Country Level Research Articles

Preferences for Redistribution: Two Decades of Gender Gaps and Generational Differences in Europe

Abstract We provide a concise overview of the literature concerning the factors influencing preferences for redistribution, with particular attention to works that have integrated considerations of gender and/or cohort heterogeneity into their analyses. We then present a series of stylized facts on preferences for redistribution based on data from the European Social Survey for a wide array of European countries over the period spanning from 2002 to 2022. We document that, since 2002, the average preferences for redistribution have increased. While the gender gap has remained substantially unchanged, the generational gap has widened over time. Distinguishing women and men by a set of individual characteristics, instead, there exists a not negligible heterogeneity both ‘between’ and ‘within’ women and men. At the country level, the overall gender gap in preferences for redistribution increases as the country’s per capita income or gender equality increase. Conversely, the gender gap decreases in more income, unequal, and religious countries. Finally, looking at the two exogenous shocks, that is, the 2008 financial and economic crisis and the Covid-19 pandemic, we observe that average individual attitudes towards redistribution react to both events but in a surprisingly opposite way, with a relevant heterogeneity across different sub-groups of women and men.

Beyond economic growth goals: can foreign aid mitigate carbon dioxide emissions in developing countries?

We provide novel and compelling evidence that foreign aid has significant mitigating impacts on carbon dioxide emissions in a comprehensive panel dataset of 127 developing countries from 1995 to 2019. This impact operates through a direct effect resulting from the adoption of green and eco-friendly investments and an indirect effect driven by economic growth. Moreover, we reveal that the effectiveness of foreign aid in reducing carbon dioxide emissions is contingent upon the country's income level. Specifically, foreign aid shows limited efficacy in curbing emissions in low-income countries, while its influence becomes substantial in middle-income countries. This result indicates that economic development plays a moderating effect in the aid – climate change nexus. Furthermore, the findings of this research are of paramount importance to donor and recipient countries emphasizing the role of governance and political stability in enhancing the effectiveness of aid in combatting climate change and identifying promising pathways for sustainable development.

Epidemiological breast cancer prediction by country: A novel machine learning approach.

Breast cancer remains a significant contributor to cancer-related deaths among women globally. We seek for this study to examine the correlation between the incidence rates of breast cancer and newly identified risk factors. Additionally, we aim to utilize machine learning models to predict breast cancer incidence at a country level. Following an extensive review of the available literature, we have identified a range of recently studied risk factors associated with breast cancer. Subsequently, we gathered data on these factors and breast cancer incidence rates from numerous online sources encompassing 151 countries. To evaluate the relationship between these factors and breast cancer incidence, we assessed the normality of the data and conducted Spearman's correlation test. Furthermore, we refined six regression models to forecast future breast cancer incidence rates. Our findings indicate that the incidence of breast cancer is most positively correlated with the average age of women in a country, as well as factors such as meat consumption, CO2 emissions, depression, sugar consumption, tobacco use, milk intake, mobile cells, alcohol consumption, pesticides, and oral contraceptive use. As for prediction, the CatBoost Regressor successfully predicted future breast cancer incidence with an R squared value of 0.84 ± 0.03. An increased incidence of breast cancer is mainly associated with dietary habits and lifestyle. Our findings and recommendations can serve as a baseline for developing educational programs intended to heighten awareness amongst women in countries with heightened risk.

The global incidence and trends of three common flavivirus infections (Dengue, yellow fever, and Zika) from 2011 to 2021.

