Higher Expenditure Research Articles

Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study.

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.

Wastewater-Based Epidemiology for Viral Surveillance from an Endemic Perspective: Evidence and Challenges.

Wastewater-based epidemiology (WBE) is currently used to monitor not only the spread of the viral SARS-CoV-2 pandemic but also that of other viruses in endemic conditions, particularly in the absence of syndromic surveillance. The continuous monitoring of sewage requires high expenditure and significant time investments, highlighting the need for standardized methods and structured monitoring strategies. In this context, we conducted weekly wastewater monitoring in northwestern Tuscany (Italy) and targeted human adenovirus (HAdV), norovirus genogroup II (NoVggII), enterovirus (EV), and SARS-CoV-2. Samples were collected at the entrances of treatment plants and concentrated using PEG/NaCl precipitation, and viral nucleic acids were extracted and detected through real-time reverse transcription qPCR. NoVggII was the most identified target (84.4%), followed by HAdV, SARS-CoV-2, and EV. Only HAdV and EV exhibited seasonal peaks in spring and summer. Compared with data that were previously collected in the same study area (from February 2021 to September 2021), the results for SARS-CoV-2 revealed a shift from an epidemic to an endemic pattern, at least in the region under investigation, which was likely due to viral mutations that led to the spreading of new variants with increased resistance to summer environmental conditions. In conclusion, using standardized methods and an efficient monitoring strategy, WBE proves valuable for viral surveillance in pandemic and epidemic scenarios, enabling the identification of temporal-local distribution patterns that are useful for making informed public health decisions.

Energy-efficient regeneration routing in satellite optical networks under translucent optical payload architectures.

The translucent optical payload architecture is most economical and feasible for optical switching in the satellite optical network (SON) using laser inter-satellite links (LISLs), where the wavelength division multiplexing (WDM) technology enables lightpaths to transparently pass through relay satellites, minimizing on-board processing. For the long-distance lightpath in SONs, lightpath regeneration is necessary to ensure the acceptable quality of transmission (QoT), where optical-electrical-optical (OEO) conversion causes non-negligible energy consumption. The rechargeable battery is an important component for low-earth-orbit (LEO) satellites, and unrestrained use batteries at a deep depth of discharge (DOD) will accelerate battery aging and shorten satellite lifetime, causing extremely high expenditure costs. How to improve energy efficiency in lightpath regeneration is a key problem in SONs, which has no related studies. This paper proposes energy-efficient regeneration routing (EE-RR) in SONs under translucent optical payload architectures, which is to reduce the battery life consumption of lightpath regeneration. We define the maximum bypass hops (MBH) to ensure the bit error rate (BER) requirement of lightpaths in SONs, considering the noise accumulation of amplifier spontaneous emission (ASE) and Doppler shift (DS) crosstalk. Two greedy baselines are proposed for EE-RR, which are the regeneration routing scheme minimizing the number of regeneration nodes (RRS-MRN) and the regeneration routing scheme minimizing single satellite's battery life consumption (RRS-MBL), respectively. Based on two greedy baselines, the regeneration routing scheme using genetic algorithms (RRSGA) is developed to improve the optimization ability of EE-RR. To our knowledge, this is the first study to propose taking battery aging into account in lightpath regeneration in SONs. Through numerical simulation, we find that blindly reducing the number of regeneration nodes in lightpaths may not reduce overall battery life consumption, and RRSGA can effectively reduce battery life consumption of lightpath regeneration in SONs.

Effect of Behavioral Health Disorders on Surgical Outcomes in Cancer Patients.

