Three essays on households' financial decisions

Nel primo capitolo della tesi, ho analizzato empiricamente la relazione tra risparmio precauzionale e vincoli di liquidità in Italia usando dati panel sulle famiglie. Ho utilizzato un indicatore soggettivo della varianza delle crescita del reddito, che ha permesso di misurare il movente precauzionale al risparmio, e una varietà di indicatori dei vincoli di liquidità. Utilizzando l’approccio della switching regression endogena, ho visto come il movente precauzionale al risparmio sia più forte per i nuclei familiari che devono affrontare i vincoli vincolante o prevedano che questi vincoli siano vincolanti per il futuro. Sussiste infatti un rapporto di complementarità tra risparmio precauzionale vincoli di liquidità effettivi e attesi. Inoltre, l'introduzione di una misura soggettiva di avversione al rischio consente una migliore identificazione del coefficiente associato alla misura soggettiva della varianza della crescita del reddito. Nel secondo capitolo, basandomi su una domanda circa la quantità desiderata di ricchezza precauzionale presente nell’ Indagine sulla ricchezza delle famiglie italiane, mi propongo di analizzare le principali determinanti del movente precauzionale al risparmio. In particolare, mi propongo di fornire una valutazione empirica del legame esistente tra la composizione del portafoglio delle famiglie e la quantità di ricchezza che le famiglie desiderano avere per proteggersi da eventi inattesi. I risultati mostrano come sussista una forte correlazione negativa tra la quantità desiderata di ricchezza precauzionale e il fatto di detenere un portafoglio composto esclusivamente da attività non rischiose. Tuttavia, le famiglie non sembrano utilizzare diversificazione del portafoglio per ridurre l'esposizione al rischio totale. Infine, è stato affontato il problema della complementarità/sostituzione tra assicurazione “formale” ed “informale”. In realtà, la fiducia nel mercato dei capitali in modo da ridurre notevolmente la quantità di ricchezza delle famiglie desiderano detenere per motivi precauzionali. Tuttavia, non vi è alcuna prova a favore di un legame forte tra il negativo e il risparmio precauzionale e le assicurazioni. Nel terzo capitolo, ho analizzato il rapporto tra il livello iniziale della ricchezza delle famiglie e la probabilità di iniziare un’attività imprenditoriale in Italia e negli Stati Uniti, utilizzando i dati dell’Indagine sulla ricchezza delle famiglie italiane (SHIW) e la Panel Survey of Income Dynamics statunitense (PSID). Sono state formulate diverse previsioni teoriche, che sono state poi confrontate con i dati a disposizione. In primo luogo si è sostenuto che il livello iniziale di ricchezza iniziale debba contare di più per i potenziali imprenditori italiani, che potrebbero incontrare maggiori difficoltà rispetto a quelli statunitensi nell’ ottenere un finanziamento da una banca o da una società finanziaria per avviare un’attività imprenditoriale. Da questo punto di vista, "i mercati informali" (es. gli aiuti da amici o parenti) dovrebbero svolgere un ruolo più significativo in Italia per i potenziali imprenditori, e specialmente per coloro che hanno più probabilità di essere razionati. In secondo luogo, un mercato finanziario ben sviluppato, riducendo l'esposizione delle famiglie al rischio finanziario, dovrebbe avere un impatto positivo sulla probabilità di diventare imprenditore. Pertanto, è stata colmata una lacuna nella letteratura introducendo un indice di diversificazione del portafoglio, calcolato come l'inverso dell'indice Herfindhal, al fine di valutare il livello di sofisticazione finanziaria. Infine, è stata stimata contemporaneamente la probabilità di diventare imprenditore e le variazioni della ricchezza netta. Utilizzando un modello di switching regression endogeno è stato possibile affrontare i problemi di endogeneità dovuti al fatto che le famiglie possono effettivamente accumulare ricchezza al fine di iniziare un’attività imprenditoriale.In the first chapter of the present thesis, I empirically investigate precautionary savings under liquidity constraints in Italy using household panel data. I exploit a unique indicator of subjective variance of income growth, which allows to measure the strength of the precautionary motive for saving, and a variety of survey-based indicators of liquidity constraints. Using an endogenous switching regression approach, I eventually found the precautionary motive for savings to be stronger for those households who face binding constraints, or expect constraints to be binding in the future. Indeed, a complementarity relation exists between precautionary savings and effective and expected liquidity constraints. Moreover, the introduction of a survey-based measure of risk aversion allows a better identification of the coefficient associated with the subjective measure of variance of income growth. In the second chapter, relying on a direct question about the desired amount of precautionary wealth from the 2002 wave of the Italian Survey of Household Income and Wealth, I assess the main determinants of precautionary motive for saving. In particular, I provide an empirical assessment of the linkage existing between the composition of households' portfolio and the amount of wealth households wish to have to protect themselves against unexpected contingencies. As expected, a strong and negative correlation exists between the desired amount of precautionary wealth and the ownership of a portfolio made exclusively of safe assets. However, households do not seem to use portfolio diversification to reduce exposure to total risk. Finally, I address the issue of complementarity vs. substitution between �formal� and �informal� insurance schemes. Actually, trust in capital market would lower substantially the amount of wealth households wish to detain for precautionary reasons. However, there is no evidence in favour of a negative and strong linkage between precautionary saving and insurance. In the third chapter, I assess the relationship between initial household net wealth and the probability of switching to entrepreneurship in Italy and the United States, using household-level data from the Survey of Household Income and Wealth (SHIW) and the Panel Survey of Income Dynamics (PSID). I formulated several theoretical predictions, which are then compared with the data at hand. First of all, I argue that initial wealth should matter more for potential Italian entrepreneurs, who may encounter greater difficulties than their US counterparts in obtaining sufficient funds from a bank or financial institution to start a business. From this perspective, "informal markets" (i.e. help from friends or relatives) should play a more significant role for potential entrepreneurs in Italy, especially for those who are more likely to be constrained. Secondly, I claim that a well developed financial market, by reducing household exposure to financial risk, would positively affect transition into entrepreneurship. Therefore, I fill a gap in the literature introducing a portfolio diversification index, calculated as the inverse of the Herfindhal index, in order to assess the level of financial sophistication. Last but not least, I simultaneously estimate the probability of switching to entrepreneurship and changes in net wealth. Using a sample selection model with endogenous switching makes it possible to deal with endogeneity issues, related to the fact that households may actually accumulate assets prior to setting up a business

