Medium-term Changes Research Articles

Change of leisure activity participation and associations with cognitive frailty in older adults: A population-based longitudinal study

ObjectivesTo examine changes in leisure activity participation and their associations with cognitive frailty among older adults. MethodsThe study utilized data from the Chinese Longitudinal Healthy Longevity Survey covering 2008–2018. Three distinct intervals represented short-term (2008–2011), medium-term (2008–2014) and long-term (2008–2018) changes in leisure activity participation, and the change patterns of levels of leisure activities based on the tertile were described. Restricted cubic splines (RCS) were used to determine the inflection point of the absolute value of leisure activity participation over two time points. Group-based trajectory modeling identified trajectories of leisure activity participation among participants from 2008 to 2018. Logistic regression analysis examined how changes in leisure activity participation impacted cognitive frailty. ResultsFive patterns of change in leisure activity participation were identified, including the persistently low group, the declining (medium-low, high-low, high-medium) group, persistently medium, rising (low-medium, low-high, medium-high), and persistently high levels of activity. A lower risk of cognitive frailty was found among three groups of persistently medium, rising, and persistently high levels of activity across three distinct intervals and among the declining group over the short-term and long-term intervals but not in the medium-term interval than among the persistently low group, respectively. RCS analysis showed that the inflection point of the association between absolute changes in leisure activity and cognitive frailty was -2.11 (short-term), -0.9 (medium-term), and -3.94 (long-term). Leisure activity trajectories were categorized into persistently low, persistently moderate, and persistently high groups, and both the persistently moderate and persistently high groups exhibited a lower risk of cognitive frailty compared to the persistently low group. ConclusionPersistently moderate to high levels and increasing levels of leisure activities can reduce the risk of cognitive frailty in the short, medium, and long term, and even the declining in leisure activity participation less than the threshold could protect against cognitive frailty, particularly in the short and long term.

Periprosthetic bone mineral density, assessed using dual energy x-ray absorptiometry, following arthroplasty in patients with femoral neck fracture: 5-year outcomes of a randomized controlled trial.

The relationship between the surgical approach used for hemiarthroplasty and periprosthetic bone mineral density (BMD) is not well understood. We have previously described a decrease in BMD 1 year postoperatively. Here, we assessed the medium-term changes in periprosthetic BMD. We performed a follow-up study of patients with femoral neck fracture (FNF) who underwent uncemented hemiarthoplasty using a direct lateral or anterolateral approach. Dual-energy X-ray absorptiometry (DXA) was used to evaluate the changes in BMD in 23 patients over 5 years. A mean 6% loss of total BMD occurred over 1 year, but between 1 and 5 years, BMD was restored to the baseline value. The mean total BMD in the anterolateral group had decreased by 2% after 3 months and 3% after 12 months, and increased by 2% after 5 years, vs. decreases of 7%, 8%, and 3% for the direct lateral group. Between 1 and 5 years, BMD increased in Gruen zones 2, 3, 4, 5, and 6 in both groups. There was a significantly larger increase in zone 4 in the lateral group (4%) than the anterolateral group. The surgical approach affects periprosthetic BMD in patients with FNF. Furthermore, BMD is restored to the baseline value 5 years postoperatively.ClinicalTrials.gov registration number: NCT03753100.

Medium-term effects of rapid maxillary expansion on nasal cavity and pharyngeal airway volumes considering age as a factor: A retrospective study

