COVID-19 Pandemic Research Articles

Geographical health inequalities in India: the impact of the COVID-19 pandemic on healthcare access and healthcare inequality.

With an emphasis on spatial health disparities, this study examines how COVID-19 has affected healthcare access and inequality in India. The study developed the Healthcare Access Index (HAI) and Healthcare Inequality Index (HII) to assess the pandemic's effects on healthcare. The study addresses spatial health disparities in healthcare access and inequality, filling gaps in the literature. The final aim of the study is to offer policy suggestions to lessen healthcare inequities in India, particularly in the context of COVID-19. The study incorporates secondary data from publicly accessible databases such as the National Family Health Survey, Niti-Ayog and Indian Census databases and employs a quantitative research design. The impact of the COVID-19 pandemic on healthcare access and healthcare inequality in India is examined using the HAI and the HII. The five dimensions of healthcare access - availability, accessibility, accommodation, cost and acceptability - were used in developing the HAI. The study uses a panel data analysis methodology to examine the HAI and HII scores for 19 states over the pre-COVID-19 (2015) and post-COVID-19 (2020) periods. In order to investigate the connection between healthcare access, healthcare inequality and the COVID-19 pandemic, the analysis employs statistical tests such as descriptive statistics, correlation analysis, factor analysis and visualization analysis. According to the study, COVID-19 impacted healthcare access and inequality in India, with notable regional inequalities between states. The pandemic has increased healthcare disparities by widening the gap between states with high and low HII ratings. Healthcare access is closely tied to healthcare inequality, with lower levels of access being associated with more significant levels of inequality. The report advises governmental initiatives to lessen healthcare disparities in India, such as raising healthcare spending, strengthening healthcare services in underperforming states and enhancing healthcare infrastructure. For Indian healthcare authorities and practitioners, the study has significant ramifications. In light of the COVID-19 pandemic, there has been a main focus on addressing geographic gaps in healthcare access and inequality. The report suggests upgrading transportation infrastructure, lowering out-of-pocket costs, increasing health insurance coverage and enhancing healthcare infrastructure and services in underperforming states. The HAI and the HII are tools that policymakers can use to identify states needing immediate attention and appropriately spend resources. These doable recommendations provide a framework for lowering healthcare disparities in India and enhancing healthcare outcomes for all communities. The study's originality resides in establishing the HAI and HII indices, using panel data analysis and assessing healthcare inequality regarding geographic disparities. Policy choices targeted at lowering healthcare disparities and enhancing healthcare outcomes for all people in India can be informed by the study's practical consequences.

Tracing long-term commute mode choice shifts in Beijing: four years after the COVID-19 pandemic

AbstractThe COVID-19 pandemic has brought urban mobility into a new era. This study traces post-pandemic shifts in commute mode switch behaviors and their environmental effects based on an event study design and a mobile phone signaling dataset for Beijing from April 2018 to November 2023. The results show that in the outbreak stage, public transit mode share nosedived, with transit riders 5.11 and 3.75 times more likely to switch to private car and active modes, respectively; in the post-pandemic stage, public transit recovered rapidly and to a large extent, but the increase of private mode dependency persisted, as transit riders were 1.88 times more likely to switch to private cars, and transit riders and car drivers were 1.37 and 1.32 times more likely to adopt active modes, respectively; in the pandemic-free stage, signs of private car dominance began to emerge, as driving habits strengthened and more active travelers resorted to driving, indicating the closing of the window of opportunity to promote low-carbon private transport. This study presents the longest longitudinal tracking of post-pandemic travel mode choice so far. The challenges and opportunities faced by the transportation system are discussed, and policy implications and future research directions are provided.

Association Between X/Twitter and Prescribing Behavior During the COVID-19 Pandemic: Retrospective Ecological Study

