Background Female genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how... Show moreBackground Female genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how countries differ from one another in the circumstances of genital fistula development. Methods This retrospective records review evaluated demographics and circumstances of fistula development for 6,787 women who sought fistula treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. Results Most women developed fistula during childbirth, whether vaginal (3,234/6,787, 47.6%) or by cesarean section (3,262/6,787, 48.1%). Others had fistulas attributable to gynecological surgery (215/6,787, 3.2%) or rare causes (76/6,787, 1.1%). Somalia, South Sudan, and Ethiopia had comparatively high proportions following vaginal birth and birth at home, where access to care was extremely difficult. Fistulas with live births were most common in Kenya, Malawi, Rwanda, Uganda, Tanzania, and Zambia, indicating more easily accessible care. Conclusions Characteristics of women who develop genital fistula point to geographic differences in obstetric care. Access to care remains a clear challenge in South Sudan, Somalia, and Ethiopia. Higher proportions of fistula after cesarean birth and gynecological surgery in Kenya, Malawi, Rwanda, Uganda, Tanzania, and Zambia signal potential progress in obstetric fistula prevention while compelling attention to surgical safety and quality of care. Show less
Interest groups are often described as transmission belts that connect the preferences of their members with public officials in policymaking processes. Through this linkage, public officials can... Show moreInterest groups are often described as transmission belts that connect the preferences of their members with public officials in policymaking processes. Through this linkage, public officials can obtain relevant information and gain legitimacy from those affected by public policies. However, this important intermediary function is not a straightforward endeavor as interest groups often struggle to reconcile their dual function of representing their members while being politically active. This dissertation unpacks interest groups mobilized at the European Union level and examines how they are organized so as to function as transmission belts. Subsequently, it analyzes the effects of this transmissive role for the level of access and influence obtained by groups in policymaking processes. The findings shed light on the difficult task of groups in balancing member involvement while being politically active and the implications for the legitimacy of our governance systems. Show less
The studies described in this thesis are aimed at improving the whole spectrum of unrelated HSCT in order to help as many patients in need of HSCT as possible. It covers three different but related... Show moreThe studies described in this thesis are aimed at improving the whole spectrum of unrelated HSCT in order to help as many patients in need of HSCT as possible. It covers three different but related topics; from access to HSCT to optimizing donor search and selection of acceptable mismatches to improving HSCT outcome. In chapter 2 we investigate access to HSCT in the Netherlands for children with relapsed acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) to see whether patients eligible for HSCT are actually offered one and what might be the reasons for not referring a patient. Chapter 3 describes the role frequent HLA haplotypes may play in donor search and what the effect may be on HSCT outcome. In chapter 4 we propose an algorithm constructed by logistic regression analysis for prediction of CTL alloreactivity. It is based on number, position and physicochemical compatibility of AA differences in class I HLA molecules. This algorithm may be effective in identifying mismatched donors acceptable for HSCT. Before we can use this algorithm clinical validation is needed. Therefore we tried to translate the use of this algorithm from in vitro CTLp assay to in vivo HSCT. Studies aiming at the prediction of outcome of HSCT are described in chapter 5. Finally in chapter 6 we tested an algorithm developed by the transplantation group in Cambridge, which focused on electrostatic and hydrophobic properties of AA differences in class I HLA molecules, on the population we used for development of our own algorithm. Their algorithm was developed for prediction of humoral alloreactivity in organ transplantation and we wondered what could be the additional impact of a similar approach on cellular alloreactivity in HSCT. Show less
