Multi-country Setting Research Articles

Conducting cross-cultural, multi-lingual or multi-country scale development and validation in health care research: A 10-step framework based on a scoping review.

Valid, reliable and cross-cultural equivalent scales and measurement instruments that enable comparisons across diverse populations in different countries are important for global health research and practice. We developed a 10-step framework through a scoping review of the common strategies and techniques used for scale development and validation in a cross-cultural, multi-lingual, or multi-country setting, especially in health care research. We searched MEDLINE, Embase, and PsycINFO for peer-reviewed studies that collected data from two or more countries or in two or more languages at any stages of scale development or validation and published between 2010-22. We categorised the techniques into three commonly used scale development and validation stages (item generation, scale development, and scale evaluation) as well as during the translation stage. We described the most commonly used techniques at each stage. We identified 141 studies that were included in the analysis. We summarised 14 common techniques and strategies, including focus groups or interviews with diverse target populations, and involvement of measurement experts and linguists for item content validity expert panel at the item generation stage; back-and-forth translation, collaborative team approach for the translation stage; cognitive interviews and different recruitment strategies and incentives in different settings for scale development stage; and three approaches for measurement invariance (multigroup confirmatory factor analysis, differential item functioning and multiple indicator multiple causes) for scale evaluation stage. We provided a 10-step framework for cross-cultural, multi-lingual or multi-country scale development and validation based on these techniques and strategies. More research and synthesis are needed to make scale development more culturally competent and enable scale application to better meet local health and development needs.

Enhancing environmental performance: evidence from SAARC Countries

ABSTRACT This paper examines the influence of population density, economic growth, and regulatory quality on the environmental performance of five SAARC countries from 2000 to 2020. To this end, fixed and random effects models are used. Quantitative data on socio-economic and environmental characteristics reveals notable differences across countries. The results show a significant positive and negative impact of the covariates economic growth and population density, respectively, on environmental performance. While the estimated coefficient of the regulatory quality variable was positive, it was statistically insignificant. The results also suggest a significant inter-country dependency and a significant change in environmental performance across countries over time. Based on the results, several strategic approaches are proposed at both individual and multi-country settings. Furthermore, we emphasize the roles of the government, international and regional agencies, private sector, and civil society organizations. Finally, possible extensions of the present paper are discussed.

Certolizumab Pegol for the Treatment of Plaque Psoriasis in Routine Clinical Practice: One-Year Results from the CIMREAL Study.

Certolizumab pegol (CZP) is an anti-tumor necrosis factor alpha (TNFα) approved for the treatment of moderate to severe plaque psoriasis (PSO). However, data on its real-world use is currently limited. The objective of this study was to describe the 1-year real-world effectiveness of CZP, its impact on health-related quality of life (HRQoL), and safety outcomes in patients with moderate to severe PSO in multi-country settings. CIMREAL, a prospective, noninterventional study, was conducted across Europe and Canada from August 2019 to December 2022. Patients were followed for 1-year, receivingCZP 400mg initial doses at weeks 0, 2, and 4, followed byCZP 200mg every 2weeks (Q2W) or CZP 400mg Q2W maintenance dosing. Effectiveness was assessed using the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). Safety was also evaluated. Overall, 399 patients with moderate to severe PSO were included. Of these, 93.7% (374/399) and 77.9% (311/399) completed months 3 and 12, respectively. Mean age (± standard deviation) was 42.9 ± 13.5yearsand body mass index was 28.5 ± 6.8kg/m2, with the majority of patients being female (68.2%). At 12months, CZP showed substantial effectiveness, achieving PASI 75 and PASI 90 response rates (≥ 75% and ≥ 90% improvement from baseline, respectively) of 77% and 56.5%, respectively. Patients with PASI score of ≤ 3 and ≤ 2 experienced improvement from 3months (49.8% and 41.1%, respectively) to 12months (82.0% and 75.3%, respectively). HRQoL considerably improved, with mean DLQI scores decreasing from 12.4 to 2.3 after 12months of treatment, and the proportion of patients with DLQI 0/1 increased from 28.6% at 3months to 59.4% at 12months. The 1-year probability of persistence was approximately 85%. Overall, 30.6% of the patients experienced any adverse events and 9.3% had serious adverse events. In routine clinical practice, CZP exhibited consistent effectiveness, positively impacting both skin psoriasis activity and HRQoL. The 1-year persistence of CZP was high, and no new safety signals were identified. ClinicalTrials.gov Identifier: NCT04053881 https://www. gov/study/NCT04053881 .

