Economic Health Research Articles

COVID-19, social determinants, and African American-White disparities: policy response and pathways forward.

COVID-19 translated African Americans' greater social, economic, and health-related risk, reflecting adverse Social Determinants of Health (SDOH), into greater COVID morbidity, hospitalization, and mortality, and it threatened to enlarge the very risks causing greater COVID suffering. However, following a federal policy response injecting trillions of dollars into the US economy, longstanding African American-White disparities ineconomic well-being, insurance coverage, vaccination rates, and evictions declined. On the other hand, troubling and consequential disparities in k-12 academic achievement and college attendance disparities widened. Continuous monitoring and careful research are needed to document and explain trajectories in social determinant disparities and to offer insight into how policy intervention can decrease continuing disparities in economic well-being, health care, and housing stability.

"I think all of us should have […] much better training in ethics." Ethical challenges in policy making during the COVID-19 pandemic: Results from an interview study with Swiss policy makers and scientists.

The COVID-19 pandemic posed many unprecedented challenges to health care systems and public health efforts worldwide. Policy making and science were deeply intertwined, in particular with regard to the justification of health policy measures. In this context, ethical considerations were often at the core of decision-making trade-offs. However, not much is known about the actual ethical challenges encountered by policy makers and scientists involved in policy advice. With this study, we therefore aim to explore the ethical challenges during COVID-19-related political decision-making in Switzerland as perceived by policy makers and scientists involved in policy making. We also explore the role ethics advice had during the pandemic response and what can be learned for future public health crises. We conducted thirteen qualitative expert interviews with policy makers and scientists involved in decision-making on COVID-19 policy responses in Switzerland on the regional and national level. We used inductive content analysis to analyse the interviews. Among the multitude of ethical challenges highlighted, interviewees perceived making trade-offs between the common good vs. the individual good and between economic welfare vs. health of the population, as well as proportionality of the policy measures, and the capacity of the public to accept uncertainty as central. Interviewees had diverging opinions on whether ethical considerations were sufficiently raised and discussed on the Swiss policy level during the COVID-19 pandemic. Among the reasons why ethics was not sufficiently discussed, they mentioned a lack of time in the fast-paced dynamic of the pandemic, ethics as a complex subject area, the interconnectedness between ethics and law, too much focus on few topics (mostly on vaccination-related ethical questions), and power relationships, such as dominance of medical professionals over ethicists. They evaluated ethics support to have been adequately present in the decision-making process, but wished for ethics training, involvement of the public in the discourse and for accompanying communication to build trust among the population for the future. The study provides empirical insights into the ethical considerations of COVID-19 policy making in practice in Switzerland. It can help to develop ethics assistance for future crises and inform ethical health policy and decision-making not only in Switzerland, but also in other countries.

Novel toxin biosynthetic gene cluster in harmful algal bloom-causing Heteroscytonema crispum: Insights into the origins of paralytic shellfish toxins.

Caused by both eukaryotic dinoflagellates and prokaryotic cyanobacteria, harmful algal blooms (HABs) are events of severe ecological, economic, and public health consequence, and their incidence has become more common of late. Despite coordinated research efforts to identify and characterize the genomes of HAB-causing organisms, the genomic basis and evolutionary origins of paralytic shellfish toxins (PSTs) produced by HABs remain at best incomplete. The PST saxitoxin has an especially complex genomic architecture and enigmatic phylogenetic distribution, spanning dinoflagellates and multiple cyanobacterial genera. Using filtration and extraction techniques to target the desired cyanobacteria from non-axenic culture, coupled with a combination of short and long read sequencing, we generated a reference-quality hybrid genome assembly for Heteroscytonema crispum UTEX LB 1556, a freshwater, PST-producing cyanobacterium thought to have the largest known genome in its phylum. We report a complete, novel biosynthetic gene cluster for the PST saxitoxin. Leveraging this biosynthetic gene cluster, we find support for the hypothesis that PST production has appeared in divergent Cyanobacteria lineages through widespread and repeated horizontal gene transfer. This work demonstrates the utility of long-read sequencing and metagenomic assembly toward advancing our understanding of PST biosynthetic gene cluster diversity and suggests a mechanism for the origin of PST biosynthetic genes.

Late side effects of testicular cancer and treatment: a comprehensive review.

