The Implications of Sequential Investment in the Property Rights Theory of the Firm

In the property rights theory of the firm, control over assets (ownership) affords bargaining power in the case of re-negotiation, providing incentives for parties to make relationship specific investments. The models predict that property rights will be allocated so as to maximise surplus generated from investment. However, these models assume that investments are made simultaneously. In this thesis I extend the standard property-rights framework to allow for sequential investment; the model allows for two investment periods. If a party invests first (ex-ante), they sink their investment before any contracting is possible. The parties that invest second (ex-post) do so after some aspects of the project are tangible, so that they can contract on (at least some) of their investment costs. As well as being empirically relevant, sequencing has several important theoretical implications. First, if a party gets to invest second, then – ceteris paribus – it has a greater incentive to invest. Second, the investment of parties that invest first are affected by a more than one influence. Anticipating higher ex-post investment, they can have a greater incentive to increase their investments. However, higher ex-post investment leads to greater costs being borne by the ex-ante investors (via the cost sharing contracts); this reduces ex-ante incentives to invest. Overall either effect can dominate so that ex-ante investment can either increase or decrease as a result of sequential investment. Third, as noted, sequencing of investment provides the possibility to (partially) contract on ex-post investment and costs. This is an additional method of providing incentives to invest, beyond the allocation of property rights themselves. Consequently, ex-post investors can be protected (and be provided incentives to invest) via these contracts, whereas ex-ante investors –who can not contract on their investments at all – are more likely to require the protection of property rights (through the allocation of asset ownership). The addition of sequential investment alters some of the predictions of the standard models. For example, previously the literature found that if all assets are complements at the margin all agents should have access to all assets (Bel (2005)). However, when investment sequencing is possible, making a control structure more inclusive (increasing the number of agents who have access to assets) can reduce the incentives of the ex-ante investors, decreasing overall surplus; this is because increasing the property rights of ex-post investors increases the marginal costs borne by ex-ante investors, effectively reducing their claim on surplus, diminishing their incentives to invest. This result contradicts Bel (2005), and shows that even when all assets are complimentary at the margin allocating access rights can be detrimental to incentives. Furthermore, if assets are substitutes at the margin then transfer of assets from ex-ante investors to ex-post investors can increase ex-ante investment and surplus. This counter intuitive result can occur in the case when decreasing ex-post investment is necessary to provide an incentive to ex-ante investors to increase their investments.Discipline of Economic

Diabetes-Related Distress and Depressive Symptoms Are Not Merely Negative over a 3-Year Period in Malaysian Adults with Type 2 Diabetes Mellitus Receiving Regular Primary Diabetes Care

For people with type 2 diabetes mellitus (T2DM) the daily maintenance of physical and psychological health is challenging. However, the interrelatedness of these two health domains, and of diabetes-related distress (DRD) and depressive symptoms, in the Asian population is still poorly understood. DRD and depressive symptoms have important but distinct influences on diabetes self-care and disease control. Furthermore, the question of whether changes in DRD or depressive symptoms follow a more or less natural course or depend on disease and therapy-related factors is yet to be answered. The aim of this study was to identify the factors influencing changes in DRD or depressive symptoms, at a 3-year follow-up point, in Malaysian adults with T2DM who received regular primary diabetes care. Baseline data included age, sex, ethnicity, marital status, educational level, employment status, health-related quality of life (WHOQOL-BREF), insulin use, diabetes-related complications and HbA1c. DRD was assessed both at baseline and after 3 years using a 17-item Diabetes Distress Scale (DDS-17), while depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to examine the relationship between baseline variables and change scores in DDS-17 and PHQ-9. Almost half (336) of 700 participants completed both measurements. At follow-up, their mean (SD) age and diabetes duration were 60.6 (10.1) years and 9.8 (5.9) years, respectively, and 54.8% were women. More symptoms of depression at baseline was the only significant and independent predictor of improved DRD at 3 years (adjusted β = -0.06,Public Health and primary carePrevention, Population and Disease management (PrePoD

Diabetes self-management education after pre-selection of patients: design of a randomised controlled trial

