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AimTo assess, from a United States (US) payer's perspective, the cost-effectiveness of gels designed to separate the endometrial surfaces (intrauterine spacers) placed following intrauterine surgery.Materials and methodsA decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results.ResultsIn this model, using intrauterine spacers for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of $19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan.LimitationsThere are no available data on the effects of intrauterine spacers or IUAs on patients' quality of life. Resultingly, the model could not evaluate patients' utility related to treatment with or without intrauterine spacers and instead focused on costs and events avoided.ConclusionThis analysis robustly demonstrated that intrauterine spacers would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a reduction in IUAs and improvements to patients' pregnancy-related outcomes.

This paper examines the causal effect of childcare provision on grandparents’ health in the United States. We use the sex ratio among older adults’ children as an instrument for grandparental childcare provision. Our instrument exploits that parents of daughters transition to grandparenthood earlier and invest more in their grandchildren than parents of sons. We estimate 2SLS regressions using data from the Health and Retirement Study. The results suggest that providing childcare is detrimental to grandparents’ physical functioning and subjective health. We show that these effects increase with the intensity of grandchild care provision, and the effects are driven primarily by grandmothers. [ABSTRACT FROM AUTHOR]

Behaviour change communication (BCC) remains a central component of the interventions used in the fight against malaria in Ghana. However, there is limited evidence of its effectiveness. This study evaluated the effects of BCC strategies on knowledge (symptoms, causes and prevention) and overall knowledge of malaria among Ghanaian women aged 15–49 years. The propensity score matching (PSM) approach and logistic regression were used to analyse data from the 2016 edition of the Malaria Indicator Survey (MIS). Women who participated in community-level education or heard/saw media messages on malaria, or both, had significantly more knowledge of the disease than women who lacked access to any of these mediums of communication. The effect of these strategies on women's overall knowledge of malaria is about 2% to 4% and is higher on their knowledge of the symptoms (3% to 6%) and prevention (2% to 4%) than the causes (2%). The combined effects of both mediums of communication are relatively higher than the effect of either of them as a single medium of communication. Further analysis showed that improved knowledge of the disease is associated with higher preventive measures taken by women for themselves and for their children. The results are more significant in rural and poor households than in urban and non-poor households. These findings underscore the need for the Ministry of Health and its partner institutions to adopt an innovative approach which combines the two strategies in intensively educating Ghanaians, and women in particular, on the symptoms and prevention of malaria, giving due cognisance to households' socioeconomic status and geographical location. [ABSTRACT FROM AUTHOR]

The motivation of the present study is to complement the extant literature by assessing the relevance of governance and information technology in how African trade affects female labour force participation. The study focuses on 48 African countries using data for the period 1996–2021. An adopted empirical strategy is the fixed effects regressions that are designed to address concerns for simultaneity and the unobserved heterogeneity. The fractional probit model based on the pooled Bernoulli quasi-maximum likelihood method is also employed. The following main findings are established. First, governance moderates intra-African trade to engender positive synergies on female labour force participation. The positive synergies are apparent from the overall quality of institutions, government effectiveness and the rule of law. Second, information technology does not significantly moderate intra-African trade to affect female labour force participation. The established findings from fixed effects regressions are robust to fractional probit model estimations. The findings are relevant in informing policy makers on how governance can be used to moderate the influence of African trade in promoting female labour force participation. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

The two one-sided tests (TOST) method for mean equivalence or average equivalence has been extended to assessing similarity or switchability for individual equivalence in clinical trials. Tolerance interval procedures are available to establish similarity with respect to the proportion of the response differences covered by a prespecified threshold range. However, the extended TOST procedures based on tolerance intervals are potentially susceptible to the control of Type I errors. This article aims to present an exact approach with the specified Type I error probability for appraising similarity between two treatments in comparative studies with heterogeneous variances. Analytic examination and numerical comparison are conducted to clarify the utility of the suggested similarity test and the drawback of the current TOST procedures. To enhance the usefulness of the described exact method, the related power and sample size issues are also considered. Computer algorithms are provided to implement the proposed test procedure, power calculation, and sample size determination in similarity studies. [ABSTRACT FROM AUTHOR]

The article evaluates the development of the tax burden on cigarettes in the Czech Republic from 1993 to the end of 2023. Tax burden is represented by effective tax rate. The research results show that the tax burden on these products is still increasing. Not only does the tax burden increase, but so does the price of these products. The regression analysis results show that quantities such as the price of cigarettes, the effective tax rate or the amount of cigarettes consumed are factories that positively influence tax revenue. Since the tax rate or the price of these products constantly increases, the tax revenue is also increasing. It increased almost six- fold over the entire analyzed period. At the same time, it was found that other factors, such as the average wage, also affect the tax revenue. It is necessary to consider that the cigarette consumption has been showing a downward trend in recent years. However, the reason is not only the increasing tax burden and the price of these products but also the transition of consumers to so-called e-cigarettes. A reduction in cigarette consumption may be reflected in the future by reducing healthcare costs, which will create potential reductions in public health insurance payments.