Testicular cancer is a rare solid organ tumour associated with high cure rates and young age at diagnosis, hence it has a sizeable cohort of survivors worldwide. As it is one of the earliest tumours to be cured, a lot of studies have highlighted the late side effects of cancer and its different treatment modalities including surgery, radiotherapy and chemotherapy. While we are trying to identify the population at higher risk of platinum based chemotherapy and reduce its exposure, cisplatin based regimes remain an important tool to cure testicular cancer. The list of late side effects include a number of fatal and morbid conditions including but not limited to the second malignant neoplasms, cardiovascular disease, hypogonadism, infertility, metabolic syndrome, chronic respiratory disease, renal insufficiency, hearing loss, peripheral neuropathy, infertility and psychological illnesses like stress and anxiety. These complications eventually result in compromised social and economic health as well as lower life expectancy compared to the normal population. This article provides a comprehensive review of the latest data regarding the late side effects in testicular cancer survivors. A review of these conditions can help us develop recommendations and guidelines to improve the morbidity and mortality in survivors of testicular cancer.

Prevalence of mental disorders and related risk factors in refugees and asylum seekers in Campania

IntroductionIn recent years, the increasing presence of refugees and asylum seekers displaced from their country of origin, determined significant social, economic, humanitarian and public health implications in host countries, including Italy. These populations are exposed to several potential stressful experiences which make them vulnerable to psychological distress. In fact, the majority of studies addressing the topic found a higher prevalence of mental disorders, especially post-traumatic stress disorder and major depressive disorder, in refugees and asylum seekers with respect to the general population. However, heterogeneous prevalence rates have been reported among studies, due to methodological factor as well as to the impact of a variety of risk factors related to stressful experiences lived in the country of origin, during the migration journey and in the host country.ObjectivesThe aim of the present study was to assess the prevalence of the main psychiatric diagnoses in a large group of adult refugees and asylum seekers (N=303) in the reception centers of two provinces of the Campania region, as well as to investigate the impact of potential risk factors on the occurrence of psychiatric disorders.MethodsThe diagnosis of psychiatric disorders and the identification of subjects at high risk to develop psychosis were carried out by means of structured diagnostic interviews. The following variables were explored as potential risk/protective factors to the occurrence of psychiatric disorders: socio-demographic variables, migration status (refugees/asylum seekers) and characteristics of the reception center,assessed by means of an ad hoc questionnaire; cognitive indices assessed by using standardized neuropsychological tests; traumatic experiences and level of political terror in the country of origin, assessed by means of reliable and valid self-report questionnaires.ResultsAt least one mental disorder was found in 29.7% of the sample. Most prevalent diagnoses were depressive disorders, anxiety disorders and PTSD. Women showed, with respect to men, a higher prevalence of anxiety disorders, higher trauma levels, and came from more at-risk countries. Higher trauma levels, better cognitive abilities and unemployment and refugee status were associated to the presence of a current psychiatric disorder in the whole sample.ConclusionsOur findings showed a higher prevalence of depressive disorders and PTSD in the sample of refugees and asylum seekers with respect to the general population and highlighted the role of potential risk factors whose identification may guide the implementation of preventive strategies and early treatments in these people.

Assessing the role of circular economy and green innovation in mitigating carbon emissions in the Visegrad countries

The shift towards a circular economy is an essential measure in achieving sustainable development because it seeks to separate economic expansion from resource use and environmental deterioration. To meet the European Union green deal, waste management, and the net zero emissions targets various countries are developing and adopting prudent strategies. This study investigates the dynamic affiliation between circular economy (CIR), green innovation (INV), renewable energy (REE), economic progress (GDP), and urbanisation (URB) on carbon emissions (CO2) in the Visegrad (V4) countries, comprising the Czech Republic, Hungary, Poland, and Slovakia. Using the CS-ARDL technique and quantile regression, data curation from 1990-2022 was analysed after checking for cross-sectional, unit root, and cointegration. The outcome demonstrates that circular economy, green innovation, and renewable energy had a negative effect on carbon emissions. In addition, GDP and URB had an immaterially positive influence on carbon emissions. Lastly, the quantile regression confirmed that the study provides useful information for policymakers and stakeholders in the Visegrad countries. It emphasised how important it is to take a broad approach to circular economy initiatives, support eco-friendly innovations, carry out renewable energy projects, and manage the urbanisation process well to achieve long-term economic growth and environmental health.

