Income Groups Research Articles

Residential energy demand, emissions, and expenditures at regional and income-decile level for alternative futures

Abstract Income and its distribution profile are important determinants of residential energy demand and carry direct implications for human well-being and climate. We explore the sensitivity of residential energy systems to income growth and distribution across SSP-RCP scenarios using a global, integrated, multisector dynamics model, GCAM, which tracks national/regional household energy services and fuel choice by income decile. Nation/region energy use patterns across deciles tend to converge over time with aggregate income growth, as higher-income consumers approach satiation levels in floorspace and energy services. However, in some regions, existing within-region inequalities in energy consumption persist over time due to slow income growth in lower income groups. Due to continued differences in fuel types, lower income groups will have higher exposure to household air pollution, despite lower contributions to greenhouse gas emissions. We also find that the share of income dedicated to energy is higher for lower deciles, with strong regional differences.

Distributional Impacts of Tobacco Excise Taxes in Serbia.

Numerous studies worldwide have investigated the impact of tobacco tax increase on household welfare, focusing on concerns regarding potential tobacco taxation regressivity and its effects on the poorest, whereas their scope was limited to the working population. To explore the effects of tax changes on household budgets, accounting for the retired population as well, we employed the modified Extended Cost-Benefit Analysis (ECBA) framework, assuming a 43.6% specific tax increase that fits the EU Tobacco Tax Directive recommendation of minimum EUR 90 excise taxes per 1,000 cigarettes. Our analysis encompassed changes in: 1) tobacco expenditure (accounting for price elasticities by income groups: low-, middle-, and high-income), 2) medical costs linked to smoking-related diseases (utilizing relative risk of morbidity/mortality and smoking-attributable fractions), 3) years of working life (considering the years of working life lost among the working population), and 4) years of pension receipt (accounting for the years of retirement life lost due the premature death). Under an assumed specific excise increase leading to a 22.4% retail tobacco price rise, the net gains in disposable household budgets would be 0.01% for high-income, 1.3% for middle-income, and 2.9% for low-income households. A tax increase would yield a progressive effect on income distribution, benefiting the most economically disadvantaged population thereby contributing to a more equitable income distribution. To effectively reduce tobacco consumption, subsequent smoking-related medical costs, and associated productivity and pension losses, it is recommended that Serbia implement a minimum 43.6% increase in the specific tobacco excise tax.

Determinants of parental demand of human papillomavirus vaccination for adolescent daughters in China: Contingent valuation survey.

Several types of human papillomavirus (HPV) vaccines have been approved for use in adolescent girls in China. These vaccines are regulated as non-National Immunisation Program vaccines and are optional and generally fully self-paid by vaccinees. To assess parents' demand for HPV vaccination by eliciting their willingness-to-pay for their adolescent daughters to be vaccinated against HPV and to examine the determinants of demand for HPV vaccination in China. A contingent valuation survey was conducted across three cities in Shandong Province in eastern China. We selected 11 junior middle schools with different socioeconomic features and randomly selected 6 classes in each school, and questionnaires were distributed to all girls aged 12-16 in the 66 classes for their parents to complete. A payment card approach was used to elicit parental willingness-to-pay for HPV vaccination for their daughters. We also collected a wide array of socioeconomic and psychological variables and interval regressions were applied to examine the determinants of parental willingness-to-pay. A total of 1074 eligible parents who completed valid questions were included in analyses. Over 85% of parents believed HPV vaccines were, in general, necessary and beneficiary. However, only around 10% believed that their daughters would be infected by HPV. About 8% of parents would not accept HPV vaccine even if the vaccine were free mainly due to concerns about the potential side effects and vaccine safety and quality issues, and 27.37% would only accept the vaccine if it were free. The median willingness-to-pay was 300 CNY (42 USD). Several factors were positively correlated with higher willingness-to-pay: income, urban residence (relative to rural residence), mothers (relative to fathers), parents' beliefs about vaccine benefits, whether they should make decisions for their daughters, and whether their daughters would be susceptible to HPV. Though education-level was not significantly correlated with willingness-to-pay in the main regressions, a subgroup analysis revealed interesting dynamics in the relation between education and willingness-to-pay across different income-levels. There is a large gap between parents' willingness-to-pay and the market price of HPV vaccine for girls in China. Parents generally believed the HPV vaccines were beneficial and necessary but when asked for their daughters, most parents did not believe their daughters would be infected by HPV despite the high prevalence in China. Future focus should be on ensuring the provision of accurate health information about HPV prevalence, vaccine quality, and safety to promote vaccine uptake, and promotional efforts tailored to different income groups might yield better effects. Government involvement in negotiating more widely acceptable and affordable prices or subsidising may be necessary for protecting high-risk population groups.

