Advance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally...Show moreAdvance care planning (ACP) is a process in which the patient expresses their wishes regarding future medical care in the presence of their family and health care provider. ACP is generally accepted in Western countries and has a positive effect on end-of-life care for people with dementia. However, culture affects expectations and preferences regarding end-of-life care and decision making. This study compared the acceptability of and preference for two types of ACP interventions for patients with dementia in health care providers from the Netherlands, the US and Japan. One intervention focused on concrete treatment orders in which the patient makes specific decisions. The other focused on what the patient finds important in life, resulting in global goals of care. A total of 125 participants were assessed by means of a structured interview and a questionnaire. Participants found both types of ACP acceptable, in general and per country. A multinomial logistic regression analysis indicated no significant difference in acceptability of the concrete or the global ACP approach between countries when adjusted for age and gender. However, age was a significant predictor of acceptability of the concrete ACP approach (2 (2, 123) = 6.32, p = .042), with older participants being less likely to find it acceptable compared to not finding it acceptable (W(8) = 5.50, p = 0.019). Participants preferred the global ACP approach for patients with dementia. A multinomial logistic regression analysis indicated no significant differences in preference between countries when adjusted for age and gender in general. However, Dutch participants were less likely to prefer the global ACP approach (W(8) = 5.18, p = .023). The relationship between country and preference was not influenced by whether participants most strongly considered what the patient with dementia wants for themselves, what the patient’s family wants or what they as the health care provider want for their patient when making medical decisions. ACP is generally regarded as an acceptable form of care for patients with dementia by health care providers across countries. Future research could more specifically determine which cultural or demographic aspects affect health care providers’ views on different ACP approaches.Show less
The Clarion-Clipperton Zone (CCZ) in the Pacific Ocean holds significant reserves of polymetallic nodules, making it a potential exploitation area for deep sea mining. However, the exploitation of...Show moreThe Clarion-Clipperton Zone (CCZ) in the Pacific Ocean holds significant reserves of polymetallic nodules, making it a potential exploitation area for deep sea mining. However, the exploitation of this shared natural resource poses challenges in terms of sustainability and resource management. This thesis examines the governing framework of the International Seabed Authority (ISA) for the management of deep sea mining in the CCZ. The study draws upon the design principles for governing the commons proposed by Elinor Ostrom to analyze the policies and draft regulations of the ISA. By examining to what extent the policies and regulations of the ISA are aligned with Ostrom's principles, this research aims to evaluate the current governance framework for the management of the CCZ and its resources.Show less
This thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and...Show moreThis thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and subjectively. Previous studies have established that a long delay occurs between the onset of mood symptoms in BD and the first form of treatment received, estimates ranging between 6 and 11 years. Cognitive impairments in the domains of executive functions, processing speed and memory were found to persist in BD patients even during euthymia. Such cognitive impairments burden BD patients, prevent them from regaining an appropriate level of general functioning and diminish their quality of life. Thus, in order to determine whether treatment delay impacts the cognitive impairments present in BD, 69 participants were followed over the course of one year, at three different time points. The participants took part in clinical interviews, and then were asked to complete multiple measures, such as the YMRS, the QIDS, four WAIS subscales (Block Design, Arithmetic, Information and Digit symbol), and the Cognition subscale of the WHODAS. The average treatment delay found in the current sample was 14.53 years. The results of the current study suggest that longer treatment delays did not significantly predict worse cognitive functioning in BD patients, either when measured subjectively, or when measured objectively.Show less
Bachelor thesis | Cultural Anthropology and Development Sociology (BSc)
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This thesis explores the continuum of East African knowledge production with a particular focus on the dialogue between endogenous East African and Western colonial knowledge production through...Show moreThis thesis explores the continuum of East African knowledge production with a particular focus on the dialogue between endogenous East African and Western colonial knowledge production through colonialism. This dialogue is approached through an investigation of the colonial classifications of tribe and ethnicity, depicting how these classifications were created and enforced, and their interaction with and effect on endogenous East African knowledge production.Show less
