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Can public diplomacy in times of crisis shape citizens’ attitudes towards international politics? Using a survey experiment in Italy, we evaluated whether information cues about public diplomacy efforts by the United States and China to assist the country in dealing with the COVID-19 emergency shifted the importance citizens attached to Italy’s international allies being democracies. We found that citizens who receive positive cues about USA efforts to assist Italy report a stronger preference for Italy interacting with democracies. At the same time, when they received positive cues about China’s efforts to assist Italy, they discounted the importance attached to international allies being democracies. We further found that these effects are conditional on the participants’ support for democracy at home. We argue that these findings are consistent with a cognitive dissonance framework where citizens update their attitudes to decrease dissonant cognitions when they receive information that challenges prior beliefs or expectations.
How does space matter in our analyses? How can we evaluate diffusion of phenomena or interdependence among units? How biased can our analysis be if we do not consider spatial relationships? All the above questions are critical theoretical and empirical issues for political scientists belonging to several subfields from Electoral Studies to Comparative Politics, and also for International Relations. In this special issue on methods, our paper introduces political scientists to conceptualizing interdependence between units and how to empirically model these interdependencies using spatial regression. First, the paper presents the building blocks of any feature of spatial data (points, polygons, and raster) and the task of georeferencing. Second, the paper discusses what a spatial matrix (W) is, its varieties and the assumptions we make when choosing one. Third, the paper introduces how to investigate spatial clustering through visualizations (e.g. maps) as well as statistical tests (e.g. Moran's index). Fourth and finally, the paper explains how to model spatial relationships that are of substantive interest to some of our research questions. We conclude by inviting researchers to carefully consider space in their analysis and to reflect on the need, or the lack thereof, to use spatial models.
What causes civilian victimization in conventional civil wars and in conventional wars that experience insurgencies? The authors argue that a key driver of civilian victimization is the vulnerability of the incumbent forces, specifically when the conflict’s front line is shifting. Vulnerability is a function of informational and logistical challenges: when the front line is moving, incumbents face increased informational uncertainty and unstable supply chains that augment their vulnerability. Thus, incumbents will increase the use of civilian victimization in response to a scarcity of high-quality information on the location and identity of insurgents, to limit possible information leaks, and to contain supply disruption and logistics support to adversaries. The authors support their argument using matched difference-in-differences analyses of original subnational data on Nazi-Fascist violence in World War II Italy (1943–1945) and qualitative evidence.
Previous studies in individual countries have identified inconsistent predictors of length of stay (LoS) in psychiatric inpatient units. This may reflect methodological inconsistencies across studies or true differences of predictors. In this study we assessed predictors of LoS in five European countries and explored whether their effect varies across countries.
Methods
Prospective cohort study. All patients admitted over 14 months to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and United Kingdom were screened. Putative predictors were collected from medical records and in face-to-face interviews and tested for their association with LoS.
Results
Average LoS varied from 17.9 days in Italy to 55.1 days in Belgium. In the overall sample being homeless, receiving benefits, social isolation, diagnosis of psychosis, greater symptom severity, substance use, history of previous admission and being involuntarily admitted predicted longer LoS. Several predictors showed significant interaction effects with countries in predicting LoS. One variable, homelessness, predicted a different LoS even in opposite directions, whilst for other predictors the direction of the association was the same, but the strength of the association with LoS varied across countries.
Conclusions
The same patient characteristics have a different impact on LoS in different contexts. Thus, although some predictor variables related to clinical severity and social dysfunction appear of generalisable relevance, national studies on LoS are required to understand the complex influence of different patient characteristics on clinical practice in the given contexts.
Patient satisfaction is a key indicator of inpatient care quality and is associated with clinical outcomes following admission. Different patient characteristics have been inconsistently linked with satisfaction. This study aims to overcome previous limitations by assessing which patient characteristics are associated with satisfaction within a large study of psychiatric inpatients conducted across five European countries.