Behavioral health disorders (BHDs) can often be exacerbated in the setting of cancer. We sought to define the prevalence of BHD among cancer patients and characterize the association of BHD with surgical outcomes. Patients diagnosed with lung, esophageal, gastric, liver, pancreatic, and colorectal cancer between 2018 and 2021 were identified within Medicare Standard Analytic Files. Data on BHD defined as substance abuse, eating disorder, or sleep disorder were obtained. Postoperative textbook outcomes (ie no complications, prolonged length of stay, 90-day readmission, or 90-day mortality), as well as in-hospital expenditures and overall survival were assessed. Among 694,836 cancer patients, 46,719 (6.7%) patients had at least 1 BHD. Patients with BHD were less likely to undergo resection (no BHD: 23.4% vs BHD: 20.3%; p < 0.001). Among surgical patients, individuals with BHD had higher odds of a complication (odds ratio [OR] 1.32 [1.26 to 1.39]), prolonged length of stay (OR 1.36 [1.29 to 1.43]), and 90-day readmission (OR 1.57 [1.50 to 1.65]) independent of social vulnerability or hospital-volume status resulting in lower odds to achieve a TO (OR 0.66 [0.63 to 0.69]). Surgical patients with BHD also had higher in-hospital expenditures (no BHD: $16,159 vs BHD: $17,432; p < 0.001). Of note, patients with BHD had worse long-term postoperative survival (median, no BHD: 46.6 [45.9 to 46.7] vs BHD: 37.1 [35.6 to 38.7] months) even after controlling for other clinical factors (hazard ratio 1.26 [1.22 to 1.31], p < 0.001). BHD was associated with lower likelihood to achieve a postoperative textbook outcome, higher expenditures, as well as worse prognosis. Initiatives to target BHD are needed to improve outcomes of cancer patients undergoing surgery.

Assessing Nutrition Risk among Patients in Sarawak General Hospital using Malnutrition Screening Tool (MST)

Introduction: Malnutrition in hospitalised patients is a problem that is frequently observed all around the world. Malnutrition in hospitalised patients is related to poor patient outcomes and high healthcare expenditures. The purpose of this study is to assess the nutrition risk and explore the associated risk factors of malnutrition among hospitalised patient. Methods: A cross-sectional study was done in Sarawak General Hospital located in Kuching, Sarawak using convenience sampling among adult aged 18 and above. The Malnutrition Screening Tool (MST) was used to assess the nutritional risk. Demographic characteristics, anthropometric and biochemical data were compared according to nutritional status. The chi-square test was performed to compare the differences between categorical variables. The risk factors of malnutrition were identified using logistic regression analysis. Result: A total of 207 respondents were involved in this study with 63.3% and 36.7% were male and female, respectively. Malnutrition risk was observed in 61.3% of respondents according to MST score. The malnutrition risk was significantly higher in older age, those who were admitted to oncology wards and those with lower BMI and impaired biochemical profile. Multivariate analysis revealed that age and BMI of less than 18.5 kg/m2 were the main factors contributing to the presence of risk of malnutrition. Conclusion: The risk of malnutrition is observed to be prevalent among hospitalised patients in Sarawak General Hospital. Therefore, it is important to have a routine nutritional screening and assessment to allow for early nutritional intervention and therapy.

The highest-cost Medicaid enrollees with sickle cell disease had annual health care expenditures nearing $200 000.

Sickle cell disease (SCD) is a painful chronic blood disorder that causes serious complications and comorbidities, often leading to premature death. SCD impacts millions of people worldwide, including an estimated 100 000 in the United States, most of whom are Black or Latino. We analyzed Medicaid enrollment, claims, and encounter data via the Transformed Medicaid Statistical Information System (T-MSIS) to examine the 2021 health care utilization and spending of Medicaid enrollees with SCD. Our analysis found that Medicaid enrollees with SCD have high annual medical and pharmacy expenditures that are not evenly distributed across the population. Among the most severe enrollees with genotypes eligible for clinical trials, those in the top 5% of health care spending incurred, on average, nearly $200 000 per year for this chronic condition.

