This thesis describes the wide range of long-term consequences in stroke patients who received multidisciplinary rehabilitation.Over a third of them reported pain in the shoulder, arm, wrist or... Show moreThis thesis describes the wide range of long-term consequences in stroke patients who received multidisciplinary rehabilitation.Over a third of them reported pain in the shoulder, arm, wrist or hand. About the same percentage had low patient activation scores, which is a prerequisite for effective self-management to cope with the consequences of stroke. Almost half of patients who were working before the stroke managed to maintain paid employment for two and a half years. These patients were more satisfied with their participation than patients who did not return to work. Average independence in daily activities increased during rehabilitation. The Barthel Index was found to be more sensitive to measure change than the Utrecht Scale for Evaluation of Rehabilitation. Health-related quality of life increased on average from start of rehabilitation to one year afterwards. The average social costs in the first year were €63,045 for inpatients and €24,533 for outpatients. The burden of the nearest of stroke patients was investigated, which showed that a third of them experienced a high burden.In conclusion, the consequences of stroke can also remain present, worsen or develop in the long term and are present for the individual patient, their nearest and the healthcare system. Show less
Bongaerts, T.H.G.; Buchner, F.L.; Crone, M.R.; Exel, J. van; Guicherit, O.R.; Numans, M.E.; Nierkens, V. 2022
Background: The Netherlands hosts, as many other European countries, three population-based cancer screening programmes (CSPs). The overall uptake among these CSPs is high, but has decreased over... Show moreBackground: The Netherlands hosts, as many other European countries, three population-based cancer screening programmes (CSPs). The overall uptake among these CSPs is high, but has decreased over recent years. Especially in highly urbanized regions the uptake rates tend to fall below the minimal effective rate of 70% set by the World Health Organization. Understanding the reasons underlying the decision of citizens to partake in a CPS are essential in order to optimize the current screening participation rates. The aim of this study was to explore the various perspectives concerning cancer screening among inhabitants of The Hague, a highly urbanized region of the Netherlands. Methods: A Q-methodology study was conducted to provide insight in the prevailing perspectives on partaking in CSPs. All respondents were inhabitants of the city of The Hague, the Netherlands. In an online application they ranked a set of 31 statements, based on the current available literature and clustered by the Integrated Change model, into a 9-column forced ranking grid according to level of agreement, followed by a short survey. Respondents were asked to participate in a subsequent interview to explain their ranking. By-person factor analysis was used to identify distinct perspectives, which were interpreted using data from the rankings and interviews. Results: Three distinct perspectives were identified: 1). "Positive about participation", 2). "Thoughtful about participation", and 3). "Fear drives participation". These perspectives provide insight into how potential respondents, living in an urbanized region in the Netherlands, decide upon partaking in CSPs. Conclusions: Since CSPs will only be effective when participation rates are sufficiently high, it is essential to have insight into the different perspectives among potential respondents concerning partaking in a CSP. This study adds new insights concerning these perspectives and suggests several ideas for future optimization of the CSPs. Show less
Spierenburg, W.; Wier, M.F. van; Poolman, R.W. 2022
Objective: To investigate patient preferences and the determinants of participation willingness in or-thopaedic diagnostic or invasive surgical randomized controlled trials.Methods: This... Show moreObjective: To investigate patient preferences and the determinants of participation willingness in or-thopaedic diagnostic or invasive surgical randomized controlled trials.Methods: This observational study included one hundred patients visiting an orthopaedic clinic. The pa-tients answered if they were willing to participate in a hypothetical invasive and diagnostic trial among patients with a distal radius fracture.Results: We found no difference in participation willingness in either the invasive surgical (66/100) or the diagnostic trial (68/100, p = 0.76). Willingness to participate was not associated with age, gender, country of origin, level of education, marital status, or distance of home from the hospital with the confidence interval for all odds ratios including the value 1. Patients who expressed willingness to participate do so because they wanted to contribute to science; patients who declined to participate wanted to speak with a doctor and to be better informed.Conclusion: This study showed a high rate of willingness to participate in orthopaedic surgical invasive trials and in diagnostic trials. Nevertheless, to ensure participation, it is recommended to put emphasis on the contribution to science and to give adequate information about the trial including the opportunity to talk to a doctor.(c) 2022 Elsevier Ltd. All rights reserved. Show less