ObjectivesThe medium-term effects of rapid maxillary expansion (RME) on nasal cavity (NC) and upper airway (UA) dimensions based on chronological age are still unclear. This retrospective study evaluated the medium-term changes occurring in the NC and pharyngeal airways (PA) after RME in two distinct age-based cohorts of patients. MethodsThis retrospective study included 48 subjects who underwent RME grouped in two cohorts: a 6–9-year-old group (EEG group: early expansion group - 25 subjects) and an 11–14-year-old group (LEG group: late expansion group - 23 subjects). NC and PA volumes were analyzed from CBCT imaging segmentation before RME (T0) and twelve months after RME (T1). The amount of maxillary expansion (PW) and minimal cross-sectional area (CSmin) were also considered. ResultsAll PAs’ volumetric sub-regions, CSmin and PW showed a significant volumetric increment (p < 0.05). Inter-group comparisons showed significant differences (p < 0.05) for nasopharynx and CSmin parameters (p < 0.05), while no significant changes were recorded for the other UA's sub-regions and PW (p > 0.05). According to a deviation analysis, part of the UA increase (more marked for the nasopharynx area) may have occurred due to reduced adenotonsillar tissues, which were larger in the EEG group. ConclusionsTwelve months after treatment, clinicians should not expect changes in the UAs dimensions to be solely related to treatment effects of RME; instead, normal craniofacial growth changes and spontaneous regression of the adenotonsillar tissue could represent the most significant factors influencing UAs changes. Clinical SignificanceFrom the clinical perspective, the results of the present study encourage caution when considering the therapeutic effects of RME on airways dimensions.

A qualitative inquiry into sustainable transitions and business models in Icelandic energy-related companies

In the face of escalating environmental and social crises, the potential for a sustainable transition within the current sociotechnical system has emerged through innovation and alternative technologies. Despite offering diverse perspectives, sustainable transitions remain uncertain in terms of their nature and pathways. The research aims to bridge theory and reality through a case study to investigate the potential for sector-specific businesses to contribute to a sustainable transition within the current sociotechnical system. This study focuses on five Icelandic energy-related companies and two governing bodies within the energy value chain, and examines the sustainability of companies' business models and their contributions to different futures, and contextualizes the results within economic theory. The study identified two alternative economic paradigms, Green Growth (GG) and Post Growth (PG), as potential frameworks for achieving sustainable futures. The findings suggest Icelandic energy-related companies align with GG and predominantly prioritize energy efficiency, transparency enhancement, and environmental impact reduction, reflecting contributions to medium-term tactical level changes within the sociotechnical system. Challenges arise in fully implementing PG principles due to the complexities of reconciling energy production, consumption, and growth goals. The findings underscore the pivotal role of energy-related companies in sustainable transitions but emphasize the need for policy interventions to guide macroeconomic activities towards environmental and social wellbeing. The theoretical contribution of this study is the identification of alternative economic paradigms and construction of a sustainable business model for energy related companies. The practical contribution of this study is the framework used in evaluating the business model of companies in the energy sector which can provide practical understandings of the implementation of sustainable business models and a company's sustainability performance.

Psychological precursors of epileptic seizures.

Psychological stress is the most commonly self-reported precursor of epileptic seizures. However, retrospective and prospective studies remain inconclusive in this regard. Here, we explored whether seizures would be preceded by significant changes in reported stressors or resource utilization. This study is based on high-frequency time series through daily online completion of personalized questionnaires of 9-24 items in epilepsy outpatients and compared responses 1-14 days before seizures with interictal time series. Fourteen patients (79% women, age = 23-64 years) completed daily questionnaires over a period of 87-898 days (median = 277 days = 9.2 months). A total of 4560 fully completed daily questionnaires were analyzed, 685 of which included reported seizure events. Statistically significant changes in preictal compared to interictal dynamics were found in 11 of 14 patients (79%) across 41 items (22% of all 187 items). In seven of 14 patients (50%), seizures were preceded by a significant mean increase of stressors and/or a significant mean decrease of resource utilization. This exploratory analysis of long-term prospective individual patient data on specific stressors and personal coping strategies generates the hypothesis that medium-term changes in psychological well-being may precede the occurrence of epileptic seizures in some patients.

