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Background: Pregnant and parenting youth in Canada face multiple challenges in fulfilling their parenting responsibilities while meeting their own unique needs. The COVID-19 pandemic and its associated public health restrictions exacerbated their challenges by reducing access to support networks, limiting opportunities to promote growth and well-being, and destabilizing their financial and economic standing. The impacts of the pandemic on the mental, physical, and emotional health of individuals are well-documented in the literature. However, there is limited research on how the pandemic influenced the lives, health, and well-being of pregnant and parenting youth and their children in Canada. Therefore, we aimed to examine the wider impacts (social and structural determinants that directly or indirectly impact health and well-being) of the pandemic and its implications for this population., Methods: We used a constructivist grounded theory approach to explore the experiences of pregnant and parenting youth during the pandemic and how certain social determinants of health intersected to shape health outcomes and influence their ability to access services. We conducted qualitative interviews using a semi-structured interview guide over Zoom. Using grounded theory principles, we inductively analyzed the data and categorized our findings into themes., Results: We recruited a total of 50 participants from different regions in Canada. The findings from the interviews were categorized into the following themes: (1) "They bear the burden alone": Struggles of pregnant and parenting youth, (2) "How will I live the next day?": Concerns and consequences arising from the pandemic, and (3) "Try to keep your mask on": Navigating healthcare services while maintaining public health guidelines. Our findings highlight the various challenges encountered by the youth during the pandemic, particularly those associated with financial and economic constraints, lack of accessible health and social services, and increased stress from parenting responsibilities., Conclusion: Pregnant and parenting youth in Canada encountered various barriers while accessing health and social services, maintaining their well-being, and connecting with reliable sources of support during the pandemic. Our study findings emphasize the urgent need for adaptable and comprehensive support systems explicitly catering to the needs of pregnant and parenting youth during crises, such as the pandemic., Competing Interests: Declarations Ethics approval and consent to participate Ethics approval was obtained from the University of Alberta Health Research Ethics Board (Pro00118543). Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The global impact of the COVID-19 pandemic has been extensive, disproportionately affecting various vulnerable populations. In addition to traditional vulnerable groups (TVGs) such as the elderly, women, people with lower education, disabled individuals, and low-income groups, new vulnerable groups (NVGs) have emerged, including essential workers, face-to-face workers, temporary workers, and the self-employed. This study focuses on exploring the economic and psychological effects of the pandemic on both traditional and newly recognized vulnerable groups within Korea., Methods: The study employed multiple logistic regression using micro-level social survey data from Statistics Korea to calculate the odds ratio relating to two categories of vulnerable groups and their economic and mental health impacts. Additionally, through interaction term analysis, we tried to uncover the complex interrelationship between these non-vulnerable groups and target vulnerable groups., Results: Both the newly identified and traditional vulnerable groups showed higher likelihood of facing economic and mental health challenges compared to non-vulnerable groups. The likelihood of encountering a decrease in income and work-related stress was 2.17 times higher (95% CI = 1.90-2.47) for NVGs, while those belonging to TVGs had a 1.75-fold increase (95% CI = 1.47-2.08). Moreover, female self-employed workers faced higher overall stress at 1.36 times greater risk (95% CI = 1.08-1.71), whereas elderly individuals who are self-employed exhibited lower odds of experiencing such stress at the intersection between TVGs and NVGs., Conclusion: This research offers in-depth understanding of the diverse impacts of COVID-19 on at-risk groups. Furthermore, examinations that take into account interactions between NVGs and TVGs uncovered subtle effects within subgroup dynamics, suggesting that intersecting factors play a role in different levels of vulnerability. This provides valuable evidence for informing policy decisions and allocating resources., (© 2024. The Author(s).)

Before the COVID-19 pandemic, for-profit nursing homes' revenue generally covered their costs, whereas not-for-profit nursing homes often needed donations and other nonpatient revenue to cover expenses. The unprecedented challenges presented by the pandemic caused the industry to report operating losses that were larger among not-for-profits and facilities relying on agency staff. COVID-19 public health emergency funding allowed nursing homes to remain profitable through 2021. By 2022, as these public health emergency funds were cut back, for-profit nursing homes had overall net incomes of $1.68 per resident day, whereas not-for-profit nursing homes lost $31.18 per resident day. Without public health emergency funds, for-profit and not-for-profit nursing homes would have had losses of $7.47 and $42.35 per resident day, respectively, in 2022. These results indicate that as public health emergency funds are entirely withdrawn, the long-term financial viability of nursing homes, especially not-for-profits, will be seriously challenged.

This study sought to explore the uses meanings and negotiation that female heads of household from low-income areas gave to the transferred money in the COVID health emergency period. Our specific interest is in the withdrawal of 10% of pension funds and the Emergency Family Income (IFE) due to the monetary relevance of both programs. Based on a 10th-month follow-up of 14 female heads of household from low-income areas of Santiago, Chile, this qualitative study examines how the participating women "mark," in Zelizer's sense, the money they received. Thus, we seek to account for how, based on the source of money, its forms of access and the amounts received, women determine how to use it and assign meaning to its value., (© 2024 Canadian Sociological Association/La Société canadienne de sociologie.)

Objective: This study aimed to analyze the changes in the health expenditure of households in Mexico during the COVID-19 pandemic to approximate changes in healthcare that can lead to difficulties in detecting noncommunicable diseases, among others., Methods: We compare health spending before and after the pandemic through various estimators using multivariate linear regression models at the household level. We also explore heterogeneous effects by zone, sex, and household composition by age. We explore potential mechanisms of change estimating probit models of healthcare. We use microdata from the National Health and Nutrition Survey 2018 and COVID-19., Results: The results suggest a significant reduction in health spending, mainly referring to oral health, clinical analysis, and medical studies. Moreover, differences arise by type of area and household age profile. Changes are more significant among families with children younger than 12 years and households situated in urban areas. Regarding the mechanisms, the results suggest that the lower spending is not due to fewer health needs but rather due to less healthcare attention., Conclusion: The COVID-19 pandemic had a significant and heterogeneous impact on household health spending. This lower spending could lead to less detection of noncommunicable diseases, translating into more pressure on the health system in the medium and long term., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2024 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Background: COVID-19 pandemic had devastating socio-economic and health effects, including mental health. This study examines the intersectionality between gender and mental health outcomes among Kenyan adults in informal settlements of Nairobi, Kisumu, and Kilifi Counties during the COVID-19 crisis. This is necessary to inform mental health response in case of another pandemic., Methods: We analyzed data collected in a longitudinal survey between July 2020 (fourth round) and February 2021 (fifth round). The data covered COVID-19-related effects on job loss, food insecurity, access to health services, and mental health. Participants were randomly sampled from existing cohorts at the Population Council. The outcomes of interest were depressive and anxiety disorders, combined into a binary composite outcome variable. Descriptive statistics included means for continuous variables and frequencies and proportions for categorical variables. Chi-square tests were used to examine the differences between groups. The relationship between the gendered COVID-19 socio-economic effects and participants' mental health was examined using modified Poisson regression., Results: A total of 4,050 participants were interviewed, 66% female and median age 38 [interquartile range (IQR): 29-46]. Complete income loss was strongly associated with negative mental health outcomes in multiple intersections with varied magnitudes. The association was larger among older females (≥50 years) (PR = 1.33, 95% CI = 1.17-1.51, p  < 0.001) than older males (PR = 1.22, 95% CI = 1.17-1.27, p  < 0.001). Partial loss of income was protective against negative mental health outcomes among young males (18-29 years) (PR = 0.81, 95% CI = 0.76-0.87, p  < 0.001) but linked to negative outcomes among middle-aged males (30-49 years old) (PR = 1.14, 95% CI = 1.12-1.16, p  < 0.001). Skipping meals was associated with negative mental health outcomes for both genders particularly the married (married male: PR = 1.49, 95% CI = 1.22-1.83, p  < 0.001; married female: PR = 1.42, 95% CI = 1.26-1.60, p  < 0.001)., Conclusion: We observed significant gender differences in the prevalence of depressive symptoms and anxiety disorders during the COVID-19 pandemic, underscoring the importance of socio-economic factors and health services access in shaping mental health outcomes. Interventions targeting pandemic-related mental health issues should be gender-sensitive and address economic vulnerabilities such as job losses and food insecurity. Policies to mitigate these effects, especially for at-risk groups are crucial for reducing mental health burden in future crises., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mwanga, Odero, Kadengye, Odunga, Muluve, Mugotitsa, Wafubwa, Austrian and Kiwuwa-Muyingo.)