Patient, financial and environmental impacts of a Medicines Optimisation in Care Homes (MOCH) service on polypharmacy following structured medication reviews

Abstract Introduction An NHS community trust was commissioned in February 2023 to deliver a MOCH service to about 15,000 care home residents across an Integrated Care System (ICS). Pharmacists in the MOCH service undertake Structured Medication Reviews (SMRs) to reduce inappropriate polypharmacy, working closely with care homes, General Practitioners (GPs) and community pharmacies. Pharmacy technicians undertake medication reviews to reduce low clinical value medicines. A patient-centred approach means medicines are stopped or changed following shared-decision making with the resident, carer or family. Aim To find out the impact of the MOCH service on reducing inappropriate polypharmacy, reducing medicines-related harm for residents, and to report financial savings and the environmental impact through reduction of CO2 emissions. Methods This service evaluation was approved by the Trust. No ethics approval was required. Quarterly and 6- monthly data sets covering one week reported by the MOCH service in the financial year 2023/2024 were used. These data sets were extrapolated to a full year. This service reported the number of medicines stopped, started and changed over one week of each quarter for SMRs and, pharmacy technicians reported every six months. Cost savings were calculated using the drug tariff based on continued use of medicines for one year. Pharmacists reported reduction in harm from medicines every six months based on a health interventions risk assessment scoring tool, assessing how many residents had potentially avoided moderate to serious harm following a SMR. The carbon savings were calculated based on financial savings from medicines stopped or changed using the DEFRA SIC 2020 Greenhouse Gases emission factor 0.621(kgCO2e/£) for pharmaceuticals1. Results In the first year the MOCH service completed SMRs for 11,363 residents (75% of care home residents in the ICS). Around 20,000 medicines for residents were stopped (one to two medicines per resident). Pharmacists predicted moderate to high-risk harm from medicines was reduced in approximately 4,200 residents. The cost savings from medicines stopped or changed was approximately £2.8 million, which translated to carbon savings of 1,773,340 kgCO2e, the equivalent of removing 644 cars from the road for one year. Discussion and Conclusion Reducing inappropriate polypharmacy resulted in a reduction of treatment burden, potential harm to residents2 and financial savings. Social impacts include reducing workload for care homes, GPs and community pharmacies, ultimately increasing the capacity of this stretched workforce (less dispensing, reduced risk of error, shorter medicine rounds and more time for residents). The environmental impact goes beyond carbon savings from pharmaceuticals to include reduction in workload, consumables, delivery and cost of waste disposal and prevention of hospital admissions.3 The limitations of this evaluation are that data collected over one week and then extrapolated may not be representative of all the other weeks in terms of cost savings and reduction of harm to residents, however MOCH pharmacists undertake peer reviews of reduction in harms to mitigate this. Costs incurred in making the financial savings were excluded. As the demographic of older people rises in the next 20 years a medication review is increasingly important to residents, the health economy, workforce, and our environment.

Gendered Taxation: IMF Tax Advice and the Unintended Disempowerment of Women

Case research points to the gendered effects of the value added tax (VAT), which may particularly disadvantage women by crowding out their economic participation. A key driver of VAT introductions has been the International Monetary Fund (IMF). To counterbalance of-payments woes, IMF advice for cash-stripped countries has frequently focused on shifting toward broad-based consumption taxes while lowering trade taxes and corporate income taxes. We expect this tax policy advice – while ostensibly gender-blind – to contribute in practice to a deterioration in women’s socioeconomic well-being. To test this hypothesis, we construct a panel dataset for 147 countries from 1980 to 2016 and estimate the effect of IMF programs on women’s economic participation, education and health. Accounting for selection effects, we find that women’s life chances deteriorate relative to men’s if a country undergoes an IMF program with tax conditionality. We corroborate these findings to demonstrate the mechanism underlying these effects by showing a negative effect of IMF-induced de jure VAT adoption on women’s life chances. We provide complementary individual-level evidence from the World Values Surveys based on 98 countries from 1981 to 2019. We show that during an IMF program with tax conditionality, women are significantly less satisfied with home life and report more material hardships. Our results provide evidence of the potential for unintended consequences of IMF revenue prescriptions for women, supporting calls for increased attention to gender-responsive budgeting.