This study aims to analyze the impact of racial matching between teacher and student on the academic performance of middle school students in Brazil. The data comes from an educational evaluation survey carried out by the Joaquim Nabuco Foundation – Ministry of Education of Brazil (FUNDAJ 2020), which followed the same cohort of students in the sixth and seventh years of public middle schools, between the years of 2017 and 2018. To address to the potential source of endogeneity, we use FUNDAJ panel data to estimate student fixed effects models, which makes it possible to compare students who have one race-matched and one non-race-matched teacher within the same subject in the two years of data. The results show that, when placed in a situation of racial equality with their Portuguese and Mathematics teachers, Black students will present better grades in both subjects, by about 30% of their average grade. The results also show evidence of heterogeneity, with stronger effects in female students. [ABSTRACT FROM AUTHOR]

This study identifies obesity as an important channel through which global warming affects human capital. By analyzing plausibly exogenous year-to-year temperature fluctuations in 152 countries from 1975 to 2016, we find that global warming has significantly increased obesity rates in countries located in temperate zones, while only causing a reduction in a small number of tropical countries. The estimates suggest that a 1 ∘ C increase in the annual mean temperature would result in a worldwide increase in obese adults of 79.7 million, or 12.3%. Similar patterns emerge when examining the effects of temperature bins, seasonal mean temperature, temperature variations, and temperature shocks. Furthermore, we identify substantial heterogeneity in the impact across countries with varying income levels, age structures, and education levels. Finally, by comparing the baseline model with a long-difference model, we demonstrate that long-term adaptation may not significantly mitigate the impact of global warming on obesity in temperate zones. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to contribute to the extant literature by assessing how microfinance institutions (MFIs) affect female entrepreneurship, contingent on female unemployment levels. Design/methodology/approach: The study focuses on 44 countries in sub-Saharan Africa for the period 2004–2018. The empirical evidence is based on interactive quantile regressions, which put emphasis on nations with high, low and intermediate levels of business constraints. The analysis is tailored to provide avoidable female unemployment levels in the implementation of policies designed for MFIs to promote female business ownership. Findings: The hypotheses that MFIs are favorable for female business owners and some critical rates of female unemployment should be avoided in order for the favorable incidence to be maintained is exclusively valid in the 10th quantiles of the cost of business by females and time to start-up a business by females. Policy implications are discussed. Originality/value: This study has complemented the extant literature by providing actionable female unemployment critical masses that governments can act upon in tailoring the relevance of MFIs in the doing of business by females. [ABSTRACT FROM AUTHOR]

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Clean energy transition has become a key strategy in combating global air pollution. In 2017, China launched its “coal-to-gas” policy, which provided subsidies to households for their clean energy transition. While debates on this policy focus mainly on safety and cost concerns, few studies have examined the causal relationship between energy transition and its health benefits, particularly mental health. Using data from the China Health and Retirement Longitudinal Survey (CHARLS), this paper employs a difference-in-differences (DID) approach to estimate the impact of the “coal-to-gas” policy on the mental health of the rural elderly in China. The findings indicate that the policy significantly improved the cognitive status of the elderly, especially episodic memory, which saw a 10.4% increase relative to the sample mean. The policy also significantly boosted the proportion of households using clean cooking fuels by 5.8%. Further analysis suggests that the improved sleep quality from reduced indoor air pollution by household energy transition, as a mechanism, could explain these results. This study provides a timely assessment of the policy’s effectiveness, highlighting the importance of indoor air pollution control by household energy transition.

To understand older adults’ perceptions regarding access to medical cannabis and information related to it. We employed cross-sectional survey design to recruit Canadians (≥60 years) who consume cannabis for health purpose(s). Recruitment flyers were circulated to potential sites (e.g. CanAge). Interested participants self-selected to participate by contacting the researcher and completed the online survey. Data were analyzed using descriptive statistics and conventional content analysis. A total of 107 older adults participated in the study. Most sought information from healthcare professionals (HCP) (49.5%) or cannabis retail stores (40.2%) and accessed cannabis via retail stores (56.1%). High cost, judgement from others, and HCP reluctance to prescribe were reported as the common barriers to access. Participants most often sought information related to benefits, safety, and dosage of medical cannabis. Many older adults relied on medically unauthorized sources such as retail stores to access medical cannabis and information related to it. At the policy level, initiatives are needed to help older adults for whom medical cannabis may be appropriate to learn about and access medical cannabis via authorized sources. To ensure safe and effective medical cannabis use, knowledge products about medical cannabis are necessary for older adults.