The emergence of the COVID-19 pandemic in 2019 and its rapid global spread put healthcare systems around the world to the test. This crisis created an unprecedented level of stress in hospitals, exacerbating the already complex task of healthcare management. As a result, it led to a tragic increase in mortality rates and highlighted the urgent need for advanced predictive tools to support decision-making. To address these critical challenges, this research aims to develop and implement a predictive system capable of predicting pandemic evolution with accuracy (in terms of Mean Absolute error (MAE), Root Mean Square Error (RMSE), R 2 , and Mean Absolute Percentage Error (MAPE)) and low computational and economic cost. It uses a set of interconnected Long Short Term-memory (LSTM) with double bidirectional LSTM (BiLSTM) layers together with a novel preprocessing based on future time windows. This model accurately predicts COVID-19 cases and hospital occupancy over long periods of time using only 40% of the set to train. This results in a long-term prediction where each day we can query the cases for the next three days with very little data. The data utilized in this analysis were obtained from the "Hospital Insular" in Gran Canaria, Spain. These data describe the spread of the coronavirus disease (COVID-19) from its initial emergence in 2020 until March 29, 2022. The results show an improvement in MAE (< 161), RMSE (< 405), and MAPE (> 0.20) compared to other studies with similar conditions. This would be a powerful tool for the healthcare system, providing valuable information to decision-makers, allowing them to anticipate and strategize for possible scenarios, ultimately improving public health outcomes and optimizing the allocation of healthcare and economic resources., (© 2024. The Author(s).)

Background: The phenomenon of high-cost users (HCUs) in health care occurs when a small proportion of patients account for a large proportion of health care expenditures. By understanding this phenomenon during the COVID-19 pandemic, tailored interventions can be provided to ensure that patients receive the care they need and reduce the burden on the health system., Objectives: This study aimed to determine (1) whether the HCUs phenomenon occurred during the pandemic in Thailand by exploring the pattern of inpatient health expenditures over time from 2016 to 2021; (2) the patient characteristics of HCUs; (3) the top 5 primary diagnoses of HCUs; and (4) the potential predictors associated with being an HCU., Methods: The secondary data analysis was conducted via inpatient department (IPD) e-Claim data from the National Health Security Office for the Universal Coverage Scheme, which provides health care to ~ 80% of the Thai population. Health care expenditure over time was calculated, and the characteristics of the population were examined via descriptive analysis. Multinomial logistic regression was applied to explore the potential predictors associated with being an HCU., Results: The characteristics of HCUs remained relatively the same from 2016 to 2021. In terms of the proportion of male (55%) to female patients (45%), the age ranged from 55 to 57 years, with an estimated 8-day length of hospital stay and 7 admissions per year, and the average health care cost per patient was ≥ USD 2,860 (100,000 THB). The low-cost users (LCUs) group (the bottom 50% of the population), had more female patients (55%), a younger age ranging from 27 to 33 years, a 3-day length of stay, 1‒2 admissions per year, and a lower average health care cost per patient, which was less than USD 315 (≤ 11,000 THB)., Conclusion: The HCUs phenomenon still existed even with limited health care accessibility or lockdown measures implemented during the COVID-19 pandemic. This finding could indicate the uniqueness of the need for health services by HCUs, which differ from those of other population groups. By understanding the trends of health care utilization and expenditure, along with potential predictors associated with being an HCU, policies can be introduced to ensure the appropriate allocation of health resources to the right people in need of the right care during future pandemics., (© 2024. The Author(s).)

Standardized suicide mortality rates per 100,000 (SMRs) in Japan consistently decreased from 2009 to 2019 but increased from 2020. The causes of these temporal SMR fluctuations remain to be clarified. Therefore, this study was conducted to identify the causalities underlying the recently transformed fluctuations of suicide mortality in Japan. Monthly suicide numbers disaggregated by sex and social standing, and political uncertainty indices, such as economic policy uncertainty (EPU) and government management instability (AENROP), were obtained from Japanese government databases. Interrupted time-series analysis was performed to analyze temporal fluctuations of SMRs disaggregated by sex/social standing associated with the three General Principles of Suicide Prevention Policy (GPSPP) periods and the COVID-19 pandemic. Panel data and vector autoregressive analyses were conducted to investigate causalities from political uncertainties to SMRs. During the first and second GPSPPs (2009-2017), all SMRs disaggregated by sex and social standing decreased, whereas those of unemployed females did not change. During the third GPSPP (2017-2022), decreasing trends in all SMRs were attenuated compared to previous periods. All female SMRs, except unemployed females, showed sharp increases synchronized with the pandemic outbreak. No male SMRs showed sharply increasing at the pandemic outbreak. SMRs of unemployed males/females drastically increased in the later periods of the pandemic, while SMRs of employed and multiple-person/single-person household males did not increase during the pandemic. SMR of unemployed males was positively related to AENROP but not EPU. Other male SMRs were positively related to EPU/AENROP. On the contrary, not all female SMRs were related to EPU/AENROP. Increasing AENROP generally contributed to increasing male SMRs throughout the observation period; however, susceptibility to AENROP and/or political information might have unexpectedly contributed to suppressing the sharply increasing male SMRs induced by large-scale social shocks (the COVID-19 pandemic outbreak) in Japan.

Background: After the establishment of the public health emergency of international concern in 2020, health systems worldwide and in Brazil observed the need to apply more extraordinary logistical efforts and possibly resources to combat the imminent pandemic., Methods: Using the historical series of public expenditures of the National Health Fund (FNS), 2015 to 2021, the number of confirmed cases of COVID-19, and a seasonal ARIMAX model, we sought to assess how the increase in the new virus infections affected the systematic financing of the SUS in Brazil., Results: There were signs of seasonality and an increasing trend in the expenditure variable, which in practical terms, only indicated that the resource contributions followed an increasing trajectory already underway before the advent of the pandemic. The 1% increase in COVID-19 cases, with a one-month lag, contributes to the 0.062% increase in the variation in FNS expenditures but a decrease of 0.058% with a two-month lag., Conclusion: The tests showed no evidence to confirm a positive shift on FNS spending growth trajectory due to the increase of COVID-19 cases, only observing a significant increase one month after the occurrence of COVID cases, probably due to their worsening after this period, which was followed by a similar and comparable decrease in percentage of growth in the following month., (© 2024. The Author(s).)

