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How corruption influences population health
Full text linkPolicy Points This study examines the link between corruption and mortality. We find that corruption is associated with higher mortality, particularly in low-income countries. It is also linked to lower government revenue and distorted government expenditure patterns, which may contribute to resource misallocation and constraints in health financing. Our findings contribute to the literature on upstream determinants of health by highlighting the relevance of institutional and political economy factors for population health. The Sustainable Development Goals on combating corruption and improving health are found to be complementary. Efforts to address corruption could align with and support public health objectives. Context: While public health research has examined the macro-level and structural determinants of health, the link between corruption and population health remains underexplored. This study investigates the relationship between corruption and mortality and explores potential pathways underlying this association. In doing so, it contributes to the broader literature on the political economy of health and the upstream factors associated with population health. Methods: This study draws on country-level data from 102 countries spanning 2008-2018. We use econometric methods, including instrumental variables and the Mundlak approach. To mitigate endogeneity concerns, we employ an instrumental variable approach based on ancestry and oral tradition, using historical cultural factors plausibly related to contemporary corruption levels. Findings: We find a significant relationship between corruption and higher mortality rates. Corruption is also linked with weaker fiscal capacity, reduced government funding for health care, distorted resource allocation, and patterns consistent with misallocation of public funds. Additionally, the association between corruption and mortality varies across levels of public goods provision. Conclusions: This study expands existing research on social determinants of health by highlighting the relevance of institutional and political factors for population health. Addressing corruption could be recognized as a public health priority, given its association with health financing and population health
The Condorcet dimension of metric spaces
Full text linkA Condorcet winning set is a set of candidates such that no other candidate is preferred by at least half the voters over all members of the set. The Condorcet dimension, which is the minimum cardinality of a Condorcet winning set, is known to be at most logarithmic in the number of candidates. We study the case of elections where voters and candidates are located in a 2-dimensional space with preferences based upon proximity voting. Our main result is that the Condorcet dimension is at most 3, under both the Manhattan norm and the infinity norm, which are natural measures in electoral systems. We also prove that any set of voter preferences can be embedded into a metric space of sufficiently high dimension for any p-norm, including the Manhattan and infinity norms
Connected national capital: corporations in colonial and independent Egypt
Full text linkWe use a newly assembled dataset covering all Egyptian corporations, their founders, and political officeholders, to demonstrate the differential impact of political connections on firm performance across two distinctive political and economic contexts. Before Egypt’s independence in 1922, political connections reduced firm profitability, as connected firms were perceived to be aligned with the anti-colonial, nationalist movement, unsettling investors. After independence, connections improved firm outcomes by granting preferential access to incorporation and shielding connected companies from competition. These dynamics reflect the shift from a laissez-faire colonial regime to a nationalist industrial policy that selectively favored politically connected firms
Media constitutionalism
Full text linkMedia theory lacks a convincing account of the actual, and desirable, relationship between media and the state. It therefore offers weak normative guidance for policy. Media constitutionalism is a new theoretical approach emphasizing that the media in liberal democracies are, and should be, a mediating institution between state and society, rather than simply existing as an institution that is free of the state. This account reflects the economic reality of concentrated gatekeeping power in the media sector, and the necessity of maintaining constitutional checks and balances on this power in order to maintain democratic legitimacy. Through examining a case study of the Leveson Inquiry in the UK, the value of media constitutionalism as a framework for understanding media institutions in liberal democracy is illustrated, and an explanation is provided of the Leveson inquiry’s failure to generate fundamental changes in the UK media. Media constitutionalism is a more complete theory of the media in democratic polities which can provide guidance for future developments such as the development of artificial intelligence
Edge isoperimetry of lattices
Full text linkWe present two results related to an edge isoperimetric question for Cayley graphs on the integer lattice asked by Barber and Erde (Discrete Anal Paper no. 7:16, 2018). For any (undirected) graph G, the edge boundary of a subset of vertices S is the number of edges between S and its complement in G. Barber and Erde asked whether for any Cayley graph on Zd, there is always an ordering of Zd such that for each n, the first n terms minimize the edge boundary among all subsets of size n. First, we present an example of a Cayley graph Gd on Zd (for all d≥2) for which there is no such ordering. Furthermore, we show that for all n and any optimal n-vertex subset Sn of Gd, there is no infinite sequence Sn⊂Sn+1⊂Sn+2⊂⋯ of optimal sets Si, where |Si|=i for i≥n. This is to be contrasted with the positive result in Z1 shown by Joseph Briggs and Chris Wells [arXiv:2402.14087]. Our second result is a positive example for the unit-length triangular lattice (which is isomorphic to Z2) where two vertices are connected by an edge if their distance is 1 or 3. We show that this graph has such an ordering. This is the most complicated example known to us of a two-dimensional Cayley graph for which an ordering exists
Timing of acute kidney injury in infarction-related cardiogenic shock: early onset signals a high-risk phenotype – a retrospective observational study
