Noncooperative decision making in the household: evidence from Malawi

This paper proposes a novel test of productive efficiency in the household that also allows a test of noncooperative decision making. I extend the collective model (Chiappori 1988, 1997) to allow labor choices to affect future bargaining power by raising the value of outside options. Even if household consumption sharing is efficient, labor choices are no longer efficient. Using data on Malawi, where there is predetermined variation in land rights that determine outside options in marriage, I show that individuals spend more time on agricultural labor and less time on wage labor when household land is theirs. They also have lower overall income and consumption. The results are inconsistent with the fully efficient collective model but consistent with a noncooperative model with limited commitment, where individuals allocate their labor supply to maximize future bargaining power. Limited commitment can lead to inefficient allocations that reduce household welfare

Non-invasive neuromodulation of the right temporoparietal junction using theta-burst stimulation in functional neurological disorder.

BACKGROUND Disrupted sense of agency (SoA)-the sense of being the agent of one's own actions-has been demonstrated in patients with functional neurological disorder (FND), and a key area of the corresponding neuronal network is the right temporoparietal junction (rTPJ). Several functional MRI (fMRI) studies have found hypoactivation as well as hyperactivation of the rTPJ in FND. In a proof-of-concept study, we tested whether repetitive transcranial magnetic stimulation (rTMS) over the rTPJ could restore this aberrant activity. METHODS In a randomised, crossover, single-blinded, sham-controlled study design, theta-burst stimulation (tb-rTMS) was applied over the rTPJ in 23 patients with FND and 19 healthy controls (HC), with each participant undergoing three stimulatory visits (inhibitory continuous TBS (cTBS), excitatory intermittent TBS (iTBS) and sham). During fMRI, participants played a visuomotor task artificially reducing their SoA (manipulated agency, MA), repeated after each neurostimulation. We compared brain activity and behavioural SoA as primary outcomes before and after tb-rTMS and investigated the feasibility of tb-rTMS over the rTPJ in FND as secondary outcome. RESULTS At baseline, patients showed decreased accuracy in detecting reduced agency compared with controls (p<0.001), paralleled by lower brain activation in the rTPJ during MA (p=0.037, volume of interest). A region of interest analysis on the rTPJ showed no effect of the sham condition in FND or HC (p=0.917; p=0.375) but revealed a significant effect of stimulation protocol (cTBS/iTBS, p=0.037) in patients with FND, with the excitatory protocol increasing the blood-oxygen-level-dependent (BOLD) signal, whereas this effect was not found in HC. In neither group, a behavioural effect of tb-rTMS was observed. CONCLUSION Aberrant processing of agency in FND was confirmed at baseline, reflected in behavioural outcome and reduced activity in the rTPJ. Tb-rTMS over this key region elicited neuronal changes in patients, paving ways for future studies exploring TMS as neurobiologically informed intervention to restore SoA in FND. We critically discuss methodological intricacies and outline further steps in this research line

Fertility and labor market responses to reductions in mortality

We investigate women’s fertility, labor and marriage market responses to a health innovation that led to reductions in mortality from treatable causes, and especially large declines in child mortality. We find delayed childbearing, with lower intensive and extensive margin fertility, a decline in the chances of ever having married, increased labor force participation and an improvement in occupational status. Our results provide the first evidence that improvements in child survival allow women to start fertility later and invest more in the labor market. We present a new theory of fertility that incorporates dynamic choices and reconciles our findings with existing models of behavior

Where did it go wrong? Marriage and divorce in Malawi

Do individuals marry and divorce for economic reasons? Can we measure the economic attractiveness of a person’s marriage market? We answer these questions using a structural model of consumer-producer households that is applied to rich data from Malawi. Using revealed preference conditions for a stable marriage market, we define the economic attractiveness of a potential match as the difference between the potential value of consumption and leisure with the new partner and the value of consumption and leisure in the current marriage. We estimate this marital instability measure for every possible pair in geographically defined marriage markets in 2010. We find that the marital instability measure is predictive of future divorces, particularly for women. We further show that this estimated effect on divorce is mitigated by the woman’s age, and by a lack of men, relative to women, in the marriage market, showing that these factors interact with the economic attractiveness of the remarriage market. These findings provide outof-sample validation of our model and evidence that the economic value of the marriage market matters for divorce decisions

Cognition, emotional state, and quality of life of survivors after cardiac arrest with rhythmic and periodic EEG patterns