Russian Short-Term Mortality Fluctuations Data Series

The COVID-19 pandemic has revealed significant gaps in the coverage and quality of the existing international and national statistical surveillance systems. The most reliable approach to estimating mortality associated with short-term risk factors or factors fluctuating within calendar years is based on estimating weekly excess mortality. Although this approach is obvious, its application turned out to be problematic due to the lack of reliable data. In response to this challenge, a new Short-Term Mortality Fluctuations (STMF) data series was created in 2020. The Russian Short-Term Mortality Fluctuations Data Series (RuSTMF) is a further development of the STMF idea at the regional level. It contains weekly crude and standardized death rates for the Russian regions and Russia as a whole. The main source for calculating death rates is depersonalized individual data on the deceased provided by the Rosstat. This database provides for the analysis of short- and medium-term changes in mortality in males, females and total population in Russia as a whole and its regions, as well as the estimation of «excess» deaths during short-term sharp increases in mortality due to, for example, heat or cold waves, seasonal influenza epidemics, the Covid-19 pandemic or technogenic catastrophes.

Mid-Term Electrical Remodeling after Percutaneous Atrial Septal Defect Closure with GCO Device in a Pediatric Population.

The GORE® CARDIOFORM (GCO) septal occluder is an atrial septal defect/patent foramen ovale closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance. Our aim was to evaluate the short- and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population. We enrolled 39 patients with isolated ASD submitted to trans-catheter closure from January 2020 to June 2021. ECG was performed before, at 24 h and 6 months after the procedure. P wave dispersion, QTc and QTc dispersion were calculated. ECG Holter was recorded at 6 months after implantation. Patients' age and body surface area (BSA) were 8.2 ± 4.2 years and 1.0 ± 0.3 m2 respectively. At the baseline, mean P wave dispersion was 40 ± 15 msec and decreased at 24 h (p < 0.002), without any further change at 6 months. At 24 h, PR conduction and QTc dispersion significantly improved (p = 0.018 and p < 0.02 respectively), while the absolute QTc value considerably improved after 6 months. During mid-term follow-up, QTc dispersion remained stable without a significant change in PR conduction. The baseline cardiac frequency was 88.6 ± 12.6 bpm, followed by a slight reduction at 24 h, with a further amelioration at 6 months after the procedure (87.3 ± 14.2, p = 0.9 and 81.0 ± 12.7, p = 0.009, respectively). After device deployment, two patients developed transient, self-limited junctional rhythm. One of them needed a short course of Flecainide for atrial ectopic tachycardia. No tachy/brady-arrhythmias were recorded at the 6-month follow-up. ASD closure resulted in a marked decrease in right heart volumes and diameters at 6 months after percutaneous closure. Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium-term follow-up. These electrical changes are associated with a documented positive right heart volumetric remodeling at mid-term follow-up.

Research on future demographic trends based on the Chinese population growth model

Population development plays a vital role in the healthy and orderly operation of our country. To understand the new trends and characteristics of population change can effectively grasp the basic national condition of population and promote the high-quality development of China's economy. Based on the new characteristics and influencing factors of China's population, this paper establishes the mathematical model of China's population growth in the new era, and predicts the change trend of short-term and long-term population in China. First, we adopt the classical GM (1,1) model to predict the short-and medium-term demographic changes, and the fitting effect is very good. Then, in the long-term prediction, based on China's population policy and the future trend of population development, we choose the logistic population block growth model, which also got relatively good results. Next, we selected the representative five provinces of Guangdong, Zhejiang, Hubei, Heilongjiang and Inner Mongolia for comparative analysis according to the above model, and concluded that the correlation coefficient of people such as age structure, urbanization rate, birth and mortality were the main factors affecting population change. Finally, we put forward corresponding policy suggestions by changing the age structure, urbanization rate, sex ratio model correlation coefficient, combined with our country's recent population policy.

Medium-term and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation.

