The growing number of older patients presenting to Emergency Departments (EDs) requires better risk stratification to guide treatment and dispositiondecisions. Therefore, it is essential to... Show moreThe growing number of older patients presenting to Emergency Departments (EDs) requires better risk stratification to guide treatment and dispositiondecisions. Therefore, it is essential to understand the effect of age on the associations between physiological variables and outcomes. More importantly, most risk tools are not age or sex adjusted and are not based on a statistical approach. An age and sex adjusted risk tool could improve risk stratification in the ED.This thesis is divided into three parts and has four aims, regarding ageadjusted interpretation of physiological variables for risk stratification in ED patients, developing a new age- and sex-adjusted risk tool for the hospital, and describing potential bias if risk tools are used for comparing the quality of care among departments. Show less
It is well known that military deployment can lead to mental health problems in veterans, but the long-term impact is still unclear. This thesis discusses the results of the PRISMO-study, a large... Show moreIt is well known that military deployment can lead to mental health problems in veterans, but the long-term impact is still unclear. This thesis discusses the results of the PRISMO-study, a large cohort study in a group of Dutch Afghanistan veterans with a follow-up period of ten years. It shows that at ten years post-deployment, 8% of the cohort reported severe symptoms of posttraumatic stress disorder (PTSD). Agoraphobia, anxiety, depression, and hostility symptoms are also reported more frequently at ten years post-deployment compared to pre-deployment. Furthermore, this thesis demonstrates the large heterogeneity in PTSD symptom development among veterans. Of note is the delayed onset group that experienced increasing symptom levels between five and ten years post-deployment and did not show significant symptom reduction. The results from this thesis also show that various psychological factors, such as social support, and biological factors, such as DNA methylation, are associated with the development of PTSD or other mental health symptoms after deployment. Combining these factors in a prediction model for PTSD symptoms has not led to a useful screening instrument. It does, however, offer important leads for the identification of risk factors for PTSD and the development of intervention programs. Show less
The aim of the current dissertation was to examine the psychological, neurological and behavioral impact of different types of traumatic (A1) and stressful (non-A1) life events, including a focus... Show moreThe aim of the current dissertation was to examine the psychological, neurological and behavioral impact of different types of traumatic (A1) and stressful (non-A1) life events, including a focus on the impact of childhood maltreatment. The role of brain structure (hippocampal volume) and function (neural correlates of emotional face processing and social rejection) in intergenerational transmission of child abuse versus neglect was investigated using a multi-generational family study design. Show less
Through my investigation, I expose the multiple layers of Kurdish cinema constructed by Kurdish films and directors, by academics working on Kurdish cinema, by Kurdish institutions, and by... Show moreThrough my investigation, I expose the multiple layers of Kurdish cinema constructed by Kurdish films and directors, by academics working on Kurdish cinema, by Kurdish institutions, and by contemporary artists. By employing a content analysis of films in Kurdish languages, identifying Kurdish directors as agents of history making, and investigating attempts to institutionalize Kurdish cinema, I address the Kurdish presupposition of equality to act in an aesthetic regime of art. I structure my research under three chapters: ‘A Foundation of Kurdish National Cinema’, ‘A Re-interpretation of Kurdish Trauma’, and ‘An Aesthetic Regime of Kurdishness’. Based on the detailed discussion, across these three chapters, of national cinema, the art of the un-representable, and digital revolution, I aim to reveal the necessity of exploring the aesthetics regime of Kurdishness in audio-visual terms, in order to articulate the subjectification processes leading to an ethical community in the name of Rancièrian democratic politics.I posit cinema as a home for the communicative act that will empower speech and thought for the Kurdish social body. It does so by folding the future into the present through an aesthetic regime of imperfect, mobile audio-visual assemblages. Show less