Suicidal ideation is more prevalent in people with Borderline Personality Disorder. Negative self-conscious emotions, such as shame and guilt, may be related to this relationship. In this study the...Show moreSuicidal ideation is more prevalent in people with Borderline Personality Disorder. Negative self-conscious emotions, such as shame and guilt, may be related to this relationship. In this study the relationship between suicidal ideation and borderline personality traits was explored. Shame and guilt were analysed as possible mediators. The Personality Assessment Inventory – Borderline Scale was used to assess borderline personality traits, and Ecological Momentary Assessment was used to gather data on suicidal ideation, guilt and shame four times a day, over the course of three weeks via an app. The sample consisted of (N = 82) adults with a history of a suicide attempt or moderate-to-severe suicidal ideation in the past year. The relationships were analysed using a parallel mediation model consisting of multiple multilevel regression analyses. All steps of the model showed significant relationships. The last step showed that instead of typical mediation, the model indicated suppression, because of an increase in the association between borderline personality traits and suicidal ideation when accounting for shame and guilt. More research is necessary to explore the possible cause of these findings.Show less
This research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing...Show moreThis research aims to investigate the topology of the brain during reward processing and the influence of dopamine and norepinephrine on this network. So far, most research about reward processing has concentrated on specific brain areas and connections between particular regions, rather than the brain's organization and architecture. By investigating this organisation, gaps in our understanding of the brain architecture can be addressed, which could in turn lead to a better understanding of pathologies that disrupt the brain’s architecture. It is hypothesized that the brain will be more integrated during reward processing, and that increased dopamine and norepinephrine activity will result in a more integrated brain organisation. To test this prediction, the Global Efficiency (GE) of a total of 132 Regions of Interest (ROIs) and BOLD- activity of the Substantia Nigra/Ventral Tegmental Area (SN/VTA) and the Locus Coeruleus (LC) were obtained during a reward processing task, which 38 participants completed. During a functional magnetic resonance imaging (fMRI) scan, participants completed a reward- emotion recognition test. As predicted, in the reward condition, the paired t-test showed a higher GE in comparison to the no-reward condition in several nodes, mostly in the default mode network. These findings imply that the brain is more integrated when processing reward than when it is not processing reward. However, the catecholamines showed no significant correlation with this integration. Future research is needed to investigate the topology and influence of different catecholamines in more detail. The implications of these findings will be discussed.Show less
In recent years, classical psychedelics have become increasingly popular as a possible treatment method for mental health disorders. Optimizing set and setting during psychedelic use leads to the...Show moreIn recent years, classical psychedelics have become increasingly popular as a possible treatment method for mental health disorders. Optimizing set and setting during psychedelic use leads to the most beneficial outcomes. Trait mindfulness, which is the general tendency to experience mindfulness in daily life, could be seen as part of the set. Earlier research suggested that psychedelic drug intake could lead to increases in practicing mindfulness, trait mindfulness, and cognitive flexibility (CF), all factors associated with positive mental health outcomes. Moreover, these factors seem to be interconnected, as, for instance, trait mindfulness can predict higher CF. Since there has currently been no research yet on the influence of psychedelic drug intake on CF with trait mindfulness as a mediator, as well as on the impact of psychedelic drug intake on trait mindfulness controlling for current meditation practice, this paper aimed at filling this explanatory gap. The findings suggested that psychedelic-experienced individuals are more likely to currently be a meditator than psychedelic naives and that the positive association between psychedelic use and trait mindfulness remains after correcting for current meditation practice. Further, a significant indirect relationship between psychedelic drug intake and CF with trait mindfulness as a mediator has been found, though the direct effect is non-significant. Lastly, psychedelic use-related variables were investigated, showing that the dose could positively predict CF but other variables, including frequency, recency, and likelihood of next intake could not. Implications of these findings for current practice, future research, and psychedelic-based treatment were considered.Show less