Background Many breast, colorectal, and cervical cancer screening programs were disrupted due to the COVID-19 pandemic. This study aimed to estimate the short-term impact of the temporary shutdown ... Show moreBackground Many breast, colorectal, and cervical cancer screening programs were disrupted due to the COVID-19 pandemic. This study aimed to estimate the short-term impact of the temporary shutdown (from March until May- June) of the cancer screening programs invitations in Flanders (Belgium) by looking at invitation coverage, percentage of people screened after invitation and the screening interval. Methods Yearly invitation coverage was calculated as the number of people who received an invitation, as a proportion of the people who should have received an invitation that year. Weekly response to the invitation was calculated as the number of people who were screened within 40 days of their date of invitation, as a percentage of the people who received an invitation that week (as a proxy for willingness to screen). Weekly screening interval was calculated as the mean number of months between the current screening and the previous screening of all the people who screened that week. The two last indicators were calculated for each week in 2019 and 2020, after which the difference between that week's value in 2020 and 2019 with 95% confidence intervals. Results of these two indicators were also analysed after stratification for gender, age and participation history. Results Invitation coverage was not impacted in the colorectal and cervical cancer screening program. In the breast cancer screening program invitation coverage went down from 97.5% (2019) to 88.7% (2020), and the backlog of invitations was largely resolved in the first six months of 2021. The willingness to screen was minimally influenced by COVID-19. The breast cancer screening program had a temporary increase in screening interval in the first months following the restart after COVID-19 related shutdown, when it was on average 2.1 months longer than in 2019. Conclusions Willingness to screen was minimally influenced by COVID-19, but there may be an influence on screening coverage because of lower invitation coverage, mainly for the for breast Cancer Screening Program. The increases in screening intervals for the three Cancer Screening Program seem reasonable and would probably not significantly increase the risk of delayed screening cancer diagnoses. When restarting a Cancer Screening Program after a COVID-19 related shutdown, monitoring is crucial. Show less
This research project adresses the question how local and traditional European forms of parrhesiastic theater—by which I mean events, actions, and performances staged by characters who courageously... Show moreThis research project adresses the question how local and traditional European forms of parrhesiastic theater—by which I mean events, actions, and performances staged by characters who courageously speak their minds through scenes of excess and laughter, that take place in public view and incite the spectator’s agency to speak their own minds—possibly relate to and/or provide new insights into critical artistic practices today. In this context, the project also examines the place and role of caricature today.I approach the issue as an artist-researcher concerned with socially engaged artistic practices. The experience of the playful, humorous, and sharply critical attitude of Gezi Park protesters speaking their minds in Istanbul in 2013 led me to critically reconsider my own courage in positioning myself within contemporary artistic production. Throughout the dissertation I work along a Moebius strip schema, which continually shifts from me as individual artist to dialogic collaborations to writing about the process. The research subject is investigated through a circulation process within which concepts such as communication, dialogue, and listening are continuously performed and put to the test. The dissertation aspires to provide new insights into how tensions between the roles of individual and group, “I” and “we,” may open up a parrhesiastic space for critical artistic practices. Show less
Many cities in the United States are pursuing agendas to implement ICT-based solutions to tackle urban challenges, thus achieving the ‘smart city’ label. While the discussion on this urban... Show moreMany cities in the United States are pursuing agendas to implement ICT-based solutions to tackle urban challenges, thus achieving the ‘smart city’ label. While the discussion on this urban development paradigm has revolved around the intensive use of technologies, the academic literature increasingly calls for shifting the focus to the people living in the cities. This paper argues that to achieve a people-centred smart city, cities should include the perspectives of all the local stakeholders. Under this assumption, this paper provides the views of the local stakeholders in a medium-sized city in Tennessee, Chattanooga. Particularly, this study explores their perceived smart city concept, the ethical standards that should guide smart city projects, the desired future projects in their community, and the barriers to implementing them. The data was collected using a combination of participatory budgeting, five focus groups, and twenty-eight interviews with city dwellers, entrepreneurs, university faculty, non-profit members, and government officials. The results suggest that, far from the image of a highly technological city, the stakeholders envision a city dedicated to improving the quality of life and environmental sustainability. Furthermore, to achieve this smart city, the projects need to be based on full transparency and the promotion of social inclusion. In contrast to the dominant trend towards the privatization of urban space, this study finds that the stakeholders prefer public based smart city projects such as ICT-based public transport services. However, its successful implementation will have to overcome the barriers caused by funding constraints, public acceptance, and political interests. Cities may use the results of this study to design more responsible smart city projects that strike an optimal point between citizen engagement and technological applications and innovations while supporting all stakeholders’ needs. Show less