Aim: Rhythmic and periodic patterns (RPPs) on the electroencephalogram (EEG) in comatose patients after cardiac arrest have been associated with high case fatality rates. A good neurological outcome according to the Cerebral Performance Categories (CPC) has been reported in up to 10% of cases. Data on cognitive, emotional, and quality of life outcomes are lacking. We aimed to provide insight into these outcomes at one-year follow-up. Methods: We assessed outcome of surviving comatose patients after cardiac arrest with RPPs included in the ‘treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation’ (TELSTAR) trial at one-year follow-up, including the CPC for functional neurological outcome, a cognitive assessment, the hospital anxiety and depression scale (HADS) for emotional outcomes, and the 36-item short-form health survey (SF-36) for quality of life. Cognitive impairment was defined as a score of more than 1.5 SD below the mean on = 2 (sub)tests within a cognitive domain. Results: Fourteen patients were included (median age 58 years, 21% female), of whom 13 had a cognitive impairment. Eleven of 14 were impaired in memory, 9/14 in executive functioning, and 7/14 in attention. The median scores on the HADS and SF-36 were all worse than expected. Based on the CPC alone, 8/14 had a good outcome (CPC 1–2). Conclusion: Nearly all cardiac arrest survivors with RPPs during the comatose state have cognitive impairments at one-year follow-up. The incidence of anxiety and depression symptoms seem relatively high and quality of life relatively poor, despite ‘good’ outcomes according to the CPC

Moral hazard in marriage: the use of domestic labor as an incentive device

This paper argues that some women in developing countries use domestic labor as a tool to incentivize husbands. A theoretical model is derived based on the traditions of rural Malawi, where men often supplement farm income with wage labor. As wage labor is not observed by the wife, this creates moral hazard: husbands may not make enough effort to bring home wages. The model predicts that women overcome this by using domestic labor as an incentive device: they increase their domestic labor and reduce their leisure in response to good consumption outcomes, but only if they cannot rely on divorce threat as an alternative source of incentives. This prediction is confirmed using survey data from Malawi. Identification is based on the fact that Malawi's kinship traditions exogenously determine women's accessibility to divorce. Where divorce is not an option, women make inefficient labor choices in order to provide incentives

The optimal treatment of an infectious disease with two strains

This paper explores the optimal treatment of an infectious disease in a Susceptible-Infected-Susceptible model, where there are two strains of the disease and one strain is more infectious than the other. The strains are perfectly distinguishable, instantly diagnosed and equally costly in terms of social welfare. Treatment is equally costly and effective for both strains. Eradication is not possible, and there is no superinfection. In this model, we characterise two types of fixed points: coexistence equilibria, where both strains prevail, and boundary equilibria, where one strain is asymptotically eradicated and the other prevails at a positive level. We derive regimes of feasibility that determine which equilibria are feasible for which parameter combinations. Numerically, we show that optimal policy exhibits switch points over time, and that the paths to coexistence equilibria exhibit spirals, suggesting that coexistence equilibria are never the end points of optimal paths

Psykologiska frågor i socialtjänstens barnavårdsutredningar : trångmål, begränsningar och möjligheter ur socialsekreterares perspektiv

Socialtjänstens barnavårdsutredningar utgör samhällets verktyg för att bedöma när stöd eller skydd till barn och unga som riskerar att fara illa fordras. I dessa ingår svåra bedömningar som ställer höga krav på kompetens och samverkan. Studiens syfte var att undersöka vilka svårigheter barnavårdsutredande socialsekreterare möter i arbetet med psykologiska frågor rörande barn och familj samt hur kompetens i dessa frågor finns strukturellt och praktiskt tillgänglig i arbetet. Induktiv tematisk analys av elva intervjuer med socialsekreterare genererade tre övergripande områden; trångmål i utredningen, begränsningar utifrån arbetets ramar samt möjligheter. Centrala teman rörde konflikt mellan barnets behov och kravet på föräldrasamarbete, svårigheter relaterade till samarbete med andra verksamheter, tillgänglig kompetens samt tidsbrist i arbetet. Möjligheter fokuserade på struktur för kompetensutveckling, möjlighet till psykologisk avlastning, relationsbaserat arbete, samverkan och tvärprofessionellt arbete i barnavårdsutredningar. Resultaten går i linje med tidigare forskning rörande utmaningar inom social barnavård och samverkan kring utsatta barn. Implikationer för professionens specialisering och välfärdssystemets organisering av tjänster för att identifiera och stötta utsatta barn och familjer diskuteras.