Many self-management programs have been developed so far. Their effectiveness varies. The program 'Beyond Good Intentions' (BGI) is based on proactive coping and has proven to be (cost-) effective in achieving reductions in BMI and blood pressure in screen-detected type 2 diabetes patients up until nine months follow-up. However, its long-term effectiveness in people already known with diabetes is lacking. In addition, its (cost-) effectiveness might increase if people who are likely not to be benefit from the program are excluded in a valid way. Therefore it was aimed to investigate the long-term effects of the educational program BGI on cardiovascular risk, quality of life and diabetes self-management behaviour in a pre-selected group of patients known with type 2 diabetes up to 5 years.|Randomised controlled trial with 2.5 year follow-up. Adults (≤75 years) with a type 2 diabetes duration between 3 months and 5 years will be included. With the use of a self-management screening tool (SeMaS) their potential barriers of self-management due to depression and/or anxiety will be determined. Based on the results of the SeMaS selection patients will be randomised (1:1) to the BGI-group (n = 53) or the control-group (n = 53). In addition to receiving usual care, patients in the BGI-group will follow the 12-week theory-based self-management program and a booster session a few months thereafter. The control-group will receive care as usual. The primary outcome is change in Body Mass Index after 2.5 years follow-up. Secondary outcomes are HbA1c, lipid profile and systolic blood pressure, (diabetes) quality of life, level of physical activity, dietary intake and medication adherence and proactive coping. Cost-effectiveness will be based on total use of health care resources during the entire study period. Difference between groups in change over time will be analysed according to intention-to-treat analysis.|By differentiating between patients who will and those who are likely not to benefit from the educational program, a more (cost-) effective self-management program might be designed, also on the long-run.Prevention, Population and Disease management (PrePoD)Public Health and primary car

Tailored support for type 2 diabetes patients with an acute coronary event after discharge from hospital - design and development of a randomised controlled trial

BACKGROUND: Type 2 diabetes mellitus patients with an acute coronary event (ACE) experience decreased quality of life and increased distress. According to the American Diabetes Association, discharge from the hospital is a time of increased distress for all patients. Tailored support specific to diabetes is scarce in that period. We developed an intervention based on Bandura’s Social Cognitive Theory, Leventhal’s Common Sense Model, and results of focus groups. The aim of this study is to evaluate the effectiveness of the intervention to reduce distress in type 2 diabetes patients who experienced a first ACE. METHODS: Randomised controlled trial. Two hundred patients are recruited in thirteen hospitals. A diabetes nurse visits the patients in the intervention group (n = 100) at home within three weeks after discharge from hospital, and again after two weeks and two months. The control group (n = 100) receives a consultation by telephone. The primary outcome is diabetes-related distress, measured with the Problem Areas in Diabetes (PAID) questionnaire. Secondary outcomes are well-being, health status, anxiety, depression, HbA1c, blood pressure and lipids. Mediating variables are self-management, self-efficacy and illness representations. Outcomes are measured with questionnaires directly after discharge from hospital and five months later. Biomedical variables are obtained from the records from the primary care physician and the hospital. Differences between groups in change over time are analysed according to the intention-to-treat principle. The Holm-Bonferroni correction is used to adjust for multiplicity. DISCUSSION: Type 2 diabetes patients who experience a first ACE need tailored support after discharge from the hospital. This trial will provide evidence on the effectiveness of a supportive intervention in reducing distress in these patients. TRIAL REGISTRATION: NCT0180163

Self-selection in participation in the first health survey, three weeks after a man-made disaster.

Background: Three weeks after a firework disaster in Enschede, The Netherlands, a health survey was performed among survivors. The primary aims of the study were collecting data for health care policy making and decreasing uncertainty concerning exposure to toxic substances. Therefore, each survivor could participate in the study. In the aftermath of disasters selfselection is often assumed, but the direction of the bias has rarely been studied. We were able to examine the selfselection of the survivors and the direction of the bias. Methods: The health survey included a questionnaire on health and exposure. This questionnaire was merged with the electronic medical records of the survivors in general practice according to privacy directives. The GP database included most of the survivors. Data on demographics, utilization and morbidity one year pre- and post-disaster were used. Results: Preliminary results suggest that 26% of the affected residents (N = 1171) participated in the health survey. This percentage was not different for the relocated and non-relocated residents [odds ratio (OR) = 1.1, 95% CI ¼ 0.9–1.2]. Men (OR = 0.7, 95% CI ¼ 0.6–0.8) and singles (OR = 0.5, 95% CI = 0.4–0.6) participated less often and immigrants more often (OR = 1.5, 95% CI = 1.3–1.7). Survivors who reported health complaints to their GP before and after the disaster were more likely to participate in the health survey. For example, survivors in the health survey presented more psychological complaints (OR ¼ 1.4, 95% CI ¼ 1.1–1.7) to their GP before the disaster than the survivors who did not participate. Conclusions: In the survey 3 weeks after the disaster, we had a selection of fewer men and singles and of more immigrants. Survivors with more health complaints selected to participate, which might have lead to higher prevalence estimates of health problems. After future disasters, information on self-selection in surveys will be necessary to decrease the bias in the prevalence estimates on which policy is based. (aut.ref.