Agricultural knowledge and innovation system in Albania: innovation performance, universities and two arguments

Purpose. The purpose of the article is to provide an assessment of the governance of the agricultural system in Albania, by analyzing the challenges for the future operation of Agricultural knowledge and innovation system (AKIS) under the influence of two main factors, such as (і) the country’s innovation performance and (іі) universities and research institutions (URIs), for the rapid and effective adaptions of innovation and new knowledge. Results. In the Balkan region, there is a rapid dynamic (according to the income group) of countries related to innovation (Bulgaria is the 2nd after China), and some of them (Slovenia, Croatia) have overtaken old members of the EU; we prove the importance of Albania’s innovation performance and URIs for competitiveness and future operation of AKIS. Innovation and the frequent variability of technologies and effects on producers, consumers and markets can accelerate growth and competitiveness but can create also undesirable effects. The economic decisions, governance of the agri-system and resources under the influence of the rapid developments require an adequate research-decision-making focus. Science-based-guided institutions are essential for improving the country’s innovation performance and the role of URIs for the efficient adaptions of innovation, new knowledge and techniques in agri-sector as two main pillars for the future of AKIS in Albania. Scientific novelty. Most studies analyze the functioning of segments of the agricultural system (e.g. crop, livestock, etc.) or the value chain (e.g. producers, consumers) and identify the low presence of social capital in Albania, using the individual as the unit of analysis (e.g. farmer level) and the company (e.g. factors, sources). It is paid little attention to the renewal of social capital, especially in the context of current migration in Albania. Therefore, we provide an aggregate analysis of agricultural governance, by suggesting the efficiency of (formal) institutions for renewing (missing) social capital, improvement of innovation performance and the role of URIs to policy solutions and future AKIS. Practical value. Through a functional AKIS, the problem of innovation, policy formulation in the agri-sector and centralization approach or centralized policies can be overcome, by creating premises for an efficient-scientific-entity and a smart-regional-approach, including new networks of researchers and the environment for business sophistication and innovation ecosystems.

Assessing the trade response to pandemic-related non-tariff measures

ABSTRACT This paper assesses the global trade effects of COVID-19-related non-tariff measures (NTMs), with a particular emphasis on their varied impacts across products and income groups over time. Utilizing a newly constructed NTM dataset alongside monthly trade data at the product level, we employ an event study framework to analyze the implications of trade-facilitating and trade-restricting NTMs implemented during the pandemic. Our main findings indicate an average increase of 1.2% in imports due to trade-facilitating NTMs and a 12% decrease in exports due to trade-restricting NTMs. Additionally, the analysis highlights variations in trade responses at the product level and significant differences across countries of varying income levels. This research enhances our understanding of the trade response to sudden trade cost shocks, offering critical insights into the impact of temporary trade measures within the context of a global health crisis and accompanying supply chain disruptions.

Inequitable Distribution of Global Economic Benefits from Pneumococcal Conjugate Vaccination.

Many low- and middle-income countries have been slow to introduce the pneumococcal conjugate vaccine (PCV) into their routine childhood immunization schedules despite a high burden of disease. We estimated the global economic surplus of PCV, defined as the sum of the net value to 194 countries (i.e., monetized health benefits minus net costs) and to vaccine manufacturers (i.e., profits). We further explored the distribution of global economic surplus across country income groups and manufacturers and the effect of different pricing strategies based on cross-subsidization, pooled procurement, and various tiered pricing mechanisms. We found that current PCV pricing policies disproportionately benefit high-income countries and manufacturers. Based on the 2021 birth cohort, high-income countries and manufacturers combined received 76.5% of the net economic benefits generated by the vaccine. Over the two decades of PCV availability, low- and middle-income countries have not received the full economic benefits of PCV. Cross-subsidization of the vaccine price for low- and middle-income countries and pooled procurement policies that would relate the vaccine price to the value of economic benefits generated for each country could reduce these inequalities. This analysis offers important considerations that may improve the equitable introduction and use of new and under-utilized vaccines.