Full text linkBackground: Acute kidney injury (AKI) is common in cardiogenic shock (CS) and increases mortality, but the prognostic impact of onset timing in infarct-related CS is unclear. We examined whether early versus late AKI onset is associated with differences in patient characteristics and outcomes. Methods: In this retrospective observational study, 369 patients with infarct-related CS were classified by AKI timing within the first 96 h of admission: early (≤ 48 h) or late (> 48 h), according to KDIGO criteria. Clinical, hemodynamic, and inflammatory parameters and outcomes were compared. Multivariable logistic regression identified independent predictors of early AKI and in-hospital mortality. Results: AKI occurred in 143 patients (38.8%), with 56.6% early-onset. In-hospital mortality was higher with early AKI than late AKI (71.6% vs. 54.8%; absolute difference 16.8%, 95% CI 3.1–30.5; p = 0.018). Early AKI patients had higher lactate at admission (median 4.3 vs. 3.1 mmol/L; p = 0.028), greater norepinephrine requirements (0.34 vs. 0.21 µg/kg/min; p = 0.044), and more frequent mechanical ventilation (81.5% vs. 61.3%; p = 0.011). In multivariable analysis, early AKI independently predicted in-hospital mortality (adjusted OR 2.12, 95% CI 1.16–3.87; p = 0.015), and was associated with baseline creatinine (OR 5.68 per 1 mg/dL, p = 0.008) and 24-h lactate (OR 2.67 per mmol/L, p < 0.001). Conclusions: In infarct-related CS, AKI within 48 h marks a high-risk hemodynamic phenotype with markedly increased mortality, driven by renal vulnerability and early hypoperfusion. Incorporating AKI timing into risk stratification may help target early renoprotective interventions
Breaking bad or making amends? The dynamics of internal conflict after democratisation
No full textThis paper examines the impact of democratisation on internal conflict, with a focus on the timing of effects and the type of conflict involved. Using a local projection-based difference-in-differences approach and a panel of 160 countries from 1919 to 2021, we distinguish between minor (e.g., protests and strikes) and major (e.g., revolutions and assassinations) conflict events through factor analysis. We find that democratisation leads to a substantial and persistent decline in minor conflict, with effects growing stronger over time. For major conflict, point estimates are generally negative and become statistically significant only after more than a decade post-democratisation. These results are consistent with the view that democratisation can defuse lower-intensity unrest, whereas evidence on large-scale violence suggests that it is subject to a slower adjustment process. The findings enhance our understanding of the democratisation-conflict nexus and provide insights for policy formulation and conflict management strategies
A typology of private investor-ownership in health service provision and related regulatory frameworks in five countries
Full text linkPrivate sector entities can invest in and own the means of healthcare provision, creating opportunities and risks for health systems. While private investment can enhance access to capital, promote competition, and foster innovation, it can also exacerbate incentives for providers to engage in supplier-induced demand, undue price increases, quality compromises, and ‘cherry-picking’ of the most profitable patients and services. Despite the growing presence of private investors in the healthcare sector, heterogeneity in investor types remains poorly understood. This limits the ability of policymakers to consider whether, and to what extent, regulatory intervention is called for in relation to different forms of investor-ownership. By drawing on principal-agent theory, this article begins to address this gap by presenting a typology of investor-ownership in health services provision. Examining the policy relevance of such a typology, we present a case study analysis of current regulations directed at ownership across five countries, representing different health system models. We find that regulatory frameworks that differentiate between types of for-profit investor-ownership are largely absent in Europe, but more developed in the US. We argue that growing private investments require a combination of entry regulation and behavioural oversight to better align the incentives of investor-owners with public health objectives
Detecting sparse change in regression coefficients in the presence of dense nuisance parameters
No full textWe introduce a new methodology ‘charcoal’ for estimating the location of sparse changes in highdimensional linear regression coefficients, without assuming that those coefficients are individually sparse. The procedure works by constructing different sketches (projections) of the design matrix at each time point so as to eliminate the possible dense nuisance parameters. The sequence of sketched design matrices is then compared against a single sketched response vector to form a sequence of test statistics whose behavior shows a surprising link to the well-known CUSUM statistics of univariate changepoint analysis. The procedure is computationally attractive, and strong theoretical guarantees are derived for its estimation accuracy. Simulations confirm that our methods perform well in extensive settings, and a real-world application to a large single-cell RNA sequencing dataset showcases the practical relevance
Knowledge, perception, and willingness of digital psychiatry among psychiatrists in Pakistan: a multicenter cross-sectional study
Full text linkAim: A comprehensive understanding of current digital literacy and perspectives of the psychiatric workforce is important to introduce appropriate digital psychiatry interventions and implement contextually relevant measures in Pakistan. This study aims to address a gap in the existing literature by assessing psychiatrists’ knowledge, attitudes, perceived barriers, and willingness to integrate digital psychiatry into their clinical practice. Methods: A cross-sectional online survey was conducted from January 2023 to June 2023 across psychiatric departments of 18 public hospitals in Pakistan. The study included psychiatry residents, fellows, and consultants. A 48-item questionnaire, internally and externally validated, assessed knowledge, perceptions, and willingness to adopt digital psychiatry tools—telepsychiatry, artificial intelligence, mental health applications, and virtual reality. Data were analyzed using Statistical Package for the Social Sciences (version 26) for descriptive statistics, correlation, and regression analyses, while thematic analysis of open-ended responses was performed using Quirkos. Results: A total of 200 participants (56.0% aged 20–30 years, n = 112; 55.5% male, n = 111) were part of this study. 68.5% (n = 137) understood the applications of telepsychiatry, while 72.5% (n = 145) agreed that it is time-efficient and cost-effective. Only 39.5% (n = 79) of participants had received relevant artificial intelligence training to incorporate it in their psychiatric clinical practice. 62.0% (n = 124) of respondents reported unfamiliarity with the use of mental health applications. Regarding virtual reality, 32.5% (n = 65) were familiar with the technology, but only 42.5% (n = 85) were aware of its applications in psychiatric care. Thematic reflexive analysis revealed major challenges, including a ‘lack of infrastructure/resources’ (44.5%, n = 89) and a ‘lack of education/awareness’ (21.5%, n = 43). Conclusions: This study represents the first cross-sectional examination of digital psychiatric literacy in Pakistan’s healthcare system, which revealed significant gaps in digital health competencies among psychiatrists. Given the vast potential of emerging technologies in addressing mental health challenges, there is an urgent need for mental health professionals in Pakistan to integrate digitization in psychiatric practice