Background Social media has become a vital tool for health care providers to quickly share information. However, its lack of content curation and expertise poses risks of misinformation and premature dissemination of unvalidated data, potentially leading to widespread harmful effects due to the rapid and large-scale spread of incorrect information. Objective We aim to determine whether social media had an undue association with the prescribing behavior of hydroxychloroquine, using the COVID-19 pandemic as the setting. Methods In this retrospective study, we gathered the use of hydroxychloroquine in 48 hospitals in the United States between January and December 2020. Social media data from X/Twitter was collected using Brandwatch, a commercial aggregator with access to X/Twitter’s data, and focused on mentions of “hydroxychloroquine” and “Plaquenil.” Tweets were categorized by sentiment (positive, negative, or neutral) using Brandwatch’s sentiment analysis tool, with results classified by date. Hydroxychloroquine prescription data from the National COVID Cohort Collaborative for 2020 was used. Granger causality and linear regression models were used to examine relationships between X/Twitter mentions and prescription trends, using optimum time lags determined via vector auto-regression. Results A total of 581,748 patients with confirmed COVID-19 were identified. The median daily number of positive COVID-19 cases was 1318.5 (IQR 1005.75-1940.3). Before the first confirmed COVID-19 case, hydroxychloroquine was prescribed at a median rate of 559 (IQR 339.25-728.25) new prescriptions per day. A day-of-the-week effect was noted in both prescriptions and case counts. During the pandemic in 2020, hydroxychloroquine prescriptions increased significantly, with a median of 685.5 (IQR 459.75-897.25) per day, representing a 22.6% rise from baseline. The peak occurred on April 2, 2020, with 3411 prescriptions, a 397.6% increase. Hydroxychloroquine mentions on X/Twitter peaked at 254,770 per day on April 5, 2020, compared to a baseline of 9124 mentions per day before January 21, 2020. During this study’s period, 3,823,595 total tweets were recorded, with 10.09% (n=386,115) positive, 37.87% (n=1,448,030) negative, and 52.03% (n=1,989,450) neutral sentiments. A 1-day lag was identified as the optimal time for causal association between tweets and hydroxychloroquine prescriptions. Univariate analysis showed significant associations across all sentiment types, with the largest impact from positive tweets. Multivariate analysis revealed only neutral and negative tweets significantly affected next-day prescription rates. Conclusions During the first year of the COVID-19 pandemic, there was a significant association between X/Twitter mentions and the number of prescriptions of hydroxychloroquine. This study showed that X/Twitter has an association with the prescribing behavior of hydroxychloroquine. Clinicians need to be vigilant about their potential unconscious exposure to social media as a source of medical knowledge, and health systems and organizations need to be more diligent in identifying expertise, source, and quality of evidence when shared on social media platforms.

Children’s and Adolescents’ Use of Nature During the COVID-19 Pandemic in a Very Green Country

Play, physical activity, and social interaction with other children in nature are important for healthy and social development in childhood and adolescence. The extent to which lockdown policies during the COVID-19 pandemic impacted the way children engaged in outdoor activities remains unclear, especially in a country with free access to abundant nature during the pandemic. We performed a national survey of parents (n = 1002) in Norway in January 2021 to uncover changes in outdoor play for children (6–12 years, n = 396) and adolescents (13–19 years, n = 606) compared with the situation before the lockdown on 12 March 2020. Ten months after the start of the COVID-19 lockdown, 38% of the parents reported that their children played and spent time outside ‘less than usual’ in their neighborhood, compared with 15% who reported ‘more than usual’ time spent outside. Parents indicated that the children’s play activities were highly organized and institutionalized, and when the activities ceased, their children had less motivation to spend time outdoors and tended to engage more in screen-based activities indoors. We conclude that while children and adolescents had many opportunities to be outdoors in natural settings during the COVID-19 pandemic restrictions, they did so much less than before the lockdown.

COVID-19-related research data availability and quality according to the FAIR principles: A meta-research study

Background According to the FAIR principles (Findable, Accessible, Interoperable, and Reusable), scientific research data should be findable, accessible, interoperable, and reusable. The COVID-19 pandemic has led to massive research activities and an unprecedented number of topical publications in a short time. However, no evaluation has assessed whether this COVID-19-related research data has complied with FAIR principles (or FAIRness). Objective Our objective was to investigate the availability of open data in COVID-19-related research and to assess compliance with FAIRness. Methods We conducted a comprehensive search and retrieved all open-access articles related to COVID-19 from journals indexed in PubMed, available in the Europe PubMed Central database, published from January 2020 through June 2023, using the metareadr package. Using rtransparent, a validated automated tool, we identified articles with links to their raw data hosted in a public repository. We then screened the link and included those repositories that included data specifically for their pertaining paper. Subsequently, we automatically assessed the adherence of the repositories to the FAIR principles using FAIRsFAIR Research Data Object Assessment Service (F-UJI) and rfuji package. The FAIR scores ranged from 1–22 and had four components. We reported descriptive analysis for each article type, journal category, and repository. We used linear regression models to find the most influential factors on the FAIRness of data. Results 5,700 URLs were included in the final analysis, sharing their data in a general-purpose repository. The mean (standard deviation, SD) level of compliance with FAIR metrics was 9.4 (4.88). The percentages of moderate or advanced compliance were as follows: Findability: 100.0%, Accessibility: 21.5%, Interoperability: 46.7%, and Reusability: 61.3%. The overall and component-wise monthly trends were consistent over the follow-up. Reviews (9.80, SD = 5.06, n = 160), articles in dental journals (13.67, SD = 3.51, n = 3) and Harvard Dataverse (15.79, SD = 3.65, n = 244) had the highest mean FAIRness scores, whereas letters (7.83, SD = 4.30, n = 55), articles in neuroscience journals (8.16, SD = 3.73, n = 63), and those deposited in GitHub (4.50, SD = 0.13, n = 2,152) showed the lowest scores. Regression models showed that the repository was the most influential factor on FAIRness scores (R2 = 0.809). Conclusion This paper underscored the potential for improvement across all facets of FAIR principles, specifically emphasizing Interoperability and Reusability in the data shared within general repositories during the COVID-19 pandemic.

