Academic Ceremonies January 2011

“Evaluation of self-help computerized cognitive behavioural therapy for depression; Integrating clinical, economic and patient perspectives”

Depression is a very common disorder that leads to a lower quality of life and high costs. Yet, many people with depression remain untreated. This dissertation shows that low-threshold online self-help without professional guidance is no adequate solution. The therapy is less expensive than other therapies, but the improvement of depressive complaints is not very good and the therapy compliance is low. This dissertation mainly shows limitations and possible improvements of online therapy. Adding personal guidance, adjusting the therapy to the individual patient, and giving attention to required computer skills, equipment and location can optimize the treatment by realizing better therapy compliance, therapy outcomes and patient experiences. 

Key words:

depression, online self-help therapy

“Essays on individual decision making; with special references to Agribusiness and food markets”

This thesis develops economic models that reveal how Dutch producers-investors desire to co-operate and how consumers react in crisis situations. The decision contexts that used for testing these models were the Dutch, American and German agribusiness and food retailing markets. If we understand the decision-making process, then we may be able not only to predict, but also to explain economic behavior in turbulent and dynamic markets. The results of this study demonstrate: a) that Dutch producer-investors are in favor for participating in “strategic” co-op alliances; b) that the heterogeneity among food producers (members of co-op firms) should be taken into account for designing the governance structure and marketing services that these firms provide to their stakeholders; and c) whether the solution to a crisis lies in more effective communication efforts through the media or in more drastic measures with respect to product supply, such as recalls or product elimination.
The models produced could be applied to future crisis situations and other areas of economy as well, such as food product-harm crisis (bird flu, etc), financial crisis, etc. 

Key words:

economic models, decision-making, risk situations, agribusiness, food retail

“Stimulating fits”

Epilepsy is a very common neurodegenerative disorder that is difficult to treat.  25% of the patients keep having seizures in spite of medicine use. These therapy resistant epilepsy patients can benefit from nervus vagus stimulation (NVS). How it works and why these patients benefit can have from this treatment is unknown. We have developed a new epilepsy model that studies the effects of NVS. First results show that NVS decreases the seriousness and duration of epileptic seizures and that changes occur at the level of the brain stem, where the signals from the nervus vagus enter the brains. These results can be translationally converted (from the laboratory to the clinical practice) which can enable a better treatment of epilepsy in the future. 

Key words:

epilepsy, treatment, therapy resistant, nervus vagus stimulation

“Renewable Energy Tax Incentives and WTO law: Irreconcilably Incompatible”

In light of Kyoto Protocol obligations, this thesis examines  wether direct corporate tax incentives for the development of renewable energy sources, currently in place in six coutries  (Ireland, the UK, the Netherlands, Belgium, Canada and New Zealand) are in line with EU and WTO rules on subsidies. From a parallel examination of the EU legal regime it is discovered that the EU legal environment provides inspiration for the WTO regime. The WTO regime is void of environmental exceptions which would provide a safety-net for environmentally-motivated subsidies. In this thesis, suggestions are made for positive changes to be made to the current WTO legal environment to create room for environmentally-motivated subsidies such as those in place in the case-study countries for the development of renewable energy.

Key words:

tax incentives, renewable energy, WTO law

“Roken in Nederland. De keerzijde van de tolerantie”

“Local space and economic success; the role of spatial Segregation of migrants in the Netherlands”

Many non-western migrants have little to spend and live in disadvantaged neighbourhoods. The main conclusion in this dissertation is that their local space determines their economic success, both in employment and as independent entrepreneurs. This is not only influenced by the composition of the local population, but als by the built-up environment. It makes a difference whether a business is conducted in a pre-war or post-war neighbourhood. Interesting is, however, that the business success of entrepreneurs in the four main cities is not per se bigger than elsewhere in the Netherlands. Moreover, second generation migrant entrepreneurs are not more successful than their parents’ generation. Finally, it turns out that non-western migrants living in migrant neighbourhoods perform less successfully on the labour market than those who live elsewhere. This is however not due to the concentration of allochthonous inhabitants in these neighbourhoods, but due to the concentration of poverty. The concentration of people with a migration background can in fact enhance the labour market integration of newcomers.