Water Pollution and Its Correlation to Mineral Water Consumption Expenditure

Water is a basic need for human life. However, challenges of access to clean and healthy water are increasingly being by pollution. This condition forces households to pay for clean and healthy mineral water. This study examines the distribution of water pollution levels and household mineral water consumption in Indonesia. It examines the relationship between water pollution and the spending the household mineral water consumption. The data used in this study are water pollution level data for 2021 from the raw data of PODES 2021 and spending of consumption the household mineral water data from the raw data of the SUSENAS 2021. Both data were analyzed using correlation analysis to calculate the r value. Then the data is presented in a map of the distribution of water pollution and mineral water consumption spending by districts in Indonesia. The results showed that the correlation of the two variables had a positive value of 0.026. Even though the relationship is not very strong, this proves that the higher the water pollution, the greater the spending for household consumption of mineral water.. Kalimantan Island is an area with a high water pollution level. In the distribution of mineral water consumption expenditure for households, Indonesia is classified as having a low consumption level, while DKI Jakarta Province is an area that has high mineral water consumption expenditure of an average of IDR 183,396/month.

Equalization through the People’s Republic of China’s Intergovernmental Fiscal System: The Effectiveness of Central and Provincial Transfers

The People’s Republic of China’s (PRC) fiscal system is characterized by very high expenditure decentralization and heavy reliance on transfers to finance public services. The government’s embrace of inclusiveness and equalization as national goals has raised questions about whether transfers can deliver equalization. This paper seeks to answer this question by analyzing newly available fiscal data compiled from government websites. We find the allocation of central transfers remains strongly region based, resulting in high intra-regional inequality among provinces. Poorer provinces also tend to retain more central transfers at their own (provincial) level. Those provinces with greater pretransfer inequality tend to exert greater equalization efforts, but these are not necessarily proportional to their pretransfer inequality. As a result, some localities are left out of the PRC’s countrywide equalization program. These equalization patterns remained highly persistent during the coronavirus disease shock in 2020. Collectively, the findings highlight that the PRC’s complex intergovernmental fiscal system still poses challenges for equalization.

Exploring the feasibility of a gambling harm screening model in general practice and community service settings in Fairfield: a pilot study.

Gambling is a growing public health issue in Australia. However, limited research has examined the role of primary health care and social services in routine screening for gambling harm in Australia. This research aimed to explore the enablers and barriers to implementing a co-designed gambling screening model in Fairfield, New South Wales - an area with high gambling expenditure. A co-designed gambling screening and referral model for GP and community-based organisations was implemented in Fairfield in 2020. Follow-up interviews were conducted with nine health care professionals who implemented the screening in 130 patients. Thematic analysis generated key barriers and enablers for implementation of this model. Key enablers for the screening model implementation included structural factors (alignment of the screening model with current work), process factors and staffing factors (staff empowerment). However, we also noted process factors as a barrier to implementation, particularly the referral pathway following screening. Other barriers included social and structural factors, such as the complexity of gambling harm and project funding. Embedding routine screening in primary and community care settings can play a role in treating, reducing and preventing gambling-related harm, and reducing stigma in Fairfield and beyond. Additionally, screening models such as this provide health systems with clear evidence on the level of gambling harm in their community (particularly important in culturally and linguistically diverse communities who are underrepresented in research). This evidence is important for addressing system-level drivers of harm and advocating for political reform to reduce the impact of gambling on communities.

Characteristics of non-exercise activity thermogenesis in male collegiate athletes under real-life conditions.