The economic and psychological impacts of covid-19: a exploratory study of the intersection of traditional and new vulnerable groups in South Korea

BackgroundThe 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.MethodsThe 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.ResultsBoth 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.ConclusionThis 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.

Covid-19 pandemic and its economic and psychological impacts on Saudi workers: An empirical study in the kingdom of Saudi Arabia

Background: The COVID-19 pandemic has had a substantial economic and psychological impact on workers in Saudi Arabia. The objective of the study was to assess the effects of the COVID-19 epidemic on the financial and mental well-being of Saudi employees in the Kingdom of Saudi Arabia. Purpose: The COVID-19 epidemic has resulted in significant economic and societal ramifications. Current study indicates that the pandemic has not only precipitated an economic crisis but has also given rise to several psychological and emotional crises. This article provides a conceptual examination of how the pandemic impacts the economic and mental health conditions of Saudi workers, based on contemporary Structural Equation Modeling (SEM) models. Method: The current study employed a qualitative methodology and utilized a sample survey strategy. The data was gathered from Saudi workers residing in major cities of Saudi Arabia. The samples were obtained from professionals such as managers, doctors, and engineers, as well as non-professionals like unskilled and low-skilled laborers, who are employed in various public and private sectors. A range of statistical tools, including Descriptive statistics, ANOVA, Pearson’s Correlation, Factor analysis, Reliability test, Chi-square test, and regression approach, were employed to analyze and interpret the results. Result: According to the data, the pandemic has caused a wide range of economic problems, including high unemployment and underemployment rates, income instability, and different degrees of pressure on workers to find work. Feelings of insecurity (about food and environmental safety), worry, dread, stress, anxiety, depression, and other mental health concerns have been generated by these challenges. The rate of mental health decline differs among demographics. Conclusions: The COVID-19 pandemic has universally affected all aspects of our lives worldwide. It resulted in an extended shutdown of educational institutions, factories, offices, and businesses. Without a question, it has profoundly transformed the work environment, professions, and lifestyles of billions of individuals worldwide. There is a high occurrence of poor psychological well-being among Saudi workers. However, it has been demonstrated that both economic health and mental health interventions can effectively alleviate the mental health burden in this population.

HIV Self-Testing: A Discussion on the Benefits, Limitations, and Implications for Public Health with a Focus on Poland

Background/Objectives: A late HIV diagnosis represents a significant public health concern in Poland, with approximately 50% of patients being identified as late presenters (LPs), resulting in the delayed initiation of treatment. This study assesses the potential of HIV self-testing (HIVST) to enhance early detection, particularly among heterosexual individuals, and evaluates its advantages and limitations within the Polish context. Methods: This study examines the advantages and disadvantages of HIVST by analyzing data from various studies. It focuses on the acceptability, sensitivity, and specificity of HIVST, comparing blood-based and oral fluid-based tests. Moreover, the economic impact and potential public health benefits of HIVST in Poland are evaluated. Results: HIVST is well-accepted, especially among key populations; it can reduce stigma and enhance privacy. The results of studies conducted in Poland indicate that heterosexuals are more inclined to use self-testing methods than traditional diagnostic procedures. On the other hand, HIVST has the potential for false-negative results due to the serological window and the possibility of missed diagnoses of other sexually transmitted infections (STIs). Moreover, the cost of HIVST remains a significant barrier, as it is not publicly funded in Poland. Conclusions: Despite its limitations, HIVST offers a number of significant benefits, including increased rates of testing and earlier detection, which could prove vital in reducing the transmission of HIV in Poland. This study proposes that increased funding, the integration of HIVST into public health strategies, and further research to enhance its implementation, alongside education and support for its effective use, should be prioritized.

