COVID-19 Health Research Articles

Modeling the impacts of governmental and human responses on COVID-19 spread using statistical machine learning

ABSTRACT Understanding the impacts of governmental and human responses on the pandemic control is imperative for forecasting pandemic spread under various responsive scenarios and guiding localized interventions before pharmaceutical interventions are available. This study analyzed multiple data sets, including social media, mobility, policy evaluations, and COVID-19 infection reports, to delineate the interactions between governmental and human responses and COVID-19 spread in the United States in 2020 when vaccinations were unavailable. The contributions are (1) uncovering the spatiotemporal variations in governmental and human responses during COVID-19; (2) developing a statistical machine learning algorithm that incorporates spatiotemporal dependencies and temporal lag effects to model the relationships between governmental and human responses and the pandemic spread; (3) dissecting the impacts of human responses on the pandemic across space and time. Results reveal that the determinants of COVID-19 health impacts transitioned from human mobility during the initial outbreak phase to both human mobility and stay-at-home policies during the rapid spread phase, and ultimately to the compound of human mobility, stay-at-home policies and the public awareness in the full-blown phase. These findings furnish guidance for policymakers in implementing adaptive and phased strategies.

Emerging Molecular and Clinical Challenges in Managing Lung Cancer Treatment during the Covid-19 Infection

The COVID-19 pandemic now had a broad impact on the health care system since its start. Cancer patients, specifically lung cancer patients, are undergoing a more vulnerable group due to their complex pathophysiological and immunological characteristics. Therefore, they need more attention and care about health and treatment. It is yet unknown how SARS-CoV-2 (COVID-19) infected lung cancer patient's health and management of treatment impacts them. From a clinical and multidisciplinary perspective, we aimed to explain our main priorities concerning COVID-19 infection in the scenario of lung cancer patients’ group in this chapter. Various types of lung cancer therapeutic strategies, including chemotherapy, radiation therapy, and immunotherapy, can all significantly increase the risk, therefore making a patient's chances of a poor outcome higher. Patients with lung cancer need regular clinical and radiologic examinations and follow-ups, which the COVID-19 pandemic might hamper. COVID-19-related lung cancer patients’ incidental radiologic abnormalities might show up in regular radiology exams, making it challenging to understand disease progression and the effect of therapy. The COVID-19 pandemic has profoundly impacted lung cancer care, highlighting challenges in patient management, treatment outcomes, and ethical dilemmas. Quantitative analysis and exploration of future directions would enhance clinical and research impact. In addition, cancer treatment-induced pneumonitis can exhibit radiologic characteristics that are identical to those seen in acute SARS-CoV-2 pneumonia, possibly due to a wrong diagnosis and misinterpretation. The current COVID-19 health crisis is affecting many healthcare requirements, including the necessity for regular healthcare accessibility, particularly follow-ups, and the clinical trials in which this patient group may be included. The COVID-19 epidemic has placed healthcare practitioners, scientists, researchers, and institutions in a complex and dangerous situation, forcing them to address challenges with ethical scenarios.

Motivated reasoning and political ideology fueled political polarization regarding COVID-19 health recommendations in Spanish society: an experimental study

Motivated reasoning and political ideology fueled political polarization regarding COVID-19 health recommendations in Spanish society: an experimental study

Attitudes and Acceptance of the Palestinian Population Towards COVID-19 Health Precautions and Vaccinations: A Cross-Sectional Study.