Factors of cancer diagnosed family and medical system for delay in diagnosis and treatment of esophageal cancer

Introduction. The esophagus cancer patients needs early diagnosis to achieve better prognosis. The delay barriers increase progression of diseases to higher stages. The aim of work was to identify and explore the barriers in diagnosis of esophagus cancer and chart the time duration in this process. Material and Methods. The study was conducted in Jinnah Hospital Lahore (JHL), a teaching care hospital of Allama Iqbal Medical College, during a period of one year from July 2019 to July 2020. There were 49.42 % female and 50.57 % male patients. Results. Mean age found to be 56 years. Mean Total delay (TD ) time was 206 days and median Total delay (TD ) time in days were 197 days with 25th and 75th (157, 246) percentiles respectively. Longest delays were found in 51–60 age group and age related (r=0.94) significantly to delays (p=0.0004). Initial symptom of weight loss shows maximum delay and symptoms are highly correlated (r=0.94) with delay (p=0.004). The low income group presents maximum delay. Mean patient delay (PD ) time in days were 142 days with 135 Median and (88, 195) 25th and 75th percentile respectively. Mean, Median, 25th and 75th percentiles for Physician delays (PhyD) times were (20, 18, 16, 23) respectively. Treatment delay (TD ) time (Mean, Median) in days were (18, 18.52) with 25th and 75th (14, 22) percentiles. The education significantly reduces the delays with correlation (r=0.91) and significance (p=0.02). Mean system delay (SD ) time were 25 days and median were 24 days with 25th and 75th (20, 31) percentiles. Conclusion. Illiteracy, financial problems, and unavailability of information related to the cancer and health care system, very limited number of health facilities remains the main causes of these delays.

Sexual Identity and Heavy Drinking Among Adults in Canada by Racially Minoritized Status and Income, 2015-2020.

Purpose: Our objective was to estimate inequities in heavy drinking between heterosexual, gay or lesbian, and bisexual or pansexual individuals, by sex/gender, and to determine whether this association is heterogeneous across racially minoritized status and income groups in Canadians aged 15 and older. Methods: We pooled three Canadian Community Health Survey cycles (2015-2020) and used separate modified Poisson regressions to explore the sex/gender-specific association between sexual identity and heavy drinking prevalence by racially minoritized status, and income, adjusted for survey cycle, age, marital status, and region. Results: With racially minoritized status, and income categories collapsed, heavy drinking was 1.3 times higher (95% confidence interval [CI] = 1.0-1.7) among bisexual or pansexual women compared with heterosexual women, with no differences among men. Among racially minoritized women, heavy drinking was 2.9 (95% CI = 1.3-6.4) times higher among bisexual or pansexual women and 1.9 (95% CI = 0.7-5.2) times higher among gay or lesbian women compared with heterosexual women. Among racially minoritized men, heavy drinking was 1.9 (95% CI = 0.9-4.0) times higher among gay men compared with heterosexual men. No differences were observed across sexual identity in White men or women. Bisexual or pansexual women reported increased heavy drinking relative to heterosexual women across income quintiles. Conclusion: Heavy drinking is distributed heterogeneously across sexual identity, sex/gender, racially minoritized status, and income. These results encourage equity-focused interventions to reduce heavy drinking among intersecting sociodemographic groups experiencing a greater burden of heavy drinking.

Trade and price-index inequality

Abstract This commentary reviews the literature exploring the impact of international trade on the cost of living. We first summarize the strategies researchers have used to identify such impacts in the data before discussing the evidence for heterogeneity in price effects across income groups and across regions. Finally, we conclude with a discussion of how trade may have affected components of the price index such as differentiated manufactures and services where measurement is more challenging and where the existing literature has made less progress.