The intersection of the COVID-19 pandemic with other crises can amplify vulnerabilities and push communities further into poverty. In low-income countries, the dual impacts of COVID-19 and extreme weather events, along with multidimensional poverty and structural vulnerabilities in agriculture can decimate farmer livelihoods. This study aims to understand the effects of individual and compounding crises (COVID-19, cyclones, and vanilla price collapse) on smallholder vanilla farmers and local coping strategies in Madagascar, one of the world's largest vanilla producers and poorest countries. We used semi-structured and scenario-based interviews across two case study villages with contrasting enforcement of forest regulations. We found that the impact of the pandemic, combined with the cyclone event, disrupted livelihoods, resulting in income losses and food security challenges that exacerbated farmer vulnerabilities. Sixty eight percent of households reported crop losses due to strong winds and heavy rainfall brought by cyclone Enawo in 2017. The COVID-19 outbreak struck the region just as the residents were recovering from the effects of the cyclone. COVID-19-related travel restrictions in the aftermath of the cyclone took a substantial economic toll, with 54.1% of respondents experiencing a decline in earnings, and 17% facing a total loss of income due to the imposed lockdown. The decline in vanilla prices at the onset of 2020 had a far-reaching additional impact, affecting not only farmers but also residents who rely on other sources of income. Local communities reported using the forest resources more frequently as a safety net during crises in the village with more lenient regulations. This study underscores the importance of understanding the interconnectedness and compounding impacts of cascading crises on food security and natural resource use. We highlight the need for a comprehensive approach to increasing farmer resilience, particularly for those reliant on global market crops such as vanilla., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Harison et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: To assess the impact of the COVID-19 pandemic on disability insurance grants and related costs for workers with cancer., Methods: This ecological time series study uses the inflection point regression model and the federal government's open-access dataset. We analyze the annual grant and cost rates of cancer-related disability insurance in Brazil (2010-2021)., Results: In 2020, the number of disability insurance grants due to malignant neoplasms decreased by 62.26%, and the total annual cost decreased by 62.94% compared to those in 2019. All illnesses and injuries were reduced by 2.56% and 20.02%, respectively. Between 2010 and 2021, the COVID-19 pandemic has reversed the increasing trend in annual disability insurance granted due to cancer and its associated expenses to a stable trend., Conclusion: The COVID-19 pandemic has harmed the provision of disability insurance for workers with cancer., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest concerning this article's research, authorship, and publication., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Objective: To investigate the impact of Medicaid expansion on state expenditures through the end of 2022., Data Sources: We used data from the National Association of State Budget Officers (NASBO)'s State Expenditure Report, Kaiser Family Foundation (KFF)'s Medicaid expansion tracker, US Bureau of Labor Statistics data (BLS), US Bureau of Economic Analysis data (BEA), and Pandemic Response Accountability Committee Oversight (PRAC)., Study Design: We investigated spending per capita (by state population) across seven budget categories, including Medicaid spending, and four spending sources. We performed a difference-in-differences (DiD) analysis that compared within-state changes in spending over time in expansion and nonexpansion states to estimate the effect of Medicaid expansion on state budgets. We adjusted for annual state unemployment rate, annual state per capita personal income, and state spending of Coronavirus Relief Funds (CRF) from 2020 to 2022 and included state and year fixed effects., Data Collection/extraction Methods: We linked annual state-level data on state-reported fiscal year expenditures from NASBO with state-level characteristics from BLS and BEA data and with CRF state spending from PRAC., Principal Findings: Medicaid expansion was associated with an average increase of 21% (95% confidence interval [CI]: 16%-25%) in per capita Medicaid spending after Medicaid expansion among states that expanded prior to 2020. After inclusion of an interaction term to separate between the coronavirus disease (COVID) era (2020-2022) and the prior period following expansion (2015-2019), we found that although Medicaid expansion led to an average increase of 33% (95% CI: 21%-45%) in federal funding of state expenditures in the post-COVID years, it was not significantly associated with increased state spending., Conclusions: There was no evidence of crowding out of other state expenditure categories or a substantial impact on total state spending, even in the COVID-19 era. Increased federal expenditures may have shielded states from substantial budgetary impacts., (© 2024 Health Research and Educational Trust.)

Background: Baloxavir marboxil is an oral, single-dose, cap-dependent endonuclease inhibitor that reduces the duration of influenza symptoms and rapidly stops viral shedding. We developed a susceptible, exposed, infected, recovered (SEIR) model to inform a cost-effectiveness model (CEM) of baloxavir versus oseltamivir or no antiviral treatment in the UK., Research Design and Methods: The SEIR model estimated the attack rates among otherwise healthy and high-risk individuals in seasonal and pandemic settings. The CEM assumed that a proportion of infected patients would receive antiviral treatment. Results were reported at the population level (per 10,000 at risk of infection)., Results: The SEIR model estimated greater reductions in infections with baloxavir. In a seasonal setting, baloxavir provided incremental cost-effectiveness ratios (ICERs) of £1884 per quality-adjusted life-year (QALY) gained versus oseltamivir and a dominant cost-effectiveness position versus no antiviral treatment in the total population; ICERs of £2574/QALY versus oseltamivir and £128/QALY versus no antiviral treatment were seen in the high-risk population. Baloxavir was also cost-effective versus oseltamivir or no antiviral treatment and reduced population-level health system occupancy concerns during a pandemic., Conclusion: Baloxavir treatment resulted in the fewest influenza cases and was cost-effective versus oseltamivir or no antiviral treatment from a UK National Health Service perspective.

Background: Substance use disorder (SUD) is related to the interplay of various factors. The primary objective of this study was to assess the variation in substance use (SU) among a set of Lebanese people undergoing treatment for SUD during the Lebanese economic crisis, COVID-19 pandemic, and Beirut Blast., Methods: A cross-sectional study including Lebanese adults previously diagnosed with and being treated for SUD at the Skoun center was conducted. Data collection was done using a paper-based Arabic questionnaire tackling the economic crisis, the Covid-19 pandemic, and the Beirut Blast, as well as the following scores: APGAR, PHQ-9, GAD-7 and PCL-6. Data were analyzed using SPSS version 25.0 with P value<0.05 considered significant. A bivariate analysis was conducted to study the association between the use of substances and study variables and scores., Results: The sample included 126 men and 10 women. Most participants had a stable consumption of illicit drugs (58.8%), alcohol (76.5%), prescription drugs (70.6%) and non-prescription drugs (89%). Additionally, most participants had concomitant mild or moderate depression (55.1%), mild or moderate anxiety (50.7%), and PTSD (61.8%). Factors found to significantly increase SU were economic distress, change in employment status, and decrease in working hours. PTSD was also identified as a risk factor for increased illicit drug and alcohol use. Furthermore, severe anxiety was found to be a risk factor for increased alcohol consumption., Conclusion: Most participants were able to maintain a stable pattern of SU despite the quadruple crisis in Lebanon highlighting the important role played by Lebanese Non-Governmental Organizations (NGOs) and efforts employed to control SUD., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

This study investigates the economic resilience of cities in Hubei province during the COVID-19 pandemic, utilizing highway nighttime lights as a proxy indicator. By February 2020, the pandemic had caused a significant economic contraction in Hubei. However, by May 2021, a strong recovery was observed, with most cities experiencing growth rates of over 20%. Despite initially similar responses to the crisis, this study reveals significant heterogeneity in economic resilience across the examined cities in Hubei. The spatial distribution follows a core-periphery structure, with Wuhan exhibiting greater resistance to economic shocks compared to peripheral cities. Furthermore, the response capacity within the Wuhan urban agglomeration area exhibits regional variations. In summary, lockdown policies had spatially varied impacts on economic resilience across Hubei's cities. These results offer valuable insights into regional economic resilience and contribute to the formulation of strategies aimed at effectively addressing future unforeseen events., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Evidence is limited about healthcare cost disparities associated with homelessness, particularly in recent years after major policy and resource changes affecting people experiencing homelessness occurred after the onset of the COVID-19 pandemic. We estimated 1-year healthcare expenditures, overall and by type of service, among a representative sample of people experiencing homelessness in Toronto, Canada, in 2021 and 2022, and compared these to costs among matched housed and low-income housed individuals., Methods: Data from individuals experiencing homelessness participating in the Ku-gaa-gii pimitizi-win cohort study were linked with Ontario health administrative databases. Participants (n = 640) were matched 1:5 by age, sex-assigned-at-birth and index month to presumed housed individuals (n = 3,200) and to low-income presumed housed individuals (n = 3,200). Groups were followed over 1 year to ascertain healthcare expenditures, overall and by healthcare type. Generalized linear models were used to assess unadjusted and adjusted mean cost ratios between groups., Results: Average 1-year costs were $12,209 (95% CI $9,762-$14,656) among participants experiencing homelessness compared to $1,769 ($1,453-$2,085) and $1,912 ($1,510-$2,314) among housed and low-income housed individuals. Participants experiencing homelessness had nearly seven times (6.90 [95% confidence interval [CI] 5.98-7.97]) the unadjusted mean ratio (MR) of costs as compared to housed persons. After adjustment for number of comorbidities and history of healthcare for mental health and substance use disorders, participants experiencing homelessness had nearly six times (adjusted MR 5.79 [95% CI 4.13-8.12]) the expected healthcare costs of housed individuals. The two housed groups had similar costs., Conclusions: Homelessness is associated with substantial excess healthcare costs. Programs to quickly resolve and prevent cases of homelessness are likely to better meet the health and healthcare needs of this population while being a more efficient use of public resources., (© 2024. The Author(s).)