Athletes experience high total energy expenditure; therefore, it is important to understand the characteristics of the components contributing to this expenditure. To date, few studies have examined particularly the volume and activity intensity of non-exercise activity thermogenesis (NEAT) in athletes compared to non-athletes under real-life conditions. This study aimed to determine the volume and intensity of NEAT in collegiate athletes. Highly trained Japanese male collegiate athletes (n = 21) and healthy sedentary male students (n = 12) participated in this study. All measurements were obtained during the athletes' regular training season under real-life conditions. NEAT was calculated using metabolic equivalent (MET) data using an accelerometer. The participants were asked to wear a validated triaxial accelerometer for 7 consecutive days. Physical activity intensity in NEAT was classified into sedentary (1.0-1.5 METs), light (1.6-2.9 METs), moderate (3.0-5.9 METs), and vigorous (≥6 METs) intensity. NEAT was significantly higher in athletes than in non-athletes (821 ± 185 kcal/day vs. 643 ± 164 kcal/day, p = 0.009). Although there was no significant difference in NEAT values relative to body weight (BW) between the groups (athletes: 10.5 ± 1.7 kcal/kg BW/day, non-athletes: 10.4 ± 2.2 kcal/kg BW/day, p = 0.939), NEAT to BW per hour was significantly higher in athletes than in non-athletes (0.81 ± 0.16 kcal/kg BW/h vs. 0.66 ± 0.12 kcal/kg BW/h, p = 0.013). Athletes spent less time in sedentary and light-intensity activities and more time in vigorous-intensity activities than non-athletes (p < 0.001, p = 0.019, and p = 0.030, respectively). Athletes expended more energy on vigorous- and moderate-intensity activities than non-athletes (p = 0.009 and p = 0.011, respectively). This study suggests that athletes' NEAT relative to BW per day is similar to that of non-athletes, but athletes spend less time on NEAT, which makes them more active in their daily lives when not exercising and sleeping.

Impact of the COVID-19 Pandemic on Diabetic Foot Patients: A Shift in the Infectious Agent Profile Toward Nonfermentative Gram-Negative Bacilli.

Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality. This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]). During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP. The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.

OECD Ülkelerinde Askeri Harcamaların Gelişmişliğe Yansımaları

It is argued that the military expenditures have negative effects on economic development, most probably, due to the diversion of the country’s resources to the unproductive sectors and its adverse impact on civilian production and welfare level. Nevertheless, it is also recognized that the military expenditures, when coupled with openness to innovation and its evolution into civilian sectors, can contribute to sustainable development. This study investigates the functioning of the mechanism of transforming military expenditures into R&amp;D, R&amp;D into patents and patents into income for the period 1995-2020 for 32 OECD member countries with data available, through the Phillips and Sul (2007, 2009) club convergence analysis. The findings reveal that the countries in the first group with a high military expenditure share within GDP such as Australia, Canada, South Korea, and the United States, engage in military expenditures within the context of development and innovation hypotheses. On the other hand, findings show that the countries also in the first group such as Chile, Colombia, Greece, Portugal, and Türkiye, make their military expenditures with the aim of coping with external threats and deterrence, and this situation, by leading to an inefficiency of the resource utilization, results in these countries’ staying within the undeveloped group. Based on the findings of the study, it is concluded that, in countries exceeding a certain level of development, military expenditures can contribute to the development of the strategic sectors by stimulating civil sectors and foster the sustainable development of the countries through the direction of this to the high-technology fields.

The Impact of the Physical Activity Level on Sarcopenic Obesity in Community-Dwelling Older Adults

Previous studies have reported that low levels of physical activity result in sarcopenic obesity (SO). However, the effects of specific intensities of physical activity on SO and the optimal amount of physical activity for lowering the prevalence of SO have not been well studied. This study aimed to identify the effects of physical activity levels and intensity on SO and the optimal amount of physical activity related to a lower prevalence of SO. This cross-sectional study used data from the nationwide Korean Frailty and Aging Cohort Study (KFACS), which included 2071 older adults (1030 men, 1041 women). SO was defined according to the criteria of the European Society for Clinical Nutrition Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Multivariate logistic regression analysis was performed to investigate the association between the physical activity level and SO. The high activity group had a significantly lower prevalence of SO than the non-high activity (low and moderate activity) group. On the other hand, moderate-intensity physical activity was associated with a lower prevalence of SO. A total physical activity energy expenditure of &gt; 3032 kcal/week (433 kcal/day) for men and 2730 kcal/week (390 kcal/day) for women was associated with a reduced prevalence of SO. The high physical activity and total physical energy expenditure described above may be beneficial for reducing the prevalence of SO.

Outpatient depression current care expenditure changes in Liaoning Province from 2015 to 2020: a study based on the "system of health accounts 2011".