Uncertainty spill-overs: When policy and financial realms overlap

No matter its source, financial- or policy-related, uncertainty can feed onto itself, leading to identification challenges in empirical applications. We add to the stock of analytical methods able to disentangle among various types of uncertainty shocks by proposing an identification approach based on a combination of zero and absolute magnitude restrictions implemented in a multi-country setting. We find evidence of sizable spill-overs within the Euro Area (EA) arising from country-specific uncertainty shocks, with financial realm being a more important source than the policy realm. By leveraging on the flexibility of our approach, we show how important is a correct identification of each uncertainty shock type. A comparison between the on-impact responses of sovereign yields for EA members and non-members suggests that the common currency area likely features institutional arrangements and mechanisms that can initially blur the thin line separating uncertainty shock types. Because we find ECB reactions were not likely to be conditioned by the type of the uncertainty shock hitting a particular country, but by its potential to spill over abroad, we believe ECB has filled the leadership vacuum by doing “whatever it takes” to prevent fragmentation of the EA.

Putting a New ‘Spin’ on Energy Information: Measuring the Impact of Reframing Energy Efficiency Information on Tumble Dryer Choices in a Multi-country Experiment

AbstractIt has been shown that consumers often underinvest in energy efficiency despite net benefits over the longer term. One possible explanation is that they do not properly understand energy information when provided in physical units, as in most energy labels. Prior studies have investigated the effect of reframing energy information into monetary units. Outcomes are mixed, and it is unclear whether this is due to the use of different products, methodologies or to studies being conducted in countries with different energy prices and labelling standards. This paper overcomes this ambiguity by testing the effect of providing monetary energy information using the same experiment in a multi-country setting. Results show that the intervention’s effectiveness varies considerably across countries. Moreover, they highlight the presence of within-country heterogeneities based on demographic characteristics, with monetary information being more effective for high-usage households but seemingly crowding out the motivation of those whose purchasing decisions depend on environmental considerations.

Does the COVID-19 pandemic disproportionately affect the poor? Evidence from a six-country survey

PurposeThe COVID-19 pandemic has wrought havoc on economies around the world. The purpose of this study is to learn about the distributional impacts of the pandemic.Design/methodology/approachThe authors contribute new theoretical and empirical evidence on the distributional impacts of the pandemic on different income groups in a multicountry setting. The authors analyze rich individual-level survey data covering 6,082 respondents from China, Italy, Japan, South Korea, the United Kingdom and the United States. The results are robust to various econometric models, including ordinary least squares (OLS), Tobit and ordered probit models with country-fixed effects.FindingsThe authors find that while the outbreak has no impact on household income losses, it results in a 63% reduction in the expected own labor income for the second-poorest income quintile. The pandemic impacts are most noticeable for savings, with all the four poorer income quintiles suffering reduced savings ranging between 5 and 7% compared to the richest income quintile. The poor are also less likely to change their behaviors regarding immediate prevention measures against COVID-19 and healthy activities. The authors also found countries to exhibit heterogeneous impacts.Social implicationsDesigning tailor-made social protection and health policies to support the poorer income groups in richer and poorer countries can generate multiple positive impacts that help minimize the negative and inequality-enhancing pandemic consequences. These findings are relevant not only for COVID-19 but also for future pandemics.Originality/valueThe authors theoretically and empirically investigate the impacts of the pandemic on poorer income groups, while previous studies mostly offer empirical analyses and focus on other sociodemographic factors. The authors offer a new multicountry analysis of several prevention measures against COVID-19 and specific health activities.