Dementia Caregiving and Dialectical Tensions During the Early Days of the COVID-19 Pandemic

Caregiving for a loved one with Alzheimer's disease or related dementia presents significant challenges which were amplified throughout the COVID-19 pandemic. During this time, care partners were forced to navigate uncertain terrain as well as new and challenging relational tensions. This study investigated the experiences of dementia care partners and the relational tensions present as they managed the early days of the COVID-19 pandemic using Relational Dialectics Theory framework. By analyzing recorded support groups from the early days of the pandemic (April through June, 2020), we identified two chief tensions expressed by participants throughout their support groups: connection—independence and gratitude—frustration. Participants experienced these tensions in different ways, and they engaged in four tension management strategies ( selection, minimization, reframing, and venting and comradery) through the support group. As the pandemic progressed, participants’ tension management evolved, highlighting the complexity inherent in caring for a person with dementia during the COVID-19 pandemic.

Internet Control and Disinformation Across Regime Types During and After the Covid‐19 Crisis

The unprecedented scale of mitigation measures taken by governments during the Covid-19 pandemic raised concerns about if and to what extent democracy would be affected. Empirical accounts show that media freedom was the most vulnerable. This article concentrates on interference in digital media, as attacks on the digital realm during the pandemic were particularly harmful given that media activity moved from print to online all over the world. This large-n study makes various important contributions. Firstly, it uncovers whether regime types differ in their reactions to the Covid-19 pandemic regarding the digital media sector. Secondly, it takes a diachronic approach and examines the period before 2020, during the pandemic in 2020 and 2021, and after the pandemic (2022–2023). This longitudinal exploration enables us to make nuanced statements about the post-Covid-19 developments in digital media. Thirdly, the analyses take into account different degrees of measures: less and more repressive as well as disinformation strategies. The results add value to the debate because they demonstrate that all regime types, including democracies, resorted to control mechanisms during the Covid-19 pandemic. Equally relevant is the behavior of these regimes after the pandemic: While democracies by no means cut back on all measures, autocracies did not strengthen all measures. Most remarkably, full democracies are the only regime type where governments increasingly engaged in disinformation after the pandemic. Thus, an important finding is that the pandemic did not constitute a catalyzing event for all regime types to the same extent. But the most worrisome effects are associated with the democracies.

Work Engagement and Performance of Romanian School Teachers During the COVID-19 Pandemic: The Impact of Sociodemographic and Contextual Factors

The pandemic has led to significant changes in teaching environments, which may have affected teacher engagement and performance. The aim of the paper is to investigate the levels of work engagement (WE) and work performance (WP) during the pandemic among teachers in primary and lower secondary schools in Romania and to identify if the dimensions of these two concepts differ according to gender, age, residence, status, teaching degree, and course profile, filling a gap in the specialized literature regarding these variables in Romanian education. We conducted a survey between February and March 2022 on a sample of 1051 teachers using the Utrecht Work Engagement Scale (UWES) and the Individual Work Performance Questionnaire (IWPQ 0.3). Teachers reported a high level of engagement and work performance, higher levels of WE being identified among female teachers and those teaching in rural areas. Younger teachers showed the lowest work engagement, despite their familiarity with the digital tools used during the COVID-19 pandemic. Interestingly, while gender and employment status did not have a significant impact on job performance, contextual performance was higher among tenured teaching staff and women. In addition, the profile of subjects taught significantly affected engagement and performance. The results of this research can contribute to a more dynamic and supportive educational system, ultimately leading to improved outcomes for teachers and students.