This study identifies the human rights of children who live in foster care due to a family supervision order, and analyses the extent to which Dutch laws and regulations protect these rights. The... Show moreThis study identifies the human rights of children who live in foster care due to a family supervision order, and analyses the extent to which Dutch laws and regulations protect these rights. The aim of the research is to provide insight into the rights of foster children regarding four important decisions about their lives. Although the interests of the child are often taken as a starting point for these decisions, this does not do justice to the recognition of children as subjects of rights. After all, individual interpretations of the best interests of the child will inevitably depend on the normative frameworks of the decision-maker. It is argued that by identifying which children's rights can be derived from a human rights framework, children in foster care can be given stronger protection when making decisions about their life. The study concludes that the literal text of Dutch laws and regulations does not usually conflict with children's and human rights. Yet in many cases, foster children have no effective means of invoking their rights. Therefore recommendations are being made to amend the law and regulations to better protect the rights of children in foster care. Show less
Objectives: Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1)... Show moreObjectives: Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age < 65 versus >= 65 years.Methods: PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool.Results: Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age >= 65), and 2 on caregiver burden (1 study with mean age >= 65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences.Conclusions and implications: VSN has a negative impact not only on patients' independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN should be systematically and carefully assessed during rehabilitation. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice. (C) 2019 Elsevier Masson SAS. All rights reserved. Show less
The current knowledge on ABI is focused on children and the physical and cognitive outcomes. Fatigue is one of the most reported symptoms after ABI. The current thesis focuses on the adolescent... Show moreThe current knowledge on ABI is focused on children and the physical and cognitive outcomes. Fatigue is one of the most reported symptoms after ABI. The current thesis focuses on the adolescent and young adult age group and the impact of ABI on fatigue, physical activity and participation. Show less
Neonatal brachial plexus palsy (NBPP) is a nerve injury to the brachial plexus which controls arm-movements. This thesis describes the impact of this injury on the lives of patients in terms... Show moreNeonatal brachial plexus palsy (NBPP) is a nerve injury to the brachial plexus which controls arm-movements. This thesis describes the impact of this injury on the lives of patients in terms of quality of life, participation, healthcare use and treatment outcomes. Findings in this thesis have led to important insights into the care for patients with NBPP and their families. It turns out that there is considerable information need in these patients, that NBPP has impact on families of very young patients and adult patients perceive influence of NBPP on their study and career choices. This thesis also showed that when describing outcomes of shoulder surgery (tendon-transfers) it is important to take into account treatment history because outcomes differ for children with a surgical treatment history. This may help to manage patients’ outcome expectations. A recommendation in this thesis is to develop and investigate a standardized paramedic treatment protocol for the different life-phases of NBPP patients because this is not available yet. Hereby, a more strict follow-up is very important. Furthermore, better information should be developed in order to provide NBPP patients with the information they need throughout their lifespan. Findings in this thesis can be used for this. Show less
It has been well established that underserved groups have an increased risk of cardiometabolic disease and are less likely to attend health checks. This differential uptake of health checks... Show moreIt has been well established that underserved groups have an increased risk of cardiometabolic disease and are less likely to attend health checks. This differential uptake of health checks leads to suboptimal health gains from cardiometabolic screening and contributes to the widening of health inequalities in society. The cost-effectiveness of the Dutch cardiometabolic health check is still under study, but with the knowledge we already have it seems advisable to focus primarily on the underserved groups, as they have the most to gain from systematic screening. The findings described in this thesis provide strategies to optimize uptake and may be used to design future studies on this topic. In the general discussion we also advocate that the Government should invest in population-based prevention and move away from the trend of taking own responsibility as this may provide underserved groups the best possible opportunities for a healthy life(style). Show less
International law and state practice mirrors the recognition of children’s particular need for protection during peacetime but also in situations in which international crimes are being committed,... Show moreInternational law and state practice mirrors the recognition of children’s particular need for protection during peacetime but also in situations in which international crimes are being committed, the prosecution of international crimes committed against children before international courts and tribunals is well embedded. While international prosecutions are thus in line with the overall development of protecting children from the consequences of armed conflict and large scale violence, the involvement of the child in international criminal proceedings also gives rise to new questions which relate to the procedural involvement of the child. As child participation in the proceedings before the International Criminal Court (ICC) constitutes a matter of fact, one may raise the question whether such participation is a welcome development. This study examines the procedural implications of child participation and thereby intents to contribute legal views and perspectives to the underlying debate on the adequacy of child participation in ICC proceedings. Show less
