To maintain momentum towards improved malaria control and elimination, a vaccine would be a key addition to the intervention toolkit. Two approaches are recommended: (1) promote the development and... Show moreTo maintain momentum towards improved malaria control and elimination, a vaccine would be a key addition to the intervention toolkit. Two approaches are recommended: (1) promote the development and short to medium term deployment of first generation vaccine candidates and (2) support innovation and discovery to identify and develop highly effective, long-lasting and affordable next generation malaria vaccines. Show less
The fact that most healthcare resources are spend on a small subgroup of patients with an unfavourable prognosis has long been recognized. Therefore change is needed in terms of an improved... Show moreThe fact that most healthcare resources are spend on a small subgroup of patients with an unfavourable prognosis has long been recognized. Therefore change is needed in terms of an improved identification of patients with an unfavourable prognosis, early in their treatment course, which may facilitate proactive approaches to improve outcomes. We discussed two conceptually distinct constructs of predictors of prognosis in order to improve the identification of patients with an unfavourable prognosis. First, the level of control of the chronic condition as a predictor could reflect to some extent the presence of a multitude of other risk factors. Second, information on early treatment response had better predictive ability for long-term outcomes and so acts as a proxy for treatment effectiveness. Treatment effectiveness depends on different aspects e.g. adequateness of initial treatment and/or drugs, the mutual trust between clinician and patient and behavioral aspects such as treatment adherence. Treatment response adds an insight that can be acted upon; guiding personalized decisions in the treatment plan. In conclusion, this thesis leads to improvement of personalized medicine and thereby could increase the efficient use of healthcare resources, with the early identification of patients at risk of an unfavourable prognosis. Show less
Geerse, D.J.; Roerdink, M.; Marinus, J.; Hilten, J.J. van 2019
Asthma is a common non-communicable respiratory disease. In this thesis we analysed three different management strategies for adult patients with asthma in primary care. In the first, we targeted... Show moreAsthma is a common non-communicable respiratory disease. In this thesis we analysed three different management strategies for adult patients with asthma in primary care. In the first, we targeted the currently recommended aim of __Controlled asthma__, which means patients experience hardly any symptoms. The second targeted __Partly Controlled asthma__, which allowed some symptoms. The third additionally used a FeNO-measurement to assess current control. Aiming for Partly Controlled asthma significantly reduced medication usage compared to Controlled asthma, while exacerbation-rate, quality of life and asthma control were similar. FeNO-guided Controlled asthma also significantly reduced medication usage compared to Controlled asthma and additionally significantly improved asthma control compared to Partly Controlled asthma. Aiming for FeNO-guided Controlled asthma is therefore the optimal strategy. In this thesis we also analysed daily measurements of symptoms and peak-flow, which are recorded in Written Asthma Action Plans, or in apps. Hereby we were able to predict future asthma exacerbations several days in advance with reasonable accuracy. Finally, we compared an online assessment of asthma control by a questionnaire with the results of the same questionnaire assessed by a practice nurse. We showed that asthma control is perceived as better when interacting with a caregiver than by online self-assessment. Show less
The thesis deals with the question as to whether international organisations could be jointly responsible for violations of international law committed by peacekeepers deployed in a peacekeeping... Show moreThe thesis deals with the question as to whether international organisations could be jointly responsible for violations of international law committed by peacekeepers deployed in a peacekeeping operation. The study starts by exploring the development of the concept of peacekeeping operations and the relations between the UN and four specific regional organisations (NATO, EU, AU and ECOWAS) on the basis of the applicable dispositions of the UN Charter. This examination as well as the following analysis of relations among these organisations, illustrate the evolution of a division of labour and an increase of cooperation between the UN and these organisations. It justifies the formulation of a presumption that international organisations could be jointly responsible as well as the formulation of a new criterion of attribution (normative control). The case-studies of specific peacekeeping operations confirm that in certain circumstances the UN and regional organisations have to be considered jointly responsible. Show less
This thesis deals with emotional and social influences on childhood somatic complaints. Strong support is provided for the idea that negative affect contributes to the development of somatic... Show moreThis thesis deals with emotional and social influences on childhood somatic complaints. Strong support is provided for the idea that negative affect contributes to the development of somatic complaints in childhood. In addition, the studies described give information about the type and levels of negative affect associated with somatic complaints in childhood. When appraisal is characterized by the experience of little control over negative situations and emotions, this is likely to directly cause more feelings of negative affect and also to contribute to a more negative processing of emotions: children who feel little control evidently use more maladaptive emotion regulation strategies. This negative emotional processing further contributes to negative affect and subsequent somatic complaints. These relationships between negative affect and somatic complaints are even present at subclinical levels of emotional problems. With regard to social problems, it is found that they have an effect on somatic complaints that is fully mediated by aspects of children’s emotional functioning: self-perceived social problems indicate lower feelings of control and more maladaptive emotion regulation. Show less
This thesis describes aspects of the epidemiology and attempts to control infection and pathology due to the nematode parasite Oesophagostomum bifurcum . In northern Ghana and Togo O. bifurcum is... Show moreThis thesis describes aspects of the epidemiology and attempts to control infection and pathology due to the nematode parasite Oesophagostomum bifurcum . In northern Ghana and Togo O. bifurcum is an important parasite of humans; elsewhere it is predominantly seen as a parasite of non-human primates. It is shown that frequency and severity of colonic pathology, measured by ultrasound, is associated with the intensity of infection as measured with coproculture. Females are more infected than males but convincing explanations for the gender-dependent difference of infection rates are not found. Details of the route of transmission remain obscure. Mass treatment with Albendazole resulted in a very important reduction of both prevalence and morbidity of infection. Elimination of human oesophagostomiasis is within reach. The impact on hookworms, also effectively killed by the drug, is considerably smaller. Interruption of Albendazole treatment results of rapidly increasing infection rates in hookworm but not in Oesophagostomum. Integration of control activities in the filariasis elimination programme is likely to result in elimination of human oesophagostomiasis but not of human hookworm infection. Show less