COVID-19 pandemic: mental health (distress as depression) in orthodontists

ABSTRACT Objectives For health professionals, pandemic conditions impacted all societal aspects, including economic, wellness, and mental health. This study analysed sociodemographic factors, post-traumatic stress disorder symptoms (PTSD), and depression levels caused by the coronavirus disease 2019 (COVID-19) pandemic in orthodontists. Materials and Methods A sociodemographic questionnaire, the Impact of Event Scale (IES), and the Patient Health Questionnaire (PHQ-9) were used. Following data collection, multiple statistical analyses were applied: scores were compared using the Mann-Whitney and Kruskal-Wallis tests, followed by Dunnett's multiple comparisons. The association between variables was verified using Chi-square or likelihood ratio tests. Multiple logistic regression models were estimated after bivariate logistic regression tests (p < 0.10). The final models using the Stepwise backward selection method were assessed for variables at 5%. Results Of the respondents, 69.3% were women, and their mental health questionnaire scores were significantly higher (p < 0.001). The IES avoidance and PHQ-9 scores were statistically different between the age groups (p = 0.040 and p < 0.001, respectively). Subjective distress was associated with years of practice, monthly income, fear of contracting COVID-19 during dental care, transmitting COVID-19 to patients, and thinking about the future (p < 0.05). Depression was significantly associated with orthodontic practice type, self-confidence in providing dental care, pandemic impact on dental practice, remote care, monthly income, changes in financial expenses, fear of contracting COVID-19 and thinking about the future (p < 0.05). Conclusion Over half of the orthodontists experienced moderate-to-severe mental distress, and the same number suffered from mild-to-severe depression during the pandemic. Registration: Ethics and Research Committee (CEP) of the Faculty of Dentistry of the University of São Paulo (FOUSP): CAAE: 34223720.1.0000.0075 Protocol: 4.191.353

Analysis of economic crises at enterprises: from classical theories to innovative solutions

The article is devoted to a comprehensive analysis of economic crises at enterprises arising as a result of various internal and external factors that affect their stability and competitiveness. The author examines the polysemantic nature of the concept of «crisis», analyzing it in the context of various scientific disciplines and approaches. Special attention is paid to the dualistic approach to the crisis, where it is considered as a phenomenon that simultaneously carries threats and opportunities for development. The article provides a retrospective review of approaches to the study of crisis phenomena, starting from the cyclical approach, which interprets the crisis as a natural stage of the economic cycle, to modern system-synergistic methodologies, which consider the crisis as a prerequisite for self-organization and development of the enterprise. The conducted analysis of literary sources confirms the need to integrate various approaches for complex anti-crisis management at enterprises. The work also identifies unresolved aspects of the problem, including early diagnosis of crises, integration of anti-crisis tools, and the impact of digitalization on crisis processes. The article emphasizes the importance of flexible and adaptive diagnostic models capable of responding effectively to rapid changes in the business environment. The scientific novelty consists in proposing an action algorithm for diagnosing the crisis state of enterprises, based on the definition and analysis of key parameters that reflect the economic health of the business. The author emphasizes the need for a deep understanding of the specifics of each enterprise for successful anti-crisis management and the potential use of crisis phenomena to achieve new heights of development.The variety of interpretations of this term indicates its complexity and multifacetedness, which requires special attention to specify the meaning of the concept not only in the economic context, but also at the level of enterprises, underlines the relevance of this topic.

Modified Generalized Chen Distribution, Estimation and Application using Econometrics Data

In this study, a variant of the generalized Chen (GC) distribution with parameters α, β, γ, δ, and λ, termed the Modified Generalized Chen (MGC) distribution, was introduced. The study evaluated several Chen distribution variants theoretically, focusing on the MGC distribution. Variants considered include the Generalized Chen (GC), Half-Cauchy Chen (HCC), New Extended Chen (NEC), and Exponentially Generalized Modified Chen (EGMC) distributions. The objectives of the study was to derive the probability density function (PDF) and cumulative density function (CDF) of the MGC distribution, determine its statistical properties and reliability characteristics, compare these properties and characteristics to existing distributions, and empirically evaluate its performance. The study developed unique expressions for the PDF, CDF, survival function, and hazard function of the MGC distribution. By evaluating PDFs and performance measures such as the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and mean square error (MSE) across various datasets, the MGC distribution consistently demonstrated superiority over other variants. The MGC distribution offers improved model fit, predictive accuracy, and interpretability without sacrificing simplicity. The dataset employed in this study was the secondary data, encompassing economic indicators from 1981 to 2021 and public health expenditure data for Nigeria and Ghana from 1995 to 2014. Statistical analyses revealed that on the average, the MGC distribution outperforms others, with superior average AIC (-509.95), BIC (-510.49), and MSE (499.89) measures across the datasets considered in the study. This superior performance indicates better fit and accuracy in predicting economic and public health outcomes, offering valuable insights for policymakers and researchers. The study underscores the importance of adopting flexible and interpretable distribution models like the MGC distribution to enhance empirical analyses, inform policy decisions, and advance knowledge in econometrics and related disciplines.

