigated whether this is also the case for microvascular complications and retinal microvascular measures. Methods In a population-based cohort study of individuals aged 40-75 years (n = 3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated sex-specific associations, and differences therein, of (pre)diabetes (reference: normal glucose metabolism), and of continuous measures of glycemia with microvascular complications and retinal measures (nephropathy, sensory neuropathy, and retinal arteriolar and venular diameters and dilatation). Sex differences were analyzed using regression models with interaction terms (i.e. sex-by- (pre)diabetes and sex-by-glycemia) and were adjusted for potential confounders. Results Men with type 2 diabetes (but not those with prediabetes) compared to men with normal glucose metabolism, (and men with higher levels of glycemia), had significantly higher prevalences of nephropathy (odds ratio: 1.58 95% CI (1.01;2.46)) and sensory neuropathy (odds ratio: 2.46 (1.67;3.63)), larger retinal arteriolar diameters (difference: 4.29 mu m (1.22;7.36)) and less retinal arteriolar dilatation (difference: - 0.74% (- 1.22; - 0.25)). In women, these associations were numerically in the same direction, but generally not statistically significant (odds ratios: 1.71 (0.90;3.25) and 1.22 (0.75;1.98); differences: 0.29 mu m (- 3.50;4.07) and: - 0.52% (- 1.11;0.08), respectively). Interaction analyses revealed no consistent pattern of sex differences in the associations of either prediabetes or type 2 diabetes or glycemia with microvascular complications or retinal measures. The prevalence of advanced-stage complications was too low for evaluation. Conclusions Our findings show that women with type 2 diabetes are not disproportionately affected by early microvascular complications. Show less
Sutura (discretion, modesty) is a central element in Senegalese Wolof culture that, among other things, promotes feminine honour through chastity, silence with regard to discussing sexuality with... Show moreSutura (discretion, modesty) is a central element in Senegalese Wolof culture that, among other things, promotes feminine honour through chastity, silence with regard to discussing sexuality with elders, and refraining from articulating same-sex desires in general. Consequently, sutura is seen as limiting the space for non-normative sexualities. However, lesbiennes in Senegal strategically employ sutura to navigate this gender and sexual normativity, whereby they queer the initially heteronormative framework. This article explores how, at the frontiers of international sexual rights activism and its antithetical Islamic social code, young women open new avenues for thinking queer Africa. The article explores young women's diverse tactics to turn sutura from a heteronormative framework into a vehicle for queer expression. These women demonstrate the constant yet indeterminate possibilities to negotiate between normative expectations and queer lives. They furthermore propose an alternative to the international queer frontier of overt resistance and protest, and suggest that the silences that sutura prescribe are more productive for queering their urban environment. By balancing the simultaneous desires of same-sex intimacies, family life, societal expectations and urban success, these women are pioneers in offering new routes for ‘queering queer Africa’, as Stella Nyanzi has described it.Résumé: Sutura (discrétion, modestie) est un élément central de la culture wolof sénégalaise qui, entre autres choses, valorise l'honneur féminin à travers la chasteté, le silence (en ne parlant pas de sexualité avec ses aînés) et le fait de s'abstenir de parler de désirs homosexuels en général. Par voie de conséquence, on pense que sutura limite l'espace réservé aux sexualités non normatives. Or, les femmes lesbiennes sénégalaises emploient le concept de sutura de manière stratégique pour naviguer cette normativité sexuelle et de genre, moyennant quoi elles opèrent une queerization du cadre initialement hétéronormatif. Cet article explore comment, aux frontières du militantisme international pour les droits sexuels et de son code social islamique antithétique, les jeunes femmes ouvrent de nouvelles pistes pour penser l'Afrique queer. L'article explore les diverses tactiques qu'utilisent les jeunes femmes pour transformer le cadre hétéronormatif du sutura en mode d'expression queer. Ces femmes démontrent la possibilité constante mais indéterminée de négocier entre les attentes normatives et la vie queer. Elles proposent ainsi une alternative à une approche internationale flagrante de résistance et de protestation queer, et suggèrent que les silences prescrits par le concept de sutura sont plus productifs pour la queerization de leur environnement urbain. Entre désirs d'intimité homosexuelle, vie de famille, attentes de la société et réussite urbaine, ces femmes sont des pionnières qui ouvrent de nouvelles voies à ce que Stella Nyanzi décrit comme « la queerization de l'Afrique queer ». Show less
This dissertation focuses on the actors and agencies in the transnational Buddhist networks that were involved in the making of Buddhism in Indonesia from 1900 to 1959. Using the framework of... Show moreThis dissertation focuses on the actors and agencies in the transnational Buddhist networks that were involved in the making of Buddhism in Indonesia from 1900 to 1959. Using the framework of transnational networks, this dissertation endeavours to understand how Buddhism gradually secured a place in Indonesian society. By viewing the late-colonial and early post-colonial period as a continuum in which Buddhism continued to take root, it connects developments that have thus far been treated as separated by the demarcation line of Indonesian independence.Furthermore it argues that modern Buddhism in the Indonesian archipelago developed as a result of global and regional religious transformations. Particularly important was the spread of Theravada Buddhism in South and Southeast Asia. Especially, the dissertation investigates the dominant roles of lay people, Buddhist missionaries and intellectuals who were living in and travelling to colonial Indonesia. The Peranakan Chinese were the primary local actors in this process because of their pivotal role in the making of modern Buddhism from the beginning of the period under consideration until the post- independence years. The Peranakan Chinese community can be seen as a “place” where people from various backgrounds articulated their ideas about Buddhism and interacted with others. Show less