Predictive ability of anthropometric indices in identifying metabolic syndrome among US adolescents 10 to 19 years old: Analysis from the National Health and Nutrition Examination Survey 2011 to 2018 data set

ObjectiveThe aim of this study was to identify the best anthropometric indices for predicting metabolic syndrome in US adolescents. MethodsA cross-sectional study analyzed data of adolescents ages 10 to 19 y using the National Health and Nutrition Examination Survey 2011 to 2018 data. The receiver operating characteristic areas under the curve (AUCs) of waist circumference z score, body roundness index, body mass index, and A Body Shape Index in identifying predicting metabolic syndrome were assessed. Furthermore, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios of all anthropometric indices were calculated. ResultsA total of 5496 adolescents were included in the analysis. Waist circumference z score had an AUC of 0.90 (95% CI, 0.89–0.91), sensitivity of 95.0% (95% CI, 89.4–98.1), and specificity of 74.8% (95% CI, 73.6, 76.0). Body roundness index had an AUC of 0.88 (95% CI, 0.87–0.89), sensitivity of 96.7% (95% CI, 91.7–99.1), and specificity of 75.2% (95% CI, 74.1–76.4). Body mass index z score had an AUC of 0.83 (95% CI, 0.81–0.85), sensitivity of 97.5% (95% CI, 92.9–99.5), and specificity of 68.2% (95% CI, 66.9–69.4). A Body Shape Index had an AUC of 0.59 (95% CI, 0.56–0.61), sensitivity of 75.0% (95% CI, 66.3–82.5), and specificity of 50.9% (95% CI, 49.5–52.2). ConclusionsOur study found waist circumference z score and body roundness index were the best predictors of predicting metabolic syndrome compared with body mass index z score and A Body Shape Index in both boys and girls. We recommend that future studies develop global cutoff points for these anthropometric indices and examine their performance in a multi-country setting.

Does acquisition lead to the growth of high-tech scale-ups? Evidence from Europe

The post-acquisition growth of high-tech scaleups has received relatively little research attention. This is surprising since buyers are known to target these firms for growth opportunities whilst sellers increasingly seek strategic partners to access resources to scale their ventures. We examine the post-acquisition revenue and employment growth of high-tech scaleups in a multi-country setting, comprising five European economies. Using a propensity-score matching approach and difference-in-differences regression, for a sample of 2187 high-tech scaleups, we demonstrate that acquisition has a positive effect on target firms equivalent to cumulative growth of revenue (employment) of 9–13 (6−10) percent after five (four) years, relative to control firms. We find that nationality matters such that the targets of foreign-owned acquirers exhibit significantly higher cumulative revenue and employment growth than their domestic counterparts. Taking a longer-term perspective, we show that growth dips in the first year, then stabilizes and accelerates in the years following acquisition, indicating a period of adjustment.

The empirics of economic growth over time and across nations: a unified growth perspective

This research develops an expanded unified growth theory that incorporates the endogenous accumulation of physical capital, population, human capital, and technology. The model incorporates a complementarity between physical capital and human capital and can be extended to a multi-country setting with international technology diffusion. The analytical characterization of the mechanisms behind the observed patterns of long-run growth and comparative development delivers a consistent explanation for a large set of seemingly unrelated empirical facts. A quantitative multi-country version of the model matches various empirical regularities of long-run growth dynamics and comparative development patterns that have previously been studied in isolation. The findings also shed new light on the role of the demographic transition for convergence patterns, the specification of cross-country growth regressions, technology spillovers, and the secular stagnation debate.

Conducting rapid qualitative interview research during the COVID-19 pandemic-Reflections on methodological choices.