Impact of global smoking prevalence on mortality: a study across income groups

BackgroundSmoking significantly contributes to the mortality rates worldwide, particularly in non-communicable and preventable diseases such as cardiovascular ailments, respiratory conditions, stroke, and lung cancer. This study aims to analyse the impact of smoking on global deaths, and its association with mortality across the main income groups.MethodsThe comprehensive analysis spans 199 countries and territories from 1990 to 2019. The study categorises countries into four income groups: high income, upper middle income, lower middle income, and low income.ResultsThe findings underscore the profound impact of global tobacco smoking on mortality. Notably, cardiovascular disease mortality is notably affected in both upper-middle-income and high-income groups. Chronic respiratory disease mortality rates show a significant impact across all income groups. Moreover, stroke-related mortality is observed in the lower-middle, upper-middle, and high-income groups. These results highlight the pervasive influence of smoking prevalence on global mortality, affecting individuals across various socioeconomic levels.ConclusionThe study underscores the critical implications of smoking on mortality rates, particularly in high-income countries. It emphasises the urgency of targeted interventions in these regions to address the specific challenges posed by tobacco smoking on public health. Policy recommendations include implementing prohibitive measures extending to indoor public areas such as workplaces and public transportation services. Furthermore, allocating funds for research on tobacco and health, is imperative to ensure policymakers are consistently informed about emerging facts and trends in this complex domain.

Exploring Consumer Procurement Patterns: A Comparative Analysis Between H&m And Zara

Embark on a quest to unravel the enigmatic tapestry woven by the whims of Indian youth, where the threads of fashion brands H&M and Zara intertwine. This odyssey delves into the depths of the ever-evolving Indian fashion realm, seeking to illuminate the alignment between the young and these sartorial titans, unveiling the intricate patterns that guide their sartorial pursuits. The journey unfolds through a harmonious fusion of qualitative and quantitative methodologies, a symphony of surveys, interviews, and observational data analysis. Qualitative melodies unveil the intrinsic motivations that orchestrate consumer choices, while quantitative cadences lend statistical validation and broader insights into the rhythms of buying patterns. The fruits of this expedition hold profound implications for H&M, Zara, and all those who navigate the Indian fashion market's currents. By comprehending the nuanced preferences and behaviors of the youth demographic, brands can tailor their product assortments, marketing strategies, and brand positioning efforts with the deft hand of a master artisan. The recommendations born from this odyssey shall serve as beacons, guiding strategic decisions towards heightened brand awareness, expanded market reach, and elevated customer satisfaction. This voyage into the unknown contributes a novel symphony to the annals of consumer behavior within the Indian fashion industry. By focusing on the unique context of youth consumer preferences and behaviors towards H&M and Zara, the study weaves an original tapestry of market trends and consumer dynamics. Furthermore, it illuminates paths for improvement, such as amplifying awareness of collections and catering to diverse income groups, thus enriching the strategic planning and decision-making processes for brands and marketers alike.

O-158 Social disparities in achieving a live birth after initiating ART treatment: a national register-based study among women in Denmark

Abstract Study question How are educational level, labor market attachment and income associated with achieving a live birth after initiating ART treatment among women in Denmark? Summary answer Higher educational level, labor market attachment and higher income were strongly associated with achieving a live birth after initiating ART treatment among women in Denmark. What is known already Infertility is increasing in populations worldwide with an estimated lifetime prevalence of 17.5%. Approaches to this issue differs between societies and healthcare systems. In the public Danish healthcare system, three fresh ART treatments are currently offered free of charge. Additional ART treatments are self-financed in the private healthcare sector. Socioeconomic disparities in health are widely recognized. Previous studies have indicated that higher socioeconomic position (SEP) is associated with a greater probability of achieving a live birth after initiating ART treatment. However, there is limited knowledge about SEP and its relation to outcomes of ART treatment. Study design, size, duration This is a national, register-based study based on the DANAC II Cohort. Women undergoing ART treatment during 1994–2017 registered in the Danish IVF register were individually linked with data from sociodemographic registries and the Medical Birth Registry using the Danish Personal Identification number. The study population consisted of 68,738 women treated with ART. The outcome was a live birth. The women were followed until outcome, death, migration, or end of study (31/12/2017). Participants/materials, setting, methods Women included in the analyses were aged 18–45 years. Overall associations between achieving a live birth after initiating ART treatment and educational level, labor market attachment and income were examined and further stratified by nulliparity at baseline and age group. Hazard ratios (HRs) with confidence intervals (CIs) were estimated by Cox proportional hazards regression, and with adjustment for potential confounders age and ethnicity. Death was incorporated as a competing risk in all analyses. Main results and the role of chance Adjusted results showed that educational level, labour market attachment and income significantly determined the probability of achieving a live birth after initiating ART treatment. HRs of achieving a first live birth after initiating ART treatment increased stepwise with higher education and income level, respectively. Compared with primary school education the highest HR was found among women with a research education (HR = 3.02 [95% CI 2.71; 3.35]). Unemployed women had the lowest HR of achieving a live birth after initiating ART treatment (HR = 0.67 [95% CI 0.64; 0.69]) compared to employed women. Women in the highest income group had two times higher HR of achieving a live birth after initiating ART compared to women in the lowest income group. Analyses of different age groups showed that higher SEP was associated with a live birth after ART treatment in all ages. The same consistency was found for both childless women and women who had a child or children prior to ART treatment. Subanalyses showed that women with higher SEP were more likely to continue ART treatment after unsuccessful attempts, which could explain the observed social inequality in achieving a live birth after ART treatment. Limitations, reasons for caution The Danish IVF register did not register non-ART treatments (intrauterine inseminations) before 2007, thus these treatments are not included. Whether severity of infertility/prognosis differs among SEP groups is unclear. Also, geographical distance to fertility clinics could have provided additional perspectives. Wider implications of the findings Free access to fertility treatment in public healthcare should ideally provide equal access. Patients encounter barriers during treatment and, as shown, treatment success differs based on socio-economic background. Difficulties encountered during treatment that challenge certain patients more than others based on their socio-economic background needs to be addressed. Trial registration number Not applicable