Flavivirus pose a continued threat to global health, yet their worldwide burden and trends remain poorly quantified. We aimed to evaluate the global, regional, and national incidence of three common flavivirus infections (Dengue, yellow fever, and Zika) from 2011 to 2021. Data on the number and rate of incidence for the three common flavivirus infection in 204 countries and territories were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The estimated annual percent change (EAPC) was calculated to quantify the temporal trend during 2011-2016, 2016-2019, and 2019-2021, respectively. In 2021, an estimated 59,220,428 individuals were infected globally, comprising 58,964,185 cases of dengue, 86,509 cases of yellow fever, and 169,734 cases of Zika virus infection. The age-standardized incidence rate (ASIR) of the three common flavivirus infections increased by an annual average of 5.08% (95% CI 4.12 to 6.05) globally from 2011 to 2016, whereas decreased by an annual average of -8.37% (95% CI -12.46 to -4.08) per year between 2016 to 2019. The ASIR remained stable during 2019-2021, with an average change of 0.69% (95% CI -0.96 to 2.37) per year globally for the three common flavivirus infections. Regionally, the burden of the three common flavivirus infections was primarily concentrated in those regions with middle income, such as South Asia, Southeast Asia, and Tropical Latin America. Additionally, at the country level, there was an inverted "U" relationship between the SDI level and the ASI. Notably, an increase in the average age of infected cases has been observed worldwide, particularly in higher-income regions. Flavivirus infections are an expanding public health concern worldwide, with considerable regional and demographic variation in the incidence. Policymakers and healthcare providers must stay vigilant regarding the impact of COVID-19 and other environmental factors on the risk of flavivirus infection and be prepared for potential future outbreaks.

Analyzing key health factors influencing life expectancy using machine learning

With the rapid development of global medical technology and the steady improvement of social living standards, life expectancy per capita has become one of the most important indicators of a country or region's level of development. It not only reflects the quality of life and health of the local people, but also profoundly affects the economic growth and social stability of the country. In underdeveloped countries, life expectancy at birth is generally lower than in more developed countries due to resource constraints and poor medical facilities. This phenomenon has triggered extensive research interest in whether there is some correlation between life expectancy per capita and economic growth, and how improving life expectancy can contribute to a country's economic transformation and development. The purpose of this paper is to explore the impact of life expectancy per capita on economic growth and how to promote the economic transformation and development of countries by increasing life expectancy. Through a comparative study of Asian countries such as China, Singapore and Japan, this paper analyzes the impact of different factors on life expectancy through technical methods such as visual analysis, hypothesis testing, regression modeling, and decision tree modeling, and explores how these factors play a role in economic growth. The results of this study may have some guiding significance for improving life expectancy.

The importance of natural land carbon sinks in modelling future emissions pathways and assessing individual country progress towards net-zero emissions targets

Nature-based solutions (NBS), in the form of active ecosystem conservation, restoration and improved land management, represent a pathway to accelerate net-zero emissions (NZE) strategies and support biodiversity. Meaningful implementation and successful accounting depend on the ability to differentiate between anthropogenic and natural carbon fluxes on land. The United Nations Framework Convention on Climate Change (UNFCCC) land carbon accounting methods currently incorporate all CO2 fluxes on managed land in country inventories without distinguishing between anthropogenic and natural components. Meanwhile, natural land carbon sinks are modelled by earth system models but are mostly reported at global level. Here we present a simple yet novel methodology to estimate the present and future progression of natural land sinks at the country and regional level. Forests dominate the uptake of CO2 on land and as such, our analysis is based on allocating global projections of the natural land carbon flux to individual countries using a compilation of forest land areas for a historic and scenario range spanning 1960–2100. Specifically, we use MIT’s carbon cycle model simulations that are set in the context of emissions pathways from the Shell Energy Security Scenarios (2023). Our natural land carbon flux estimates for individual countries and regions such as the European Union (EU) show generally good agreement with independent estimates from recent land-use harmonisation studies for 2000–2020. Hence, our approach may also provide a simple, first-order exploration of future natural land fluxes at country level—a potential that other studies do not yet offer. In turn, this enables better understanding of the anthropogenic and natural components contributing to country NZE targets under different scenarios. Nevertheless, our findings also suggest that models such as the Shell World Energy Model (WEM) would benefit from further improvements in the apportionment of land carbon sources and sinks to evaluate detailed actions to meet country targets. More importantly, uncertainties remain regarding the resilience of land ecosystems and their capacity to store increasing amounts of carbon under progressive global warming. Therefore, we recommend that the carbon cycle modelling and energy modelling research communities continue to collaborate to develop a next generation of relevant data products to distinguish anthropogenic from natural impacts at local, regional and national levels.