The COVID-19 pandemic has wrought unprecedented disruption on global economies, leading to widespread income insecurity among individuals and households. This study investigates the impact of the pandemic on income insecurity across different income groups and assesses the role of social protection measures in mitigating these effects. Using cross-country data, we analyze the prevalence of income reduction and the effectiveness of social assistance programs in high-income, upper middle-income, lower middle-income, and low-income countries. Our findings reveal significant variations in income insecurity and social protection responses across these groups. the pandemic had a significant impact on household incomes globally, with lower-middle-income countries experiencing the most significant income reductions. The average per capita transfer amounts show a general decrease over time, which could be due to the economic strain on governments and the need for more sustainable social protection programs. The correlation between transfer amounts and the proportion of households with reduced income indicates that countries with higher income reduction rates tended to have lower average per capita transfer amounts, suggesting a potential lack of adequate support for those in need. The study highlights the importance of robust social safety nets in cushioning the economic blow of the pandemic, particularly for vulnerable populations in lower-income countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen Na. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The uncertainty-threat model of conservatism posits that people turn to political conservatism to protect themselves from perceived threats; indeed, studies show increases in conservative ideology and outgroup bias following threat priming. The COVID-19 pandemic is an unprecedented threat that has had devastating effects on the health and economic lives of Americans. Concerns surrounding the threat of COVID-19 may have secondary effects on other aspects of American life, such as political and anti-Asian racial bias. The current studies explored the effects of COVID-19 related threats on expressed political conservatism, xenophobia, and racial bias under the uncertainty-threat model. Study 1 assessed the effects of priming health or economic risks of COVID-19 (vs. control), and found that economic threat led to increased xenophobia, but had no effects on overall conservatism. Study 2 then investigated whether the effects of COVID-related economic threat prime extended to racial bias, and explored moderators and mediators of effects. Results showed that the economic threat prime increased perceived group-status threat, and indirectly increased conservatism, xenophobia, and racial bias through the mechanism of perceived group-status threat. Effects were greatest for those impacted financially by the pandemic. In general, our studies provide support for the uncertainty-threat model with the novel threat of the COVID-19 pandemic. Implications for understanding potential shifts in conservatism and bias in response to future threats in the United States are discussed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

While there is growing literature on experiences of healthcare workers and those providing unpaid care during COVID-19, little research considers the relationships between paid and unpaid care burdens and contributions. We administered a moral distress survey to healthcare workers in Canada, in 2022, collecting data on both paid and unpaid care. There were no significant differences in the proportion of participants providing unpaid care by gender, with both genders equally affected by certain responsibilities such as reduced contact with family/loved ones. However, men were significantly more distressed about specific unpaid care responsibilities. Unpaid care was not significantly associated with differences in intention to leave work. At work, women were significantly more concerned about patients unable to see family, while men were distressed by others mistreating COVID patients. This study enhances understanding of paid and unpaid care relationships, particularly during crises, and proposes an innovative method for assessing unpaid care burdens., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: to identify the repercussions of financial toxicity on the lives of adult cancer patients during the COVID-19 pandemic., Methods: an integrative review was conducted using the PubMed, Web of Science, Scopus, and Embase databases, as well as the Virtual Health Library portal, in March 2023., Results: out of 62 studies found, 13 were included for analysis. The primary repercussions of financial toxicity included difficulties in covering basic expenses such as food, housing, medication, transportation, and internet access; increased anxiety and concerns related to health and financial situations; reduction or absence of income; challenges in obtaining treatment or accessing healthcare services; rising expenses; and telemedicine as a less burdensome alternative., Conclusions: the pandemic has exacerbated financial toxicity; therefore, healthcare teams must recognize it as an adverse event of oncological treatment and understand its potential to affect various aspects of patients' lives.

Background: The rise of telehealth and telemedicine during the pandemic allowed patients and providers to develop a sense of comfort with telehealth, which may have increased the demand for virtual-first care solutions with spillover effects into venture capital funding., Objective: We aimed to understand the size and type of digital health investments occurring in the prepandemic and pandemic periods., Methods: We examined health care companies founded from March 14, 2019, to March 14, 2020 (prepandemic) versus those founded from March 15, 2020, to March 14, 2022, after pandemic onset. Data were obtained from Crunchbase, a publicly available database that catalogs information about venture capital investments for companies. We also compared companies founded prepandemic to those founded after the first year of the pandemic (pandemic steady-state). We performed a Wilcoxon rank sum test to compare median funding amounts. We compared the 2 groups of companies according to the type of funding round raised, geography, health care subcategory, total amount of funding per year since founding, and number of founders., Results: There were 2714 and 2218 companies founded prepandemic and during the pandemic, respectively. The companies were similarly distributed across geographies in the prepandemic and pandemic periods (P=.46) with no significant differences in the number of founders (P=.32). There was a significant difference in total funding per year since founding between prepandemic and pandemic companies (US $10.8 million vs US $20.9 million; P<.001). The distribution of funding rounds differed significantly for companies founded in prepandemic and pandemic periods (P<.001). On excluding data from the first year of the pandemic, there were 581 companies founded in the pandemic steady-state period from March 14, 2021, to March 14, 2022. Companies founded prepandemic had a significantly greater mean number of founders than those founded during the pandemic (P=.02). There was no significant difference in total funding per year since founding between prepandemic and steady-state pandemic companies (US $10.8 million vs US $14.4 million; P=.34). The most common types of health care companies included wellness, biotech/biopharma, and software companies. Distributions of companies across health care subcategories were not significantly different before and during the pandemic. However, significant differences were identified when data from the first year of the pandemic were excluded (P<.001). Companies founded during the steady-state pandemic period were significantly more likely to be classified as artificial intelligence (7.3% vs 4.7%; P=.005), software (17.3% vs 12.7%; P=.002), and insurance (3.3% vs 1.7%; P=.003), and were significantly less likely to be classified as health care diagnostics (2.4% vs 5.1%; P=.002)., Conclusions: We demonstrate no significant changes in the types of health care companies founded before versus during the pandemic, although significant differences emerge when comparing prepandemic companies to those founded after the first year of the pandemic., (©Smitha Ganeshan, Joshua Goldstein, Young-Jin Sohn, Amie Pollack, Russell S Phillips, Lisa Rotenstein. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.08.2024.)