COVID-19 is a new pandemic and the best protection against this infection is by vaccination. This study aims to assess the commitment to COVID-19 health precautions and willingness to receive vaccination among the Palestinian population. An online-based survey was carried out for an observational cross-sectional study. A total of 1367 participants were recruited conveniently between February and June 2021. To carry out comparisons, Mann-Whitney or Kruskal-Wallis was used for numerical variables and chi-square or Fisher's exact for categorical. Multiple logistic regression was used to evaluate health precautions and multinomial logistic regression was used to observe willingness for vaccination. The commitment to the majority of health precautions was predicted by perceiving COVID-19 threat, educational level, and city residency (p < 0.05). Social distancing and sterilizer usage were associated with city residency (p < 0.001). Students, males, and unemployed participants were less committed to health precautions (p < 0.05). Vaccination willingness was less predicted by the perception of an ineffective vaccine (p < 0.001), perceiving no threat of COVID-19 (p < 0.05) or perception of threat for old/or chronic diseases (p < 0.05), employed participants (p < 0.05), without chronic diseases (p < 0.05), and not committed to wearing a mask (p < 0.001). COVID-19 threat perception, high education level, and city residency predict more commitment to health precautions, in contrast to male students and unemployed participants. On the other hand, having no chronic diseases, perception of ineffective vaccines, unperceived COVID-19 threat, and unwillingness to wear masks predicted less vaccination acceptance. Therefore, it is critical to increase awareness about the COVID-19 threat, health precautions, and vaccination efficacy. This study is cross-sectional. Future works concerning changes in Attitudes toward COVID-19 health precautions and vaccination should be encouraged, including vaccinated participants.

Analyzing Uttarakhand's COVID-19 Outbreak: Demographic Insights and Strategies for Future Pandemic Prevention

Background:: The Indian state of Uttarakhand, also known as "Dev Bhoomi" or the Abode of Gods, is snuggled in the lap of the Himalayas. It is endowed with an abundant natural hilly environment and occupies more people in total than Israel, Switzerland, Hong Kong, etc. In this report, we look closely at the impact of COVID-19 on both high land/ hilly and low land/ plain bhabar zones across the state. Methods:: The data was retrieved from the Uttarakhand Government Covid-19 health bulletin for 12 months using the Python command line. The data analysis covers percentage positivity/COVID-19 positivity rate, recovery, deceased and doubling rate, along with a detailed statistical analysis. Results:: In the first wave, low-land- inhabitants residing in 4 districts, Dehradun, Haridwar, U. S. Nagar and Nainital, were found more vulnerable, with a peak positive case during the 21st – 26th week. On the other hand, the districts with exclusive hilly terrains, including Chamoli, Pauri Garhwal, and Rudraprayag, were found to be the least susceptible and reported a high number of positive cases between the 30th and 31st week. The highest recovery rate was found to be in the hilly district of Rudraprayag. The multiple regression with confirmed cases was explained in relation to deceased, recovered, other, and tested variables (R2 adj= 0.99). The analysis also revealed a very high doubling rate from the last week of May to the first week of Jun 2020. Conclusion:: The reduced number of COVID-19 cases in high-altitude hilly districts may be associated with factors such as enhanced ventilation, improved arterial oxygen transport, and increased tissue oxygenation. The findings from this study offer insights that can contribute to future pandemic prevention efforts. Summarising the current study, we have suggested 5-point solutions for preventing the next pandemic. It's important to note that while this study suggests a potential link between these factors and lower COVID-19 cases, further research is needed to establish a conclusive connection.

COVID-19 and social care screening for older adults in social housing: a CP@clinic adaptation

BackgroundCOVID-19 has changed healthcare access and delivery, especially impacting older adults. The Community Paramedicine at Clinic (CP@clinic) program is a chronic disease prevention, management, and health promotion program for community-dwelling low-income older adults. We investigated a telephone-based CP@clinic program adaptation during the pandemic.MethodsCommunity paramedics delivered CP@clinic via telephone to residents of 36 social housing buildings. They conducted screening for COVID-19, emergency preparedness, and social health factors. Community paramedics provided education on staying safe, self-isolating, self-monitoring, and preparing for pandemics using governmental infographics. Descriptive analysis was conducted on assessments completed between March and June 2020. Paramedic documentation was thematically analyzed to identify common themes.ResultsAll 191 participants had ≥ 1 telephone visit and 34.6% had ≥ 2 telephone visits, 82.8% were aged 65 years and older, 30.9% had internet access, and 57.9% had cable TV (limiting exposure to COVID-19 information). The CP@clinic program infrastructure provided a platform for paramedics to swiftly contact many vulnerable older adults to screen for COVID-19, educate on safe practices, and facilitate healthcare access. One-quarter of participants screened positive for social isolation. Thematic analysis described participants’ experiences adapting to daily life in the pandemic, emotional experience during the pandemic, and paramedics supporting participants during the pandemic.ConclusionsPublic health interventions are needed for low-income or hard-to-reach older adults, especially during pandemics. Community paramedics were able to support vulnerable older adults living in social housing through the unique CP@clinic adaptation. This innovative program delivery increased vulnerable populations’ access to public health services and information at a time of great health need.