Moral Distress (MD) refers to the negative experience that arise when a person cannot act in accordance with their values and principles when caring for patients, associated with individual, social or institutional barriers. This article presents the result of the qualitative research analyzing MD in health personnel of high complexity hospital in Bogotá, Colombia focusing in the attention of older patients with chronic or acute illnesses. The study used qualitative methods that included semi-structured interviews, focus groups and participant observation. The data was analyzed based on a theoretical matrix, considering how MD is configured, the way participants experience it, the contexts in which it happens, whether they consider consequences of this, and whether the education they have received provided them with tools to confront it. Findings include the constant presence of MD among healthcare personnel while confronting death and patient suffering. It is influenced by the level of education, previous work experience, and hierarchies within the healthcare system. Additionally, coping strategies such as emotional distancing and the of seeking knowledge are identified, although there is a noted lack of specific training in managing death and morbidity situations, as well as effective communication skills.

Spatial neglect in stroke survivors is associated with a decrease in quality of life. This disorder occurs in 20–80% of stroke survivors and up to 1/3 of stroke survivors will continue to experience chronic impairment. Occupational therapists are uniquely qualified to treat stroke survivors with spatial neglect due to their holistic approach but access to therapy is limited. Diagnostic coding is used to help determine appropriate reimbursement and continuation of care including rehabilitation services. The objectives of this study were to 1) identify the prevalence of diagnostic coding for spatial neglect in stroke survivors, and 2) identify the prevalence and types of rehabilitation for patients with diagnostic coding for spatial neglect. We completed a retrospective cohort analysis using 2018 and 2019 5% Medicare Limited Data Sets from the Centers for Medicare and Medicaid Services. We extracted all ischemic stroke survivors and stratified them by the presence of a secondary diagnostic code indicating spatial neglect. Rehabilitation Current Procedural Terminology codes were used to identify stroke survivors who received rehabilitation. Despite recommendations from clinical practice, only 4.9% had a diagnostic code for spatial neglect. Of those formally diagnosed, only 2.3% received outpatient occupational therapy after being discharged from acute care.

AbstractThe paper examines the relationship between health and economic growth using a dynamic panel with threshold effect and endogeneity. The study uses a sample of 136 countries over the period of 1965–2015 and the results indicate that the relationship between health and economic growth is nonlinear. The findings suggest that the impact of health on economic growth is only positive in countries that have attained minimum benchmarks of health improvement. These findings carry significant policy implications. Low-income countries need a comprehensive approach, encompassing multiple factors, such as education enhancement, productivity boost, and entrepreneurship promotion, that go beyond health promotion to foster substantial economic growth. In countries already attaining satisfactory health outcomes, policies prioritizing improved health outcomes, through directing investments towards Research and Development can serve as an effective means to promote sustainable economic growth.

Background: While foreign migrants contribute to economic development, they may impact public health by transmitting communicable diseases to the local population. With its geopolitical position, Thailand has been a primary destination for migrants from neighbouring countries in Southeast Asia and beyond. This positioning makes it a focal point for examining the complexities of migration dynamics and its implications for public health. Through a quantitative analysis, this paper investigates the influence of foreign migrants on physical health issues in Thailand, exploring their impact on various types of communicable diseases. The utilization of provincial-level data from Thailand offers insights into the localized effects of migrant populations on public health within the country. These insights can serve as a valuable resource for researchers and policymakers who conduct comparative analyses, facilitating a deeper understanding of the complex relationship between international migration and public health worldwide. Methods: A spatial panel autoregressive model (SAR) is applied on the provincial level communicable diseases and socio-economic data in Thailand from the period 2016 to 2021. Results: The results indicate that the influence of foreign migrants on communicable diseases in Thailand varies depending on the type of disease. While an increase in migrants correlates with a higher prevalence of respiratory and other communicable diseases, it conversely reduces the prevalence of vaccine-preventable diseases. Additionally, we found that migrants do not significantly impact the prevalence of food- and water-borne diseases, insect-borne diseases, animal-borne diseases, or sexually transmitted diseases in Thailand. Additionally, other factors, such as GPP per capita, unemployment, poverty, and technology access, strongly correlate with most types of communicable diseases. Conclusion: As revealed by this study, the increase in migrants leads to a rise in respiratory and other communicable diseases, as well as a decrease in vaccine-preventable diseases, which carries significant policy implications. These results urge policymakers, the Ministry of Labour, and the Ministry of Public Health to implement tailored policies and measures to enhance public health and effectively mitigate the risk of communicable diseases transmitted by migrants in the future. [ABSTRACT FROM AUTHOR]