Introduction: Depression is the leading cause of disability worldwide and has become a health issue of global concern. Based on the "System of Health Accounts 2011" (SHA 2011) for patients with depression, this paper studies the changes in the current curative expenditure (CCE) of outpatient depression in Liaoning Province, China, and provides policy recommendations. Method: A stratified multistage random sample of 56,994 patients with depression included from 1,227 healthcare facilities in Liaoning Province were included. The significance of differences in variables within groups was analyzed by univariate analysis (including descriptive statistics analysis, Mann-Whitney U test and Kruskal-Wallis H test), and factors influencing depression outpatient CCE were analyzed by multiple linear regression analysis and constructing structural equation models (SEM). Results: The CCE of outpatient depression was ranging from CNY 75.57 million to CNY 100.53 million in 2015-2020, with the highest of CNY 100.53 million in 2018, CNY 103.28 million in 2019. Medical expenditures are mainly concentrated in general hospitals and provincial healthcare institutions, accounting for about 90% of all provincial scope expenditures. The multiple regression results show that provincial healthcare institutions, purchase of drug, select medical treatment for depression, general hospitals and urban employees' health insurance are the main influencing factors for depression outpatient CCE. The results of SEM show that insurance status negative impact outpatient expenditure. Conclusion: Health insurance is an important factor in equitable access to healthcare resources for patients, and medication expenditure is the influential factor affecting the high expenditure of outpatient clinics. It is of great importance to reduce the medical burden of patients by increasing the coverage of medical insurance, increasing the proportion of bills that are eligible for reimbursement, and improving the system by guaranteeing the supply of psychotropic medication.

Cancer mortality-to-incidence ratio among Iraqi citizens: Nine-year National Estimates (2012-2020) and its relation to population growth rate and health expenditure.

Cancer continues to be a significant worldwide health concern with substantial mortality. The cancer mortality-to-incidence ratio (MIR), a proxy measure of observed five-year survival, can serve as a valuable indicator of cancer management outcomes and healthcare disparities among countries. This study aims to determine the MIR trend for all cancers combined among Iraqi citizens during 2012-2020 for health expenditure percentages out of the gross domestic product (e/GDP (%)) and population growth rate. The study used the Iraqi Cancer Registry annual reports for cancer data and World Bank data for health expenditure and population growth. Simple linear regression analysis examined the relationship between health expenditure, growth rate, and MIR, while joinpoint regression analysis examined the trend over time. The Ethics Committee of the College of Medicine at the University of Basrah approved the study. An increasing trend in crude incidence rates for all cancer types combined was seen with a decrease in mortality rates from 2012 to 2020 in both sexes. A non-statistically significant reduction in MIR was found with an average annual percent change (AAPC) of -3.1% (P = 0.100). The decrease in MIR was higher among females than males, with a statistically significant difference (P = 0.003). High health expenditure presented as e/GDP (%) was associated with a favorable cancer survival rate, but this was not statistically significant (R2 = 0.263, P = 0.158). In contrast, a low growth rate was significantly associated with cancer patients' survival (R2 = 0.505, P = 0.032). As indicated by the MIR and the MIR complement (1-MIR), the proxy five-year survival rate is improving in Iraq with time. Although not statistically significant, high health expenditure favorably affected overall cancer survival. A low growth rate, on the other hand, significantly improves cancer patients' survival.

Energy Requirements of Paralympic Athletes: Insights from the Doubly Labeled Water Approach.