Haematological Profile in Patients With Acute Falciparum Malaria: A Hospital-Based Study.

Introduction Malaria is the most common parasitic disease affecting humans. Haematological alterations in malaria are expected, and these changes play a significant role in fatal complications. The present study aims to assess the clinical and haematological profile in patients with acute falciparum malaria and the significance of various haematological and coagulation alterations with the clinical severity of malaria. Methods The prospective cross-sectional study included 68 acute falciparum malaria cases. Thick and thin blood film microscopy and a rapid diagnostic kit were used to diagnose malaria. The cases were subjected to various haematological and biochemical investigations. Bone marrow aspiration samples were also collected. Using appropriate statistical methods, the findings were compared between severe and uncomplicated malaria cases. A p-value below 0.05 was considered significant. Results The participants' ages ranged from 14 to 78. Most participants (n = 51, 75%) were male and belonged to the lower income group (33, 48.5%). Significant variations in mean parasite count between severe and uncomplicated malaria cases (p-value < 0.01) were observed. The severe and uncomplicated groups showed significant differences in haemoglobin (gm/dL), haematocrit, red blood cell count, reticulocyte, serum iron, and ESR levels (p-value < 0.05). The severe malaria group had considerably reduced mean platelet counts (p-value < 0.01). Only five instances (7.3%) had an appropriate erythropoietic response after day 28. Erythroid hyperplasia with dyserythropoietic alterations was most common in patients with severe anaemia and low-grade parasitaemia. Conclusion Acute falciparum malaria is often associated with haematological alterations. Anaemia and thrombocytopenia were the most expected alterations associated with disease prognosis and mortality.

Do pregnant persons want influenza vaccines? Knowledge, attitudes, perceptions, and practices toward influenza vaccines in 8 low- and middle-income countries.

While vaccination is the most effective way to prevent influenza infection and adverse outcomes, and despite WHO recommendations to vaccinate pregnant persons, access to seasonal influenza vaccines remains low. We explored knowledge, attitudes, and practices of pregnant persons about seasonal influenza vaccines to inform actions to improve vaccine uptake among this priority population. We pooled individual-level data from cross-sectional surveys assessing pregnant persons' attitudes toward seasonal influenza vaccines in eight low- and middle-income countries during 2018-2019. The eight countries used a standard protocol and questionnaire to measure attitudes and intents toward influenza vaccination. We stratified by country-level (presence/absence of a national influenza vaccination program, country income group, geographic region) and individual-level factors. Our analysis included 8,556 pregnant persons from eight low- and middle-income countries with and without seasonal influenza vaccination programs. Most pregnant persons (6,323, 74%) were willing to receive influenza vaccine if it was offered for free. Willingness differed by presence of an existing influenza vaccination program; acceptance was higher in countries without influenza vaccination programs (2,383, 89%) than in those with such programs (3,940, 67%, p < 0.001). Most pregnant persons in middle-income countries, regardless of influenza vaccination program status, were willing to be vaccinated against influenza if the vaccine was provided free of charge. National investments in influenza vaccination programs may be well-received by pregnant persons, leading to averted illness both in pregnant persons themselves and in their newborn babies. US Centers for Disease Control and Prevention.