How Sexism in Institutions and Everyday Interactions Shapes Early Childbearing

Early childbearing is associated with poor outcomes for parents and children, potentially exacerbating inequality within and across generations. Building on the structural sexism and health perspective, we argue that systemic gender inequality is a conceptually important—and understudied—factor in early childbearing. Using survey data from the National Longitudinal Study of Adolescent to Adult Health ( N = 5,052 female respondents and 32,595 person-years) merged to state, county, and school characteristics, we investigate how exposure to structural sexism during adolescence shapes early childbearing. We measure structural sexism in institutional domains with state and county-level measures of economic, cultural, and reproductive health. We also generate a novel measure of structural sexism in interactional domains, capturing gendered expectations, power dynamics, and conservative religious beliefs among school peers. We find that institutional sexism is associated with a higher likelihood of early childbearing among young women racialized as Black, but not among those racialized as White. Interactional sexism is also a significant predictor of early childbearing, and is especially salient for adolescents as they turn to peers for social cues about gender roles. Our results underscore the importance of institutional and interactional forces for shaping families and raise questions about increasingly polarized gender climates post- Dobbs.

Considerations for the use of laboratory-based and field-based estimates of environmental tolerance in water management decisions for an endangered salmonid

Water infrastructure development and operation can provide for human economic activity, health, and safety. However, this infrastructure can also impact native fish populations resulting in regulatory protections that can, in turn, alter operations. Conflict over water allocation for ecological function and human use has come to the forefront at Shasta Reservoir, the largest water storage facility in California, USA. Shasta Reservoir supports irrigation for a multibillion-dollar agricultural industry, provides water for urban and domestic use, provides flood protection for downstream communities, and power generation as part of the larger Central Valley Project in California. Additionally, an endangered run of Chinook Salmon relies on cold water management at the dam for successful spawning and egg incubation. Tradeoffs between these uses can be explored through application of models that assess biological outcomes associated with flow and temperature management scenarios. However, the utility of models for predicting outcomes of management decisions is contingent on the data used to construct them, and data collected to evaluate their predictions. We evaluated laboratory and field data currently available to parameterize temperature-egg survival models for winter run Chinook Salmon that are used to inform Shasta Dam operations. Models based on both laboratory and field data types had poor predictive performance which appears to limit their value for management decisions. The sources of uncertainty that led to poor performance were different for each data type (field or laboratory) but were rooted in the fact that neither data set was collected with the intention to be used in a predictive model. Our findings suggest that if a predictive model is desired to evaluate operational tradeoffs, data should be collected for the specific variables and life stages desired, over an appropriate range of values, and at sufficient frequency to achieve the needed level of precision to address the modeling objective.

Using QALYs as an Outcome for Assessing Global Prediction Accuracy in Diabetes Simulation Models.

(1) To demonstrate the use of quality-adjusted life-years (QALYs) as an outcome measure for comparing performance between simulation models and identifying the most accurate model for economic evaluation and health technology assessment. QALYs relate directly to decision making and combine mortality and diverse clinical events into a single measure using evidence-based weights that reflect population preferences. (2) To explore the usefulness of Q2, the proportional reduction in error, as a model performance metric and compare it with other metrics: mean squared error (MSE), mean absolute error, bias (mean residual), and R2. We simulated all EXSCEL trial participants (N = 14,729) using the UK Prospective Diabetes Study Outcomes Model software versions 1 (UKPDS-OM1) and 2 (UKPDS-OM2). The EXSCEL trial compared once-weekly exenatide with placebo (median 3.2-y follow-up). Default UKPDS-OM2 utilities were used to estimate undiscounted QALYs over the trial period based on the observed events and survival. These were compared with the QALYs predicted by UKPDS-OM1/2 for the same period. UKPDS-OM2 predicted patients' QALYs more accurately than UKPDS-OM1 did (MSE: 0.210 v. 0.253; Q2: 0.822 v. 0.786). UKPDS-OM2 underestimated QALYs by an average of 0.127 versus 0.150 for UKPDS-OM1. UKPDS-OM2 predictions were more accurate for mortality, myocardial infarction, and stroke, whereas UKPDS-OM1 better predicted blindness and heart disease. Q2 facilitated comparisons between subgroups and (unlike R2) was lower for biased predictors. Q2 for QALYs was useful for comparing global prediction accuracy (across all clinical events) of diabetes models. It could be used for model registries, choosing between simulation models for economic evaluation and evaluating the impact of recalibration. Similar methods could be used in other disease areas. Diabetes simulation models are currently validated by examining their ability to predict the incidence of individual events (e.g., myocardial infarction, stroke, amputation) or composite events (e.g., first major adverse cardiovascular event).We introduce Q2, the proportional reduction in error, as a measure that may be useful for evaluating and comparing the prediction accuracy of econometric or simulation models.We propose using the Q2 or mean squared error for QALYs as global measures of model prediction accuracy when comparing diabetes models' performance for health technology assessment; these can be used to select the most accurate simulation model for economic evaluation and to evaluate the impact of model recalibration in diabetes or other conditions.

