Majanduslikud tingimused ja toetus võimulolijatele: kas ja milline on majanduse roll?

Akadeemilisest kirjandusest on teada, et majanduse ja valimistulemuste vahel on tugev seos. Valijad peavad võimulolijaid riigi majanduse eest vastutavaks: valitsusparteide toetus kasvab, kui majandus kosub, ning kannatab, kui majandusel läheb kehvasti. Paraku ei ole aga kõikide valimiste tulemused ühtmoodi majandusest tingitud. Majanduslik hääletamine esineb sageli, kuid mitte alati ega igal pool, ja pole päris selge, miks see nii on. Hiljutine finants- ja majanduskriis näitas selgelt nende kahe nähtuse vahelise seose ebastabiilsust. Kriisi ajal koges valdav enamik läänemaailma riikidest sügavat majanduslangust, mis klassikalistest teooriatest lähtudes peaks viima tõsiste poliitiliste tagajärgedeni. Mitmed Euroopa valitsusparteid saidki valimistel armutult lüüa, ent mitmetel teistel õnnestus oma positsioon säilitada või seda isegi tugevdada. Majandusliku hääletamise ebastabiilsus oli ka selle väitekirja kirjutamise ajendiks. Kui seost majanduse ja valimiste vahel ei eksisteeri, siis on valijate võimalused võimulolijaid majandustulemuste eest vastutavaks pidada piiratud, mis omakorda jätab viimastele vabad käed ellu viia neile sobivaid poliitikaid, isegi kui need ei ole kooskõlas avaliku huviga. Kui aga demokraatliku vastutuse mehhanism toimib, siis on kodanikel võimalik osaleda otsustusprotsessides ja kaasa rääkida selles, milliseks riigi poliitikad kujunevad. Väitekiri käsitles majanduslikku hääletamist kolmest aspektist. Esmalt uuris töö majanduse ja poliitilise toetuse vahelise seose üldist tugevust. Analüüs, mis põhines mahukal küsitlusandmestikul erinevatest Euroopa riikidest ja ajahetkedest, näitas, et majanduslikel kaalutlustel on tugev mõju valijate poliitilistele eelistustele. Riigi majanduse käekäik on arenenud riikide kodanike jaoks oluline – seda jälgitakse ja võetakse oma poliitiliste eelistuste kujundamisel arvesse. Teiseks uuris töö, mil moel mõjutas majanduslikku hääletamist finants- ja majanduskriis ja leidis, et statistiline seos majanduse ja hääletamise vahel jäi sarnasele tasemele, isegi ajal, mil Euroopat raputas viimaste aastakümnete tugevaim majanduslangus. See viitab asjaolule, et majandusliku hääletamise mehhanism on välistele šokkidele võrdlemisi immuunne. Viimaks tõi töö välja uudse dimensiooni majanduslikus hääletamises, suunates fookuse majanduspoliitikale. Analüüs näitas, et majanduskriisi järel pöörasid kodanikud fiskaalpoliitikatele enam tähelepanu kui varem, ja mitmel pool karistati valitsusparteisid karmide kärpemeetmete eest. Veelgi enam, majanduspoliitikad on tavapäraste tegurite kõrval kerkinud üheks keskseimaks teguriks, mis indiviidi valimisotsust määravad, viidates asjaolule, et majandusliku hääletamise fenomen on muutunud mitmetahulisemaks.Academic research lends significant support to the expectation that there is a strong link between the economy and election outcomes. Voters hold incumbents responsible for the national economy: public support for governing parties drops when the economy performs poorly and increases when the economy grows. However, not all elections are determined by the economy. Economic voting is found often, but not always and not everywhere, and it remains unclear why that is. The recent financial and economic crisis has further accentuated the concerns as to the instability of economic voting. The majority of Western countries experienced steep recession, which should lead to major political consequences. Indeed, a number of governing parties witnessed landslide electoral defeat, but on several other occasions incumbents managed to maintain their position despite the unprecedented economic turmoil. The instability in economic voting was the main motivation for writing this dissertation. If the link between economic conditions and elections does not exist, then voters’ ability to assign responsibility for economic outcomes is limited, and this leaves leaders free to pursue whatever policies they please irrespective of their public consequences. However, when the mechanism of democratic accountability is in good health, then citizens maintain their ability to participate in the process of decision-making and help determine national policy. The dissertation addressed economic voting from three different aspects. Firstly, it tested the overall strength of the link between the economy and political support. The analysis, which relied on an extensive dataset of surveys across nations and over time, demonstrated, that economic considerations have a strong effect on incumbent support. Citizens regularly observe national economic outcomes and shape their electoral decisions accordingly. Secondly, the work examined the performance of economic voting in Europe in the wake of the financial and economic crisis. The findings show that the statistical relationship between the economy and voting remained remarkably constant, even after the most dramatic economic recession in our lifetime, suggesting that the economic voting mechanism is largely immune to external shocks. Finally, the dissertation revealed a new dimension of economic voting by shifting the focus onto national economic policies. Citizens paid more attention to national fiscal policies after the crisis than they did before, and on many occasions held incumbents responsible for painful austerity programs. In fact, economic policies have emerged as one of the key predictors of individual vote choice next to more conventional determinants, revealing the new and multidimensional face of economic voting