Anxious Thoughts and Well-Being in University Students with Anxiety in the Two Years After the COVID-19 Pandemic: The Mediational Relationship of Physical Symptoms and Sadness Rumination

Objective: This study examines the relationship between anxious thoughts and well-being, with physical symptoms and sadness rumination as mediators, in young people who suffer from anxiety in the first two years after the COVID-19 pandemic. Methods: A community sample of 198 participants, 94 males and 104 females, aged between 19 and 35 years, all of them experiencing an anxiety disorder in their past, answered an online survey during the years 2022–2023. The instruments were the Rumination of Sadness and Anger Questionnaire, The Burns Inventory, and Ryff’s Psychological Well-being Scale. The data analysis used hierarchical regression. Results: The results show that the conditional indirect effects of anxious thoughts on well-being are statistically significant (β = −0.29, SE = 0.08, p < 0.001) for high physical symptoms of anxiety (β = 0.25, SE = 0.11, p < 0.001) and for high sadness rumination (β = −0.82, SE = 0.04, p < 0.001). Physical symptoms of anxiety (β = 0.25, SE = 0.11, p < 0.001) and sadness rumination (β = 0.05, SE = 0.07, p < 0.001) have a partial serially mediating effect on the relationship between anxious thoughts and well-being (β = −0.74, SE = 0.02, p < 0.001).

Global trends in antibiotic consumption during 2016–2023 and future projections through 2030

Antibiotic resistance is a global public health threat. Many factors contribute to this issue, with human antibiotic consumption being significant among them. Analyzing trends and patterns in consumption can aid in developing policies to mitigate the burden of antimicrobial resistance and global disparities in access to antibiotics. Using pharmaceutical sales data licensed from IQVIA, we estimate national-level trends in antibiotic consumption in 67 countries during 2016–2023 and analyze the effects of economic growth and the COVID-19 pandemic. Finally, we estimate global human consumption and project growth through 2030 assuming current trends. We find that estimated antibiotic consumption in reported countries increased 16.3% from 29.5 to 34.3 billion defined daily doses (DDDs) from 2016 to 2023, reflecting a 10.6% increase in the consumption rate from 13.7 to 15.2 DDDs per 1,000 inhabitants per day. Increases were most pronounced in upper-middle- and lower-middle-income countries. While the COVID-19 pandemic significantly reduced consumption globally, this was most pronounced in high-income countries, and in these countries, reductions in antibiotic use in 2020 were sharper, and lasted longer, than in other countries. By 2030, we project that, without reductions in rapidly developing nations, such as investments to improve infrastructure, particularly water and sanitation, along with improved access to vaccination, global antibiotic consumption will increase by 52.3% from an estimated 49.3 billion in 2023 to 75.1 billion DDDs.

Recent Advances for the Development of Sustainable Transport and Their Importance in Case of Global Crises: A Literature Review

The 21st century is a time of rapid development, marked by technological advances, globalization, and international cooperation. It is also a period that has witnessed numerous global crises. In light of recent events, such as the migration crisis, the COVID-19 pandemic, and the escalation of the conflict between Ukraine and Russia, it is crucial to consider how to ensure economic stability and enhance the security of the transportation sector in the face of emerging threats. The goal of this publication is to identify the latest solutions in sustainable transportation development and to highlight their relevance in the context of potential global crises. To achieve this, a systematic review of the current research on transportation industry innovations was conducted using 4 different databases, yielding 492 results. From these, 223 publications were selected for analysis based on established criteria. The selected transport solutions were grouped into specific categories, and then their relevance in the context of global crises was discussed. The findings highlighted key solutions essential for economic stability and transport sector safety in potential crisis situations, while also pointing to further research directions. Additionally, they offer actionable concepts for transport organizers to promote a more resilient and sustainable flow of passengers and goods in anticipation of future crises.

How did educational institutions respond to students with special needs during COVID-19: considerations for policy?