Objective: Atrial Fibrillation (AF) and chronic kidney disease frequently coexist in the elderly. Warfarin-like drugs (WLDs) may be associated with a relatively greater decrease of estimated glomerular filtration rate (eGFR) as compared to direct oral anticoagulants (DOACs), but there is no evidence on the medium- and long-term changes. To further elucidate this issue in elderly patients with AF, we investigated the renal function deterioration in the two groups of the study (DOACs or WLDs). Patients and Methods: A total of 420 AF patients were enrolled (mean age: 77.0 ± 6.0 years; 136 on WLDs and 284 on DOACs). These patients underwent three eGFR measurements during the follow-up period. The between-arms difference of eGFR decline over time was investigated by Linear Mixed Models and group-based trajectory model analyses. Results: In the whole study cohort, after a median follow-up of 4.9 years (interquartile range: 2.7-7.0 years), eGFR decreased from 67.4 ± 18.2 to 47.1 ± 14.3mL/min/1.73m2 (p < 0.001). Remarkably, patients on DOACs experienced a significantly smaller eGFR decline than WLDs patients (-21.3% vs. -45.1%, p < 0.001) and this was true both in the medium-term (-6.6 vs. -19.9mL/min/1.73m2) and in the long-term (-13.5 versus -34.2mL/min/1.73m2) period. After stratification into five subgroups according to trajectories of renal function decline over time, logistic regression showed that DOACs patients had from 3.03 to 4.24-fold greater likelihood to belong to the trajectory with less marked eGFR decline over time than WLDs patients. Conclusion: Elderly patients with AF on treatment with DOACs had a relatively smaller decline of eGFR over time compared to those on treatment with WLDs. This is consistent with what was partly reported in the literature.

Computationally-defined markers of uncertainty aversion predict emotional responses during a global pandemic.

Exposure to stressful life events involving threat and uncertainty often results in the development of anxiety. However, the factors that confer risk and resilience for anxiety following real world stress at a computational level remain unclear. We identified core components of uncertainty aversion moderating response to stress posed by the COVID-19 pandemic derived from computational modeling of decision making. Using both cross-sectional and longitudinal analyses, we investigated both immediate effects at the onset of the stressor, as well as medium-term changes in response to persistent stress. 479 subjects based in the United States completed a decision-making task measuring risk aversion, loss aversion, and ambiguity aversion in the early stages of the pandemic (March 2020). Self-report measures targeting threat perception, anxiety, and avoidant behavior in response to the pandemic were collected at the same time point and 8 weeks later (May 2020). Cross-sectional analyses indicated that higher risk aversion predicted higher perceived threat from the pandemic, and ambiguity aversion for guaranteed gains predicted perceived threat and pandemic-related anxiety. In longitudinal analyses, ambiguity aversion for guaranteed gains predicted greater increases in perceived infection likelihood. Together, these results suggest that individuals who have a low-level aversion toward uncertainty show stronger negative emotional reactions to both the onset and persistence of real-life stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Discrete patterns of microbiome variability across timescales in a wild rodent population

Mammalian gastrointestinal microbiomes are highly variable, both within individuals and across populations, with changes linked to time and ageing being widely reported. Discerning patterns of change in wild mammal populations can therefore prove challenging. We used high-throughput community sequencing methods to characterise the microbiome of wild field voles (Microtus agrestis) from faecal samples collected across 12 live-trapping field sessions, and then at cull. Changes in α- and β-diversity were modelled over three timescales. Short-term differences (following 1–2 days captivity) were analysed between capture and cull, to ascertain the degree to which the microbiome can change following a rapid change in environment. Medium-term changes were measured between successive trapping sessions (12–16 days apart), and long-term changes between the first and final capture of an individual (from 24 to 129 days). The short period between capture and cull was characterised by a marked loss of species richness, while over medium and long-term in the field, richness slightly increased. Changes across both short and long timescales indicated shifts from a Firmicutes-dominant to a Bacteroidetes-dominant microbiome. Dramatic changes following captivity indicate that changes in microbiome diversity can be rapid, following a change of environment (food sources, temperature, lighting etc.). Medium- and long-term patterns of change indicate an accrual of gut bacteria associated with ageing, with these new bacteria being predominately represented by Bacteroidetes. While the patterns of change observed are unlikely to be universal to wild mammal populations, the potential for analogous shifts across timescales should be considered whenever studying wild animal microbiomes. This is especially true if studies involve animal captivity, as there are potential ramifications both for animal health, and the validity of the data itself as a reflection of a ‘natural’ state of an animal.

What can analysis of Space-Time of Action tell us about medium-term changes in adults’ and children’s access to place of activity? The example of Bogotá

This article draws on the space-time prism as formalized in time-geography (Hägerstrand 1970) and on spatial analysis methods to examine medium-term changes to household members’ access to place of activity, against the backdrop of urban change. The analytical framework thus uses the concept of Space-Time of Action (Demoraes et al. 2020a), referring to the combination of all the places of work or study that individuals go to, and the time taken to reach them from home. The analysis is based on two surveys conducted in Bogotá (Colombia) in 1993 and 2009 to apprehend individuals’ spatial mobilities. Two groups at different stages in their life course and co-residing in the same households are studied: schoolchildren and working adults. First, Space-Times of Action are calculated and mapped using kernel outer rings delineating the concentration of destinations for the two groups and the nine survey zones at each date. Second, the statistical significance of the discrepancies between Space-Times of Action is assessed using a bivariate colocation test. The test indicates overall stability in children’s access to place of schooling, but a more contrasting situation for adults.

The impact of the Covid19 pandemic on social and regional differences in the sports behaviour of the Swiss population

The Covid19 pandemic and the accompanying measures between March 2020 and March 2022 had a strong impact on the sport system. The various restrictions on sports activities affected not only school sports, but also clubs and fitness centres, as well as competitive sports in general. At the same time, a considerable increase in unorganised outdoor sports activities and a shift in sport preferences could be observed.&#x0D; In order to assess and quantify the short- to medium-term changes in the sporting behaviour of the Swiss population due to the Covid 19 pandemic, the Federal Office of Sport commissioned a representative population survey. For this purpose, 2,130 people aged 15 and over were surveyed in the summer of 2022 in the three national languages German, French and Italian by means of an online questionnaire. To facilitate comparisons over time, the survey was based on the survey instrument of the "Sport Switzerland" studies (cf. Lamprecht et al., 2020), with additional questions on the assessment and management of the Covid19 pandemic.&#x0D; For the present paper, on the one hand, results on the changes in sports behaviour during the Covid19 pandemic will be presented and it will be shown how these changes affected sports activity in the different settings in the medium term. On the other hand, the consequences of these changes on social and regional differences in sports behaviour (cf. Lamprecht &amp; Nagel, 2022) will be examined. Did the Covid19 pandemic and the accompanying measures in the field of sport tend to increase or rather level out the differences according to age, gender, social status and place of residence? Did the pandemic lead to a situation in which population groups who were only sparingly and irregularly active in sport were increasingly discouraged from taking part in sport, while those who were more active in sport found it easier to switch to other types of sport and settings? With regard to the regions, it will be investigated whether a connection can be found between compliance with the Corona measures and the changes in sports behaviour.&#x0D; Finally, the question will be raised as to how lasting the measured changes and shifts are likely to be and how an increase in social inequality in the field of sport could be countered. &#x0D; References&#x0D; Lamprecht, M., &amp; Nagel, S. (2022). Sportsoziologie: Einführung. Nomos.&#x0D; Lamprecht, M., Bürgi, R., &amp; Stamm, H. (2020). Sport Schweiz 2020: Sportaktivität und Sportinteresse der Schweizer Bevölkerung. Bundesamt für Sport BASPO.

Economy and elderly population, complementary or contradictory: A cross-continental wavelet coherence and cross-country Granger causality study.