Bridging the gap: how education transforms health outcomes and influences health inequality in rural China.

This study focuses on the impact of education on health and health inequalities in rural areas of China. Education significantly enhances economic status and health, driving economic growth and improving public health standards. Integral to the "Healthy China Strategy," it provides essential guidance for public policy and underscores the need for strategic human capital investments to achieve these goals. The study utilizes data from the China Family Panel Studies (CFPS) spanning 2010-2020 and employs the average educational level within counties as an instrumental variable. The causal impact of education on health and health inequalities is estimated using the two-stage least squares (2SLS) method. The findings reveal a significant positive correlation between enhancing education levels and health improvements. Specifically, after controlling for endogeneity, the duration of individual education significantly improves both subjective and objective health outcomes. It reduces health inequalities, with these effects being more pronounced among women and low-income groups. Mechanistically, education positively impacts health primarily by altering health behaviors and social network levels and reducing health inequalities through socio-economic factors. This paper provides important implications for public policy, suggesting that enhancing educational investments can drive economic development and improve population health standards.

The impact of drought and climate change on economy, environment and human health in southern Iran: A qualitative study

Drought and climate change are one of the most important environmental health challenges of the current century. It has been predicted that the occurrence of drought, its intensity, and its adverse effects on the environment, human health, societies, and economy will increase in the coming decades. This qualitative content analysis study aimed to explore the impact of drought on the lives of people living in the south of Iran. Data were collected through in-depth semi-structured interviews with farmers, urban and rural officials, and physicians. A total of 25 interviews were conducted. All interviews were recorded and then transcribed. Data were analyzed using MAXQDA version 18. The concepts raised by interviewees regarding the consequences of drought were categorized into four themes, including economic consequences, environmental hazards, health consequences, and adaptation options; and most of these consequences were inter-related. Participants believed that drought has affected the soil, environment, ecosystem, and the quality and quantity of water, and this can lead to extensive effects on humans’ physical, mental, and community wellbeing. Drought can also cause adverse economic effects, which can further intensify its adverse effects. It seems like the adverse effects of drought in Iran are severe and destructive, and this is due to the mismanagement of water and environmental resources and other socio-economic problems. Fundamental changes in the management of water and environmental resources are necessary.

DESCRIMINALIZAÇÃO DE DROGAS: UMA ANÁLISE ENTRE AS COMPETÊNCIAS DO LEGISLATIVO E JUDICIÁRIO

Drug use is proven to be harmful, both physically and intellectually. Currently, drugs are the main social evil, linked to all types of crime. The methodology used was the literature reference, and the STF decisions of 2023 and 2024 on the issue. In this sense, the objective of this research/article is to develop a study on the decriminalization of marijuana possession and its legal, economic, moral, and public health consequences. To do this, initially a definition of competences is made from the perspective of doctrine and jurisprudence regarding the limits of powers to legislate. It also addresses the main aspects related to drug use and its consequences; And, finally, the positive and negative points within the legal, moral, social, economic and public health sphere of this decision. It is concluded that this is a matter that should be entirely up to congress to decide, and that the STF usurps the functions of the Legislative and Executive branches by giving its opinion on topics that would be the responsibility of the technical body ANVISA. Even because they are decisions with broad repercussions, which could have major consequences for society, including in the field of public security, crime, society in general and public health.