Peru has a fragmented health insurance system in which most insureds can only access the providers in their insurer's network. The two largest sub-systems covered about 53% and 30% of the population at the start of the pandemic; however, some individuals have dual insurance and can thereby access both sets of providers. We use data on 24.7 million individuals who belonged to one or both sub-systems to investigate the effect of dual insurance on COVID-19 mortality. We estimate recursive bivariate probit models using the difference in the distance to the nearest hospital in the two insurance sub-systems as Instrumental Variable. The effect of dual insurance was to reduce COVID-19 mortality risk by 0.23% compared with the sample mean risk of 0.54%. This implies that the 133,128 COVID-19 deaths in the sample would have been reduced by 56,418 (95%CI: 34,894, 78,069) if all individuals in the sample had dual insurance., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests:HG has no conflicts of interest to declare. MAM is recognised by the Peruvian State as a victim of the Shining Path terrorist group during 1980-2000, and so has the right to claim dual insurance in SIS and ESSALUD while in formal employment in Peru. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Anaya-Montes, Gravelle. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The coronavirus disease-19 (COVID-19) pandemic had a profound effect on society and various industries. Moreover, hospitals experienced huge financial losses owing to COVID-19 prevention efforts. This study aims not only to comprehensively inspect the financial impact of the pandemic on Korean hospitals but also to consider financial performance by hospital characteristics. Data were collected from 255 general hospitals that uploaded their income statements on the website, and 1530 data points were collected from 2016 to 2021. We used the paired t-test, linear mixed-effects (LME) model in R software (Ver. 4.3.2). We then selected operating margin ratio (OMR) and total margin ratio (TMR) to measure financial performance and used location, type of hospital, and ownership as hospital characteristics. We found that OMR and TMR worsened after COVID-19 breakout, and the labor and management cost ratios increased. According to the LME model with hospital characteristics, the OMR of hospitals located in the capital area worsened more than that of hospitals in noncapital areas (β5 = -6.3, P < .01). Regarding type of hospitals, tertiary general hospitals maintained a surplus and recorded a better OMR than general hospitals during the pandemic (β6 = 9.5, P < .01). The OMR of public hospitals worsened more than that of private hospitals during the pandemic (β7 = -25.4, P < .01), but the TMR of public hospitals increased compared to that of private hospitals (β7 = 3.9, P < .01). We confirmed that the COVID-19 pandemic had a negative impact on the financial status of hospitals. Considering hospital characteristics, the impact of the pandemic on hospital financial performance differed based on location, type of hospital, and ownership. As the contributions of this study, the government could establish support policies such as government subsidies based on hospital characteristics and hospital administrators could set a contingency plan to mitigate national disasters., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Research suggests an association between COVID-19 infection and certain financial hardships in the shorter term and among single-state and privately insured samples. Whether COVID-19 is associated with financial hardship in the longer-term or among socially vulnerable populations is unknown. Therefore, we examined whether COVID-19 was associated with a range of financial hardships 18 months after initial infection among a national cohort of Veterans enrolled in the Veterans Health Administration (VHA)-the largest national integrated health system in the US. We additionally explored the association between Veteran characteristics and financial hardship during the pandemic, irrespective of COVID-19., Methods: We conducted a prospective, telephone-based survey. Out of 600 Veterans with COVID-19 from October 2020 through April 2021 who were invited to participate, 194 Veterans with COVID-19 and 194 matched comparators without a history of infection participated. Financial hardship outcomes included overall health-related financial strain, two behavioral financial hardships (e.g., taking less medication than prescribed due to cost), and seven material financial hardships (e.g., using up most or all savings). Weighted generalized estimating equations were used to estimate risk ratios (RR) and 95% confidence intervals (CI) of financial hardship by COVID-19 status, and to assess the relationship between infection and Veteran age, VHA copay status, and comorbidity score, irrespective of COVID-19 status., Results: Among 388 respondents, 67% reported at least one type of financial hardship since March 2020, with 21% reporting behavioral hardships and 64% material hardships; 8% reported severe-to-extreme health-related financial strain. Compared with uninfected matched comparators, Veterans with a history of COVID-19 had greater risks of severe-to-extreme health-related financial strain (RR: 4.0, CI: 1.4-11.2), taking less medication due to cost (RR: 2.9, 95% CI: 1.0-8.6), and having a loved one take time off work to care for them (RR: 1.9, CI: 1.1-3.6). Irrespective of COVID-19 status, Veterans aged < 65 years had a greater risk of most financial hardships compared with Veterans aged ≥ 65 years., Conclusions: Health-related financial hardships such as taking less medication due to cost and severe-to-extreme health-related financial strain were more common among Veterans with a history of COVID-19 than among matched comparators. Strategies are needed to address health-related financial hardship after COVID-19., Trial Registration: NCT05394025, registered 05-27-2022., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: This study examined manual therapy business owners' perception of official recommendations during the COVID-19 pandemic and the impact on their clinics' economic performance, including clinic activity hours and business turnover., Materials and Methods: In a longitudinal study design, data were collected in November 2021 (baseline), and after three months, six months, and 12 months. Participants were manual therapists who were business owners. A growth curve model was used to analyze differences in clinical activity trajectories. Multinomial logistic regression analysis was used to assess the relationship between perceived disruptions in business and turnover. Qualitative text analysis was used to examine participants' responses to open-ended questions concerning economic measures taken to sustain their business during the pandemic., Results: This study of 443 manual therapy business owners found that clinics were initially active with minimal variation, but activity changed following COVID-19 recommendations. Business owners perceived that the disruptions had no significant impact on turnover during the initial stages of the official recommendations. Economic support and the previous decrease in turnover increased the likelihood of experiencing a decreased turnover at 12 months. Business owners implemented cost-cutting measures and diversified income sources to navigate COVID-19 challenges and sustain their businesses., Conclusion: The official recommendations in Sweden had an impact on manual therapists' businesses as the COVID-19 pandemic lingered. Some business owners were concerned at the early stages about lower turnover but showed financial resilience by cutting costs and finding new revenue sources to overcome COVID-19 challenges., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Aboagye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The COVID-19 pandemic has imposed significant challenges on global health, emphasizing the persistent threat of large-scale infectious diseases in the future. This study addresses the need to enhance pooled testing efficiency for large populations. The common approach in pooled testing involves consolidating multiple test samples into a single tube to efficiently detect positivity at a lower cost. However, what is the optimal number of samples to be grouped together in order to minimize costs? i.e. allocating ten individuals per group may not be the most cost-effective strategy. In response, this paper introduces the hierarchical quotient space, an extension of fuzzy equivalence relations, as a method to optimize group allocations. In this study, we propose a cost-sensitive multi-granularity intelligent decision model to further minimize testing costs. This model considers both testing and collection costs, aiming to achieve the lowest total cost through optimal grouping at a single layer. Building upon this foundation, two multi-granularity models are proposed, exploring hierarchical group optimization. The experimental simulations were conducted using MATLAB R2022a on a desktop with Intel i5-10500 CPU and 8G RAM, considering scenarios with a fixed number of individuals and fixed positive probability. The main findings from our simulations demonstrate that the proposed models significantly enhance the efficiency and reduce the overall costs associated with pooled testing. For example, testing costs were reduced by nearly half when the optimal grouping strategy was applied, compared to the traditional method of grouping ten individuals. Additionally, the multi-granularity approach further optimized the hierarchical groupings, leading to substantial cost savings and improved testing efficiency., (© 2024. The Author(s).)

The COVID-19 pandemic has exacerbated the local debt in Spanish municipalities with negative consequences on the macroeconomic financial stability at national and eurozone level. The main objective is to identify the causes of public debt per capita in four groups of Spanish municipalities according to size. It is based on a quantitative analysis based on correlational and causal-comparative approaches. It consists in the construction of panel quantile regressions (MMQ) and mean group (ME) estimators to explain public debt per capita in Spanish municipalities. Moreover, the Juodis test for causality analysis in panel data is applied. The research is constructed around various types of potential determinants related to economic factors (GDP per capita and unemployment rate), demographic factors (population under 15 and population over 65), and political factors (political party, ideology, and political strength). The results based on MMQR for the period 2011-2020 indicate common factors that reduce local debt (short-run economic growth), but also differences between clusters in what concerns factors that increase or decrease the debt. The Juodis et al. (2021) test shows that growth and unemployment are factors that influence the level of public debt in all groups of municipalities except one (5001-20,000 inhabitants) where political party affects debt. These empirical findings support policy proposals to reduce the local debt in Spanish municipalities. The main initiatives to reduce debt should be based on the promotion of economic growth and creation of new jobs, especially for young people., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Fuel poverty is a widespread problem which affects people's health and has serious economic and social repercussions. Mental health has been adversely affected by the COVID-19 pandemic and appears to be particularly influenced by fuel poverty. We analyze this relationship while highlighting the unequal vulnerability of individuals in the population. We first built a novel database of 4194 representative observations of the French adult population. We then used a conditional mixed-process model to quantify the causal effect of fuel poverty on mental health using instrumental variables to overcome potential endogeneity. We prove the robustness of this causal effect by providing different sensitivity tests. Our results show that being fuel poor decreases the mental health score by 6.3 points out of 100. Fuel poverty also increases the depression score by 5.35 points, the anxiety score by 6.48 points, and decreases the social health score by 6.82 points. Our results show that tackling energy poverty can lead to positive spillover effects to improve mental health. Mitigation policies to provide energy-efficient housing should also become a priority to address climatic and economic hazards in the long term because they imply co-benefits in health., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The COVID-19 pandemic has had a significant impact on religion and its practice. This paper aims to examine how the pandemic affects religious activities, donations, and finances over time and across regions within the United Methodist Church (UMC) in the USA. To address this question, we analyze survey data collected during the pandemic from 2963 churches in the USA by United Methodist Communications. Our analysis utilizes several quantitative techniques, including Z-tests, one-way analysis of variance (ANOVA), and multinomial logistic regressions. The results indicate a decrease in church attendance over time, with a more pronounced effect observed in non-urban areas (suburban, small town, and rural). Similarly, while church donations and finances mitigate over time across churches, churches in urban areas experience a quicker rebound compared to those in non-urban areas. Lastly, we find that church attendance and donations positively affect finances. These findings hold important implications for churches in various regions, offering insights to develop strategies for navigating the challenges posed by the COVID-19 pandemic., (© 2024. The Author(s).)