The paper analyzes the optimal lockdown policy using the SQAIRD model over a network with three population groups (young, adult, and old). We show that different lockdown policies may be justified by different socioeconomic structures (objective cost functions that are either convex or concave). We also show that a lockdown policy is always better than a laissez-faire policy, and a targeted policy specific to each group outperforms a uniform policy. In our benchmark example, we consider the case of Italy. Our simulations show that: (a) a lockdown policy is always better than the laissez-faire policy because it limits the costs generated by the pandemic in an uncontrolled situation; (b) a group-specific targeted lockout policy is more effective than a uniform policy to the extent that the groups differ. The latter is a less expensive targeted policy (as it optimally minimizes direct, indirect, and vaccination costs), and it is equally effective in controlling the pandemic. One finding of particular interest is that the optimal lockdown rate should be higher for the young and elderly than for adults. This is motivated by the fact that younger individuals are more likely to spread the virus in question asymptomatically. [ABSTRACT FROM AUTHOR]

Using detailed data from the third round of the District Level Household Survey of India, this paper examines in detail the effect of child marriage of women on contraceptive usage and access to skilled care during pregnancy and delivery. This paper particularly focuses on sixteen different outcome variables categorized under four broad sub-groups; namely, family planning and contraceptive usage, birth history, utilization of antenatal care; and finally, natal and postnatal care. The overall results presented in the paper suggest that women who marry early, i.e. before they reach the legal age of marriage are more likely to have experienced miscarriage, give birth before they turn 18 and lose children. They also lack current contraception usage and are less likely to access public health facilities during both pregnancy and childbirth. These results, however, vary widely based on the state of residence and age of the women in question. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine how the starting of business by females can be promoted by assessing critical levels of microfinance institutions (MFIs) penetration that policymakers must endeavor to maintain and/or attain in order for female unemployment not to represent a constraint in the doing of business. A constraint in doing business is understood in terms of the procedure that a woman has to go through to start a business. Design/methodology/approach: The focus of the study is on 44 countries in Sub-Saharan Africa for the period 2004–2018, while the empirical evidence is based on interactive quantile regressions. Findings: The following findings are established. The validity of tested hypotheses is exclusively apparent in the lowest and highest quantiles of the conditional distribution of the procedure women have to go through to start a business. MFI penetration levels needed to reverse the unfavorable incidence of female unemployment in doing business are provided. These are minimum MFIs penetration thresholds that are required in order for female unemployment not to negatively affect the procedure that a woman should go through to start a business. Originality/value: The study complements the extant literature by assessing critical microfinance penetration levels that are needed to promote female doing of business, contingent on existing levels of female doing of business. [ABSTRACT FROM AUTHOR]

This article examines the effect of televised international sporting events (e.g., FIFA World Cup or Summer Olympics) on crime in Jamaica. We use a fixed effects model that compares, within each police division, the level of crime that occurs during these international sporting events to the rate of crime on similar days when these events are not occurring. We found that on days when the FIFA World Cup matches are held, there is a reduction in the number of murders (23.3%), shootings (20%), break-ins (19.4%), and robberies (11.7%), relative to the average number of each incident. We found no evidence of crime displacement, as these crimes also reduced during nonmatch periods during the FIFA World Cup. On the other hand, our results suggest that the international events that are less popular in Jamaica (the World Athletics Championship, the Summer Olympics, and the Winter Olympics) had a minimal impact on crime. [ABSTRACT FROM AUTHOR]

The assessment of environmental and health impacts stemming from sports mega-events plays an important role in evaluating the overall cost–benefit of the events. This study utilizes microdata sourced from the China Household Income Project in conjunction with a time-varying difference-in-differences methodology. Through this approach, we estimated the impact of the 2010 Guangzhou Asian Games on both air quality and public health conditions within China. The results reveal the following: (1) The Games wield substantial and favorable effects on self-perceived health; (2) The primary avenue through which the Games improve self-perceived health is by mitigating air pollution levels in the cities associated with the Games; (3) The cost–benefit analysis unveils that hosting the Games has led to a reduction of 1103.12 million RMB in residents' medical expenses, with the improved air quality accounting for 20.15% of the cost reduction. [ABSTRACT FROM AUTHOR]