Potential users’ preferences towards cardiac telemedicine: a discrete choice experiment investigation in Sardinia

Background: Potential users’ preferences for telemedicine services directed to cardio-vascular diseases are investigated applying a discrete choice experiment (DCE). Given the potential of telemedicine to minimize costs without reducing overall efficiency, assessing preferences for these types of services represents a priority for policy makers. This is especially true for those pathologies that absorb a relatively high quota of total health expenditure. The empirical setting is Sardinia (Italy) because of its insularity and the underdeveloped internal transport network. Telemedicine is likely to mitigate distance between healthcare providers and final users. Methods: A survey conducted between February and May 2013 was administered to a selected Sardinian population older than 18 (potential users) through face-to-face interviews. A discrete choice experiment was implemented and four attributes (i.e. scanning mode, location, waiting list and cost) assess in what measure these influence potential users’ utility by using a random parameter modelling with heterogeneity (RPH). Results: The empirical findings, based on 2000 interviews, highlight that potential users are not very open to the application of telemedicine services in cardiology, mostly preferring the intromoenia (visit at the hospital) and private system. Besides, remarkable individual heterogeneity has been found. Conclusions: Potential users see the implementation of new technologies in healthcare with a certain caution. However, the relatively higher preferences towards services provided at their own municipality suggests that there is ground to explore further the implementation of telemedicine services through the family doctor and local pharmacy

Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial)

Introduction: Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK. Methods and analysis: An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)–Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost–utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective). Ethics and dissemination: Ethics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme). Trial registration number: NCT02653716; Pre-results

A framework for conducting economic evaluations alongside natural experiments

Internationally, policy makers are increasingly focussed on reducing the detrimental consequences and rising costs associated with unhealthy diets, inactivity, smoking, alcohol and other risk factors on the health of their populations. This has led to an increase in the demand for evidence-based, cost-effective Population Health Interventions (PHIs) to reverse this trend. Given that research designs such as randomised controlled trials (RCTs) are often not suited to the evaluation of PHIs, Natural Experiments (NEs) are now frequently being used as a design to evaluate such complex, preventive PHIs. However, current guidance for economic evaluation focusses on RCT designs and therefore does not address the specific challenges of NE designs. Using such guidance can lead to sub-optimal design, data collection and analysis for NEs, leading to bias in the estimated effectiveness and cost-effectiveness of the PHI. As a consequence, there is a growing recognition of the need to identify a robust methodological framework for the design and conducting of economic evaluations alongside such NEs. This paper outlines the challenges inherent to the design and conduct of economic evaluations of PHIs alongside NEs, providing a comprehensive framework and outlining a research agenda in this area

Synthesis, biological evaluation, and SAR study of novel pyrazole analogues as inhibitors of Mycobacterium tuberculosis: Part 2. Synthesis of rigid pyrazolones

Two series of novel rigid pyrazolone derivatives were synthesized and evaluated as inhibitors of Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis. Two of these compounds showed a high activity against MTB (MIC = 4 μg/mL). The newly synthesized pyrazolones were also computationally investigated to analyze if their properties fit the pharmacophoric model for antitubercular compounds previously built by us. The results are in agreement with those reported by us previously for a class of pyrazole analogues and confirm the fundamental role of the p-chlorophenyl moiety at C4 in the antimycobacterial activity

Is Sedentary Behavior or Physical Activity Associated With Loneliness in Older Adults? Results of the European-Wide SITLESS Study

Research has found that social relationships are central to the health and well-being of an aging population. Evidence exploring the association between physical activity (PA) and sedentary behavior (SB) with social isolation and loneliness is limited. This study uses objectively measured PA and SB (ActiGraph®) and self-reported measures of loneliness (the De Jong Gierveld Loneliness Scale) and social engagement (the Lubben Social Network Scale) from the SITLESS study, a European-wide study of community-dwelling older adults. Social isolation was associated with SB where higher levels of SB were associated with an increase in the level of social isolation, controlling for age, sex, living arrangements, employment status, body mass index, educational background, marital status, and self-reported general health. In contrast, PA was not associated with social isolation, and neither SB nor PA was a statistically significant predictor of loneliness. SB may be linked to social isolation in older adults, but PA and SB are not necessarily linked to loneliness in older community-dwelling adults

Associations of sedentary behavior bouts with community-dwelling older adults' physical function

The study aim was to explore associations between sedentary behavior (SB) bouts and physical function in 1360 community-dwelling older adults (≥65 years old). SB was measured using an ActiGraph wGT3X + accelerometer for seven consecutive days at the dominant hip and processed accordingly. Various SB bout lengths were assessed including: 1- to 9-minutes; 10- to 29-minutes; 30- to 59-minutes; and ≥60-minutes, as well as maximum time spent in a SB bout. Total SB time was adjusted for within the SB bout variables used (percentage SB time in the SB bout length and number of SB bouts per total SB hour). Physical function was assessed using the 2-minute walk test (2MWT), 5-times sit-to-stand (chair stand) test, and unipedal stance test (UST). Hierarchical linear regression models were utilized. Covariates such as moderate-vigorous physical activity (MVPA), demographic and health characteristics were controlled for. Lower percentage time spent in ≥60-minute SB bouts was significantly (P <.05) associated with longer 2MWT distance while lower numbers of ≥60-minute SB bouts were associated with longer 2MWT distance, shorter chair stand time and longer UST time. There were mixed associations with physical function for 10- to 29-minute SB bouts. In a large cohort of European older adults, prolonged SB bouts lasting ≥60-minutes appear to be associated with reduced physical function after controlling for MVPA and numerous other important covariates. Besides reducing SB levels, these findings suggest there is a need to regularly interrupt prolonged SB to improve physical function in older adults