The COVID-19 experience among international migrant workers in the Republic of Korea: knowledge and awareness of treatment and immigration policies

IntroductionThe COVID-19 pandemic has exposed various health risks and inequities experienced by international migrant workers. The number of migrant workers in the Republic of Korea (ROK) is rapidly growing and is expected to continue growing. Health related research on migrant workers in ROK is limited, especially among undocumented migrant workers who were more vulnerable to the pandemic. This study aims to examine the experiences of migrant workers and their knowledge and awareness of treatment and immigration policies during the pandemic.MethodsWe used data from the International Migrant Workers’ COVID-19 Health Literacy and Access to Medical Care project, a cross-sectional survey conducted with international migrant workers residing in ROK in 2021 (n = 537). Descriptive statistics and multivariable regression models were employed to understand different demographic, occupational, and immigration factors affecting migrant workers’ knowledge and awareness of treatment and immigration policies.ResultsUndocumented migrant workers had a longer length of residence in ROK and earned less compared to workers with work visa status. None of the undocumented migrant workers had access to health insurance since they were ineligible to enroll in the national health insurance scheme. In the early days of the pandemic, most undocumented migrant workers experienced a decrease in their average income. After adjusting for demographic differences and language proficiency, undocumented migrant workers (AOR: 0.41, 95% CI: 0.21, 0.78) were less likely to be aware of the policy allowing foreigners, including undocumented individuals, to access COVID-19 testing and treatment without the risk of deportation. Workers with a longer length of residence (AOR: 1.29, 95% CI: 1.09, 1.53) were more likely to be aware of this policy.ConclusionUndocumented migrant workers were often less informed about COVID-19 policies. While most of the survey respondents were knowledgeable about governmental policies regarding COVID-19 treatment and immigration, our results reveal multiple occupational and health insurance vulnerabilities of undocumented migrant workers living in ROK. More attention is needed to understand healthcare service barriers and how to provide adequate resources for this vulnerable population.

‘COVID impacted my life in so many ways’: a qualitative study of the lived experiences of the COVID-19 pandemic among people of Black ethnicities living with HIV in England

ABSTRACT Objectives COVID-19 disproportionately affected people of Black ethnicities whilst also negatively affecting the health, wellbeing and livelihoods of people living with HIV. This may have been amplified by pre-existing socioeconomic marginalisation, poorer health, and structural racism. Despite being disproportionately affected by the pandemic, little is known about lived experiences of the COVID-19 pandemic within these communities. Given these disparities, this paper explores the lived experiences of the COVID-19 pandemic among people living with HIV and of Black ethnicities in England. Design This qualitative study, comprising five focus group discussions (FGDs) with people of self-reported Black ethnicity, living with HIV in the UK (n = 30). FGDs were conducted between June and August 2022. Topics covered included beliefs and attitudes about COVID-19 (including prevention), COVID-19 information sources and lived experiences. Data were analysed using a reflexive thematic approach. Results Analysis of the data generated several main themes: the collective trauma experienced by Black communities; racial bias influenced by inequitable research; conflicting COVID-19 health messages and medical mistrust; socioeconomic marginalisation including financial hardship; intersecting oppressions such as sexism and ageism; and the overall impact of living with a stigmatising condition such as HIV. Participants additionally found navigating the infodemic, being labelled ‘clinically vulnerable,’ and balancing multiple non-medical needs alongside their cultural, spiritual, and religious beliefs, challenging. Conclusion The COVID-19 pandemic has had profound and enduring multidimensional impacts on the lives of people of Black ethnicities living with HIV. This study reveals how socioeconomic, cultural, behavioural, and biological factors intersected to shape experiences of the pandemic within these communities in the UK. Our data illustrate the lived realities of worsening health and social inequalities due to COVID-19, while at the same time highlighting the central importance of trusted community organisations in mitigating some of these negative impacts. Trial Registration Ethical approval was obtained from the University College London Research Ethics Committee (Project ID/Title: 6698/004).

