Obstructive sleep apnoea and sexual function in men

Obstructive sleep apnoea (OSA) is associated with sexual dysfunction. Untreated OSA and erectile dysfunction (ED) have both been identified as being indicative of a high risk of developing cardiovascular disease. Treatments for ED, such as testosterone supplementation or PDE-5 inhibitors, and for OSA, such as Continuous Positive Airways Pressure (CPAP) are both readily available. The effects of these treatments on the other associated conditions have not been fully assessed. The efficacy of testosterone supplementation, in untreated OSA, on sexual function and quality of life has not been investigated. PDE-5 inhibitors are an established treatment for erectile dysfunction, however, there is a paucity of information regarding their efficacy in OSA, and there is a theoretical risk of worsening of OSA with their use. CPAP, in some observational and non-treatment or alternative treatment controlled studies, has been shown to improve erection function in men with OSA, however the majority of these studies have been in men with OSA, with and without ED. Two randomised controlled trials investigating the effects of testosterone in untreated OSA (n=67), and the effects of CPAP and a PDE-5 inhibitor in men with OSA and ED using a factorial design (n=61) were performed. Sleep, sexual function and quality of life was assessed. CPAP increased the quantity of nocturnal erections and a PDE-5 inhibitor improved their quality. However, neither CPAP use, exogenous testosterone nor a PDE-5 inhibitor improved subjective erectile function in men with OSA. Post-hoc analysis showed that adherent CPAP use (>4hours per night) increased subjective erectile function and sexual desire, as well as several parameters of quality of life in men with OSA and ED. Testosterone also increased sexual desire in men with OSA

Citizenship Status and Pressure Group Action

This thesis investigates the intersection between citizenship status and pressure group action. It asks a two-pronged question. First, does variation in citizenship status (to be citizen or noncitizen) produce variation in pressure group action? Second, where there is variation, how is it that citizenship status matters; where there is no variation, how is it that citizenship status (a decidedly political status) does not matter? In response to this two-part question, a two-part theoretical framework has been developed. To answer the question of whether citizenship status matters, an interactive model of action has been developed. This provides a common measure through which similarities and differences in action-paths between citizen and non-citizen pressure groups can be uncovered. It is found that citizenship status does have an effect on pressure group action, notably in a pressure group’s interaction with a) their constituency; b) potential allies; c) other-state political institutions; and d) other-state media. To answer the question of how citizenship matters and does not matter, the idea of the capability mechanism has been developed. This asserts that variation in citizenship status - understood through either a rights or identity framework - produces, reduces, or removes capabilities. This, in turn, shapes action. This model is also used to explain similarities. Both the empirical findings and the theoretical frameworks developed within this thesis are useful for further analysis of the significance of citizen or non-citizen status on one’s relationship to political systems

Identity and Interests: Understanding the Meltdown in Israeli-Turkish Relations 2002-2012

The recent deterioration of the strong bilateral alliance between Israel and Turkey has significant affects on the balance of power within the Middle East. As such, it is important that scholars determine why this meltdown has occurred. This thesis sought to explain the deterioration of relations between Israel and Turkey and overcome gaps in the existing literature concerned with this meltdown of bilateral relations by taking a fresh look into the role of identity and the interests it creates. Hence, the framework of Wendtian constructivism was applied in order to examine the social origins and impacts of identity and interests on alliance formation and deterioration. In this thesis, I suggested that Israel’s identity has changed slowly over the past decade and as such, should be perceived as ‘relatively’ stable. Conversely, however, Turkey’s national identity changed sharply, drifting away from the Ataturk agenda of Westernisation and secularism towards an Islamic heritage. In order to strengthen my argument that this shift in Turkish identity has primarily accounted for the deterioration of its relations with Israel, I analysed Turkish attitudes towards foreign policies other than its bilateral relationship with Israel, as well as its newly defined interests. Thus, whereas Israel’s relatively stable national identity and domestic policies were matched by its relatively stable foreign interests over the past decade, deep changes to Turkey’s national identity redirected its domestic policies under Recep Tayyip Erdoğan’s government. Consequently, Turkey has employed a number of political tensions and events as pretexts in order to unilaterally disengage from its relations with Israel so that it can further new foreign policies and interests. Identity matters, and for better or worse, identity changes precede foreign policy change, a lesson we must not forget

The value of merging medical data from ambulance services and general practice cooperatives using triple aim outcomes

Background: Acute care services are currently overstretched in many high income countries. Overcrowding also plays a major role in acute care in the Netherlands. In a region of the Netherlands, the general practice cooperative (GPC) and ambulance service have begun to integrate their care, and the rapid and complete transfer of information between these two care organisations is now the basis for delivering appropriate care. The primary aim of this mixed-methods study is to evaluate the Netherlands Triage System (NTS) merger project and answering the question: What is the added value of implementing a digital NTS merger in terms of healthcare use and healthcare costs? A secondary question is: What are the experiences of patients and care professionals in different acute healthcare organisations following implementation of the digital NTS merger?Methods: Patients who made an acute care request during the 12 months before the NTS merge intervention (control period) were compared with matched patients in the 12 months following the start of the NTS merge. Outcomes included difference in healthcare use 30 days after an acute event and patient' and care professional' experiences during the intervention period. To assess healthcare costs, we used reference prices updated to 2021.Results: Compared to patients in the control period, patients in the intervention period were hospitalized less often (52.9% vs 64.4%, p = 0.061) and had fewer emergency department (ED) visits (58.7% vs 69.3%, p = 0.074) in the 30 days following the acute care request. The ED costs were significantly lower during the intervention period compared to the control period (p = 0.042). Furthermore, patients in the intervention period were very satisfied overall with the acute care network (4.63 of 5) and care professionals were fairly satisfied with the cooperation to date (2.73 of 4).Conclusion: The Triple Aim for acute care can be met using relatively simple interventions, but medical data merging is a prerequisite for achieving more robust results covering on the various aspects of the Triple Aim. These successes should be communicated so that a common language can be developed that will support the successful further implementation of larger scale initiatives.Prevention, Population and Disease management (PrePoD)Public Health and primary car

Behandeling van acute, ernstige dyspneu bij astma en COPD in de huisartspraktijk : een literatuuronderzoek

Contains fulltext : 25351___.PDF (publisher's version ) (Open Access

Behandeling astma door de huisarts gemakkelijker dan diagnostiek

Item does not contain fulltex

Welke inhalaties gebruikt u? (CARA-morgana's)

Item does not contain fulltex