Exploring influences of supervision on psychotherapists’ professional development: correlates across career-level cohorts

ABSTRACT This exploratory study aims to extend and strengthen the empirical base for supervision as a facilitator of professional growth, as outlined in an established conceptual model, by exploring its correlates among psychotherapists across their entire professional career. Ratings of the impact of supervision by 6267 psychotherapists of different professions, theoretical orientations, and career levels in many countries who were currently in supervision were correlated, separately for each of five career cohorts, with aspects of their treatment experience, work situation, and personal characteristics. Large percentages of psychotherapists at all career levels, including senior psychotherapists, engaged in supervision and rated its impact on their development positively. Growth-facilitating supervision was associated broadly but moderately in all career cohorts mainly with interpersonal aspects of therapists’ treatment experience, with supportive work settings, and with caring and expressive personal characteristics. Some differential findings among cohorts also reflected potential developmentally based functions of supervision. The implications of results were considered both for supervisory practice, training and for future supervision research.

Country Level Incidence of Alzheimer Disease and Related Dementias is Associated with Increased Omega6 PUFA Consumption.

Clinical and genetic studies have implicated lipid dysfunction in Alzheimer Disease (AD) pathogenesis. However, lipid consumption at the individual-level does not vary greatly within most cohorts, and multiple lipids are rarely measured in any one study. Mean country-level lipid intakes were compared to Age-Standardized Alzheimer-Disease-Incidence-Rates(ASAIR) in 183 countries across all inhabited continents. Penalized spline regression and multivariable-adjusted linear regression, including a lag between intake and incidence, were used to assess the relationships between five lipid intakes and ASAIR. Validation was conducted using longitudinal within-country changes between 1990 and 2019. Omega6 Polyunsaturated-Fatty-Acid(PUFA) intake exhibited a positive linear relationship with ASAIR(multivariable-adjusted model: β=2.44; 95%CI: 1.70, 3.19; p=1.38×10-9). ASAIR also increased with saturated-fat, trans-fat, and dietary-cholesterol up to a threshold. The association between Omega6-PUFA and ASAIR was confirmed using longitudinal intake changes. Decreasing Omega6-PUFA consumption on the country-level may have substantial benefits in reducing the country-level burden of AD.

Understanding determinants of outward foreign direct investment: the role of economic policy uncertainty, institutional quality, and globalization

PurposeThis research aims to investigate the role of the economic policy uncertainty (EPU) in the outward FDI (OFDI) of the United Kingdom (UK) by considering the institutional quality (IQ) and globalization level of the host country as contextual factors.Design/methodology/approachThe UK’s OFDI to its twenty partners is analyzed by using the factor augmented model for the 2005–2019 period.FindingsThe results show that the EPU of the host country has a negative and significant effect on the UK's OFDI. Furthermore, the findings surprisingly illustrate that the globalization level of the host country has a negative and significant impact on the UK's OFDI. In terms of IQ, this study indicates that, while government effectiveness and regulatory quality have a negative and significant influence on the UK's OFDI, the rule of law has a positive and significant effect on the UK's OFDI.Originality/valueThis will be one of a few studies considering OFDI in the scope of EPU. Also, the contradicting results of the study add unique perspectives to the literature about the relationship between OFDI, globalization, and IQ.