The coronavirus pandemic of 2019 (COVID-19) was arguably the most pivotal global event that current generations have witnessed, with unprecedented global challenges, and colossal effects on health systems. The financial consequences, in particular, were profound and far-reaching. Staggering estimates of up to $50.7 billion dollars per month in lost revenue for the US health system were reported by the American Hospital Association (Kaye et al., 2021). The pandemic caused significant increases in cost of drugs, disruptions to medical supply chains, day-to-day workflow, and operations in all areas of medicine and various healthcare systems. Radiology experienced a significant burden of the damage, finding itself at the forefront of the pandemic's economic fallout (American Hospital Association)., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Racial-ethnic disparities in experiences of economic hardship during the pandemic are well documented in the population overall and among older adults. Existing research shows that this economic hardship was much less common at older than younger ages. Little is known about the intersection of racial-ethnic and age disparities in pandemic-related hardship in later life. This research report investigated racial-ethnic gaps in economic hardship by age group among older adults., Methods: Data were from the 2018 and 2020 U.S. Health and Retirement Study (HRS) including the 2020 coronavirus disease 2019 module. We estimated Heckman-corrected linear probability models to examine differences in experiences of pandemic-related economic hardship in the 2020 HRS by race-ethnicity (non-Hispanic White, non-Hispanic Black, U.S.-born Hispanic, foreign-born Hispanic) across age groups (55-64, 65-74, 75+). In the multivariable analysis, we controlled for sociodemographic characteristics, participation in social programs, pre-existing health conditions and behaviors, and economic resources from the 2018 HRS., Results: Experiences of economic hardship declined with age within each racial-ethnic group. Racial-ethnic gaps in hardship remained at older ages without any controls. However, when all controls were added, racial-ethnic gaps in economic hardship were eliminated for those ages 75+. Individual characteristics prior to the pandemic explained racial-ethnic differences in hardship for the oldest adults (75+) but did not explain gaps for those ages 55-74., Discussion: Results point to structural factors generating new racial-ethnic gaps in pandemic-related economic hardship among those approaching retirement (ages 55-74) that did not affect the oldest adults (ages 75+)., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

This study delves into the global evolution of 43 Sustainable Development Goals (SDG) indicators, spanning 7 major health themes across 185 countries to evaluate the potential progress loss due to the COVID-19 pandemic. Both the cross-country and temporal variability of the dataset are employed to estimate an empirical model based on an extended version of the Preston curve, which links well-being to income levels and other key socioeconomic health determinants. The approach reveals significant global evolution trends operating in each SDG indicator assessed. We extrapolate the model yearly between 2020 and 2030 using the IMF's pre-COVID-19 economic growth projections to show how each country in the dataset are expected to evolve in these health topics throughout the decade, assuming no other external shocks. The results of this baseline scenario are contrasted with a post-COVID-19 scenario, where most of the pandemic costs were already known. The study reveals that economic growth losses are, on average, estimated as 42% and 28% for low- and lower middle-income countries, and of 15% and 7% in high- and upper middle-income countries, respectively, according to the IMF's projections. These disproportional figures are shown to exacerbate global health inequalities revealed by the curves. The expected progress loss in infectious diseases in low-income countries, for instance, is an average of 34%, against a mean of 6% in high-income countries. The theme of Infectious diseases is followed by injuries and violence; maternal and reproductive health; health systems coverage; and neonatal and infant health as those with worse performance. Low-income countries can expect an average progress loss of 16% across all health indicators assessed, whereas in high-income countries the estimated loss is as low as 3%. The disparity across countries is even more pronounced, with cases where the estimated progress loss is as high as nine times worse than the average loss of 8%. Conversely, countries with greater fiscal capacity are likely to fare much better under the circumstances, despite their worse death count, in many cases. Overall, these findings support the critical importance of integrating the fight against inequalities into the global development agendas., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Silveira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Covid-19 has reinforced health and economic cases for investing in pandemic preparedness and response (PPR). The World Bank and World Health Organization (WHO) propose that low- and middle-income governments and donor countries should invest $31.1 billion each year for PPR. We analyse, based on the projected economic growth of countries between 2022 and 2027, how likely it is that low- and middle-income country governments and donors can mobilize the estimated funding., Methods: We modelled trends in economic growth to project domestic health spending by low- and middle-income governments and official development assistance (ODA) by donors for years 2022 to 2027. We modelled two scenarios for countries and donors - a constant and an optimistic scenario. Under the constant scenario we assume that countries and donors continue to dedicate the same proportion of their health spending and ODA as a share of gross domestic product (GDP) and gross national income (GNI), respectively, as they did during baseline (the latest year for which data are available). In the optimistic scenario, we assume a yearly increase of 2.5% in health spending as a share of GDP for countries and ODA as a share of GNI for donors., Findings: Our analysis shows that low-income countries would need to invest on average 37%, lower-middle income countries 9%, and upper-middle income countries 1%, of their total health spending on PPR each year under the constant scenario to meet the World Bank WHO targets. Donors would need to allocate on average 8% of their total ODA across all sectors to PPR each year to meet their target., Conclusions: The World Bank WHO targets for PPR will not be met unless low- and middle-income governments and donors spend a much higher share of their funding on PPR. Even under optimistic growth scenarios, low-income and lower-middle income countries will require increased support from global health donors. The donor target cannot be met using the yearly increase in ODA under any scenario. If the country and donor targets are not met, the highest-impact health security measures need to be prioritized for funding. Alternative sources of PPR financing could include global taxation (e.g., on financial transactions, carbon, or airline flights), cancelling debt, and addressing illicit financial flows. There is also a need for continued work on estimating current PPR costs and funding requirements in order to arrive at more enduring and reliable estimates., (© 2024. The Author(s).)

This study explores the effects of banking uncertainty on firms' debt financing. Employing data from 2007 to 2022 of Vietnam-a bank-based economy, we document that banking uncertainty negatively impacts corporate debt. The impact firmly holds across various debt maturities and sources, with the most predominant driver witnessed in bank debt. We also investigate the potential underlying mechanism linking banking uncertainty to debt financing, thereby validating the working of three crucial channels, including increased costs of debt, substitution of trade credit, and contractions in firm investment. Furthermore, conducting extended analysis, we find that debt financing exhibits more pronounced reactions to banking uncertainty for firms with closer ties to banks or during macroeconomic shocks, as captured by the financial crisis and the COVID-19 pandemic. Our findings survive after robustness checks by alternative measurement, static and dynamic econometric models, and endogeneity controls., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Huynh, Phan. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In March 2020, the outbreak of COVID-19 precipitated one of the most significant stock market downturns in recent history. This paper explores the relationship between public sentiment related to COVID-19 and stock market fluctuations during the different phases of the pandemic. Utilizing natural language processing and sentiment analysis, we examine Twitter data for pandemic-related keywords to assess whether these sentiments can predict changes in stock market trends. Our analysis extends to additional datasets: one annotated by market experts to integrate professional financial sentiment with market dynamics, and another comprising long-term social media sentiment data to observe changes in public sentiment from the pandemic phase to the endemic phase. Our findings indicate a strong correlation between the sentiments expressed on social media and market volatility, particularly sentiments directly associated with stocks. These insights validate the effectiveness of our Sentiment(S)-LSTM model, which helps to understand the evolving dynamics between public sentiment and stock market trends from 2020 through 2023, as the situation shifts from pandemic to endemic and approaches new normalcy., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright: © 2024 Xia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

US health care use declined during the initial phase of the COVID-19 pandemic in 2020. Although utilization is known to have recovered in 2021 and 2022, it is unknown how revenue in 2020-22 varied by physician specialty and practice setting. This study linked medical claims from a large national federation of commercial health plans to physician and practice data to estimate pandemic-associated impacts on physician revenue (defined as payments to eligible physicians) by specialty and practice characteristics. Surgical specialties, emergency medicine, and medical subspecialties each experienced a greater than 9 percent adjusted gross revenue decline in 2020 relative to prepandemic baselines. By 2022, pathology and psychiatry revenue experienced robust recovery, whereas surgical and oncology revenue remained at or below baseline. Revenue recovery in 2022 was greater for physicians practicing in hospital-owned practices and in practices participating in accountable care organizations. Pandemic-associated revenue recovery in 2021 and 2022 varied by specialty and practice type. Given that physician financial instability is associated with health care consolidation and leaving practice, policy makers should closely monitor revenue trends among physicians in specialties or practice settings with sustained gross revenue reductions during the pandemic.