As the COVID-19 pandemic has shown, setting up studies in time to gather relevant, real-world data enables researchers to capture current views and experiences, focus on practicalities on the ground, and deliver actionable results. Delivering high quality rapid studies in healthcare poses several challenges even in non-emergency situations. There is an expanding literature discussing benefits and challenges of conducting rapid research, yet there are relatively few examples related to methodological dilemmas and decisions that researchers may face when conducting rapid studies. In rapidly-changing emergency contexts, some of these challenges may be more easily overcome, while others may be unique to the emergency, magnified, or emerge in different ways. In this manuscript, we discuss our reflections and lessons learnt across the research process when conducting rapid qualitative interview studies in the context of a healthcare emergency, focusing on methodological issues. By this we mean the challenging considerations and pragmatic choices we made, and their downstream impacts, that shaped our studies. We draw on our extensive combined experience of delivering several projects during the COVID-19 pandemic in both single and multi-country settings, where we implemented rapid studies, or rapidly adapted an existing study. In the context of these studies, we discuss two main considerations, with a particular focus on the complexities, multiple facets, and trade-offs involved in: (i) team-based approaches to qualitative studies; and (ii) timely and rapid data collection, analysis and dissemination. We contribute a transparent discussion of these issues, describing them, what helped us to deal with them, and which issues have been difficult to overcome. We situate our discussion of arising issues in relation to existing literature, to offer broader recommendations while also identifying gaps in current understandings of how to deal with these methodological challenges. We thus identify key considerations, lessons, and possibilities for researchers implementing rapid studies in healthcare emergencies and beyond. We aim to promote transparency in reporting, assist other researchers in making informed choices, and consequently contribute to the development of the rapid qualitative research.

A multi-country study of factors and threshold values affecting sovereign debt-taking behavior

PurposeThis manuscript reports evidence on how debt-taking decisions of top management in a multi-country setting do affect credit rating scores assigned by credit rating agencies (CRAs) as global monitors of creditworthiness of borrowers. This aspect has been long ignored by researchers in the literature. The purpose of this paper is twofold. A test model is specified first using theories to connect debt-taking behavior to credit rating scores. Once that model helps to identify a number of statistically significant factors, the next step helps to identify threshold values at which the variables driving debt-taking behavior would worsen the credit rating scores as turning points of the thresholds.Design/methodology/approachThe study identifies factors driving creditworthiness scores due to debt-taking behavior of countries and develops a correct research design to identify a model that explains (1) credit rating scores and the factors driving the scores and runs (2) panel-type regressions to test model fit. Having found factors driving debt-taking behavior by observed units, the next step identifies threshold values of factors at which point further debt-taking is likely to worsen credit rating risk of the observed units. This is a robustness test of the methodology used. The observed units are 20 countries with data series across 14 years.FindingsFirst, new findings suggest there are about six major factors associated with debt-taking behavior and credit rating changes. Second, the model developed in this study is able to account for substantial variability while the identified factors are statistically significant within the normal p-values for acceptance of hypotheses. Finally, the threshold values of factors identified are likely to be useful for managerial decisions to judge the levels at which further debt-taking would worsen the credit rating scores of the observed units.Research limitations/implicationsThe observed units are from 20 countries over 14 years of annual data available on credit rating scores (privately obtained from Standard and Poor [S&P]). The sample represents major economies but did not include emerging countries. In that regard, it will be worthwhile to explore the debt-taking behavior of emerging economies in a future study using the methodology verified in this study.Practical implicationsThe findings help add few useful guidelines for top management decisions. (1) There are actually factors that are associated with debt-taking behavior, so the authors now know these factors as guides for managerial actions. (2) The authors are free to state that the credit rating changes occur on objective changes in the factors found as significantly related to the debt-taking behavior. (3) The threshold values of key factors are known, so top management could use these threshold values of named factors to monitor if a debt-taking decision is going to push the credit rating to a worse score.Social implicationsThere are society-wide implications. Knowing that the world's debt level is high at US$2.2 for each gross domestic product (GDP) dollar across almost 200 countries, any knowledge on what factors help drive creditworthiness scores, thus credit riskiness, is revealed in this paper. Knowing those factors and also knowing the turning points of the factors – the threshold values – likely to worsen creditworthiness scores is a powerful tool for controlling excessive debt-taking by an observation unit included in this study (The dataset in this research can also be used to see inter-temporal movement on debt-taking in a future study).Originality/valueIn the authors' view, there are many studies on debt-taking behavior. But none has connected debt-taking on how (1) named factors are observable to management that affect credit rating changes and (2) if a factor affects creditworthiness, at which point of the factor value, the creditworthiness will flip to worsen the score. These aspects are seldom found in the literature. Hence, the paper is original with practical value at the global level.