Background Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are...Show moreBackground Alzheimer's dementia (AD) and mild cognitive impairment (MCI) are neurodegenerative conditions associated with cognitive decline. Previous research suggests that motor impairments are also present in individuals with MCI and AD. This thesis study aims to evaluate motor sequence learning abilities in patients with amnestic MCI (aMCI) and AD compared to healthy controls. This thesis study also explores the relationship between amyloid-β burden, a known biomarker for MCI and AD, and motor sequence learning to study whether such motor learning could also be a behavioral biomarker. This is because measuring amyloid-β is very costly and invasive, and thus the search for other biomarkers is important. Methods A cross-sectional design was employed, and participants included 28 AD patients, 33 aMCI patients, and 53 healthy controls. Motor sequence learning was assessed using a computerized task measuring reaction time and accuracy per trial, and with this information the rate and final amount of learning was calculated, i.e. how fast and how much information the participants are able to learn, respectively. Amyloid-β burden was measured using PET imaging, with higher burden reflecting more severity of the symptoms of aMCI and AD. Results The final amount of learning was not different amongst the groups, and the rate of learning was only significantly different between the AD and aMCI groups, with the AD groups showing a faster rate of learning. The AD and healthy control group did not, however, differ significantly in terms of rate of learning. The amount of amyloid-β in the brain was not associated with motor sequence learning abilities. Conclusion The findings suggest that motor sequence learning abilities are preserved in individuals with aMCI and AD, both in terms of how fast and how much they learn. In fact, patients with AD showed a faster rate of learning than patients with aMCI, although this was not found when comparing the AD patients with the healthy individuals. It is possible that this finding is because patients had more to learn by the end of the task than the aMCI group given that their memory is worse, and displayed a faster rate of learning due to this. This thesis study also suggests that motor sequence learning is not a behavioral biomarker for aMCI and AD. The search for less invasive and more easily measurable biomarkers continues to be imperative.Show less
In a world of rising economic inequality, exploring factors that contribute to a more equal society is vital. The extent to which people are generous towards those around them can help reduce local...Show moreIn a world of rising economic inequality, exploring factors that contribute to a more equal society is vital. The extent to which people are generous towards those around them can help reduce local inequalities. While previous literature has established a link between economic mobility and preferences for redistribution, the impact on individual giving remains unclear. Therefore, this study examined the influence of economic mobility on giving behavior and whether meritocratic beliefs mediate this effect. The sample included 301 participants, predominantly from Global South countries. Participants were randomly assigned to ranks on a 5-rank ladder resembling socioeconomic classes and to conditions of low or high economic mobility. First, participants played a game in which they estimated the number of dots in a picture. Those with high economic mobility could earn 3 points, and those with low economic mobility could earn 1 point per round. In a dictator game, they could indicate how many points they want to give to reach rank. Results showed that the high economic mobility condition had significantly stronger meritocratic beliefs about the estimation game, aligning with the first hypothesis. However, contrary to the second hypothesis, participants in the high economic mobility condition gave significantly more to the ranks below them. Meritocratic beliefs about the estimation game did not mediate the effect. This suggests that inducing high economic mobility seems to increase generosity, particularly towards those with fewer resources. Policymakers and non-governmental organizations should promote high economic mobility to foster generosity in society.Show less
Social media has become a platform for sharing alcohol and other drug (AOD) recovery journeys, with #selflove as a prominent theme. This study explores the association of self- views, positive...Show moreSocial media has become a platform for sharing alcohol and other drug (AOD) recovery journeys, with #selflove as a prominent theme. This study explores the association of self- views, positive emotions, and social connections in the context of social media, particularly regarding #selflove and in AOD recovery. Specifically, social connections are examined as they are considered to be a relevant point of support during the recovery process. Positive emotions are examined, as employing a more positive outlook towards oneself is associated with a more positive self-view and a more sustained recovery process. The dataset comprises 902 posts from Instagram and Twitter in 2019 collected by Ziemer (2022). The present study addresses two research questions: (1) What is the association between positive and negative self-views in social media posts using chi-square analysis to identify a balanced self-view (discussing negative and positive self-views) during the recovery journey, (2) to what extent can positive self-view mentions be predicted through logistic regression, based on expressed connectedness with family/friends, the AOD recovery community, and positive emotions in the posts. Surprisingly, the results challenge the initial hypothesis of predominantly balanced self-views in these posts, as no association was found between mentioning positive and negative self-views within a single post. Contrary to expectations, mentioning positive self- views was not linked to references to connecting with others or positive emotions. Future research should employ more nuanced coding for emotions and social connections. Qualitative measures can help capture potential differences between sharing one's recovery journey online and the actual offline experience.Show less