The aim of this study is to explore the causal relationship between the economy and the elderly population globally as well as continent-wise. This research was designed as a continent-wide study to investigate the differences between several regions simultaneously. The economy was measured by the Gross Domestic Product (GDP) per capita growth rate while the population aged above 65 as a percentage of the total was considered the elderly population. A panel dataset published by the World Bank for a period of six decades from 1961 to 2020 covering 84 countries was used as data for the analysis. Wavelet coherence was the methodology used for the study since it was considered suitable to present causality as well as the causal direction between the two variables for different sections during the six decades. Thereafter, Granger causality was applied for a cross-country analysis to gain further insights on the causality of individual countries over the years. Findings of the study reveal that the causality and its direction have been changing over time for most continents. Negative correlations with the leading variable interchanging with time are evident for the majority of the regions. Nevertheless, results indicate that in a global perspective, elderly population predominantly leads the economic growth with a positive correlation. Research approach allows ascertaining the short-term and medium-term changes that occurred concerning the direction of the relationship throughout the stipulated period of the study, which could not be drawn by any previous study. Even though region-wise literature is available on this topic, global studies for decades have not been conducted yet.

Use of remote sensing and bio-geochemical models to estimate the net carbon fluxes of managed mountain grasslands

The current paper presents a methodology which can simulate the net carbon fluxes of semi-natural grasslands based on the combination of a parametric and a bio-geochemical model. The first model (modified C-Fix) estimates grassland gross primary production (GPP) by driving the light use efficiency approach with remotely sensed normalized difference vegetation index (NDVI) data. The latter model (BIOME-BGC) simulates all main ecosystem processes based on meteorological and ancillary data. The outputs of the two models are finally combined and corrected for the effects of human-induced biomass changes (i.e. mowing, grazing, etc.). The modelling strategy, fed with ancillary and MODIS NDVI data, is tested in two semi-natural grasslands, the first (Amplero) on the Apennines and the second (Monte Bondone) on the Alps (Central and Northern Italy, respectively). The two sites, which show diversified eco-climatic conditions and are managed differently (i.e. Amplero by spring mowing plus cattle grazing and Monte Bondone by summer mowing), were selected for the availability of eddy covariance observations of GPP and net ecosystem production (NEP) collected during several years (from 2003 to 2012). These observations were used to assess the estimates of the modelling strategy, obtaining promising results for both study sites. The greatest estimation errors are found in the Alpine site and are mostly induced by the inaccurate detection of local grassland NDVI values, which is due to the insufficient spatial and temporal resolutions of the used MODIS NDVI imagery. The results of the study highlight the importance of information on the local management practices applied, which is decisive for quantifying medium-term changes in net carbon fluxes.

Mathematical models of non-stationary random processes in the SVVP representation

The work examines methods and mathematical models that provide the possibility of researching the statistical characteristics of complex and non-stationary random processes describing a wide class of physical phenomena. The proposed models can be used to study the processes observed in various fields of human activity, namely, to analyze the trajectories of unmanned aerial vehicles, their acoustic signals, meteorological processes reflecting the state of the atmosphere.&#x0D; Real and simulated non-stationary random processes considered in the work are represented by the complex vector random process (CVRP) model. In this case, the length of the subvector is equal to the period of the seasonal component. In fact, in such a representation, the time series readings are replaced by their aggregate, i.e. subvectors. Statistical relationships are analyzed for subvectors, and not, as usual, for process counts. If the length of the subvector is equal to one, all operations in the SVVP representation are equivalent to the usual operations for time series.&#x0D; The mathematical apparatus developed in the article was used to analyze changes in time series of atmospheric temperature observed over a long period of time; average annual temperatures were estimated with subsequent smoothing with a low-pass filter. The results obtained can be used to analyze medium-term and long-term changes in atmospheric conditions, refine the results obtained by traditional methods of mathematical statistics, analyze and predict data flows in mobile communication networks, as well as in other areas of human activity.

Medium-term changes of vegetation composition on fens of the rural landscape, tested using fixed permanent plots

Medium-term changes of vegetation composition on fens of the rural landscape, tested using fixed permanent plots

Prediction of post-operative adding-on or compensatory lumbar curve correction after anterior vertebral body tethering.

Anterior Vertebral Body Tethering (AVBT), a fusionless surgical technique based on growth modulation, aims to correct pediatric scoliosis over time. However, medium-term curvature changes of the non-instrumented distal lumbar curve remains difficult to predict. The objective was to biomechanically analyze the level below the LIV to evaluate whether adding-on or compensatory lumbar curve after AVBT can be predicted by intervertebral disc (ID) wedging and force asymmetry. 33 retrospective scoliotic cases instrumented with AVBT were used to computationally simulate their surgery and 2-year post-operative growth modulation using a finite element model. The cohort was divided into two subgroups according to the lumbar curvature evolution over 2years: (1) correction > 10° (C); (2) maintaining ± 10° (M). The lumbar Cobb angle and residual ID wedging angle under LIV were measured. Simulated pressures and moments at the superior endplate of LIV + 1 were post-processed. These parameters were correlated at 2years postoperatively. On average, the LIV + 1 simulated moment was 538Nmm for subgroup C, 155Nmm for subgroup M with lumbar Cobb angle > 20° and 34Nmm for angle < 20° whereas the ID angle was 1° for C and 0° for M. On average, a positive moment on the LIV + 1 superior growth plate led to correction of the lumbar curvature, whereas a null moment kept it stable, and a parallel immediate postoperative ID under LIV contributed to its correction or preservation. Nevertheless, the significant interindividual variability suggested that other parameters are involved in the distal non-instrumented curvature evolution. IV.

IMPACT OF CORONAVIRUS (COVID-19) ON THE GLOBAL ECONOMY

The COVID-19 pandemic and associated lockdowns have hit the global economy and affected the basis of the socio-economic and business models, which have already undergone some complex changes. Industrialized countries are witnessing a steady decline in interest rates and GDP growth rates, possibly due to medium-term demographic and technological changes, a growing demand for savings assets, and increasing divergences between individuals, firms, and regions. In conditions of the demographic transition, pension provision and health care are placing an additional burden on the state budget. These trends are increasingly restricting monetary and fiscal policy to stabilize the economy in the event of adverse shocks. On the technological side, the digitalization of consumption and production requires structural adjustments in various areas in order to remain competitive and create new opportunities for displaced jobs. For a number of years, globalization has been facing serious obstacles associated with growing protectionism and skepticism about the universal benefits due to ever-increasing international trade and financial integration. The article focuses on the interaction of these trends and the shock caused by COVID-19. International economics and economic policy deal mainly with macroeconomic, trade and technological aspects. The article concluded that measures to restore the economy should be comprehensive, not limited to individual areas.

Assessing Changes in Anxiety, Empowerment, Stigma and Wellbeing in Participants Attending an Online-Based Recovery College in Quebec During the Covid-19 Pandemic: A Pre-Experimental Study.

Objectives: The present study aims to evaluate the effect of an online Recovery College (RC) program implemented in Quebec (Canada) during the COVID-19 pandemic. From October 2020 to June 2021, 27 training groups were conducted with a total of 362 attendees. Methods: Outcome was evaluated using a single group repeated measure design, assessing participants prior the training (T0), after the training (T1) and at follow up (T2). 107 learners of the Quebec RC program attended three two-hour sessions agreed to participate to the research. Results: Overall findings show at T1 a small but statistically significant reduction of anxiety and increase in empowerment, and below threshold reduction of stigmatizing attitudes and increase of wellbeing. Conversely, the medium-term changes at follow up were non-significant for all the outcome dimension except for anxiety. Conclusion: Findings suggest that the RC online program can be considered as a potential effective strategy to support self-regulation and empowerment of individuals and to reduce anxiety in the context of crisis for the general population.