Do environmental preferences in wealthy nations persist in times of crisis? The European environmental attitudes (2008-2017)

How do economic recessions affect European citizens’ attitudes towards environmental policies? In this article we investigate the attitudes of European citizens towards environmental protection considering its importance both at individual and country levels and adopting a longitudinal view. In light of the existing research on the link between pro-environmental attitudes and economic affluence of societies, including Ronald Inglehart’s theory of post-materialism, we hypothesise that levels of economic well-being as well as trust in political institutions are important drivers of Europeans’ attitudes towards environmental protection. Taking into consideration some macroeconomic indicators and the environmental attitude of public opinion, our main results show that even in time of crises, citizens’ pro-environmental attitudes persist in terms of importance, both at country and individual levels

The "business" of compliance

Defence date: 12 January 2016Examining Board: Professor László Bruszt, European University Institute (EUI Supervisor); Professor Adrienne Héritier, European University Institute; Professor Wade Jacoby, Brigham Young University; Professor Frank Schimmelfenning, ETH Zürich.The dissertation aims at understanding and explaining the existence of variation in sustainable compliance with EU legislation in two similarly rule-taking countries. The cases under examination are Hungary and Poland which have experienced a similar historical background, similar environmental problems and have been subject to similar EU conditions and requirements for accession. Nevertheless, the EU Annual Progress Reports and the Tri-Annual Monitoring Reports showed a variation in their compliance with European environmental requirements. The existing literature has explained this divergence by taking a supply-side approach, focusing on those state actors and incumbents who could decide to supply compliance or not. In particular, researchers of compliance and of Europeanisation have focused on differences in capacity limitations or incentives to domestic actors. These supply-side approaches, however, do not seem to fully explain the existing divergence between the performances of Hungary and Poland nor do they sufficiently tackle the issue of "sustainable compliance" in the post-Accession period. In my analysis, I instead explain variation in sustainable compliance by exploring demand-side explanations. To this end, the thesis explores the hypothesis of demand for compliance emerging on the part of stakeholders who recognise its potential for profitability and, thus, influence its sustainability. Its starting point is the Tsebelis' study on stakeholders which describes them solely as "veto players" along the road to compliance; however, this analysis demonstrates that there is also another dimension to the influence they may have. I build my hypothesis around the existence of such factors as market incentives and pre-existing cooperative strategies that make compliance convenient for stakeholders. Moreover, I consider the role played by external assistance and the existence of alliances between external and domestic stakeholders to improve the overall compliance performance of less-regulated countries. The study proves the significance of market incentives and pre-existing cooperative strategies in fostering sustainable compliance while showing how the two strong explanatory variables are interlinked: compliance is not a "business" per se. It has a potential to be made a "good deal" via cooperative strategies among diverse stakeholders creating a win-win settlement

What is governance in global telecoupling?

The concept of telecoupling is increasingly used as a framework to understand globally distant interconnections and their sustainability implications. Although there is a growing research focus on issues of governance related to global telecoupling, there appears little consensus over the meaning of "governance" in this respect. Papers in the recent Ecology and Society special feature titled "Telecoupling: A New Frontier for Global Sustainability" reveal quite different understandings of the telecoupling-governance relationship. We want to suggest that greater clarity and a common understanding of how governance figures in telecoupled systems will aid constructive dialogue on how to govern telecoupling toward more sustainable pathways in the face of pressing global social and environmental issues. This response, though not aiming to define a single, definitive framework of governance as it pertains to telecoupling, seeks to identify three distinct perspectives applied to governance in the context of global telecoupling: (1) governance by states or other actors that induces or fosters telecoupling in the first place, often irrespective of its sustainability implications; (2) governance mainly by private companies that coordinates telecoupled flows; and (3) governance by states, nonstate actors, and hybrid or multistakeholder initiatives that aims to address the negative externalities of telecoupling. By distinguishing these perspectives, we aim to make underlying understandings of governance explicit, and to foster further constructive exchange on the topic

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Make EU trade with Brazil sustainable

Brazil, home to one of the planet's last great forests, is currently in trade negotiations with its second largest trading partner, the European Union (EU). We urge the EU to seize this critical opportunity to ensure that Brazil protects human rights and the environment

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors

Drug Prescription and Delirium in Older Inpatients: Results From the Nationwide Multicenter Italian Delirium Day 2015-2016

Objective: This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis. Methods: Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes. Results: Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P =.009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia. Conclusions: Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship