Background In the Netherlands, in 2002, euthanasia became a legitimate medical act, only allowed when the due care criteria and procedural requirements are met. Legally, an Advanced Euthanasia Directive (AED) can replace direct communication if a patient can no longer express his own wishes. In the past decade, an exponential number of persons with dementia (PWDs) share a euthanasia request with their physician. The impact this on physicians, and the consequent support needs, remained unknown. Our objective was to gain more insight into the experiences and needs of Dutch general practitioners and elderly care physicians when handling a euthanasia request from a person with dementia (PWD). Methods We performed a qualitative interview study. Participants were recruited via purposive sampling. The interviews were transcribed verbatim, and analyzed using the conventional thematic content analysis. Results Eleven general practitioners (GPs) and elderly care physicians with a variety of experience and different attitudes towards euthanasia for PWD were included. Euthanasia requests appeared to have a major impact on physicians. Difficulties they experienced were related to timing, workload, pressure from and expectations of relatives, society’s negative view of dementia in combination with the ‘right to die’ view, the interpretation of the law and AEDs, ethical considerations, and communication with PWD and relatives. To deal with these difficulties, participants need support from colleagues and other professionals. Although elderly care physicians appreciated moral deliberation and support by chaplains, this was hardly mentioned by GPs. Conclusions Euthanasia requests in dementia seem to place an ethically and emotionally heavy burden on Dutch GPs and elderly care physicians. The awareness of, and access to, existing and new support mechanisms needs further exploration.

Data for low- and middle- income countries (LMICs) are used to investigate the effect of the demographic transition on economic growth at sub-national level. We introduce a detailed classification of demographic window phases, determine how these phases are distributed among and within LMICs, and analyze the relationship between the demographic window of opportunity (DWO) and economic growth for 1921 urban and rural areas of sub-national regions within 91 LMICs. Many areas in Asia, Latin America and the Middle East have entered the window, but most of Sub-Saharan Africa is still in the traditional or pre-window phase. Our analyses reveal higher growth rates in areas passing through the DWO. Positive growth effects are particularly strong in rural and more educated regions and in countries with lower levels of corruption. Policy measures aimed at effectively using the DW for achieving growth should combine investments in education and rural development with better governance.

Governments try to improve re-election chances by using fiscal instruments; they can shift voters' expectations of government competence because some voters are impaired by uninformedness. We argue that uninformed voters may also be impaired in another way which has not been considered in the literature, namely that uninformed voters are uncertain about the precision of that expected competence. Analytically, we show that political budget cycles (PBCs) are only produced when we have many uninformed voters and their expected competence of the government is fairly uncertain; or with few uninformed voters and certain expectations. This could explain two empirical puzzles on why we sometimes find and sometimes not (i) PBCs in developed and democratic countries with strong institutions, and (ii) that press freedom exacerbates PBCs. In a panel of 70 countries we find empirical support for these findings. Results are robust to alternative specifications and explanations like fiscal rules, corruption and expected downturns.

Data for 91 low- and middle- income countries (LMICs) are used to investigate the effect of the demographic transition on economic growth at sub-national level. We introduce a detailed classification of demographic window (DW) phases, determine how these phases are distributed among and within LMICs, and analyze the relationship between the DW and economic growth for 1,921 urban and rural areas of sub-national regions. Many regions in Asia, Latin America and the Middle East have entered the window, but most of sub-Saharan Africa is still in the traditional or pre-window phase. Multilevel analyses reveal higher growth rates in areas with lower and decreasing dependency ratios. Demographic effects are stronger in rural, more developed and more educated regions. Findings indicate that, in the coming years, the DW might strengthen economic growth in rural areas of LMICs, and particularly if accompanied by investments in education and rural development.

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