The effectiveness and complexity of interventions targeting sedentary behaviour across the lifespan: a systematic review and meta-analysis

Background: Evidence suggests that sedentary behaviour (SB) is associated with poor health outcomes. SB at any age may have significant consequences for health and well-being and interventions targeting SB are accumulating. Therefore, the need to review the effects of multicomponent, complex interventions that incorporate effective strategies to reduce SB are essential. Methods: A systematic review and meta-analysis were conducted investigating the impact of interventions targeting SB across the lifespan. Six databases were searched and two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias and complexity of each of the included studies. Results: A total of 77 adult studies (n=62, RCTs) and 84 studies (n=62, RCTs) in children were included. The findings demonstrated that interventions in adults when compared to active controls resulted in non-significant reductions in SB, although when compared to inactive controls significant reductions were found in both the short (MD -56.86; 95%CI -74.10, -39.63; n=4632; I2 83%) and medium-to-long term (MD -20.14; 95%CI -34.13, -6.16; n=4537; I2 65%). The findings demonstrated that interventions in children when compared to active controls may lead to relevant reductions in daily sedentary time in the short-term (MD -59.90; 95%CI -102.16, -17.65; n=267; I2 86%), while interventions in children when compared to inactive controls may lead to relevant reductions in the short-term (MD -25.86; 95%CI -40.77, -10.96; n=9480; I2 98%) and medium-to-long term (MD -14.02; 95%CI -19.49, -8.55; n=41,138; I2 98%). The assessment of complexity suggested that interventions may need to be suitably complex to address the challenges of a complex behaviour such as SB, but demonstrated that a higher complexity score is not necessarily associated with better outcomes in terms of sustained long-term changes. Conclusions: Interventions targeting reductions in SB have been shown to be successful, especially environmental interventions in both children and adults. More needs to be known about how best to optimise intervention effects. Future intervention studies should apply more rigorous methods to improve research quality, considering larger sample sizes, randomised controlled designs and valid and reliable measures of SB

Cost-effectiveness of a programme to address sedentary behaviour in older adults: results from the SITLESS RCT

Background: This study details the within-trial economic evaluation and long-term economic model of SITLESS, a multi-country, three-armed randomized controlled trial comparing a combined intervention of exercise referral schemes (ERS) enhanced by self-management strategies (SMS) against ERS alone and usual care (UC). Methods: A cost-utility analysis, conducted from the base-case perspective of the National Health Service and personal and social services, estimated the incremental cost per incremental quality-adjusted life year (QALY) and years in full capability (YFC). A secondary analysis combined the costs with a broad set of outcomes within a cost-consequence framework, from a societal perspective. A Markov-type decision-analytic model was developed to project short-term changes in physical activity to long-term outcomes and costs, over a 5- and 15-year time horizon. Results: The results of the within-trial analysis show that SMS+ERS is highly likely to be cost-effective compared to ERS alone (ICER €4270/QALY), but not compared to UC. Participants allocated to the SMS+ERS group also showed an improvement in YFC compared to ERS alone and UC. The long-term analysis revealed that SMS+ERS is likely to be a cost-effective option compared to ERS and UC over a 5-year, but not with a 15-year horizon, being then dominated by ERS alone. Conclusion: This research provides new evidence that SMS is a cost-effective add-on to ERS strategies. This economic evaluation informs the case for further, cost-effective, refinement of lifestyle change programmes targeted to older adults, with the aim of ultimately reducing the impact of non-communicable diseases in this population