Cancer incidence and survival for 11 cancers in the Commonwealth: a simulation-based modelling study

The number of new cancer cases in Commonwealth countries rose by 35% between 2008 and 2018, but progress in cancer control has been slow in many low-income and lower-middle-income member states. We aimed to examine cancer outcomes and priority areas in the Commonwealth to provide insight and guidance on prioritisation of efforts to improve cancer survival and make the best use of scarce resources. We adapted a previously developed microsimulation model of global cancer survival for 11 cancer sites (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate). All 56 Commonwealth countries were included and classified based on the 2020 World Bank Income groups (low-income, lower-middle-income, upper-middle-income, and high-income countries) and Commonwealth geographical areas. We modelled the number of incident cancer cases in each Commonwealth country in 2020, based on age group-specific estimates of incidence rates from GLOBOCAN 2020. We simulated 5-year net survival for each patient, accounting for the stage at diagnosis (I-IV), availability of specific treatment and imaging modalities, and quality of care (based on residual differences in expected versus observed survival after accounting for the availability and effectiveness of treatment and imaging modalities). We also simulated counterfactual policy scenarios, in which we scaled up various aspects of cancer care to the mean level of high-income countries to estimate the comparative effectiveness of different policies. Incident cancers in the Commonwealth accounted for an estimated 14·3% of global diagnosed cancer cases in 2020 among the 11 cancers modelled (1 610 000 Commonwealth cases [95% UI 1 556 000-1 674 000] of 11 227 000 global cases [11 069 000-11 406 000]) and are estimated to increase to 17·3% in 2050 due to population growth (3 330 000 [3 154 000-3 539 000] of 19 308 000 [18 706 000-19 911 000]). The 5-year net survival across 11 cancers combined in 2020 was 30·7% (95% UI 22·4-38·6) in Commonwealth countries, ranging from 4·1% (0·04-15·2) in low-income countries, 17·8% (3·7-30·9) in lower-middle-income countries, 33·1% (23·7-46·0) in upper-middle-income countries, to 59·0% (57·8-60·2) in high-income countries. Among single treatment policies, scaling up access to radiotherapy had the largest survival impact in low-income countries, surgery had the largest impact in lower-middle-income and upper-middle-income countries, and targeted therapy had the largest impact in high-income countries. By geographical area, improving radiotherapy availability was estimated to have the largest impact in Africa, surgery in Asia, targeted therapy in the Caribbean and the Americas and Europe, and quality of care in the Pacific Commonwealth countries. Comparing packages of scaling up the availability of all treatment modalities versus imaging modalities, expanding availability of imaging yielded the largest benefits in high-income countries, and in the Caribbean and the Americas, Europe, and the Pacific, whereas expanding treatment yielded larger benefits in all other income groups and geographical areas. We found large variation in 5-year net survival, with a nearly 15-times difference in cancer survival by country income group within the Commonwealth. Efforts to improve the availability of treatment and imaging modalities and quality of care will be crucial to reduce these disparities, with specific priorities of scale-up policies varying by setting. The Commonwealth could leverage a broad range of knowledge and resources and have an important role in supporting member countries with setting-specific priorities to improve cancer outcomes. Harvard T H Chan School of Public Health.

Geopolitics of the Horn of Africa: Arab Countries’ Stance on the Grand Ethiopian Renaissance Dam, with Special Focus on the GCC Position