This study assesses the health benefits of better air quality by examining the causal impact of China's stringent " 2 + 26 " regional air pollution control policy on local air quality and population health. Employing a spatial regression discontinuity design that capitalizes on the policy's location-specific features, we present compelling evidence that the 2 + 26 policy results in an average reduction of 12.2 units in the local Air Quality Index (AQI) and a 47.0% decrease in per capita medical expenditure from 2014 to 2018. A one-unit reduction in AQI corresponds to a 0.88% reduction in per capita annual medical spending, equivalent to RMB 30.2 (US$4.6). These health gains stem from reduced chronic disease prevalence and improved subjective well-being. Nationally, air quality improvement during 2014–2018 could save RMB 674 billion (US$104 billion) annually in national direct medical costs, constituting 11.6% of national medical expenditure in 2018. Our findings underscore the substantial health and welfare gains achievable through pollution controls in developing countries. [ABSTRACT FROM AUTHOR]

Hungarian A poszttraumás stressz szindróma (PTSD) az egyik olyan pszichiátriai betegség, ami az egészségügyi ellátó rendszer szélesebb körű használatához vezethet, azonban kevés ismerettel rendelkezünk arról, hogy milyen betegségteher vizsgálatok állnak rendelkezésre ehhez kapcsolódóan. Magyarországi költségelemzést eddig nem publikáltak a PTSD betegségterhével kapcsolatosan és nemzetközi szinten is kevés, módszertanilag rendkívül heterogén szakirodalom áll csak rendelkezésre. A tanulmány célja, hogy betöltse ezt az űrt és szisztematikusan áttekintse a PTSD betegségterhével foglalkozó szakirodalmat. Kutatásom során Medline-keresést végeztem 2022. augusztusig bezárólag, mely során a beválogatási kritériumok a következők voltak: (1) eredeti közlemények, (2) angol nyelvű absztrakttal, melyek (3) költségelemzést jelentettek PTSD-ben. Az így kiválasztott 15 tanulmány közül mindegyikben részletesen tárgyalták a direkt egészségügyi költségeket, két tanulmányban elemezték a direkt nem egészségügyi költségeket is, ideértve az informális ellátás költségeit, két további cikk az indirekt költségeket is vizsgálta. A tanulmányok széles skálán mutattak ki költségkülönbségeket: az egy betegre jutó éves direkt egészségügyi kiadások Ausztráliában 4 461 és 43 362 EUR között mozogtak, az Egyesült Államokban 2 442 és 35 967 EUR között, míg Európában 217 és 36 204 EUR között változtak. Szintén jelentős eltéréseket tapasztaltak a direkt nem egészségügyi költségek terén, ahol az összegek 98 és 9 372 EUR között mozogtak. Az indirekt költségek tekintetében a legalacsonyabb összeg 2 918 EUR, míg a legmagasabb 11 061 EUR volt. A tanulmányokból továbbá kiderült, hogy a gépjármű balesetet és a bántalmazást követő PTSD-ben figyelték meg a legmagasabb költségeket, de a betegség súlyossága is szignifikánsan növeli a keletkező költségeket volumenét. English Post-traumatic stress disorder (PTSD) is a psychiatric condition associated with increased utilization of healthcare services. Despite its significance, there is a paucity of comprehensive studies addressing the burden of illness related to PTSD, and the existing literature displays considerable methodological heterogeneity. Notably, there has been no published cost analysis of the disease burden of PTSD in Hungary, and international literature on the topic remains limited. This study aims to address this gap by systematically reviewing the literature on the burden of PTSD. A systematic search of the Medline database was conducted up to August 2022, employing the following inclusion criteria: (1) original publications, (2) English-language abstracts, and (3) studies reporting cost analyses of PTSD. Fifteen studies meeting these criteria were selected for review. All of these studies provided detailed discussions of direct healthcare costs, while two studies additionally analyzed direct non-healthcare costs, including informal care costs. Moreover, two articles examined indirect costs. The analysis revealed a broad range of cost estimates. In Australia, annual direct healthcare expenditure per patient ranged from €4,461 to €43,362. In the United States, costs varied from €2,442 to €35,967, and in Europe, from €217 to €36,204. Direct non-healthcare costs exhibited significant variability, ranging from €98 to €9,372. Indirect costs were reported to range from €2,918 to €11,061. The studies indicated that the highest costs were associated with PTSD resulting from motor vehicle accidents and abuse. Additionally, the severity of the illness was found to significantly elevate the total costs incurred.