In this thesis a literature review was conducted to map the results of earlier neuroimaging studies in minors who experienced childhood psychological trauma. Next, three different structural... Show moreIn this thesis a literature review was conducted to map the results of earlier neuroimaging studies in minors who experienced childhood psychological trauma. Next, three different structural neuroimaging techniques were employed to study the effects of childhood sexual trauma in youth .Main findings:1. Neuroimaging studies in traumatised children and adolescents are scarce and heterogeneous in design, in particular with regard to the sample studied and type of trauma.2. The results of structural neuroimaging studies in traumatised minors differ from those in adult populations, in particular with regard to findings on hippocampus and corpus callosum (CC).3. Paralleling the inconsistent findings on hippocampal volume reduction in traumatised minors, our VBM-study did not show differences between groups for hippocampal volume.4. VBM showed smaller volumes of key regions of the limbic system (ACC, amygdala) in the CSA-related PTSD group compared to controls.5. Adolescents with sexual abuse-related PTSD show no abnormalities in cortical thickness, in line with findings in adults. 6. Adolescents with CSA-related PTSD show less integrity of parts of the CC compared to healthy non-traumatised controls.7. Our structural neuroimaging studies showed limited associations with trauma symptomatology, in line with findings in studies in minors. Show less
This dissertation focused on the role of attachment-based interventions in child protection cases involving young children. The results confirmed that placement decisions are impacted by subjective... Show moreThis dissertation focused on the role of attachment-based interventions in child protection cases involving young children. The results confirmed that placement decisions are impacted by subjective factors, including professionals’ own attitudes and mind-set. Because we argue that the influence of subjective factors can be reduced by inserting relevant evidence into the decision-making process, we tested the effectiveness of one procedure that might produce such information. Evidence for the notion that implementing an attachment-based intervention in parenting capacity assessments can enhance the quality of placement decisions was partially found in this dissertation: We found initial evidence for improved reliability, but not for improved validity, of placement decisions. Taking these findings together with international evidence, we do tentatively conclude that attachment-based interventions can contribute to an improved quality of placement decisions. However, more research is needed to determine what implementation would be most fruitful in the Dutch child protection context. Finally, our finding that maltreating parents with more severe levels of childhood trauma benefited less from an attachment-based intervention implicates that we need to consider families’ individual needs when conducting interventions in this setting. This way, not only more parents will benefit from these interventions, their responses to these interventions might also be a more valid source of information to support placement decisions. Show less
According to different diagnoses, the advent of democracy in Chile was characterised by a fragmentation of and crisis within social movements, due to the lack of demonstrations by civilian society... Show moreAccording to different diagnoses, the advent of democracy in Chile was characterised by a fragmentation of and crisis within social movements, due to the lack of demonstrations by civilian society and even due to an absence of civilians. The aim of this study is to examine and open up debate on activation processes and the deactivation of Chilean civil society in particular, paying special attention to the period of democratic reconstruction during the four Concertación governments as a time of social demobilisation. In the same way, this study goes into more depth and broadens academic discussion on the factors that influenced this deactivation. It poses that social demobilisation between 1990 and 2010 was heavily influenced by traumatic post-dictatorial memories, by civil society’s relationship with the state and the paradigm of governability and, finally, by the market and logic of neoliberal modernity. The influence of political, psychological and economic factors as important inhibitors of eventual mobilising actions in the transition become, at the same time, components of this new socio-political mould. With this, new identities became possible and were also brought to light during the 2011 cycle of demonstrations. Show less
Trauma is a global problem, and carries a high price that is paid by individuals, communities, and nations. Road traffic accidents, industrial injuries, farming accidents and interpersonal... Show moreTrauma is a global problem, and carries a high price that is paid by individuals, communities, and nations. Road traffic accidents, industrial injuries, farming accidents and interpersonal violence account for traumatic injuries with varying prevalences throughout the world. Globally the liver is the most frequent injured intra-abdominal organ following trauma. Selection of patients with liver injuries for nonoperative management, definitive surgical repair or a damage control laparotomy is the topic of ongoing debates. The surgeon, who encounters a severely injured patient with a liver injury, will rapidly need to make several critical decisions. Nonoperative Management of hemodynamically stable patients following blunt and penetrating hepatic trauma is safe in adequately selected patients. Use of damage control techniques is recommended in patients with a major hepatic bleeding or in patients with a minor liver injury with associated vascular injury and before the onset of metabolic failure. As a result of improved survival following severe hepatic parenchymal damage an increase in intrahepatic vascular and biliary complications has become evident. Many of these complications can be prevented by surgical ligation if a laparotomy is warranted, or can be managed by less invasive, percutaneous techniques in the acute (vascular) or secondary (biliary) stage. Show less