Call to Action: Responding to COVID-19, Racism, and Student Mental Health on University Campuses

ABSTRACT The onset of the COVID-19 pandemic initiated a cascade of stressors that occurred concurrently with increasing issues of racism and racial injustice events. These compounded healthcare and societal stressors significantly impacted the mental health of individuals worldwide, including university students. To address the needs of students, a survey was administered to undergraduate, graduate, and professional students at a large public university in the southeastern United States. Qualitative data were collected regarding student mental health, recommendations for institutional resources, and support needs therein. Thematic analysis of qualitative responses from 1050 university students indicated six areas students stated they wanted the university to address to support their mental health needs: (1) Communication, (2) Academic Concerns, (3) Mental Health Resources and Connections, (4) COVID-19 Safety, (5) Social Injustice, and (6) Financial Concerns. To address these areas, we propose a set of evidence-based recommendations within the Social-Ecological Framework for colleges and universities to adopt to support student mental health considering all races, backgrounds, and experiences. Additionally, we propose strategies for university and college counseling centers to provide an essential leadership role on campuses to move these recommendations forward and positively impact the mental health of students.

Suicidal ideation among Canadian adults during the third year of the COVID-19 pandemic compared to pre- and early pandemic periods

PurposeThis study examined the prevalence of suicidal ideation among adults in Canada during the third year of the COVID-19 pandemic comparing to the pre- and early pandemic periods, and assessed sociodemographic and pandemic-related factors. MethodsWe estimated prevalence of suicidal ideation from the Survey on COVID-19 and Mental Health (SCMH) conducted between February and May, 2023 (11,526 respondents, response rate 46.5 %), and compared with the prevalence in the 2019 Canadian Community Health Survey (57,034 respondents, response rate 54.9 %) and the 2021 SCMH (5,742 respondents, response rate 51.2 %). We used logistic regressions to assess the likelihood of reporting suicidal ideation. ResultsIn 2023, 3.8 % of adults reported suicidal ideation in the past 12 months, which was not significantly different from the 4.2 % in 2021, but higher than the 2.7 % in 2019. Adults aged 35-64 years and females 65 years or older had significantly higher prevalence in 2023 compared to 2019. Higher prevalence compared to the pre-pandemic baseline was also observed in other subpopulations, but none of them significantly differed from the prevalence in 2021. Adults who were aged 65 years or younger, White, Indigenous, born in Canada, with low income, without a spouse or child, LGBTQ2, with disability, or had experienced pandemic-related impacts had higher risk of suicidal ideation than their peers. ConclusionPrevalence of suicidal ideation remained elevated compared to the pre-pandemic baseline among most adults in Canada during the late pandemic period. Continued surveillance to evaluate middle and long-term impacts of the pandemic on mental health is needed.

Environmental Policy vs. the Reality of Greenhouse Gas Emissions from Top Emitting Countries

The 21st century climate crisis has been compounded by the COVID-19 health crisis and the Russian war. What at first appeared to be an opportunity to move towards sustainable growth and development has turned into the opposite. In this context, it seems necessary to pause and analyze what countries are doing and where they are heading in order to ensure that their environmental efforts are not in vain. This article analyzes the environmental policies of the seven countries emitting the most GHGs from 1990 to the present day and compares them with the reality of their emissions. These behaviors are extrapolated into the future and, finally, conclusions are drawn as to which countries are not fully living up to their commitments, which have implemented the most effective measures, and where particular attention needs to be directed for maximum efficiency in decarbonizing the energy mix.