Advanced insight in energy requirements of Paralympic athletes is imperative for optimizing their nutritional counseling. Given the lack of accurate data on total daily energy expenditure (TDEE) of Paralympic athletes, this study aimed to assess energy expenditure and nutritional intake of a large cohort of Paralympic athletes, across different sports and disabilities. In this cross-sectional study, 48 Dutch and Norwegian Paralympic athletes (19 male/29 female) with various disabilities, competing in Para cycling, wheelchair tennis, wheelchair basketball, Para Nordic skiing, and alpine skiing participated. TDEE was assessed by the gold standard doubly labeled water method over a 14-d period, resting metabolic rate by ventilated hood indirect calorimetry, energy intake by three unannounced 24-h dietary recalls, body composition by dual-energy x-ray absorptiometry, and exercise training duration by a training log. Mean TDEE was 2908 ± 797 kcal·d -1 , ranging from 2322 ± 340 kcal·d -1 for wheelchair basketball players to 3607 ± 1001 kcal·d -1 for Para cyclists. Regression analysis identified fat-free mass, exercise duration, and the presence of a spinal cord disorder as the primary predictors of TDEE, explaining up to 73% of the variance in TDEE. Athletes' energy intake (2363 ± 905 kcal·d -1 ) was below their TDEE, whereas their body mass remained constant, indicating underreporting. Carbohydrate intake (4.1 ± 1.9 g·kg -1 body mass) was low, even when considering underreporting, whereas protein intake (1.8 ± 0.6 g·kg -1 body mass) was relatively high. Paralympic athletes display moderate- to high-energy expenditure, varying across sports and individuals. Much of the variation in TDEE can be attributed to individual differences in fat-free mass and exercise duration. This study establishes the benchmarks for energy requirements of Paralympic athletes, serving as the foundation for future dietary guidelines within this population.

Is there a relationship between housing deprivation and crime? Evidence for the Spanish case

Purpose Crime increased in Spain during the period of 2017–2019 after a decade of decline. This coincides with severe housing deprivation multiplying by three in just four years, affecting 3.4% of the population in 2020. However, no research has been found that analyzes whether this deterioration of the physical conditions of housing and its environmental elements has impacted the level of crime in Spain. This study aims to analyze how housing deprivation affects crime in the Spanish context. Design/methodology/approach For this purpose, different items that are considered by Eurostat as elements of housing deprivation are used. The difference generalized method of moments estimator is used for 16 Spanish regions that comprises the period from 2013 to 2019. Findings The results suggest that certain structural and environmental elements of housing are positively associated with crime: space (0.5% and 0.4%) and high housing expenditure (0.4% and 0.5%) are positively correlated with the two dependent variables; the lack of light and overcrowding stand out as they establish a positive and statistically significant association with four out of the six analyzed crime categories; the absence of lighting effect reaches up to 1.8% and 1.7% in the case of violent robberies and vehicle theft, respectively. Finally, pollution is negatively associated with robbery with violence (−1.9%), theft (−0.7%) and robbery with force (−0.5%). Originality/value To the best of the author’s knowledge, this is the first study that examines whether this deterioration of the physical conditions of housing has impacted the level of crime in Spain. It is also pioneering at the European level by using nonmonetary dimensions of inequality such as housing.

Prevalence And Risk Factors Associated with Musculoskeletal Discomfort among Vegetable Street Vendors

Background: The common health problem among workers is musculoskeletal disorders due to intensive manualwork(1). Pain, stiffness, swelling are the symptoms of musculoskeletal disorders(1)..High energy expenditures,heavy spinal loading during lifting and carrying, highly repetitive movements and crawling, stooping andother difficult work postures are require at field work and for material handling(14).Aim: To determine the prevalence and risk factors associated with musculoskeletal discomfort among vegetablestreet vendors.Objectives: To find out prevalence of musculoskeletal discomfort in vegetable street vendors by using NordicMusculoskeletal questionnaire.To find out correlation between personal factors, working factors and musculoskeletal discomfort.Materials and methodology: 125 Vegetable vendors were participated in this study. Age range between 18-60years. Subjects having more than 5 years of experience are included.They were given consent form ,screeningform and Nordic musculoskeletal questionnaire and the area of pain was marked by them on scale. The data wastaken on excel sheet and data analysis was done then results were calculated.Result: The prevalence of 69.60% was obtained in vegetable street vendors. The most body part involved arelower back 44.80% , ankle/feet 32% ,the least affected body parts are elbows and wrist/hands. The musculoskeletaldiscomfort is positively associated with gender, age and not associated with other factors such asBMI, work experience, working hours/day,working days/week, excessive repetition,sitting for long period atwork,etc.Conclusion: According to the present study there is a high prevalence of musculoskeletal disorders among vegetablestreet vendors in latur city. The commonly affected body region are lower back, ankle/feet and knees.