Arst ja teadlane

Eesti Arst 2021; 100(4):203 &nbsp

Opportunity or threat?: how Europeans view freedom of movement

Freedom of movement was one of the major issues during the UK’s EU referendum, but how do citizens in other EU countries view the topic? Drawing on new research, Sofia Vasilopoulou and Liisa Talving explain that although freedom of movement is popular overall among EU citizens, there is substantial variation between countries, with citizens in richer member states likely to have more negative views

Second-order effects or ideational rifts? Explaining outcomes of European elections in an era of populist politics

This article seeks to enhance our understanding of the European Parliament (EP) elections in an era of populist and anti-European Union (EU) politics. Specifically, it aims to evaluate both the conventional second-order elections theory as well as an alternative approach that regards EP elections as an arena for conflict between liberal-democratic Europeanism and populist, extremist and euroskeptic alternatives. It does so by deriving a series of hypotheses from both approaches and testing these with party-level data from all EU member states in the context of 2019 EP elections. Our results challenge both explanations. Party size is a robust predictor of electoral performance in EP elections, and its effect is moderated by electoral system design. While large parties lost votes across the EU, their losses were more pronounced in countries where national legislatures are elected under plurality or mixed systems. We find no evidence of incumbent losses or electoral cycle effects. Party-level populism, extremism and euroskepticism did not systematically predict electoral performance but party ideology appears to have moderated the effects of incumbency and party size. Incumbency was associated with vote gain among populist and far-right parties but not other parties, and the effect of size also varied across party ideologies. In sum, these results suggest that vote fragmentation in the 2019 EP elections is partly explained by electoral system design, while it was not driven by the desire to punish political incumbents. Populist and far-right parties in power appear to be particularly immune to punishing behavior often associated with EP elections

Still second-order? European elections in the era of populism, extremism, and euroskepticism

The continued relevance of the second-order elections (SOE) theory is one of the most widely debated issues in the study of European Parliament (EP) elections. While the theory has been criticized from many angles, the recent success of populist, extremist, and Eurosceptic parties raises additional questions about the applicability of a model that depicts EP elections as a lowstakes affair revolving around national issues. This article tests the SOE model with party-level data from all 175 EP elections held between 1979 and 2019. While turnout in EP elections remains well below participation rates in national elections, the 2019 EP elections were marked by a significant reduction in the average turnout gap. Across all election years, party size is the most potent predictor of electoral gains and losses in EP elections. Incumbency is associated with electoral losses in most EP election years. These effects are moderated by the electoral cycle and the electoral system in some but not all years. The expectation that the SOE model performs worse in countries with fragmented party systems was not confirmed. All in all, the SOE model continues to wield significant explanatory power in both the West and the East