The Horn of Africa holds a strategic position, bordering on the Red Sea, the Gulf of Aden, the Indian Ocean, and the Nile region. The Bab al-Mandab Strait, which connects three continents – Asia, Africa, and Europe-lie within its ambit. Over the past decade, external powers have begun to take a heightened interest in this region. Consequently, security issues in this strategically vital area have become increasingly salient, and local conflicts, famines, the proliferation of terrorist groups and maritime piracy have all found their way onto wider regional and international agendas. The current conflict between Ethiopia, Sudan, and Egypt regarding the Grand Ethiopian Renaissance Dam (GERD) is of particular significance in this new scenario. This paper explores the position of the Gulf Cooperation Council (GCC) countries and the general Arab stance on the dispute. It is worth noting that despite the considerable efforts made by Egyptian diplomacy to establish a unified Arab position on the Renaissance Dam issue, there are significant differences among Arab countries in regard to the issue. At the level of the GCC countries, the United Arab Emirates adopts a relatively flexible and neutral position, sometimes positioning itself as a mediator between the conflicting parties. Conversely, Kuwait maintains a firm stance in support of the Egyptian-Sudanese position, considering water security for Egypt and Sudan as a justifiable national security concern for the two countries. Saudi Arabia appears to be neutral in the conflict and emphasises that the African Union should play the primary role in resolving the issue. Even the two downstream countries, Egypt and Sudan, have failed to adopt cohesive stances on the issue. At the Arab Summit held in Algeria on 2 November 2022, significant differences between Sudan and Egypt emerged in the working of the final document, even though they had been intent on welding wider Arab support behind their conflict with Ethiopia. This paper explores the nature of, and the reasons behind, the differences between GCC countries and the broader Arab community regarding the Renaissance Dam issue. Furthermore, it examines the potential for developing a unified yet flexible Arab Gulf position which could help to lay the basis for a balanced and fair agreement between Ethiopia, Sudan, and Egypt on the Renaissance Dam issue.

Trade and economic cooperation of the EAEU: state, dynamics, ensuring national security

The relevance of the study lies in the fact that in the context of international political and economic tensions, the role of regional integration is more important than ever. Despite the fact that the EAEU is one of the youngest integration associations in the world, the history of its existence testifies to the importance for both participating countries and third countries and the global economy, as well as conducting joint policies in various spheres of international relations. The article provides an analysis of trade and economic cooperation between the EAEU countries from the point of view of studying the history and causes of its appearance, the current state and development prospects. The current state and features of trade and economic cooperation between the EAEU countries, the main macroeconomic and trade and economic indicators of the EAEU member states are considered. It is shown that since the creation of the EAEU in 2015, measures have been taken and successfully implemented aimed at identifying and gradually eliminating factors hindering the development of integration processes. With the help of the created strategies for the development of the grouping, supranational bodies strive to minimize the influence of internal and external factors on the growth of the economies of the member countries of the union. The EAEU has significant economic and trade, as well as investment potential. According to the authors, it is important for the EAEU countries and the association as a whole to more actively implement measures aimed at maintaining the economic security of the association and the participating countries, which requires new unified approaches to training at the country and regional levels.

Can global health security frameworks measure One Health implementation in West Africa?A mixed-methods study

BackgroundThe 2014 outbreak of the Ebola virus disease highlighted the importance of overhauling and transforming healthcare systems in West Africa to improve the ability of individual countries to deal with infectious diseases. As part of this effort, in November 2016 the West African Health Organization (WAHO) began the process of institutionalizing the One Health (OH) approach to health security across the Economic Community of West African States (ECOWAS). The lack of clear metrics and evaluation frameworks to measure the progress of OH implementation in West Africa has been reported as a challenge. Therefore, this study sought to assess and explore whether the existing metrics of global health security frameworks can measure the successful implementation of OH activities, evaluate the progress made since 2016, and identify key areas for improvement in the region.MethodThe study employed predetermined keywords to select indicators from the International Health Regulations (IHR) Monitoring Frameworks, specifically the State Party Self-Assessment Annual Report (SPAR) and Joint External Evaluation (JEE), deemed relevant to the OH approach. In addition, the COVID-19 performance index scores (severity and recovery) for June 2022 were extracted from the Global COVID-19 Index (GCI). The GCI Recovery Index evaluated the major recovery parameters reported daily to indicate how a country performed on the path to recovery from the COVID-19 pandemic compared to other countries. National documents were also analyzed using categorical variables to assess the performance status of OH platforms across implementing countries. A quantitative analysis of these indicators was conducted and supplemented with qualitative data gathered through interviews with key stakeholders. Between March and April 2022, we conducted 18 key informant interviews with purposively selected representatives from regional governmental agencies and international multilateral agencies, including ECOWAS member states. Interviews were conducted online, transcribed, and analysed following the tenets of thematic analysis.ResultsOur quantitative analysis revealed no significant association between the implementation status of OH activities and any of the selected indicators from SPAR and JEE. The descriptive analysis of the JEE scores at the country level revealed that countries with existing OH platforms scored relatively higher on the selected JEE indicators than other countries in the pre-implementation stage. OH implementation status did not significantly affect COVID-19 recovery and severity indices. The qualitative findings with relevant stakeholders revealed noteworthy challenges related to insufficient human capacity, inadequate coordination, and a lack of government funding for the sustainability of OH initiatives. Nonetheless, countries in the ECOWAS region are making progress toward the integration of OH into their health security systems.ConclusionStandardized metrics were used to assess the implementation and efficacy of OH systems in the ECOWAS region. Current indicators for monitoring global health security frameworks lack specificity and fail to comprehensively capture essential OH components, particularly at the sub-national level. To ensure consistency and effectiveness across countries, OH implementation metrics that align with global frameworks such as IHR should be developed.