Trefwoorden:

non-western immigrants, residential environment, economic success, 

“Chronic oxidative stress and telomere shortening”

“Surgical revascularisation in patients with left ventricular dysfunction, management and predictors of outcome”

As shown in earlier studies, patients with a decreased left ventricular function benefit more from bypass surgery than from treatment with medication or a dotter procedure.  Left ventricular dysfunction Nevertheless, left ventricular dysfunction remains one of the main risk factors for early and late death after bypass surgery. This dissertation mainly describes the predictive factors of both the short-term and the long-term results after bypass surgery in patients with a decreased heart function. In addition to the earlier described risk factors, it turns out that anaemia and disturbed kidney function are important predictors for early death in this patient population. Patients with a normal ventricular function, who underwent bypass surgery, have a long-term survival comparable to and even better than the regular Dutch population. The use of a special pacemaker (biventricular, for both ventricles) improves the blood circulation and lowers the need for supporting medication. 

Key words:

Bypass surgery, left ventricle, dysfunction, result

“The role of technological advances in sodium prescription and adequacy assessment during hemodialysis”

During the dialysis treatment various options can be used that are available on the dialysis machine. This dissertation describes, tests and validates several of these options.  
The ‘online’ measured plasma conductivity appears to match plasma natrium. That provides insight into the fact that the use of the standard dialysis fluid sodium (most used in the Netherlands) can lead to an increase of plasma sodium as a consequence of the dialysis treatment. This dissertation therefore advocates individualized dialysis fluid sodium. Also, the ‘online’ effectiveness of the dialysis treatment can be measured, which can secure good quality control. 

Key words:

dialysis, dialysis fluid conductivity, sodium, dialysis effectiveness

“Constraints to Human Capital Investment in Developing Countries: Using the Asian Financial Crisis
in Indonesia as a Natural Experiment”

Families in developing countries invest less in education than would be expected. This dissertation investigates whether families have a low preference for education, are confronted with low market returns or they face actual constraints in investing in their children’s human capital. Parents in Indonesia face two main constraints to fully investing in their children aged 6 - 15. The first constraint is low family income and this is given that families have to finance up to 60% of their children’s entire education. The second constraint is inadequate state provision of basic school building facilities particularly in underdeveloped areas across the Indonesian archipelago. The challenge is for policymakers to remove these two constraints and create incentives for parents to choose to keep investing in their children at higher schooling levels. 

Key words:

investment in education, developing countries

“Impact Evaluation of a Job-Training Programme for Disadvantaged Youths: The Case of Projoven”

This dissertation evaluates the effects of Projoven, a job-training programme targeting economically disadvantaged youths in Peru. This study suggests that training could be an effective policy intervention. However, to enhance training potential it should be taken into account that the programme works differently for different people (depending on their poverty status and prior work experience); that not all the trainees receive the same doses of training (in terms of quality and quantity); and that precarious internship conditions could lead them to drop out of the programme. Since the behaviour of trainees, training providers and training firms are affected by the set of rules and incentives under which the programme is carried out, the analysis of the institutional framework must be also taken into consideration when evaluating Projoven’s effectiveness.

Key words:

job-training programme, disadvantaged youths

“Lamin interA/Ctors: from the premature to senescence”

Progeria patients age approximately ten times faster than normal and die on average at the age of 13. Genetic defects in the lamin-A gene cause Progeria via mainly unknown mechanisms. This dissertations shows that Progeria-associated lamin-A binds other proteins and DNA than healthy lamin-A, and among others looses binding with the NURD protein complex. This loss leads to irreparable genetic damage, which is an important cause of ageing, and it also appears to underlie the normal ageing process in healthy persons. The discovery of this new ageing mechanism has contributed to the set-up of a screening for new medication against senescence symptoms.

Key words:

Progeria, senescence, lamin-A  

“Transparency of Transferability; diagnosing International aspects of economic evaluations of health care technologies”

Economic evaluations are increasingly used in the decision making process about reimbursing new medical treatments. Judging to which extent results from economic evaluations are usable in another country is known as judging the transferability. Because of the growing demand for economic evaluations and the limited research capacity it is not efficient to conduct all studies personally. This dissertation studies this transferability, so that policymakers can determine if foreign data can be used and which data should possibly be gathered in the own country. The conclusion is that transferability-related problems are partly the consequence of differences in national guidelines. It also turns out that national methods to assess patients’ quality of life lead to considerable differences between countries in terms of cost effectiveness of interventions. This leads to two recommendations, namely the development of an international guideline for economic evaluations and the development of an instrument to adjust data to another country.  

Key words:

economic evaluations, transferability, health care technologies