Public health and economic impact of COVID-19 vaccination with the Pfizer-BioNTech COVID-19 Vaccine, KP.2, among adults in 2024/2025 in the United States

ABSTRACT Objectives To assess the public health and economic impact of vaccination with the Pfizer-BioNTech COVID-19 vaccine, KP.2, in 2024/2025 in the United States. Methods A combined cohort Markov-decision tree model was used to estimate the cost-effectiveness and budget impact of vaccination versus no vaccination in adults aged ≥18 years. The adult population was further stratified into 18-64 years and ≥65 years age groups. Public health surveillance data informed the annual proportion of individuals infected with and vaccinated against SARS-CoV-2 and the proportion of those infected who were hospitalized, stratified by age. Other age-stratified clinical, cost, and vaccine effectiveness parameters were informed by literature. The budget impact analysis was based on a hypothetical 1-million-member plan and used a payer perspective. Parameter uncertainty was tested in sensitivity analyses. Results Without vaccination, the model projected 21.4 million new symptomatic cases, 15,793 deaths, 629,098 hospitalizations, $115.5 billion in total costs, and 1 million QALYs lost among adults aged ≥18 years, with the greatest health burden observed among older adults aged ≥65 years (72% of hospitalizations and 86% of deaths) and the greatest economic burden in adults aged 18 to 64 years (62% of total costs). Vaccination was projected to prevent 915,501 cases, 1,057 deaths, and 37,489 hospitalizations, resulting in cost savings of $513 million, 9,173 LYs gained, 56,482 QALYs gained, and a dominant ICER. In the budget impact analysis, vaccination was estimated to result in total incremental cost savings for the population aged ≥ 65 years and a modest budget increase for the population aged 18 to 64 years. Conclusions Vaccination with the Pfizer BioNTech COVID-19 vaccine, KP.2, is a cost-effective measure from the societal perspective at a willingness-to-pay threshold of $50,000 that could reduce the health and economic burden of COVID-19.

Factors Affecting Life Satisfaction Among People With Physical Disabilities During COVID-19: Observational Evidence from a Korean Cohort Study.

To determine the factors influencing the life satisfaction of people with physical disabilities during the COVID-19 pandemic, considering demographics, disability-related characteristics, health behaviors, and psychosocial characteristics. We used cross-sectional data from 301 respondents of the 2021/2022 survey of the Korean Health Cohort Study for People with Physical Disabilities. Descriptive statistics were used to analyze the research subjects' characteristics, and chi-square tests and multiple logistic regression were used to identify the determinants of life satisfaction. Among socio demographic variables, occupation had a strong association with life satisfaction. Significant health behavior variables included daily regular meals, weight control effort, and chronic pain. All psychosocial characteristics (perceived stress, depression, suicidal ideation, cognitive function assessment, subjective health status, family satisfaction, income satisfaction) were strongly associated with life satisfaction. Results of the analysis of factors affecting life satisfaction showed that unemployment, lack of regular exercise, elevated stress, suicidal thoughts, and dissatisfaction with family contributed to increased life dissatisfaction. Economic support through job creation that considers the specific characteristics of people with disabilities, and social access through community integration services that encourage participation in social activities, should be prioritized.

Fear of COVID-19 and mental health status among the medical students of a selected medical college in Bangladesh.

COVID-19 pandemic and mental health of people are related to each other. To assess the relationship between fear of COVID-19 (FCOV) and the psychological status of medical students of Bangladesh. A total of 967 medical students and intern doctors of Sher-E-Bangla Medical College participated in this cross-sectional study. FCOV was measured using the Fear of COVID-19 Scale (FCV-19S). Mental health status was assessed using the Depression Anxiety Stress Scale (DASS-21). Correlation between these two variables was done followed by general linear model to assess the relationship of other covariates with mental health. FCOV had a highly significant relationship with mental health (DASS-21 and all its components, p < 0.001 for all). Females suffered more from fear than males except the interns. Clinical students, students with middle income groups, students residing with the families, and students having family members in health services exhibited more FCOV compared to their counterparts. When we looked at the DASS-21 and its components, females suffered more from stress. Having family members in health services was related to higher anxiety and stress with higher DASS-21 scores as well. Students who expressed their lives to be affected by COVID-19 had higher DASS-21 and its components compared to those whose lives were not affected as such. Students residing with their families revealed increased stress. FCOV and life affected by COVID-19 were constantly related to DASS-21 and its components (p < 0.001), adjusted for other variables. Fear of COVID-19 is associated with poor mental health of medical students.