Commodity prices and economic growth: Empirical evidence from countries with different income groups

The purpose of this paper is to examine the effect of global commodity prices such as beverage, energy, fertilizer, food, metal and mineral, precious metal and agricultural raw material on GDP per capita of countries with different income levels which are low, lower-middle, upper-middle, and high. The results of the study using panel system GMM method over the period 2007–2021 showed that for all income group countries, the impact of energy and fertilizer prices on GDP per capita is negative, while the impact of food and metal and mineral prices is positive on GDP per capita. The study also found that rising prices of agricultural raw materials reduces GDP per capita of all income group countries except lower-middle income countries. Moreover, according to the results of the study, rising beverage prices increased the GDP per capita only of high-income countries, while rising precious metal prices decreased the GDP per capita of lower-middle and high-income countries. The study revealed that price changes in all commodity groups have an impact on the GDP per capita of high-income countries. It is demonstrated that price changes in all commodity groups have an impact in both directions on the GDP per capita of all income groups, depending on whether they are net producers or net consumers. The results of the study showed that, contrary to the literature, the countries most affected by commodity prices are high-income countries. Based on the empirical findings, this study point to the need for international cooperation to minimize the adverse effects of commodity price changes.

Exploring Sense of Purpose and Conscientiousness as Correlates to Health and Well-Being With Indigenous and Low Socioeconomic Communities on Coast Salish Territories, Vancouver, Canada.

Research is needed to better understand factors promoting health and well-being with Indigenous Peoples and people with socioeconomic barriers in Canada, given they face multiple social determinants that are barriers to health. Individual dispositions, sense of purpose and conscientiousness, are known to predict health and well-being in broader samples. In a community-based approach, guided by Indigenous Elders with traditional ways of knowing, we aimed to determine whether these measures correlate with self-rated health and well-being among Indigenous (n = 149) and non-Indigenous (n = 151) Peoples in Vancouver, Canada. The majority of participants (mean age 49 years, and 58% male) had relatively low income (≤$15,000/year) and educational attainment (<high school). Factors were valid and reliable in all groups. Mean scores were similar between Indigenous and non-Indigenous groups, and lower among participants with lower than with higher income. Correlations were similar between Indigenous and non-Indigenous groups: purpose significantly correlated with health (SF-6; 0.34 and 0.28, p < .001) and life satisfaction (0.55 and 0.58, p < .001), and conscientiousness with health (0.19 and 0.18, p < .05). Correlations were similar between income groups. When exploring and promoting the health, equity, and well-being of Indigenous and low socioeconomic status communities, purpose and personal disposition are factors to consider alongside social determinants of health.

A Cross-Sectional Study of Mental Illnesses Among Infertile Women in Saudi Arabia.

Infertility is a global issue and carries significant mental health implications. Data on mental health among infertile women in Saudi Arabia are limited. This study aimed to assess the prevalence and severity of depression, anxiety, and stress among infertile women in Saudi Arabia. This analytical cross-sectional study included women of reproductive age visiting governmental hospitals in Jeddah, Saudi Arabia. The participants were asked to fill out a pre-structured questionnaire, which included the Depression, Anxiety, and Stress Scale (DASS-21) to assess their mental health status. Data analysis was conducted using IBM SPSS Statistics, Version 29.0 (released 2023, IBM Corp., Armonk, NY). The three outcome variables derived from the DASS-21 were categorized into five distinct groups for descriptive purposes. In this study, infertile women had significantly higher median scores for depression (18), anxiety (15), and stress (20) compared to fertile women who had median scores of 8, 8, and 10 for depression, anxiety, and stress, respectively. The differences between these two groups were statistically significant (p-value < 0.001). Furthermore, employed infertile women reported higher median scores for depression (87), anxiety (84.5), and stress (84.5) compared to unemployed women. In addition, infertile women with a monthly income of 10,001-20,000 SAR had notably higher median scores for depression (89.56), anxiety (90.22), and stress (89.94) compared to other income groups. These differences were statistically significant (p-values < 0.05). Infertility significantly contributes to mental health issues among women in Saudi Arabia. The findings highlight the need for targeted psychological interventions alongside infertility treatment to enhance the quality of life of these women.