Environmental, social and governance performance and earnings management – The moderating role of law code and creditor's rights

This study examines whether environmental, social, and governance (ESG) engagement affects firms’ earnings management (EM) behavior in a multicountry set up. Employing the Tobit and panel regression framework and co`nsidering performance-matched measure of EM, we show that ESG performance substantially reduces opportunistic firms’ EM behavior. Moreover, the civil law code and superior credit rights negatively moderate the ESG–EM relationship. Empirical findings are robust and survive the use of alternative methodology and endogeneity test.

Unregulated Corporate Financial Disclosure and Analysts’ Forecast Properties: The Case of Embedded Value Reporting by Life Insurers

This paper investigates the association between life insurers’ voluntary disclosure of embedded value (EV), an unregulated market-driven fair value measure, and analyst forecast accuracy and dispersion. EV is an estimate of the present value of future net cash flows from in-force life insurance business. Advocates of this disclosure believe that EV is a better measure of economic performance than traditional GAAP measures. Others argue that corporate management has discretion in estimating and reporting EV. Further, analysts may have access to information that allows the development of possibly more accurate estimation metrics in the absence of EV disclosure. It is then an empirical issue to determine whether EV disclosure has any incremental effect on analysts’ forecast properties. Using a multi-country setting, we find that EV disclosure is positively associated with analysts’ earnings forecast accuracy and negatively related to forecast dispersion. This result is consistent with the alternative hypothesis that disclosure of EV provides a richer information set that enriches analysts’ forecasts beyond their own in-house developed surrogates. As guidance for insurance accounting and disclosure evolves, our findings support the value of continuing to provide EV information to the public.

Uncertainty spill-overs: when policy and financial realms overlap

No matter its source, financial- or policy-related, uncertainty can feed onto itself, inflicting the real economic sector, altering expectations and behaviours, and leading to identification challenges in empirical applications. The strong intertwining between policy and financial realms prevailing in Europe, and in Euro Area in particular, might complicate the problem and create amplification mechanisms difficult to pin down. To reveal the complex transmission of country-specific uncertainty shocks in a multi-country setting, and to properly account for cross-country interdependencies, we employ a global VAR specification for which we adapt an identification approach based on magnitude restrictions. Once we separate policy uncertainty from financial uncertainty shocks, we find evidence of important cross-border uncertainty spill-overs. We also uncover a new amplification mechanism for domestic uncertainty shocks, whose true nature becomes more blurred once they cross the national boundaries and spill over to other countries. With respect to ECB policy reactions, we reveal stronger but less persistent responses to financial uncertainty shocks compared to policy uncertainty shocks. This points to ECB adopting a more (passive or) accommodative stance towards the former, but a more pro-active stance towards the latter shocks, possibly as an attempt to tame policy uncertainty spill-overs and prevent the fragmentation of the Euro Area financial markets.