Machine learning as a surrogate model for EnergyPLAN: Speeding up energy system optimization at the country level

In the field of energy system modelling, increasing complexity and optimization analysis are essential for understanding the most effective decarbonization options. However, the growing need for intricate models leads to increased computational time, which can hinder progress in research and policy-making. This study aims to address this issue by integrating machine learning algorithms with EnergyPLAN and EPLANopt, a coupling of EnergyPLAN software and a multi-objective evolutionary algorithm, to expedite the optimization process while maintaining accuracy. By saving computational time, we can increase the number of evaluations, thereby enabling deeper exploration of uncertainty in energy system modelling. Although machine learning models have been widely employed as surrogate models to accelerate optimization problems, their application in energy system modeling at the national scale, while preserving high temporal resolution and extensive sector-coupling, remains scarce. Several machine learning models were evaluated, and an artificial neural network was selected as the most effective surrogate model. The findings demonstrate that incorporating this surrogate model within the optimization process reduces computational time by 64 % compared to the conventional EPLANopt approach, while maintaining an accuracy level close to that obtained by running EPLANopt without the surrogate model.

Chronic Myeloid Leukemia in Bulgaria in the New Millennium: Identification of Directions for Improvement in Management and Outcomes Reporting

Background: In the last two decades, tyrosine kinase inhibitors (TKIs) and advances in molecular diagnostics have revolutionized management and long-term clinical outcomes in chronic myeloid leukemia (CML). Real-world data from different countries allow for the identification of country-specific issues in the clinical management and development of specific plans for improvement. Here, we aimed to analyze the trend in overall survival in Bulgarian CML patients since 2000. Methods: We retrieved publicly available Bulgarian CML data from several sources such as the Bulgarian National Cancer Registry, Bulgarian National Statistical Institute, and National Health Insurance Fund since 2000. We used the retrieved data of a total of 1513 Bulgarian CML patients to describe the trends in overall survival (OS), conditional overall survival, life expectancy, and life years lost over five time periods. We also described the trends in healthcare expenditures for TKIs and CML patients’ coverage with TKIs since 2014. Results: In both uni- and multivariate models, we found a constant increase in OS over the three 5-year periods until 2014. The period 2015–2019 was not associated with an additional increase in OS. Identical dynamics in the improvement in life expectancy (LE) and in life years lost (LYLs) was observed. Additionally, conditional 5-year survival did not improve during 2015–2019 in comparison to 2010–2014. Population-level data did not show consistent changes in the documented number of deaths due to CML since 2013. The period after 2013 is marked by a constant increase in the annual expenditures for TKIs, reaching to about 2.0 EUR/capita. The number of patients who received at least one TKI also increased during that period. Conclusions: After the initial significant improvement in the clinical outcomes for Bulgarian CML patients until 2014, subsequent periods did not bring further benefit in spite of the improved coverage with second- and third-line TKIs. Multiple factors may contribute to these suboptimal outcomes. Therefore, one can propose several additional measures at the country level, which could lead to additional improvement in the OS of Bulgarian CML patients.