Small island territories are one of the first that face the disruptive consequences of climate change, although they have historically contributed least. Therefore they increasingly demand...Show moreSmall island territories are one of the first that face the disruptive consequences of climate change, although they have historically contributed least. Therefore they increasingly demand reparative climate justice through climate litigation. The academic debate focuses on sovereign Small Island Developing States, thereby ignoring the relevant differences between SIDS and non-sovereign island territories such as sub-national island jurisdictions (SNIJs). Therefore this research investigates what is owed to sub-national island jurisdiction Bonaire in terms of reparative justice. In May 2023 GreenPeace together with Bonaire sent a pre-litigation letter to the Dutch government. Through a normative method and a case study I investigate their two central reparative demands. I argue that climate reparations for Bonaire, and thus SNIJs should prioritize equity and inclusion. In addition, the two mechanisms climate litigaiton and truth and reconciliation are compared in their ability to facilitate repair for SNIJs. Lastly, theoretical implications about the meaning of post-colonial relationships in reparative justice are formulated.Show less
Conduct Disorder (CD) is a common psychiatric disorder of childhood and adolescence characterized by severe aggressive and antisocial behaviors that often result in impaired social, academic, or...Show moreConduct Disorder (CD) is a common psychiatric disorder of childhood and adolescence characterized by severe aggressive and antisocial behaviors that often result in impaired social, academic, or occupational functioning. The subtype CD with callous-unemotional (CU) traits has been suggested to be part of the developmentary trajectory of psychopathy, with both being linked to amygdalar volume deficits. Research into the neurodevelopmental perspective of CD/CU+ has been inconsistent due to methodological, demographic and cultural factors. Therefore, the current study examined amygdala morphology in two matched juvenile groups: CD offenders (N = 51) and healthy control subjects (HC; N = 36). In an additional set of analyses, the CD group was divided in two subgroups: CD with CU traits (CD/CU+; N = 26), CD without CU traits (CD/CU-; N = 25), and compared to HC participants. Additionally, the influence of CU traits on brain morphology was assessed in a dimensional manner across all participants (N = 87). Analyses revealed significant lower left amygdalar volumes in all CD youth compared to HC youth, while no significant differences emerged in the right amygdalar volumes. Furthermore, no significant differences in amygdalar volumes emerged between CD/CU- vs. CD/CU+ vs. HC youths. Moreover, the severity of CU traits did not relate to brain morphology in a dimensional manner across all participants. The current findings reflect the complexity and inconsistency of research into the relationship between brain morphology and CD diagnosis, and add to the research into the neurodevelopmental perspective of CD/CU+Show less
Objective: Informal caregivers of palliative care patients face many challenges and are in need of support by healthcare providers. We aim to assess the care provided to informal caregivers, the...Show moreObjective: Informal caregivers of palliative care patients face many challenges and are in need of support by healthcare providers. We aim to assess the care provided to informal caregivers, the effects of healthcare providers’ background characteristics and actions undertaken to improve the care provided in healthcare organizations. Method: A cross-sectional mixed-method approach was applied. Questionnaires were used for statistical analysis. First, the care provided to informal caregivers (i.e. basic emotional care and specific care tasks) was examined using descriptive statistics. Second, the effects of healthcare providers’ background characteristics (i.e. healthcare setting, profession, age and work experience) on the care provided were examined using bivariable analyses and general linear model (GLM). Third, actions to improve the care provided in healthcare organizations were examined using qualitative conventional content analysis. Journey mapping workshops provided input for the 19 analyzed action plan reports. Results: 586 healthcare providers and volunteers of 19 Dutch healthcare organizations completed the questionnaire (response rate: 49%). First, participants had an average basic emotional care of 6.70 (SD = 3.33, 0-10 range) and an average of specific care tasks of 8.51 (SD = 2.89, 0-13 range). Second, volunteers and paramedics scored lower than other healthcare providers on basic emotional care (p = .003, p = .012) and volunteers scored lower on specific care tasks (p = .012). The age of healthcare providers and volunteers seemed to have a quadratic effect on the basic emotional care (p = .017) with an increase until 45-55 years. The same effect was found on specific care tasks (p = 0.042) after excluding the volunteers. Third, improvement categories were derived from the action plan reports. For individual healthcare providers: care and support for informal caregivers during the illness-trajectory, bereavement care for informal caregivers, cooperation with informal caregivers, interprofessional cooperation. For healthcare organizations: organizational support. Discussion: The care provided to informal caregivers is still in need of improvement. The age and profession of healthcare providers were found to affect the care provided. The actions found to improve the care provided to informal caregivers are promising and can be a source of inspiration for healthcare organizations.Show less