The corpus of the Ottoman Turkish literary utopias is little known. It has not received its due share of attention in Ottoman Turkish literary history, and many works of this kind have sunken... Show moreThe corpus of the Ottoman Turkish literary utopias is little known. It has not received its due share of attention in Ottoman Turkish literary history, and many works of this kind have sunken into oblivion. The present dissertation aims at unearthing these works and at performing a comprehensive examination of this corpus which furnishes valuable insight into the Ottoman Turkish political, cultural, and literary history in the 19th and 20th centuries. It also demonstrates that the Balkan War of 1912-1913 represents a significant rupture in the trajectory of this literature. This dissertation argues that the catastrophic defeat suffered by the Ottomans in the Balkan War, along with its tragic consequences, produced profound shock and trauma in the Ottoman Turkish public and intelligentsia. The state’s teetering on the brink of collapse transformed and radicalized political and ideological positions on the country’s future. At the same time, this extreme setback transformed literature as well, assigning to it the mission of narrativizing this trauma and envisioning a future for Turkey. Accordingly, in the period following the Balkan War, many utopian works were produced in Ottoman Turkish literature, and some of these works have been helpful in the creation of new categories of identity. Show less
Confidence in a theory increases when it is confirmed by relevant data. Alongside some consistent findings, the data in the prevailing thesis largely detail a lack of confirmation of the... Show moreConfidence in a theory increases when it is confirmed by relevant data. Alongside some consistent findings, the data in the prevailing thesis largely detail a lack of confirmation of the neurotrophin hypothesis. And where expected associations were established (e.g., abnormally low serum BDNF concentrations in the depressed state), the meaning often was not that clear (e.g., reverse causation). I therefore conclude, whilst taking limitations into account and acknowledging that the results are contingent upon imperfect and peripheral measurement, that the most reliable evidence in humans does not corroborate the neurotrophin hypothesis. So, given the data, the final words of this thesis are that solid work over novelty shows that the neurotrophin hypothesis should no longer be credited in its original form. All that glitters is not gold - back to the drawing table Show less
After the Bijlmermeer aviation disaster on October 4th 1992, there was growing concern about the health of the residents and rescue workers exposed to the disaster. Persisting rumours about the... Show moreAfter the Bijlmermeer aviation disaster on October 4th 1992, there was growing concern about the health of the residents and rescue workers exposed to the disaster. Persisting rumours about the cause of the crash, toxic exposure and health consequences led more than eight years later to the Medical Investigation Bijlmermeer Aviation Disaster (Dutch acronym: MOVB). The MOVB consisted of an epidemiological investigation to assess the relationship between health complaints and exposure to the disaster and an individual medical examination for all individuals who considered themselves to be suffering from the consequences of the disaster. This thesis describes the results of the effects of participation in both studies. Overall, participation in the MOVB has had a negative effect on residents and rescue workers: after the investigation they became more worried about their health and more sensitive for complaints. Several factors seem important in explaining this adverse effect: whether or not they consulted a physician to discuss the results of the examination, the way in which communication of the results of the epidemiological study took place, the timing of this investigation more than eight years after the aviation disaster, and individual differences and vulnerabilities among the participants. Show less
The studies in this thesis concentrate on memory for an emotional event, with a specific focus on completeness, consistency and accuracy of emotional memories and their predictors. In doing so,... Show moreThe studies in this thesis concentrate on memory for an emotional event, with a specific focus on completeness, consistency and accuracy of emotional memories and their predictors. In doing so, both field and laboratory studies were conducted. The results show that overall, memory for emotional events is fairly complete and consistent over time. Still, the human memory is sometimes incomplete and prone to inaccuracies and inconsistencies. Maybe an elephant never forgets, people occasionally do! Emotional state, psychiatric status and psychological variables, with the exception of (peri) traumatic dissociation, did not have a strong influence on completeness, consistency and accuracy of memory for emotional events. Show less