Why some countries but not others? Urbanisation, GDP and endemic disease predict global SARS-CoV-2 excess mortality patterns

ContextThe global impact of the SARS-CoV-2 pandemic has been uneven, with some regions experiencing significant excess mortality while others have been relatively unaffected. Yet factors which predict this variation remain enigmatic, particularly at large spatial scales.ObjectivesWe aimed to uncover the key drivers of excess mortality across countries and regions to help understand the factors contributing to the varied impacts of the pandemic worldwide.MethodsWe used spatially explicit Bayesian models that integrate environmental, socio-demographic and endemic disease data at the country level to provide robust global estimates of excess SARS-CoV-2 mortality (P-scores) for the years 2020 and 2021.ResultsWe find that urbanization, gross domestic product (GDP) and spatial patterns are strong predictors of excess mortality, with countries characterized by low GDP but high urbanization experiencing the highest levels of excess mortality. Intriguingly, we also observed that the prevalence of malaria and human immunodeficiency virus (HIV) are associated with country-level SARS-CoV-2 excess mortality in Africa and the Western Pacific, whereby countries with low HIV prevalence but high malaria prevalence tend to have lower levels of excess mortality. While these associations are correlative in nature at the macro-scale, they emphasize that patterns of endemic disease and socio-demographic factors are needed to understand the global dynamics of SARS-CoV-2.ConclusionsOur study identifies factors associated with variation in excess mortality across countries, providing insights into why some were more impacted by the pandemic than others. By understanding these predictors, we can better inform global outbreak management strategies, such as targeting medical resources to highly urban countries with low GDP and high HIV prevalence to reduce mortality during future outbreaks.

Individualism and bank financial structure similarity

We use a sample of 75 countries to conduct the first international study of national culture on bank financial structure similarity. We construct a novel and comprehensive measure of bank financial structure similarity using banks’ financial statement data. Our empirical results show that individualism is robustly and positively associated with bank financial structure similarity, holding bank-pair levels, bank levels, and country levels equal. We find that other cultural dimensions, such as power distance, uncertainty avoidance, masculinity, and long-term orientation, have little effect on similarity. Our work also shows that financial structure similarity is correlated with higher bank risk.

The effect of investor protection on forced CEO turnover

PurposeThis paper aims to analyze the direct and indirect effects of investor protection on forced CEO turnover.Design/methodology/approachThe authors investigate 5,175 firm-year observations from 16 European countries over 2012–2018, collect data on four national investor protection indicators, identify 196 forced CEO turnovers and use multiple logistic regression models.FindingsThe results show that a reduction in the degree of investor protection significantly increases the probability of a forced change of the company’s CEO. Furthermore, when the degree of investor protection increases, directors are attributed a lower degree of responsibility in the event of a decline in earnings performance. Therefore, the relation between a decrease in profitability and a forced change of CEO is reduced.Research limitations/implicationsThe research is focused on countries belonging to the European Economic Area and most of the investor protection indicators are derived from surveys. Concerning policy implications, the findings suggest that regulators should focus on the effective enforcement of investor protection mechanisms.Social implicationsThe results confirm that characteristics at the country level have an impact on corporate decisions, highlighting the importance of increasing the degree of investor protection as a means of mitigating agency conflicts and improving stewardship.Originality/valueTo the best of the authors’ knowledge, this study explores a relatively underinvestigated topic as it uses investor protection indicators to jointly evaluate both direct and indirect effects on forced changes of CEO through cross-national research.