Ambient carbon monoxide and daily mortality: a global time-series study in 337 cities

Epidemiological evidence on short-term association between ambient carbon monoxide (CO) and mortality is inconclusive and limited to single cities, regions, or countries. Generalisation of results from previous studies is hindered by potential publication bias and different modelling approaches. We therefore assessed the association between short-term exposure to ambient CO and daily mortality in a multicity, multicountry setting. We collected daily data on air pollution, meteorology, and total mortality from 337 cities in 18 countries or regions, covering various periods from 1979 to 2016. All included cities had at least 2 years of both CO and mortality data. We estimated city-specific associations using confounder-adjusted generalised additive models with a quasi-Poisson distribution, and then pooled the estimates, accounting for their statistical uncertainty, using a random-effects multilevel meta-analytical model. We also assessed the overall shape of the exposure-response curve and evaluated the possibility of a threshold below which health is not affected. Overall, a 1 mg/m3 increase in the average CO concentration of the previous day was associated with a 0·91% (95% CI 0·32-1·50) increase in daily total mortality. The pooled exposure-response curve showed a continuously elevated mortality risk with increasing CO concentrations, suggesting no threshold. The exposure-response curve was steeper at daily CO levels lower than 1 mg/m3, indicating greater risk of mortality per increment in CO exposure, and persisted at daily concentrations as low as 0·6 mg/m3 or less. The association remained similar after adjustment for ozone but was attenuated after adjustment for particulate matter or sulphur dioxide, or even reduced to null after adjustment for nitrogen dioxide. This international study is by far the largest epidemiological investigation on short-term CO-related mortality. We found significant associations between ambient CO and daily mortality, even at levels well below current air quality guidelines. Further studies are warranted to disentangle its independent effect from other traffic-related pollutants. EU Horizon 2020, UK Medical Research Council, and Natural Environment Research Council.

The economic theory of cost-effectiveness thresholds in health: Domestic and international implications.

Public health insurers often use an implicit or explicit cost-effectiveness threshold to determine which health products and services should be insured. We challenge the convention of a single threshold. For competitively provided products and services, prices are determined by cost; but for products with market power, patentees will increase the price according to the perceived threshold. As a result, a change in the threshold affects the prices of all patented products, including those which would have been developed even at a lower threshold. The insurer can increase efficiency by reducing the threshold for patented products, even accounting for the effect on innovation. We also model a multi-country setting, in which thresholds for patented products will fall below the globally cooperative solution because each country does not recognize the positive externality of its own spending on innovative medicines. We show that this tragedy of the commons problem can be partly corrected through referencing other countries' thresholds, but only when the countries have similar willingness to pay.

COVID-19: Psychol­­­ogical Distress, Fear, and Coping Strategies Among Community Members Across 17 Countries

Background: The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally. Our study aimed to examine the extent and associated factors to psychological distress, the level of fear of COVID-19, and coping strategies amongst a diverse range of community people in multi-country settings.Methods: A cross-sectional study across 17 countries was conducted. Psychological distress (based on the Kessler Psychological Distress Scale) was categorized into low and moderate to very high, fear of COVID-19 (based on the Fear of COVID-19 Scale) was categorized into low and high, and coping (based on the Brief Resilient Coping Scale) was categorized into low and medium to high. For country-wise comparisons, we selected the reference country based on the lowest prevalence of each outcome and examined the status for other countries. Multivariate analyses were conducted to adjust potential confounders including in-country variations; adjusted odds ratio (AOR) and 95% confidence intervals (CIs) were reported.Findings: A total of 8559 people participated in this study. Mean age (±SD) was 33 (±13) years and two-thirds (64%) were females. More than one-third (40%) self-identified as frontline or essential service workers. More than two-thirds (69%) experienced moderate to very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (AOR 1.56 [1.29-1.90]), being affected by the change of financial situation, comorbidity with mental health conditions (AOR 3.02 [1.20-7.60]), unsure contact with COVID-19 patient, and use of healthcare services in the last six months were associated with moderate to very high levels of psychological distress. Doctors had higher psychological distress (AOR 1.43 [1.04-1.97]), but low levels of fear of COVID-19 (AOR 0.55 [0.41-0.76]); nurses had medium to high resilient coping (AOR 1.30 [1.03-1.65]). Participants from 10 countries (Hong Kong, Oman, Libya, Kuwait, Saudi Arabia, UAE, Jordan, Syria, Palestine and Egypt) demonstrated significantly higher psychological stress compared to the participants from Thailand. Participants from four countries (Oman, Indonesia, Hong Kong and Pakistan) exhibited higher levels of fear of COVID-19 compared to those from Libya. Participants from 12 countries (Jordan, Egypt, Saudi Arabia, Kuwait, Hong Kong, UAE, Palestine, Thailand, Oman, Nepal, Indonesia and Syria) demonstrated statistically significant medium to high resilience coping compared to those from Australia.Interpretation: Females and people with existing mental health issues were the most vulnerable groups of populations for adverse psychological impact of COVID-19 pandemic across 17 countries. While these two groups had ongoing challenges in a COVID-free world, the pandemic worsened their wellbeing. There is an urgent need to prioritise their needs. Adequate medical and social support along with specific health promotion policies should be considered within the strategic response to the ongoing pandemic and future crises.Funding Information: None.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Ethics approval was obtained from the Human Research Ethics Committee from each participating country. The survey was voluntary in nature and it was clarified in the PLIS, so that participants got the opportunity to have informed decision to participate in the study. Privacy and confidentiality of the collected data were maintained. All responses were anonymous and there was no information about the identity of the participants.