Psychometric properties of a COVID-19 health literacy scale in a sample of German school principals applying Rasch analysis

BackgroundDuring the COVID-19 pandemic, health literacy was found to be an asset to manage health-related information. The HLS-COVID-Q22 has been developed to measure COVID-19 health literacy. External validation needs to be assessed in different populations to verify the questionnaire’s functioning. The present study aimed to evaluate the psychometric properties of the HLS-COVID-Q22 in a sample of German school principals.MethodsThe sample consisted of 2187 German school principals who completed the HLS-COVID-Q22 online from April to March 2021. The data was analyzed using Rasch analysis, applying the Partial Credit Model for polytomous data. Dimensionality, item fit statistics and rating scale functioning was tested. Values for item difficulty and person ability as well as reliability indices were computed.ResultsUnidimensionality could be confirmed. The rating scale categories worked as intended, participants used every rating step category. Generally, item fit was verified. One item showed potential misfit but could remain in the questionnaire as excluding the item did not reduce reliability. A person separation index of 3.41 and person reliability of 0.92 showed excellent differentiation between COVID-19 health literacy levels. Furthermore, the values for item separation of 20.08 and item reliability of 1.0 indicate good construct validity.ConclusionsThe German version of the HLS-COVID-Q22 appears to be a reliable measurement tool for the target population. Evidence for construct, statistical and fit validity was collected. Future studies need to test additional types of validity like convergent and divergent validity to further evaluate the questionnaire. Moreover, the psychometric properties of the translated versions of the HLS-COVID-Q22 should be compared using Rasch analysis.

Prevalence and Impact of Stress in the Indian Population: A Retrospective Survey Analysis

Post-COVID-19 pandemic, individuals are experiencing various forms of stress. This study assessed the prevalence of stress among Indian adults, examined its physical and psychological impacts, and investigated stress management strategies, aiming to fill existing gaps in research. This retrospective observational study utilized an online survey from March 16, 2023, to July 30, 2023, using snowball sampling to target the Indian population. Respondents aged ≥18 years participated in the study. The survey collected data on demographic information, self-reported stress levels, and Perceived Stress Scale (PSS) scores. The chi-square test was applied for statistical analysis, and results with a p-value under 0.05 were considered significant. Among 1,479 respondents (638 males, 841 females; mean age: 23.7±7.7 years), 76.0% of respondents resided in Karnataka. Out of 1,479 respondents, 9.6% experienced mild stress, 84.9% experienced moderate stress, and 5.5% experienced severe stress according to the PSS. Females experienced significantly higher stress levels when compared with males (p=0.047), but both experienced moderate stress levels. Financial problems (20.7%) and studies (36.4%) were the most common stressors among respondents. They most frequently manage stress through personal strategies, such as sleeping and listening to music. The present study's findings indicate that, following the COVID-19 health crisis, moderate levels of stress are significantly prevalent in the Indian population, primarily due to academic and job-related pressures.

Communication Strategies Employed By 103.9 MMUST Fm to Capture Listeners’ Attention Regarding COVID-19 Pandemic in Lurambi Sub-County, Kenya

The COVID-19 pandemic occurred so unexpectedly and spread so fast that the media had to play its role of informing and educating the public about it. The people were in panic and the Kenyan government invested in strategies to address this like the daily speeches and text statements on COVID-19 through the available media for the masses. This saw media stations such as MMUST FM change tact to improve on their efficiency and thus new strategies of communication were adopted alongside the existing ones. The current study seeks to investigate the communication strategies adopted by MMUST FM from 2020 to 2021 to capture the attention of residents of Lurambi Sub-County regarding COVID-19 messages. The study was guided by the Framing Theory of mass communication. It adopted the descriptive survey research design where a mixed-method approach was utilized to collect, analyze and present data. The participants were 115 residents of Lurambi Sub-County as selected using Krejcie and Morgan’s formula with a confidence level of 95% for a population of 188,212 people. In addition, 6 key informants comprising 4 MMUST FM producers and 2 COVID-19 health experts interviewed by the station at the time were purposively selected for in-depth interviews. Data was collected using questionnaires from the residents and interview guides from the MMUST FM producers and the COVID-19 health experts. The validity of the qualitative data was achieved by establishing trustworthiness while the validity of the quantitative data was calculated using Cronbach Alpha Co-efficient calculations. A descriptive analysis of the quantitative data while a thematic analysis of the qualitative data was presented. From the study, we also realize that the station used communication strategies similar to the other media stations during other pandemics such as message consistency, honesty, the language used and how humanity and empathy were communicated while advocating for behavior change. However, the study reveals that the strategy that stood out with 103.9 MMUST FM is the radio program that was slotted to address the issues about COVID-19 when the pandemic was at its peak. This among the existing strategies helped the station successfully broadcast on the COVID-19 pandemic.