Zuidberg, Lida; Kortbeek, Simone; Kingma, Koos; Koning, Ans 2020
In 2012 we returned to Southern Mali, where we have worked in the Women and Development programme of the Malian cotton company (CMDT) between 1987 and 1995. We were curious to find out what had... Show moreIn 2012 we returned to Southern Mali, where we have worked in the Women and Development programme of the Malian cotton company (CMDT) between 1987 and 1995. We were curious to find out what had changed for women in the cotton area since 1980. Have women been able to improve their economic position? Are the changes tangible in women’s control of their lives; their social participation; the relationship between men and women or between the generations? The book is a fabric of memories and images of our experiences of the past and our journey in 2012, coloured with perceptions and stories of the people we met. According to the review of Prof. Dr. Wouter van Beek the text does not represent a classic book, but rather a report based on information derived directly from the words of women and men who shared their views and experiences with us. In addition, the book does not only describe the changes in women's lives, but also the role of the CMDT being the largest parastatal in Southern Mali until 2003. Résumé: En 2012 nous sommes retournées au Mali-Sud, où nous avons travaillé dans le programme Femmes et Développement de la Compagnie Malienne pour le Développement des Textiles (CMDT) entre 1987 et 1995. Nous étions curieuses de découvrir ce qui avait changé pour les femmes dans la zone cotonnière depuis 1980. Les femmes ont-elles pu améliorer leur position économique ? Les changements, sont-ils tangibles dans le contrôle de leur vie ; leur participation sociale ; la relation entre hommes et femmes ou entre les générations ? Le livre est un tissu de mémoires et d’images de nos expériences du passé et de notre séjour en 2012, coloré des perceptions et des histoires des gens rencontrés. Selon la revue de Prof. Dr. Wouter van Beek le texte ne représente pas un livre classique, mais plutôt un reportage basé sur des informations dérivées directement des mots des femmes et des hommes qui ont partagé leurs vues et expériences avec nous. De plus, le livre ne traite pas seulement des changements dans la vie des femmes, mais aussi du rôle de la CMDT étant le plus grand parastatal au Mali-Sud jusqu’à 2003. Show less
Conditional cash transfers have become the tool of choice in poverty reduction throughout the global South, granting women significant access to social protection. Yet, their inclusion has not... Show moreConditional cash transfers have become the tool of choice in poverty reduction throughout the global South, granting women significant access to social protection. Yet, their inclusion has not necessarily resulted in more equal gender outcomes in employment. This paper addresses the question: to what extent has targeted social protection supported women in creating a more level playing field in the labour market? Two cities in the south of Ecuador form the context of new empirical evidence gathered to study the Bono de Desarrollo Humano programme (Ecuador) used to explore narratives of dependence associated to the provision of conditional cash transfers in a context marked by deep-rooted gender inequalities. The paper argues that the essentialist views of women’s capacities that underpin conditional cash transfer hinder their intended transformative impact, failing to introduce changes that would otherwise permit women to take full-time secure employment or move towards guaranteeing their social rights. Show less
The first of its kind, this volume collects more than seventy South African women’s voices, from 1652 until today. We share the joys and sorrows of these women through their entertaining, sometimes... Show moreThe first of its kind, this volume collects more than seventy South African women’s voices, from 1652 until today. We share the joys and sorrows of these women through their entertaining, sometimes disturbing texts. A testament to a significant segment of the linguistic and cultural history of the country, they speak in Dutch, then in different varieties of Afrikaans. The printing press arrived late at the Cape, and when it finally did, it took another century before the first publications by women appeared. Initially their writing bore a strong biblical influence, but gradually, as women began to have access to better educational opportunities, they began to produce literature of world stature in Afrikaans. Through this literature, we can see women’s perspectives on the tumultuous history of South Africa from colonisation to democracy as it unfolded. Show less
This study focuses on the issue of a “moral crisis” which was a widely discussed topic among the Ottoman intelligentsia. Moving on from the common view that the “moral crisis” reached a peak... Show moreThis study focuses on the issue of a “moral crisis” which was a widely discussed topic among the Ottoman intelligentsia. Moving on from the common view that the “moral crisis” reached a peak during the First World War, this study investigates how morality was related to the war and the preconditions that created the perception of a crisis in morality. The study argues that morality was a contested space among the intellectuals and explains how rival ideologies set forth their political positions depending on differing understandings of morality. For the state, on the other hand, moral decline became a matter of national security during the war. The study demonstrates how wartime rivalries were reflected in the cultural sphere through morality discourses. In public opinion and political circles, immorality was generally considered a social problem that had been imported from European countries. At the social level, the study focuses on family, women, and morality related crimes with an emphasis on the impact of war on traditional family order. The dissertation sheds a light on the place of morality in lawmaking processes, the ideas of reform and progress, and plans for a new society. Show less