This bibliometric study analyzes the scientific production on the educational response of institutions to families with children with special educational needs (SEN) during the COVID-19 pandemic. The research identifies emerging trends and distinctive characteristics, providing a foundation for improving strategies in schools. The analysis reveals an increase in publications from 2020 to 2023, peaking at 24 articles in 2022. A total of 246 researchers participated, with Castro-Kemp S and McIntyre LL standing out for their productivity and citations. Institutions such as UCL and the University of Oregon led in publications, while the University of California, Santa Barbara, topped the citations. In terms of scientific production, the United States had the most articles, followed by the United Kingdom and Spain. However, the United Kingdom led in global citations, indicating a high level of interest in the topic. The main journals in this field include Frontiers in Education and Education Science. Twelve collaboration networks among authors were identified, with a primary network of seven closely collaborating researchers. The pandemic exacerbated pre-existing difficulties in the education of children with SEN, increasing stress and emotional burden on parents. The transition to home education and the lack of adapted resources presented significant challenges. However, some strategies, such as dialogic literary gatherings and collaboration between schools and families, proved effective in mitigating negative impacts. The study underscores the need for inclusive public policies that address disparities in educational support and prioritize the psychological well-being of children with SEN. It recommends a proactive and equitable approach in school psychology training and educational practice. In conclusion, this analysis provides a solid foundation for future research and improvements in schools, promoting an inclusive and resilient educational environment.

The Effect of Telehealth on Cost of Health Care During the COVID-19 Pandemic: A Systematic Review

The Effect of Telehealth on Cost of Health Care During the COVID-19 Pandemic: A Systematic Review

The Impact of Domestic Violence on the experience of being a mother: a systematic review of the subjective accounts of survivors

Abstract Domestic violence (DV) is still a silent public health pandemic globally, more so during the COVID-19 pandemic. Domestic abuse has a well-documented impact on women and its potential transgenerational consequences for their children. However, the influence of DV on a survivor's experience as a parent is rarely studied, especially in developing nations. Through a systematic review, this study aimed to examine and synthesise current global research on DV survivors' experiences regarding their parenting capacities. The objective was to understand how DV survivors perceive how their parenting capacities were impacted by the experience of DV. Five databases were searched between the periods 2010 to 2020. Fourteen studies met the inclusion criteria. Through a thematic analysis of the included articles, three core themes emerged: first, the mothers’ state of psychosocial and physical health, exacerbated or associated with the DV experience, holds association with their perceived capacity within a parental role. Second, the influence of DV on motherhood is not necessarily predictive of negative parenting practices but somewhat contingent on the mothers’ ability to mobilise supportive internal and external resources, which are often restricted and disrupted by the abusive partner. Last, decisions to leave the abusive partner are complex and subjectively reasoned by the mothers, with a common intention to protect the family. These findings suggest that more comprehensive support and preventative interventions are needed in local communities to create supportive environments that are accessible to mothers who parent in the context of DV.

Self-poisoning in young Australians: The impact of COVID-19 and recent trends following easing of restrictions

Introduction: Self-poisoning is the most common form of hospitalised self-harm in young people and has been increasing over the last decade. The COVID-19 pandemic was associated with further increases in self-harm in adolescents. There are limited data on changes after pandemic restrictions ended. This study aimed to describe recent trends in self-poisoning in young people. Setting: Australia 2018–2023. Methods: A retrospective analysis of self-poisoning calls to Australia’s poisons information centres. Intentional poisoning exposures in people aged 5–19 years were included in the main analysis. We also examined intentional poisonings in people aged 20 and over for comparison. We used interrupted time-series analysis to estimate the impact of COVID-19 (March 2020) and ‘re-opening’ (December 2021), when many restrictions were lifted in Australia. We compared effects in the jurisdictions with most disruptions and lockdowns with other jurisdictions. Results: There were 201,755 self-poisonings documented, 64% female, with 19,946 children (aged 5–14, 9.9%) and 44,388 adolescents (aged 15–19, 22.0%). There was a steep increase in the rate of poisoning in female children and adolescents – with the annual increase being 1.361 (95% confidence interval = [1.074, 1.735]) and 1.154 (95% confidence interval = [1.049, 1.283]) times faster than pre-pandemic trends in these two groups between March 2020 and December 2021. Following relaxation of restrictions, there was a sudden drop and then slow decline in self-poisonings (despite rising COVID-19 infection rates). There was an overall 29.6% increase in intentional poisonings in young people over the study period. This is markedly more pronounced among young females (37.0%) vs males (11.2%). There were substantial jurisdictional variations, with larger increases in Victoria, Tasmania and the Australian Capital Territory. Conclusion: There has been a marked increase in child and adolescent female self-poisonings over the last 6 years, with increases strongly associated with COVID-19 pandemic restrictions but persisting after their removal.