Methods
All patients with a diagnosis of psychotic (F2), affective (F3) or anxiety/somataform (F4) disorder admitted to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and the UK were included. Data were collected from medical records and face-to-face interviews, with patients approached within 2 days of admission. Satisfaction with inpatient care was measured on the Client Assessment of Treatment Scale.
Results
Higher satisfaction scores were associated with being older, employed, living with others, having a close friend, less severe illness and a first admission. In contrast, higher education levels, comorbid personality disorder and involuntary admission were associated with lower levels of satisfaction. Although the same patient characteristics predicted satisfaction within the five countries, there were significant differences in overall satisfaction scores across countries. Compared to other countries, patients in the UK were significantly less satisfied with their inpatient care.
Conclusions
Having a better understanding of patient satisfaction may enable services to improve the quality of care provided as well as clinical outcomes for all patients. Across countries, the same patient characteristics predict satisfaction, suggesting that similar analytical frameworks can and should be used when assessing satisfaction both nationally and internationally.
In Europe, at discharge from a psychiatric hospital, patients with severe mental illness may be exposed to one of two main care approaches: personal continuity, where one clinician is responsible for in- and outpatient care, and specialisation, where various clinicians are. Such exposure is decided through patient-clinician agreement or at the organisational level, depending on the country’s health system. Since personal continuity would be more suitable for patients with complex psychosocial needs, the aim of this study was to identify predictors of patients’ exposure to care approaches in different European countries.
Methods:
Data were collected on 7302 psychiatric hospitalised patients in 2015 in Germany, Poland, and Belgium (patient-level exposure); and in the UK and Italy (organisational-level exposure). At discharge, patients were exposed to one of the care approaches according to usual practice. Putative predictors of exposure at patients’ discharge were assessed in both groups of countries.
Results:
Socially disadvantaged patients were significantly more exposed to personal continuity. In all countries, the main predictor of exposure was the admission hospital, except in Germany, where having a diagnosis of psychosis and a higher education status were predictors of exposure to personal continuity. In the UK, hospitals practising personal continuity had a more socially disadvantaged patient population.
Conclusion:
Even in countries where exposure is decided through patient-clinician agreement, it was the admission hospital, not patient characteristics, that predicted exposure to care approaches. Nevertheless, organisational decisions in hospitals tend to expose socially disadvantaged patients to personal continuity.
It remains contested whether peacekeeping works. The impact of peacekeepers’ actions at the local subnational level for overall mission success has lately received critical attention. Local peacekeeping is expected to matter because it reassures local actors, deters resumption of armed hostilities, coerces parties to halt fighting, and makes commitment to agreements credible. Thus peacekeepers affect the relations between central and local elites and avoid the emergence of local power vacuums and areas of lawlessness. This study uses new subnational data on the deployment of United Nations peacekeepers. It uses matching and recursive bivariate probit models with exogenous variables for temporal and spatial variation to deal with possible nonrandom assignment of the treatment. We demonstrate that conflict episodes last for shorter periods when peacekeepers are deployed to conflict-prone locations inside a country, even with comparatively modest deployment. The effect of peacekeeping on the onset of local conflict is, however, less clear cut.
United Nations (UN) peacekeepers tend to be deployed to ‘hard-to-resolve’ civil wars. Much less is known about where peacekeepers are deployed within a country. However, to assess peacekeepers’ contribution to peace, it matters whether they are deployed to conflict or relatively safe areas. This article examines subnational UN peacekeeping deployment, contrasting an ‘instrumental’ logic of deployment versus a logic of ‘convenience’. These logics are evaluated using geographically and temporally disaggregated data on UN peacekeepers’ deployment in eight African countries between 1989 and 2006. The analysis demonstrates that peacekeepers are deployed on the frontline: they go where conflict occurs, but there is a notable delay in their deployment. Furthermore, peacekeepers tend to be deployed near major urban areas.