Grootens-Wiegers, P.; Vries, M.C. de; Beusekom, M.M. van; Dijck, L. van; Broek, J.M. van den 2015
The results of the studies included in this thesis suggest that the incidence of ABI in children and youth is considerable. Moreover, it was found that relatively many have long-term health... Show moreThe results of the studies included in this thesis suggest that the incidence of ABI in children and youth is considerable. Moreover, it was found that relatively many have long-term health problems, including limitations in psychosocial functioning, participation and QoL and that the impact on their families is substantial. These findings underscore the need for an increasing awareness for the impact of paediatric ABI. One study explored the effects of usage of serious gaming found that physical activity, the speed of information processing, attention, response inhibition, and parent-perceived Quality of life (QoL) were improved directly after the intervention. Participation is the most relevant outcome of recovery and main goal of rehabilitation. However, a better general understanding and improvements of assessment and treatment are required to decrease the impact of paediatric ABI on participation of youth and their families. Recommendations based on this thesis are: a) implement the ICF-model to improve comprehension of participation (problems) after paediatric ABI; b) measure and monitor participation after paediatric TBI and NTBI and c) develop and evaluate trajectories optimising participation. Show less
The Zimbabwean issue has often divided opinion. President Robert Mugabe's domination of the country__s political and media landscapes has attracted scrutiny and criticism from the West. The ... Show moreThe Zimbabwean issue has often divided opinion. President Robert Mugabe's domination of the country__s political and media landscapes has attracted scrutiny and criticism from the West. The "oppressed" people of Zimbabwe are said to have not had an alternative to state-sponsored TV or daily media outlets. The availability of new media vices including the Internet is being seen as offering a new platform to fight these perceived forms of dictatorships. This PhD employed qualitative methods to probe the potential of new media in sustaining democracy in Zimbabwe. Show less
Installation art is one of the most common forms of contemporary art. Installations constitute themselves both in space and time. They are made of multiple media and materials. Often they are... Show moreInstallation art is one of the most common forms of contemporary art. Installations constitute themselves both in space and time. They are made of multiple media and materials. Often they are compared to stage sets, which the viewer can enter physically. Well-known installations are the site-specific works created by Carsten Höller, Doris Salcedo and Olafur Eliasson for the Turbine Hall of London’s Tate Modern. Installation art is particularly known for the kind of spectatorship that it has brought about. Installations are said to turn passive viewers into active participants. This dissertation aims to analyze this spectatorship: How do we experience works of installation art, what is so particular about this spectatorship, and how does it reflect on the ‘experience society’ we are supposed to be living in? The aim of my research is to contribute to the theoretical reflection on spectatorship. I contend that installation art transforms the viewer into a ‘performing observer’. In experiencing an installation viewers revert to their own memories, associations, wishes and dreams. Inadvertently they are writing themselves into the ‘play’ that is suggested by the scenario in which they find themselves. Performing an installation means entering into a playful yet reflective interaction with one’s surroundings. Show less
This study examines the links between the state and civil society in Chile and the ways social policies have contributed since 1990 to the construction of democratic governance in that country. The... Show moreThis study examines the links between the state and civil society in Chile and the ways social policies have contributed since 1990 to the construction of democratic governance in that country. The main transformations in the link between the state and civil society in the period under consideration took shape in public policies, particularly in the social area. This was the top priority in government management and constituted the main difference from the previous neoliberal stance adopted by the Pinochet regime (1973-1990). On the basis of such policies, furthermore, participatory guidelines were set forth and efforts were directed to ensure social inclusion of the poorest sectors in society. The study discusses the role of public policies and the opportunities they provide for civil society in a scenario of political stability and economic growth based on opening to the foreign sector and the predominance of market economy. Given a broad notion of governance, it is argued that public policies have been the main instrument for transformation resorted to by democratic administrations since 1990 to amend the circumstances inherited from the military regime. However, the ability of these policies to expand democratic governance has proved to be limited, to the extent that such policies have become subordinate to an elitist model of democracy and adopted a restricted form of citizen participation. In this context, the following are discussed: (a) major social policy agendas; (b) selected innovations in the link between civil society and public policies; and (c) personal trajectories from civil society to positions of government power. Show less