Estimated timing of the first menstrual period and dietary and nutritional correlates of menarche among urban school-going adolescents in four sub-Saharan African sites.

Characterizing the timing of menarche and the factors that are associated with it is important for understanding a population's reproductive health needs and long-term health trajectories. We estimated the age at the menstrual onset among adolescent girls and the association between dietary and nutritional factors and menarche in four sub-Saharan African urban sites. We used cross-sectional school-based data from 2307 female adolescents aged 10-14 years collected by the Africa Research, Implementation Science, and Education (ARISE) Network in Ouagadougou, Burkina Faso; Addis Ababa, Ethiopia; Khartoum, Sudan; and Dar es Salaam, Tanzania. Logit models were used to estimate the median age at menarche at each site. Associations between menarche and BMI-for-age, stunting, dietary qualityand food insecurity across settings were assessed using Poisson regression models adjusted for country and school levels. The estimated median age at menarche was 13.1 years (95% confidence interval: 12.7, 13.5) in Ouagadougou; 12.9 (12.6, 13.2) in Addis Ababa; 13.3 (12.7, 13.6) in Khartoum; and 13.2 (12.3, 14.0) in Dar es Salaam. Between 18% and 49% of the girls in each setting had already menstruated. Based on the pooled multivariable models, underweight participants were 42% less likely (adjusted prevalence ratio [PR]0.58 [0.44, 0.77]) to have experienced menarche in comparison to normal-weight individuals. The likelihood of experiencing menarche increased for overweight [PR 1.47 (1.30,1.66)] and obese [PR 1.57 (1.35,1.82)] in comparison to normal-weight girls. Those stunted were 47% less likely to have experienced menarche [PR 0.53 (0.41, 0.69)] than their nonstunted counterparts. A lower likelihood of menarche among those experiencing moderate/severe hunger when compared to those with no/little hunger was also observed (PR 0.78 [0.63,0.96]). No evidence of association with dietary quality was found. Further research is needed to strengthen the body of evidence and inform evidence-based initiatives in low- and middle-income settings.

Mobile vaccination units to increase COVID-19 vaccination uptake in areas with lower coverage: a within-neighbourhood analysis using national registration data, the Netherlands, September-December 2021.

BackgroundVaccine uptake differs between social groups. Mobile vaccination units (MV-units) were deployed in the Netherlands by municipal health services in neighbourhoods with low uptake of COVID-19 vaccines.AimWe aimed to evaluate the impact of MV-units on vaccine uptake in neighbourhoods with low vaccine uptake.MethodsWe used the Dutch national-level registry of COVID-19 vaccinations (CIMS) and MV-unit deployment registrations containing observations in 253 neighbourhoods where MV-units were deployed and 890 contiguous neighbourhoods (total observations: 88,543 neighbourhood-days). A negative binomial regression with neighbourhood-specific temporal effects using splines was used to study the effect.ResultsDuring deployment, the increase in daily vaccination rate in targeted neighbourhoods ranged from a factor 2.0 (95% confidence interval (CI): 1.8-2.2) in urbanised neighbourhoods to 14.5 (95% CI: 11.6-18.0) in rural neighbourhoods. The effects were larger in neighbourhoods with more voters for the Dutch conservative Reformed Christian party but smaller in neighbourhoods with a higher proportion of people with non-western migration backgrounds. The absolute increase in uptake over the complete intervention period ranged from 0.22 percentage points (95% CI: 0.18-0.26) in the most urbanised neighbourhoods to 0.33 percentage point (95% CI: 0.28-0.37) in rural neighbourhoods.ConclusionDeployment of MV-units increased daily vaccination rate, particularly in rural neighbourhoods, with longer travel distance to permanent vaccination locations. This public health intervention shows promise to reduce geographic and social health inequalities, but more proactive and long-term deployment is required to identify its potential to substantially contribute to overall vaccination rates at country level.