Previous studies identified several domestic factors that may influence a country’s level of structural coup-proofing, i.e., counterbalancing strategies that shall prevent internal groups from seizing power via a coup d’état. We suggest that a country’s level of counterbalancing is also affected by such policies in what we term countries’ “peer groups.” When deciding the appropriate level of counterbalancing, rulers may be affected by external information flows from a “peer group” with similar structural coup-risk characteristics (institutions) or a similar coup-risk experience (coup history). Using maximum likelihood spatial lag models and data in 1976–2005, we find that leaders learn from and emulate counterbalancing in other states, but rather only through an “experiential peer group.”
For a given number of troops in a peace operation, is it advisable to have soldiers from a single country, or should the UN recruit peacekeepers from a variety of donor countries? Since 1990, the number of contributors to peace operations has grown threefold, and most operations have carried the mandate to protect civilians. This article explores the effect of diversity in the composition of a mission, measured by fractionalization and polarization indices, on its performance in protecting civilians in Africa in the period 1991–2008. It finds that mission diversity decreases the level of violence against civilians, a result that holds when geographic and linguistic distances between countries are considered.
Aims - This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health (“Progetto Obiettivo 1994-1996”) ten years after its launch. Methods - The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents. Results - CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites. Conclusions - A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.
Declaration of Interest: The study has been supported by the Regione del Veneto, Giunta Regionale, Ricerca Sanitaria Finalizzata 2004, Venezia, Italia (grant to Professor M. Ruggeri).
Aims – To evaluate the quality of psychiatric care during the acute psychotic episode and the early post-acute period. Methods – Data concerning 24 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT's Project to evaluate the implementation of NICE recommendations in Italian Mental Health Services. Results – The treatment of the acute episode in the Italian Mental Health Services is not based only on admissions in Psychiatric Ward in General Hospitals, but also on intensive home based care. The utilization of day hospital facilities for treating acute episodes is less frequent, as the presence of home based follow up after discharge. About of Departments of Mental Health did not have clinical guidelines concerning the pharmacological treatment in this area. However usually the standard practices followed NICE recommendations in terms of prescribed dosages, monitoring side effects and rationale for shifting to atypical antipsychotic drugs. Antipsychotic drugs, atypical or conventional, were frequently prescribed concurrently, while utilization of atypical antipsychotic drugs was increasing. Conclusions – The results show critical points concerning on one hand the scarce diffusion of clinical guidelines, on other hand the connection between standard practices, clinical guidelines and marketing of atypical antipsychotic drugs. It should be reinforced the role of the community and particularly at service level the capacity of community mental health teams to treat the acute patients.
This study was designed to investigate the effect of both hypertension and ageing on the efficiency of glucose metabolism. A 12-sample, 120 min intravenous glucose tolerance test (IVGTT) was applied to 36 rats: two groups of nine young (12 weeks) spontaneously hypertensive and Wistar Kyoto rats (Y-SHR and Y-WKY group, respectively) and two groups of nine old (40 weeks) SHR and WKY rats (O-SHR and O-WKY group, respectively). Insulinaemia and glycaemia data were interpreted in terms of estimates of glucose effectiveness, SG, and insulin sensitivity, SI, provided by the minimal model of glucose kinetics. The possible link between insulin resistance and hypertension was investigated by comparing Y-SHR vs. Y-WKY and O-SHR vs. O-WKY groups. Comparison of O-SHR vs. Y-SHR and O-WKY vs. Y-WKY groups enabled us to investigate the role of age in the development of abnormalities in glucose metabolism. No significant differences (P > 0.05) were observed in the mean SG and SI estimates between SHR and age-matched WKY groups. This finding indicates that exposure of SHR to high blood pressure levels does not necessarily lead to the development of insulin resistance and impaired glucose effectiveness. Similarly, no significant differences (P > 0.05) were observed in SG and SI estimates between old and young SHR and WKY groups. This finding indicates that, in this animal model of hypertension, insulin sensitivity and glucose effectiveness do not even deteriorate with ageing. Experimental Physiology (2003) 88.3, 399-404.
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