Objectives: To calculate the direct cost of personal protective equipment (PPE) used during the COVID-19 pandemic from the perspective of a Brazilian tertiary public hospital., Methods: We evaluated the cost of PPE during the pandemic to the cost before (2021 vs 2019, respectively) using the microcosting method. Cost estimates were converted into US dollars in 2023, taking inflation into account and using purchasing power parity conversion rates. Our expenses included gloves, disposable gowns, head coverings, masks, N95 respirators, and eye protection. The number of PPE used was determined by the hospital's usual protocol, the total number of hospitalized patients, and the number of days of hospitalization. We used the following variables for uncertainty analysis: PPE adherence, an interquartile range of median length of hospitalization, and variance in the cost of each PPE., Results: In 2021, 26 618 individuals were hospitalized compared with 31 948 in 2019. The median length of stay was 6 and 4 days, respectively. The total and per-patient direct cost of PPE were projected to be 2 939 935.47 US dollar (USD) and 110.45 USD, respectively, during the pandemic, and 1 570 124.08 USD and 49.15 USD, respectively, before the pandemic. The individual cost of PPE was the most influential cost variable., Conclusions: According to the hospital's perspective, the total estimated direct cost of PPE during the COVID-19 pandemic was nearly twice as high as the previous year. This difference might be explained by the 3-fold increase in PPE in the treatment of patients with COVID-19 compared with patients without isolation precautions., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2024 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

The inefficiency observed in investment within state-owned enterprises presents a significant practical challenge that can affect the sustainable development of China's economy. To address this issue, this study comprehensively explores the intricate mechanisms underlying the governance implications of mixed ownership on the investment efficiency of listed companies. Drawing on unbalanced panel data encompassing Shanghai and Shenzhen Stock Exchange A-share listed companies in China spanning the period from 2008 to 2022, this study employs a fixed-effects model to unveil the nuanced ways in which mixed ownership influences investment efficiency through the lens of agency costs. This study transcends the boundaries of traditional agency conflicts between managers and shareholders. It delves deeper, illuminating the diverse effects of agency conflicts between significant controlling shareholders and minority shareholders. The results revealed a noteworthy positive correlation between mixed ownership and investment efficiency, and verified the intermediary role of agency costs between mixed ownership and investment efficiency, which is an important result of our research. Heterogeneity analysis indicates that the relationship between the two can be affected by external events, such as during the COVID-19 pandemic, investment efficiency is not the most concerned issue for enterprises. The findings have practical implications for practitioners and policymakers, as they offer avenues for optimizing investment strategies and fostering efficient and effective corporate governance practices., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Huo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In response to the COVID-19 pandemic, governments directly funded vaccine research and development (R&D), quickly leading to multiple effective vaccines and resulting in enormous health and economic benefits to society. We develop a simple economic model showing this feat could potentially be repeated for other health challenges. Based on inputs from the economic and medical literatures, the model yields estimates of optimal R&D spending on treatments and vaccines for known diseases. Taking a global and societal perspective, we estimate the social benefits of such spending and a corresponding rate of return. Applications to Streptococcus A vaccines and Alzheimer's disease treatments demonstrate the potential of enhanced research and development funding to unlock massive global health and health-related benefits. We estimate that these benefits range from 2 to 60 trillion (2020 US$) and that the corresponding rates of return on R&D spending range from 12% to 23% per year for 30 y. We discuss the current shortfall in R&D spending and public policies that can move current funding closer to the optimal level., Competing Interests: Competing interests statement:D.E.B. and A.S. are co-authors on the comment, “A timely call to establish an international convention on the rights of older people”, published September 2021 in The Lancet Healthy Longevity.

Background: Health policy and systems research (HPSR) can strengthen health systems and improve population health outcomes. In the Eastern Mediterranean Region (EMR), there is limited recognition of the importance of HPSR and funding remains the main challenge. This study seeks to: (1) assess the reporting of funding in HPSR papers published between 2010 and 2022 in the EMR, (2) examine the source of funding in the published HPSR papers in the EMR and (3) explore variables influencing funding sources, including any difference in funding sources for coronavirus disease 2019 (COVID-19)-related articles., Methods: We conducted a rapid scoping review of HPSR papers published between 2010 and 2022 (inclusively) in the EMR, addressing the following areas: reporting of funding in HPSR papers, source of funding in the published HPSR papers, authors' affiliations and country of focus. We followed the Joanna Briggs Institute (JBI) guidelines for conducting scoping reviews. We also conducted univariate and bivariate analyses for all variables at 0.05 significance level., Results: Of 10,797 articles screened, 3408 were included (of which 9.3% were COVID-19-related). More than half of the included articles originated from three EMR countries: Iran (n = 1018, 29.9%), the Kingdom of Saudi Arabia (n = 595, 17.5%) and Pakistan (n = 360, 10.6%). Approximately 30% of the included articles did not report any details on study funding. Among articles that reported funding (n = 1346, 39.5%), analysis of funding sources across all country income groups revealed that the most prominent source was national (55.4%), followed by international (41.7%) and lastly regional sources (3%). Among the national funding sources, universities accounted for 76.8%, while governments accounted for 14.9%. Further analysis of funding sources by country income group showed that, in low-income and lower-middle-income countries, all or the majority of funding came from international sources, while in high-income and upper-middle-income countries, national funding sources, mainly universities, were the primary sources of funding. The majority of funded articles' first authors were affiliated with academia/university, while a minority were affiliated with government, healthcare organizations or intergovernmental organizations. We identified the following characteristics to be significantly associated with the funding source: country income level, the focus of HPSR articles (within the EMR only, or extending beyond the EMR as part of international research consortia), and the first author's affiliation. Similar funding patterns were observed for COVID-19-related HPSR articles, with national funding sources (78.95%), mainly universities, comprising the main source of funding. In contrast, international funding sources decreased to 15.8%., Conclusion: This is the first study to address the reporting of funding and funding sources in published HPSR articles in the EMR. Approximately 30% of HPSR articles did not report on the funding source. Study findings revealed heavy reliance on universities and international funding sources with minimal role of national governments and regional entities in funding HPSR articles in the EMR. We provide implications for policy and practice to enhance the profile of HPSR in the region., (© 2024. The Author(s).)

During the COVID-19 pandemic, tele-mental health (TMH) was a viable approach for providing accessible mental and behavioral health (MBH) services. This study examines the sociodemographic disparities in TMH utilization and its effects on healthcare resource utilization (HCRU) and medical expenditures in Mississippi. Utilizing a cohort of 6787 insured adult patients at the University of Mississippi Medical Center and its affiliated sites between January 2020 and June 2023, including 3065 who accessed TMH services, we observed sociodemographic disparities between TMH and non-TMH cohorts. The TMH cohort was more likely to be younger, female, White/Caucasian, using payment methods other than Medicare, Medicaid, or commercial insurers, residing in rural areas, and with higher household income compared to the non-TMH cohort. Adjusting for sociodemographic factors, TMH utilization was associated with a 190% increase in MBH-related outpatient visits, a 17% increase in MBH-related medical expenditures, and a 12% decrease in all-cause medical expenditures (all p < 0.001). Among rural residents, TMH utilization was associated with a 205% increase in MBH-related outpatient visits and a 19% decrease in all-cause medical expenditures (both p < 0.001). This study underscores the importance of addressing sociodemographic disparities in TMH services to promote equitable healthcare access while reducing overall medical expenditures.