COVID-19 and global mental health: The mutual impact of clinical and socio-cultural realities

COVID-19 and global mental health: The mutual impact of clinical and socio-cultural realities

Disability and Vulnerable Groups Inclusion in COVID-19 Policy and Planning in Sub-Sahara African Countries

Background: The COVID-19 pandemic has caused an excess burden of disease in disabled and vulnerable populations. These populations may face an increased risk of contracting COVID-19, greater demand for services and social support, and reduced access to treatment. Despite various national and international efforts towards disability rights and inclusion, substantial gaps exist between disability rights legislation and its implementation. Aims: To assess the inclusion of people with disability and other vulnerable groups in policy and planning documents related to the COVID-19 pandemic response in sub-Sahara Africa. Methods: We conducted content analysis using the EquiFrame policy analysis tool and assessed commitment to 12 vulnerable groups and 21 core human rights in policy and planning documents related to the COVID-19 pandemic. We included documents on general pandemic response, stakeholder engagement, risk communication, and the COVID-19 vaccine from five sub-Saharan African countries, including Nigeria, South Africa, Ethiopia, Kenya, and Zambia. Results: The study highlights the varying degrees to which countries integrate disability, vulnerable groups, and other core human rights concepts into their COVID-19 health policies and planning documents. Only Kenya mentioned disability in their pandemic response plan. However, all countries have explicitly mentioned disability in their stakeholder engagement plans. Except for Kenya, all countries have included disability in their risk communication plans. Notably, South Africa and Zambia demonstrated extensive disability inclusion in their stakeholder engagement and vaccine plan. Thus, these countries have the potential for comprehensive and inclusive health policymaking. In contrast, Nigeria and Ethiopia lag, therefore highlighting areas of improvement across all policy domains. Conclusion: The findings emphasize the critical importance of not only mentioning disability and other vulnerable groups, but also ensuring the depth and quality of this inclusion. While there are positive strides in certain areas, there remains a consistent need for deeper and broader inclusion across all policy domains. Received: 10 September 2024 | Reviewed: 16 October 2024 | Revised: 03 November 2024 | Accepted: 05 November 2024.

AN EMPIRICAL ANALYSIS OF THE IMPACT OF HEALTH POLICIES ON OUT-OF-POCKET HEALTHCARE EXPENDITURE IN USA: THE PRELIMINARY RESEARCH ON DEVELOPING IMPROVED HEALTH POLICIES IN THE UNITED STATES

This study examines the impact of U.S. health policies on out-of-pocket healthcare expenditures, revealing that certain policies are notably more effective in reducing costs for individuals. The regression model explains 99.5% of the variation in out-of-pocket expenses (R² = 0.995). Key findings show the Inflation Reduction Act (IRA) as the most impactful, reducing costs by $0.43 per unit (β = -0.426, p = 0.007), followed by COVID-19 Response and Health Policy Changes (CRHPC), which reduces costs by $0.16 (β = -0.162, p = 0.019). Government Expenditure on Health, however, has a positive impact, increasing out-of-pocket spending by $0.69 per dollar spent (β = 0.695, p = 0.001), suggesting inefficiencies. Inflation also drives costs up, with each 1% increase resulting in an additional $0.02 out-of-pocket (β = 0.017, p = 0.032). The findings recommend focusing on high-impact policies like the IRA and CRHPC, while reevaluating lower-impact programs to optimize resource allocation and control healthcare inflation.