Evaluation for the effect of low-carbon city pilot policy: evidence from industry in China.

The investigation of the implementation effect of the low-carbon city pilot (LCCP) policy in promoting industrial low-carbon development is important for economic growth and carbon reduction in China. This paper takes the industry sector as an independent investigation object, and aims to examine the effectiveness of the policy in improving industrial low-carbon development. The industrial total factor carbon emission efficiency index (ITFCEE) is constructed to measure the level of industrial low-carbon development by the global frontier directional distance function. From the perspective of the multiple participants of the policy, we analyze the mechanisms of the policy, and construct the time-varying difference-in-difference model to test how LCCP policy impacts the ITFCEE. We conclude that (1) LCCP policy improves significantly the ITFCEE. (2) Heterogeneity analysis results show that the positive influence of LCCP policy is significant in cities with high industrial carbon emission intensity, high industrial structure upgrading, and high government expenditure. (3) The result of the mechanism analysis is that LCCP policy can benefit the ITFCEE by promoting enterprise green technology innovation, public environment concern, government technology support, and administrative regulation.

The catastrophic cost of motorcycle road traffic injuries: Experience from a major reference centre in a lower-middle income country

BackgroundMotorcycle crashes are an increasing public health problem in low- and middle-income countries (LMICs). An accurate estimation of the economic burden of these crashes could be complex owing to a prevalent system of out-of-pocket (OOP) payment for health care services in these countries. Our study aims to objectively evaluate the cost implication of motorcycle Road Traffic Injuries (RTIs) among road crash victims managed at a major trauma reference hospital in Nigeria. Two economic evaluation methods were used to accurately reflect the cost-of-care (C-o-C) of each victim as well as for cross-validation. MethodThis is a prospective cohort study conducted between August 2020 and May 2021. All patients involved in motorcycle road traffic crashes presenting to the Emergency Department of the University College Hospital, Ibadan, Nigeria, were included in the study. For each patient, all medical expenses from the time of injury (T0) to 30 days after injury (T30) or Time to death (TD) – whichever occurred first, were valued in costs, and added (Activity-based costing or ABC), while also estimating overall cost-of-care (C-o-C) at T30 or TD, using the willingness-to-pay (WTP) method. Following the WHO definition, catastrophic expenditure was defined as expenditure > 25% of the patient's estimated annual household income. ResultsOf the 150 consecutively managed motorcycle crashes victims during the study period, 112 had complete data. The median monthly household income for the cohort was $121 with 75% of them earning less than $180. The median cost-of-care (C-o-C), by ABC, was $242 ($143 - 828). For individual care items, expenditure on surgical intervention(s) was the highest followed by prosthesis and implant procurement, and radiological investigations. On the other hand, the estimated medical cost was $2356 (IQR $938 - 6475) by WTP. Only 14% had health insurance coverage. The overall expenditure was catastrophic for 46% of the patients. Monthly household income of < $180 (AOR=9.2; 95% CI=2.6–32.8; p < 0.001), absence of health insurance coverage (AOR=10.7; 95% CI=1.1–101.6; p = 0.040), and prolonged hospital stay above 14 days (AOR=25.1; 95% CI=5.5 -115.1; p = 0.001) were predictors of catastrophic expenditure. There was a weak positive correlation between actual cost-of-care using the ABC method and WTP (r = 0.247; p = 0.102). ConclusionThe aggregate cost of motorcycle RTIs is catastrophic for nearly half of the victims attending the University College Hospital, Ibadan. The willingness-to-pay method, though less tedious is often less reliable in these settings owing to a prevalent OOP payment system. This study identified the need to implement effective financial protection mechanisms against the high OOP expenditure faced by motorcycle crash victims in LMICs.