Background: This study addresses the economic challenges posed by the Coronavirus Disease 2019 (COVID-19) pandemic, with a specific focus on Nepal. Employing a Systems Thinking approach, the study develops a comprehensive model that integrates macroeconomic interventions, exploring the trade-offs and synergies among various economic sectors. The interconnectedness of health, economic, and policy domains highlights the need for a holistic understanding of the pandemic's effects., Methods: An exploratory research design was used. The model introduces three primary subsystems-import, local demand, and local production-illustrating their interdependence. The causal loop diagram depicts the implications of fiscal and monetary policies on the economy, emphasizing the synergy and trade-offs resulting from policy interventions., Results: Findings reveal the significant economic impact of the pandemic on Nepal, leading to its negative growth rate in FY 2020/21, the first time Nepal has experienced this in the last two decades. The results show that both intended and unintended consequences are observed following the adoption of fiscal and monetary policy that aimed at minimizing the spread of virus suggesting a complex nature of relationship among the policy variables. The fiscal policy induced negative consequences on the increasing loan, slow revenue growth, while positive feedbacks are observed on increased investment opportunities, and boosting of local economy. The monetary measures yielded unintended consequences on the rising land prices, surge in share market., Conclusions: The study concludes by emphasizing the crucial role of informed policymaking in navigating the complex landscape, offering insights for creating a resilient and sustainable post-pandemic future.

Introduction: Our study explores how New York City (NYC) communities of various socioeconomic strata were uniquely impacted by the COVID-19 pandemic., Methods: New York City ZIP codes were stratified into three bins by median income: high-income, middle-income, and low-income. Case, hospitalization, and death rates obtained from NYCHealth were compared for the period between March 2020 and April 2022., Results: COVID-19 transmission rates among high-income populations during off-peak waves were higher than transmission rates among low-income populations. Hospitalization rates among low-income populations were higher during off-peak waves despite a lower transmission rate. Death rates during both off-peak and peak waves were higher for low-income ZIP codes., Discussion: This study presents evidence that while high-income areas had higher transmission rates during off-peak periods, low-income areas suffered greater adverse outcomes in terms of hospitalization and death rates. The importance of this study is that it focuses on the social inequalities that were amplified by the pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tung, Perveen, Wohlars, Promisloff, Lee-Wong and Szema.)

The prevalence of depression in U.S. adults during the COVID-19 pandemic has been high overall and particularly high among persons with fewer assets. Building on previous work on assets and mental health, we document the burden of depression in groups based on income and savings during the first two years of the COVID-19 pandemic. Using a nationally representative, longitudinal panel study of U.S. adults (N = 1,271) collected in April-May 2020 (T1), April-May 2021 (T2), and April-May 2022 (T3), we estimated the adjusted odds of reporting probable depression at any time during the COVID-19 pandemic with generalized estimating equations (GEE). We explored probable depression-defined as a score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9)-by four asset groups, defined by median income (≥$65,000) and savings (≥$20,000) categories. The prevalence of probable depression was consistently high in Spring 2020, Spring 2021, and Spring 2022 with 27.9% of U.S. adults reporting probable depression in Spring 2022. We found that there were four distinct asset groups that experienced different depression trajectories over the COVID-19 pandemic. Low income-low savings asset groups had the highest level of probable depression across time, reporting 3.7 times the odds (95% CI: 2.6, 5.3) of probable depression at any time relative to high income-high savings asset groups. While probable depression stayed relatively stable across time for most groups, the low income-low savings group reported significantly higher levels of probable depression at T2, compared to T1, and the high income-low savings group reported significantly higher levels of probable depression at T3 than T1. The weighted average of probable depression across time was 42.9% for low income-low savings groups, 24.3% for high income-low savings groups, 19.4% for low income-high savings groups, and 14.0% for high income-high savings groups. Efforts to ameliorate both savings and income may be necessary to mitigate the mental health consequences of pandemics., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ettman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The study aims to uncover the impact of COVID-19 and capital structure on the financial performance of 1787 renewable and nonrenewable energy firms in China from 2010 to 2022. Using the fixed effect approach, our study found that financial leverage negatively affected the return on assets and equity ratios for both renewable and nonrenewable energy. On the other hand, the study shows that COVID-19 adversely affected the financial performances of non-renewable energy firms. Conversely, COVID-19 positively affected the financial performances of renewable energy firms. The conclusions drawn by the present study are helpful for the policymakers in making corresponding financial decisions. The study suggests that policymakers must adopt profitable capital structure strategies for firms and shareholders in this context. Finally, policymakers must design more policies to overcome the adverse influence of the COVID-19 pandemic crisis and avoid any future unforeseeable pandemics., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Samour et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Double-Duty Carers (DDCs) refer to people who work in the healthcare industry while also providing unpaid care to relatives, friends, or neighbours. The expectations placed on DDCs is expected to grow, and these employees already experience a high caring burden. As such it is important to understand how best to support their health and wellbeing. This paper explores DDCs' wellbeing during the COVID-19 pandemic, focusing an understudied factor: their mobility constraints. Following the Mobility of the Care Economy framework and a qualitative research design, it does so through a thematic analysis of 16 semi-structured interviews with female DDCs in Southern Ontario, Canada. Once data saturation was reached, three mobility pathways during the pandemic were identified, all of which negatively affected DDCs wellbeing. First, some COVID-19 policies (e.g., testing requirements) resulted in increased mobility demands and increased spatiotemporal constraints. Second, the closure of institutions that care for dependents (schools, daycares, day centres) resulted in forced reduced mobility, which increased financial stress. Finally, indirect mobility effects were identified: the reduced mobility of other informal carers increased the workload and emotional strain on DDCs. The paper concludes with a discussion of mobility-related policies that could improve DDC wellbeing.

This paper analyzes the determinants of COVID-19 mortality across over 140 countries in 2020, with a focus on healthcare expenditure and corruption. It finds a positive association between COVID-19 deaths and aging populations, obesity rates, and healthcare expenditure while noting a negative association with rural residency and corruption perception. The study further reveals that mortality is positively associated with aging populations in high-income countries and positively associated with obesity in upper-middle to high-income countries. Mortality is positively associated with healthcare expenditure, which likely reflects a country's preparedness and ability to better track, document, and report COVID-19 deaths. On the other hand, mortality is negatively associated with corruption perception in upper-middle-income countries. Further analyses based on 2021 data reveal COVID-19 deaths are positively associated with the proportion of the population aged 65 and older in low to lower-middle-income countries, with obesity in high-income countries, and with tobacco use across most countries. Interestingly, there is no evidence linking COVID-19 deaths to healthcare expenditure and corruption perception, suggesting a post-2020 convergence in preparedness likely due to proactive pandemic responses, which might have also mitigated corruption's impact. Policy recommendations are proposed to aid the elderly, address obesity, and combat tobacco use., (© 2024. The Author(s).)

Background: Following clinical research of potential coronavirus disease 2019 (COVID-19) treatments, numerous decision-analytic models have been developed. Due to pandemic circumstances, clinical evidence was limited and modelling choices were made under great uncertainty. This study aimed to analyse key methodological characteristics of model-based economic evaluations of COVID-19 drug treatments, and specifically focused on modelling choices which pertain to disease severity levels during hospitalisation, model structure, sources of effectiveness and quality of life and long-term sequelae., Methods: We conducted a systematic literature review and searched key databases (including MEDLINE, EMBASE, Web of Science, Scopus) for original articles on model-based full economic evaluations of COVID-19 drug treatments. Studies focussing on vaccines, diagnostic techniques and non-pharmaceutical interventions were excluded. The search was last rerun on 22 July 2023. Results were narratively synthesised in tabular form. Several aspects were categorised into rubrics to enable comparison across studies., Results: Of the 1047 records identified, 27 were included, and 23 studies (85.2%) differentiated patients by disease severity in the hospitalisation phase. Patients were differentiated by type of respiratory support, level of care management, a combination of both or symptoms. A Markov model was applied in 16 studies (59.3%), whether or not preceded by a decision tree or an epidemiological model. Most cost-utility analyses lacked the incorporation of COVID-19-specific health utility values. Of ten studies with a lifetime horizon, seven adjusted general population estimates to account for long-term sequelae (i.e. mortality, quality of life and costs), lasting for 1 year, 5 years, or a patient's lifetime. The most often reported parameter influencing the outcome of the analysis was related to treatment effectiveness., Conclusion: The results illustrate the variety in modelling approaches of COVID-19 drug treatments and address the need for a more standardized approach in model-based economic evaluations of infectious diseases such as COVID-19., Trial Registry: Protocol registered in PROSPERO under CRD42023407646., (© 2024. The Author(s).)