The cumulative lifetime risk of developing breast cancer for a Dutch woman is about 12%. In some families breast cancer seems to occur even more frequently or women fall ill at a relatively young... Show moreThe cumulative lifetime risk of developing breast cancer for a Dutch woman is about 12%. In some families breast cancer seems to occur even more frequently or women fall ill at a relatively young age. Such families may have a genetic susceptibility towards breast cancer. To learn more about the likelihood of this susceptibility actually being present, members of such families may request genetic counselling and DNA-testing. The main purpose of this thesis is to provide more insight into some effects of genetic counselling and DNA testing for breast cancer. We address effects on: (a) risk perception; (b) psychological distress; and (c) intentions for risk-management behaviour. Regarding the effects of DNA testing, special attention is paid to women who receive a so-called uninformative DNA-test result. The data of this thesis do not provide support for one of the two hypotheses which has been postulated about the impact of an uninformative result. They suggest that, as a group, women seem to be reassured upon learning their uninformative result, but to a lesser extent than women who received a true negative result. Only a small minority of women with an uninformative result incorrectly concluded that the chance of a mutation being present was non-existent. Show less
Purpose Type 2 diabetes requires patients to make lifestyle changes and perform daily self-care. To determine at what stages patients may need particular self-management support, we examined (1)... Show morePurpose Type 2 diabetes requires patients to make lifestyle changes and perform daily self-care. To determine at what stages patients may need particular self-management support, we examined (1) whether patients' performance of self-care related to their diabetes duration, and (2) whether illness characteristics (treatment and complications) and diabetes-related distress influenced this relationship. Methods Cross-sectional data from 590 type 2 diabetes patients were analysed through linear and logistic regression analysis. Self-care behaviours were assessed by the revised Summary of Diabetes Self-Care Activities (SDSCA) measure. Diabetes duration (model 1), treatment and complications (model 2), and distress, as assessed by the Problem Areas In Diabetes (PAID) scale (model 3), were stepwise included. Sociodemographic characteristics were added to all models to account for confounding. Results Patients with a longer history of diabetes were less physically active, but monitored their blood glucose levels more frequently than more recently diagnosed patients. These relationships were mediated by the presence of complications and the use of insulin, with lower levels of physical activity being found among patients with macrovascular complications and higher frequencies of glucose monitoring among patients on insulin. All predictors together explained maximally 5% of the variance in self-care, except for glucose monitoring (37%) and smoking (11%). Conclusion Type 2 diabetes patients' self-care activity changes over the course of illness. To provide tailored self-management support, diabetes care providers should take into account patients' phase of illness, including their treatment and complications, as well as their personal characteristics and distress level. Show less
This dissertation reports about the construction and validation of the Apperception Test God Representations. First, results of a meta-analysis demonstrated that for adherents of monotheistic... Show moreThis dissertation reports about the construction and validation of the Apperception Test God Representations. First, results of a meta-analysis demonstrated that for adherents of monotheistic religions, their perceived and experienced relationship with the personal god they believe in, was associated with well-being and distress. Also, as was expected based on object-relations and attachment theory, God representations were associated with views of self and others and with neuroticism/optimism. However, these results were mostly based on self-report measures of God representations, which are thought to be susceptible to social desirability and doctrine effects. Many scholars believe that God representations are for an important part implicit. Because well-validated implicit God representation measures did not exist, this thesis project examined the validity of a newly developed measure. In a group of 74 Christian patients with personality disorders and a group of 71 Christian nonpatients, associations of implicitly measured God representations with implicitly and explicitly measured distress and object-relational and explicitly measured personality functioning were compared with associations of explicitly measured God representations with these variables. For patients, associations between changes in God representations and changes in distress and explicit object-relational functioning after psychotherapy were examined. Results predominantly corroborated the construct validity of the ATGR. Show less