Household Health Care Payments Under Rate Setting, Spending Growth Target, and Single-Payer Policies

Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households. To estimate the distribution of household health care payments across income under health care reform policies. Cross-sectional study with microsimulation used nationally representative data of the US population in 2030. Civilian, noninstitutionalized population from the 2022 Current Population Survey linked to expenditures from the 2018 and 2019 Medical Expenditure Panel Survey and 2022 National Health Expenditure Accounts were included. Rate regulation of hospital, physician, and other health care professional payments equal to the all-payer mean in the status quo, spending growth target at 4% annual per capita growth, and single-payer health care financed through taxes. Household health care payments (out-of-pocket expenses, premiums, and taxes) as a share of compensation. The synthetic population contained 154 456 records representing 339.5 million individuals, with 51% female, 7% Asian, 14% Black, 18% Hispanic White, 56% non-Hispanic White, and 5% other races and ethnicities (American Indian or Alaskan Native only; Native Hawaiian or other Pacific Islander only; and 2 or more races). In the status quo, mean household health care payments as a share of compensation was 24% to 27% (standard error [SE], 0.2%-1.2%) across income groups (median [IQR] 22% [4%-52%] below 139% of the federal poverty level [FPL]; 21% [4%-34%] for households above 1000% FPL [11% of the population]). Under rate setting, mean (SE) payments by households above 1000% FPL increased to 29% (0.6%) (median [IQR], 22% [6%-35%]) and decreased to 23% to 25% for other income groups. Under the spending growth target, mean (SE) payments decreased from 23% to 26% (SE, 0.2%-1.2%) across income groups. Under the single-payer system, mean (SE) payments declined to 15% (0.7%) (median [IQR], 4% [0%-30%]) for those below 139% FPL and increased to 31% (0.6%) (median [IQR], 23% [3%-39%]) for those above 1000% FPL. Uninsurance fell from 9% to 6% under rate setting due to improved Medicaid access, and to zero under the single-payer system. Single-payer financing based on the current federal income tax schedule and a payroll tax could substantially increase progressivity of household payments by income. Rate setting led to slight increases in payments by higher-income households, who financed higher payment rates in Medicare and Medicaid. Spending growth targets reduced payments slightly for all households.

Beyond borders: an appraisal of the global congenital cardiac surgery workforce.

Congenital heart disease (CHD) is the most common congenital abnormality worldwide. Patients in resource-constrained environments experience higher levels of mortality and morbidity from CHD. Many studies have quantified the incidence of CHD in resource-constrained environments and compared these to availability of surgeons per population. However, no study to date has compiled and created a repository of the global paediatric cardiac surgical workforce. We aimed to quantify the number and details of the congenital cardiac surgeons globally, compare the population of under 15's in each respective countries, and address the workforce gaps that currently exist within paediatric cardiac surgery. Cardiothoracic Surgery Network (CTSNet) was searched in 2021 to extrapolate the current paediatric cardiac surgical workforce. The data was evaluated with the current literature to address current gaps in workforce planning and sustainability to produce this appraisal. A total of 4,027 congenital cardiac surgeons were identified from CTSNet with 75% residing in high-income countries (HICs) or upper-middle-income countries (UMICs) despite these income groups only accounting for 16% of the world population. Despite similar incidence and prevalence of CHD globally, we found an unequal distribution in the availability of congenital cardiac surgeons worldwide. The disparity in the availability of surgeons between HICs and low-middle-income countries (LMICs) is a global health issue that will require serous thought and planning to resolve. The high proportion of preventable deaths from CHD cases is a regrettable figure that governments and medical organisations should further strive to decrease. Education and proactive investments in training up local teams in LMICs will allow for sustainability in global congenital cardiac surgery.

The Influence of Financial Inclusion and Internet Access on the Income of Poor Households

West Java is the most populous province and has high levels of unemployment and poverty in Indonesia. This research analyzes the impact of financial inclusion and internet access on poor households' income in West Java. The study uses data from the March 2022 Social and Economic Survey by the Indonesian Central Bureau of Statistics and applies an econometric model. The analysis introduces a novel approach by categorizing poverty based on the poverty line, specifically targeting the lowest 20% and 40% of income-earning households. This method allows for a deeper understanding of financial inclusion and internet access's impact on these segments. The findings highlight that financial inclusion and internet access positively influence the income of poor households. Specifically, savings ownership increases the income of poor households. Access to credit positively affects income for the lowest 40% income bracket. However, internet access mainly influences sales and purchases within the 40% lowest income group, with limited use in purchasing activities.