Läbivate kõhuvigastuste selektiivne mitteoperatiivne käsitlus ning praktika Põhja-Euroopa traumakeskustes

Selektiivne mitteoperatiivne kõhupiirkonna noa- ja laskevigastuste käsitlus (SMOK) on tänapäevaste traumakeskuste ravitaktika osa. Ülevaateartiklis on käsitletud SMOKi taktika arengut, rakendamist ja tulemeid. Lisaks on antud ülevaade Põhja-Euroopa traumakeskuste, sealhulgas Põhja-Eesti Regionaalhaigla praktikast hiljuti ilmunud artikli põhjal, milles käsitleti SMOKi temaatikat

Ägeda apenditsiidi tänapäevane käsitlus

Esimese teadaoleva apendektoomia tegi 1735. aastal Prantsuse päritolu kirurg dr Amyand St. George’i haiglas Londonis Inglismaal ja 19. sajandi teisest poolest on apendektoomia olnud apenditsiidi ravi valikmeetod. Vaatamata apenditsiidi käsitluse suhteliselt pikale ajaloole erinevad veel tänapäeval hinnangud ägeda apenditsiidi optimaalse käsitluse kohta. Järjest enam on teaduskirjanduses arutletud apenditsiidi konservatiivse ravi üle antibiootikumidega ning väheinvasiivsete vahelesegamiste osakaal kasvab. Käigus on mitmeid uuringuid, et leida täpsemaid laborimarkereid diagnoosi välistamiseks või kinnitamiseks. Artiklis on antud ülevaade viimastest soovitustest ja tõenduspõhistest suundadest ägeda apenditsiidi käsitluses.Eesti Arst 2016; 95(11):723–72

Management of penetrating vascular injuries

Universitatea din Tartu, Facultatea de Medicină, Departamentul de Chirurgie, Tartu, Estonia, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Managementul leziunilor vasculare (LV) a suportat schimbări semnificative pe parcursul ultimilor decenii. Resuscitarea hipotensivă, utilizarea turnichetelor în leziunile extremităţilor, înlocuirea angiografiei prin cateter cu CT-angiografie (CTA) şi „damage control” sunt doar câteva componente ale evoluţiei recente. Traumatismele penetrante reprezintă peste 36- 50% din totalul LV traumatice. Diagnosticul: Recunoaşterea LV periferice se bazează pe examenul clinic cu stratificarea manifestărilor în „semne majore”, „semne minore” sau „semne absente”. În prezenţa semnelor majore repararea vasculară este necesară în aproape 100% cazuri. Aproximativ 1-8% dintre bolnavii cu semne minore pot avea LV ce necesită intervenţie, fapt ce dictează necesitatea examenului imagistic. Recent investigaţia de elecţie s-a schimbat de la angiografie prin cateter spre CTA şi sonografie duplex. În absenţa semnelor LV investigaţiile ulterioare nu sunt indicate. Managementul chirurgical: Recoltarea grefei venoase la nivelul extremităţilor inferioare întotdeauna necesită condiții sterile. După realizarea controlului proximal şi distal, vasul lezat este debridat în limita ţesuturilor sănătoase. Cu ajutorul cateterului Fogarty se curăţă vasele aferente şi eferente şi se aplică heparinizarea locală. Leziunile arteriale se repară prin sutura pr imară sau prin interpoziţia unui grefon autolog sau din PTFE. Leziunile venoase se ligaturează conform tuturor scenariilor de „damage control”, deşi în condiţii controlate şi cazuri selectate poate fi aplicată sutura laterală a venei. Venele: mezenterica superioară, portă, cava supra-renală şi venele jugulare interne bilateral se ligaturează numai în situaţii cu pericol pentru viaţă, manevra fiind insoţită de o morbiditate semnificativă. Pentru „damage control” utilizăm şunturi cu diametru maximal aplicabil leziunilor arteriale. Majoritatea absolută a şunturilor va rămâne patentă timp de 24 ore. Venele majore sau de importanţă vitală la fel pot fi şuntate. Evaluarea rezultatelor: Mortalitatea generală în LV civile constituie circa 29%, iar rata amputaţiilor alcătuieşte 8%. Perspective: Au fost bine stabilite opţiunile de tratament endovascular în leziunile trunchiului arterial. În acealaşi timp patenţa leziunilor tratate endovascular la nivelul extremităţilor rămâne până în prezent nedefinită.Introduction: The management of vascular injuries (VI) has experienced significant changes in recent decades. Hypotensive resuscitation, utilization of tourniquets in extremity injuries, shift from catheter-based angiography to CT-angiography (CTA) and damage control are a few components of the recent evolution. Penetrating trauma results in more than 36-50% of all traumatic VI. Making the diagnosis: The diagnosis of peripheral VI is based on clinical examination stratifying injuries into “hard signs”, “soft signs” or “no signs”. When hard signs are present close to 100% require vascular repair. About 1-8% of patients with soft signs of VI harbor a lesion requiring repair and thus imaging are advocated. Recently the investigation of choice has shifted from catheter based angiography to CTA or Duplex ultrasound. With no sign of VI, no further evaluation is indicated. Operative management: Always include the lower extremities for conduit harvest in the sterile field. After obtaining proximal and distal vascular control, the injured vessel is debrided to the healthy tissue. A Fogarty catheter sweep clears the vascular inflow-outflow and regional heparinization is provided. The arterial injury is repaired primarily or utilizing autologous or PTFE interposition graft. Venous injuries are ligated in all damage control scenarios; however, in controlled settings in selected patients lateral venous repair can be performed. The superior mesenteric, portal, supra-renal cava, and bilateral internal jugular veins are ligated only in life-threatening settings with a significant morbidity. In damage control, we utilize the largest diameter shunt applicable for arterial injuries. The vast majority of shunts stay patent for 24 hours. Large and vital veins can likewise be shunted. Outcome measures: Overall mortality in VI in civilian setting is about 29% and overall amputation rate is at 8%. Future perspectives: Endovascular treatment options for truncal arterial injuries have been established. However, the patency of lesions managed by endovascular interventions in extremity injuries remains undefined