STEM Students’ Sensemaking of Instructional Technology After the COVID-19 Pandemic

STEM Students’ Sensemaking of Instructional Technology After the COVID-19 Pandemic

Statistical Data-Driven Modelling and Forecasting: An Application to COVID-19 Pandemic

Statistical Data-Driven Modelling and Forecasting: An Application to COVID-19 Pandemic

Profiling serum immunodominance following SARS-CoV-2 primary and breakthrough infection reveals distinct variant-specific epitope usage and immune imprinting

Over the course of the COVID-19 pandemic, variants have emerged with increased mutations and immune evasive capabilities. This has led to breakthrough infections (BTI) in vaccinated individuals, with a large proportion of the neutralizing antibody response targeting the receptor binding domain (RBD) of the SARS-CoV-2 Spike glycoprotein. Immune imprinting, where prior exposure of the immune system to an antigen can influence the response to subsequent exposures, and its role in a population with heterogenous exposure histories has important implications in future vaccine design. Here, we develop an accessible approach to map epitope immunodominance of the neutralizing antibody response in sera. By using a panel of mutant Spike proteins in a pseudotyped virus neutralization assay, we observed distinct epitope usage in convalescent donors infected during wave 1, or infected with the Delta, or BA.1 variants, highlighting the antigenic diversity of the variant Spikes. Analysis of longitudinal serum samples taken spanning 3 doses of COVID-19 vaccine and subsequent breakthrough infection, showed the influence of immune imprinting from the ancestral-based vaccine, where reactivation of existing B cells elicited by the vaccine resulted in the enrichment of the pre-existing epitope immunodominance. However, subtle shifts in epitope usage in sera were observed following BTI by Omicron sub-lineage variants. Antigenic distance of Spike, time after last exposure, and number of vaccine boosters may play a role in the persistence of imprinting from the vaccine. This study provides insight into RBD neutralizing epitope usage in individuals with varying exposure histories and has implications for design of future SARS-CoV-2 vaccines.

Household Food Insecurity During the COVID-19 Pandemic Between Slum and Non-Slum Areas in Kinshasa, DR Congo: A Cross-Sectional Study

Introduction: Food insecurity is a vital issue, especially in places such as Kinshasa. Additionally, food insecurity has been worsened by the COVID-19 pandemic, particularly in low- and middle-income countries. Thus, this study examined food insecurity in Kinshasa after the peak of the pandemic to understand the impact of post-pandemic recovery efforts as well as the heterogeneity of this problem according to the residence of respondent (slum vs. non-slum areas). Methods: Grounded in the four key dimensions of food security (availability, access, vulnerability, and utilization), this cross-sectional study was conducted in Kinshasa with a representative sample of 2170 households selected from 62 enumeration areas. We used a questionnaire to interview participants about their food situations. Interviews were conducted with the head of each household or their designated representative by 150 master’s students using tablets powered by the SurveyCTO application. Household food security status was evaluated using the Household Food Insecurity Access Scale. A logistic regression model was developed to assess household risk factors associated with food insecurity. Results: Most people we talked to were over 40 years old, and many lived in households with fewer than six people. About a third of the households were overcrowded. The prevalence of food insecurity was 76.5% (95%CI: 74.6–78.3). Factors associated with food insecurity included being a household head aged over 50 years, insufficient living space, lower socioeconomic status, and residing in slum areas (AOR: 1.38; 95% CI: 1.06–1.79). Conclusions: Vulnerable groups, such as slum residents, older adults, and informal workers are more likely to be affected by food insecurity. Addressing these challenges requires the government to develop targeted strategies that bolster resilience and mitigate household vulnerability during crises.

Traditional and Complementary Medicine in Health Tourism: Cupping and Leech Therapy Case from Kayseri

The primary objective of this research is to investigate the potential of traditional and complementary medicine (T&CM) practices, especially cupping and leech therapy, in the context of health tourism. The research aims to ascertain the extent of tourist mobility on national and international levels related to these two practices and identify potential future trends in this field. First, a literature review was undertaken to figure out the role of cupping and leech therapies in health tourism, which informed the development of the qualitative study research design. Subsequently, a semi-structured interview was employed to collect data from twelve health professionals, mostly working in T&CM units within hospitals in Kayseri. Findings obtained after content analysis, demonstrate a growing interest in cupping and leech therapy as T&CM practices in health tourism, particularly after the COVID-19 pandemic. However, the study noted that most health tourists coming to Kayseri for these therapies are expatriates or regional tourists rather than international tourists traveling specifically for these treatments. Based on findings, the study suggests that growth in this area depends on better promotion of these therapies which can also be seen as intangible cultural heritage. Additionally, the findings indicate that T&CM practices, including acupuncture, ozone therapy, homeopathy, and phytotherapy, could have significant potential to contribute to the future development of health tourism.