Laparoscopic antireflux surgery increases health-related quality of life in children with GERD

Contains fulltext : 177152.pdf (publisher's version ) (Open Access)INTRODUCTION: Improving health-related quality of life (HRQoL) is increasingly recognized as an essential part of patient care outcome. Little is known about the effect of laparoscopic antireflux surgery (LARS) on the HRQoL in the pediatric patients. The aims of this study were to evaluate the effect of LARS on HRQoL in children with gastroesophageal reflux disease (GERD) and to identify predictors that influence HRQoL outcome after LARS. METHODS: Between 2011 and 2013, 25 patients with therapy-resistant GERD [median age 6 (2-18) years] were included prospectively. Caregivers and children with normal neurodevelopment (>4 years) were asked to fill out the validated PedsQL 4.0 Generic Core Scales before and 3-4 months after LARS. RESULTS: The PedsQL was completed by all caregivers (n = 25) and 12 children. HRQoL total score improved significantly after LARS, both from a parental (p = 0.009) and child's perspective (p = 0.018). The psychosocial health summary and physical health summary scores also improved significantly after LARS. HRQoL before and after LARS was significantly lower in children with impaired neurodevelopment (p < 0.001). However, neurodevelopment did not influence the effect of LARS on HRQoL. The only significant predictor for improvement in HRQoL after LARS was age at the time of operation (p = 0.001). CONCLUSIONS: HRQoL significantly improves after LARS. Although children with impaired neurodevelopment had lower overall HRQoL, neurodevelopment by itself does not predict inferior improvement in HRQoL after LARS. Older children have a more favorable HRQoL outcome after LARS compared to younger children. This may suggest caution when considering LARS in younger GERD patients

Symptoms and related functioning in a traumatized community.

BACKGROUND: Traumatic events are described as precipitating factors for medically unexplained symptoms. The aim of this study was to examine the prevalence and course of symptoms reported by disaster survivors and to assess whether the symptoms have features similar to those of medically unexplained symptoms. METHODS: A 3-wave longitudinal study was performed after an explosion of a fireworks depot. As a result of the explosion, 23 people were killed, more than 900 people were injured, and about 500 homes were damaged or destroyed. Respondents completed a set of validated questionnaires measuring their health problems 3 weeks (wave 1), 18 months (wave 2), and 4 years (wave 3) after the disaster. A comparison group was included at waves 2 and 3. RESULTS: The study population included 815 survivors who participated in the 3 waves. The mean number of symptoms was higher among survivors compared with control subjects at wave 2 (7.5 vs 5.8 symptoms) and at wave 3 (6.1 vs 4.9 symptoms) (P < .001 for both). Survivors and control subjects with more symptoms reported significantly lower mean scores on all scales of the Dutch version of the RAND 36-item health survey. Illness behavior and depression and anxiety were associated with the number of symptoms. For example, more than 60% of survivors with 10 or more symptoms reported depression and anxiety, compared with 2.4% of survivors with 0 to 1 symptoms (P < .001). CONCLUSIONS: Up to 4 years after the disaster, symptoms were more prevalent among survivors than controls. Although medical disorders cannot be excluded, the reported symptoms showed several features similar to those of medically unexplained symptoms in the general population. (aut.ref.

Risk factors for unexplained symptoms after a disaster: a five-year longitudinal study in general practice.

BACKGROUND: Medically unexplained symptoms (MUS) are a common reason to seek medical care. When presented to the general practitioner (GP), more than three-quarters of symptoms such as stomach ache, headache, and pain in bones and muscles cannot be explained by a medical disorder. OBJECTIVE: The authors examined the course of MUS presented to the GP in the 1 year before the disaster and in the 4 years after a disaster in order to study the risk factors for MUS. METHOD: Data were extracted from the electronic medical records of survivors and from a questionnaire (N=1,216). RESULTS: Although the mean number of MUS was significantly increased statistically in the first 2 years post-disaster, the increase was not clinically significant. CONCLUSION: The authors identified several important risk factors, such as immigrant status and psychological problems, that are easy for GPs to recognize. Despite this, the sensitivity of the regression model was relatively low

A longitudinal comparative study of the physical and mental health problems of affected residents of the firework disaster Enschede, The Netherlands

Objectives: After the firework disaster in Enschede, The Netherlands, on 13 May 2000, a longitudinal health study was carried out. Study questions were: (1) did the health status change over this period; and (2) how is the health status 18months after the disaster compared with controls? Study design: A longitudinal comparative study with two surveys at 3 weeks and 18 months after the disaster. Methods: A control group for the affected residents was included in the second survey. Respondents filled in a set of validated questionnaires measuring their physical and mental health problems. Results: The prevalence of physical and emotional role limitations, severe sleeping problems, feelings of depression and anxiety, as well as intrusion and avoidance decreased from 3 weeks to 18 months after the disaster for the affected residents. Independent of background characteristics and other life events, residents had 1.5 to three times more health problems than the control group; for example, physical role limitations (odds ratio [OR] ¼ 1.5, 95% confidence interval [CI] 1.2–2.0) and anxiety (OR ¼ 3.1, 95% CI 2.4–4.2).Conclusions: Although health problems decreased compared with 3 weeks after the disaster, 18 months after the disaster, the affected residents had more health problems than the people from the control group