Suguhormoonide östradiooli ja progesterooni koespetsiifiline roll inimese endomeetriumis ja rinnanäärmes

Artiklis on antud ülevaade östradiooli (E2) ja progesteroon (P4) olulisusest inimese endomeetriumis ja rinnanäärmes ning kirjeldatud nende hormoonide varjupoolt seoses viljatuse ja rinnavähiga. On oluline mõista, et samadel hormoonidel võib erinevates kudedes olla erinev või lausa vastupidine efekt. Vaatamata laialdastele uuringutele on paljud küsimused seoses suguhormoonide regulatsiooniga seni veel vastamata. Rinnavähk ja sellega seonduv on tänapäeval üks enim uuritud valdkondi, kuid see on naiste seas siiani enim elusid nõudnud vähitüüp. Üha rohkem paare vajab kunstliku viljastamise protseduuride (IVF) kliinikute abi lapse saamisel ning jätkuvalt otsitakse võimalusi, kuidas ravi tulemuslikkust parandada ja võimalikke kõrvalmõjusid vähendada. Autorid tahaksid rõhutada kogu genoomi sekveneerimismeetodite olulisust, sest need meetodid võimaldavad uurida korraga kogu inimese genoomi. Vastav info võimaldab tulevikus muu hulgas ennustada, kuidas üks või teine ravim või preparaat konkreetsele inimesele mõjub. Eesti Arst 2012; 91(4):182-18

Emergency general surgery: a time for a new surgical specialty?

Universitatea din Tartu, Facultatea de Medicină, Departamentul de Chirurgie, Tartu, Estonia, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: În ultimele decenii societăţile chirurgicale din Europa şi America de Nord au aprobat separarea specialităţii de chirurgie programată de la cea de urgenţă. La baza acestor tendinţe au stat: rezultatele nesatisfăcătoare ale spitalizărilor urgente, coordonarea inadecvată a serviciului, lipsa literaturii şi a training-urilor specializate, alocarea limitată a resurselor şi complexitatea înaltă caracteristică chirurgiei de urgenţă. Realizări: Asociaţia Americană de Chirurgie a Traumei (AAST) a stabilit curriculum pentru o specialitate nouă – Chirurgia Stărilor Acute (Acute Care Surgery – ACS) care include trei elemente practice de bază: chirurgia de urgenţă, trauma şi terapia stărilor critice. Astfel de compoziţie educaţională asigură o bază vastă de experienţă necesară pentru tratamentul pacienţilor chirurgicali critici. Societatea Europeană de Traumă şi Chirurgie de Urgenţă (ESTES), la fel este în proces de definire a curriculum-ului pentru specialitatea – Chirurgia Generală Urgentă (EGS), deşi fără includerea compartimentului de terapie a stărilor critice, din motivul altor standarde de pregătire a chirurgilor în Europa. Asociaţia Japoneză de Medicină Urgentă (JAAM) a realizat 3 conferinţe anuale comune cu AAST şi a lansat o revistă oficială proprie – Journal of Acute Medicine and Surgery. Evaluarea rezultatelor: O multitudine de literatură demonstrează beneficiile majore în urma creării acestei specialităţi chirurgicale noi. S-a înregistrat ameliorarea rezultatelor tratamentului efectuat de către specialiştii ACS/EGS pentru cea mai răspîndită patologia chirurgicală urgentă – apendicita. La fel, s-au ameliorat rezultatele operaţiilor efectuate de echipe specializate în chirurgia de urgenţă la pacienţii cu afecţiuni biliare şi colorectale acute. Perspective: Specialitatea Chirurgia Generală Urgentă pare să aibă o perspectivă de extindere continuă pe viitor, întrucît chirurgii cu o pregătire specială vor demonstra rezultate superioare. Programele educaţionale în ACS/EGS vor include elementele esenţiale ale ortopediei, neurochirurgiei, reanimatologiei, chirurgiei vasculare, chirurgiei generale de urgenţă, hepatobiliare, toracice şi pediatrice pentru asigurarea capacităților adecvate ale specialiştilor în acordarea asistenţei medicale acestei categorii de bolnavi.Introduction: During the recent decades, both North American and European surgical societies have advocated separation of elective and emergency general surgical specialties. These aspirations have been fueled by poor outcomes in emergency admissions, inadequate leadership, lack of literature and training, scarce allocation of resources, and high complexity of the emergency surgical disease burden. Developments: The American Association for the Surgery of Trauma (AAST) has established a training curriculum for the Acute Care Surgery (ACS) which involves three pillars of practice: emergency surgery, trauma, and surgical critical care. Such a composition of training allows a broad base of expertise to serve the needs of critically ill surgical patients. The European Society of Trauma and Emergency Surgery (ESTES), is likewise in process of defining the training curriculum for the Emergency General Surgery (EGS), however, excluding surgical critical care for reasons adherent to training of surgeons in Europe. The Japanese Association of Acute Medicine (JAAM) has had 3 joint annual meetings with the AAST and JAAM has launched their official publication, the Journal of Acute Medicine and Surgery. Outcome measures: There is a multitude of literature depicting major outcome benefits following establishment of the new surgical specialty. The most common emergent surgical condition such as appendicitis has experienced improved outcomes following care provided by ACS/EGS. Likewise, patients suffering emergency biliary conditions and colorectal emergencies have shown improved outcomes after establishment of dedicated emergency surgical teams. Future perspectives: The EGS specialty will likely expand in the future as outcomes are improving through care under specialists with appropriate training. ACS/EGS fellowship programs will develop their training elements incorporating basic orthopedics, neurosurgery, resuscitation, vascular, emergency general surgery, hepatobiliary, thoracic, pediatric to ensure a adequate capability for this patient category