Gender inequality during the COVID-19 pandemic: Income, expenditure, savings, and job loss.

The COVID-19 outbreak has brought unprecedented disruptions to the global economies and has led to income loss and high unemployment rates. But scant, if any, evidence exists on gender gaps in economic outcomes such as income, expenditure, savings, and job loss in a multi-country setting. We investigate the impacts of COVID-19 on gender inequality in these outcomes using data from a six-country survey that covers countries in different geographical locations and at various income levels. Our findings suggest that women are 24 percent more likely to permanently lose their job than men because of the outbreak. Women also expect their labor income to fall by 50 percent more than men do. Perhaps because of these concerns, women tend to reduce their current consumption and increase savings. Factors such as the different participation rates in work industries for men and women may take an important part in explaining these gender gaps. Our estimates also point to country heterogeneity in these gender differences that is likely due to varying infection rates and shares of women in the labor force.

Panic buying in the COVID-19 pandemic: A multi-country examination

The global crisis of COVID-19 pandemic has ravaged the world economy and healthcare, igniting much fear, panic, and uncertainty among billions of people. As lockdowns being implemented in many places, panic buying has emerged as a reliable feature of the Coronavirus outbreak. Therefore, it is of urgent needs to examine consumers' panic buying behaviors during COVID-19 to gain a better understanding of the phenomenon and to provide managerial insights for policy-makers and marketers alike. In this study, under the theoretical guidelines of the Stimuli-Organism-Response model and the Competitive Arousal model, we investigate how in the panic situation created by the pandemic, external stimuli such as Limited Quantity Scarcity (LQS) and Limited Time Scarcity (LTS) affect the emotional arousal among people, which in turn influences consumers’ impulsive and obsessive buying behaviors. This study is conducted in a multi-country setting including the U.S., China, India, and Pakistan. Online surveys were conducted during the peak time of pandemic. Our findings show that LQS and LTS significantly increase perceived arousal in consumers, which further leads to more impulsive and obsessive buying. In addition, our results also reveal that excessive social media use intensifies the relationship between scarcity messages and perceived arousal whereas the urge to buy impulsively moderates the relationship between perceived arousal and behavioral outcomes in all selected countries except for India. Theoretical and managerial implications are discussed in details.

Validation of mobile Decision Support System for scheduling age-appropriate immunizations

Abstract Background The prevalence of missed opportunities for immunization among children is estimated to be 32.2%. The introduction of new vaccines in EPI schedule and lack of training of frontline health workers (FHWs) on the guidelines for number and spacing of doses and manual construction of vaccine schedules based on a child's age deteriorates efficiencies of FHWs, especially in forecasting catch-up schedules. We have designed and tested the validity of an innovative Decision Support System Application Programming Interface (DSS-API) which will automatically generate an age-appropriate immunization schedule for a child. Methods Using a multi-country setting approach, DSS was deployed in six immunization facilities of Pakistan and Bangladesh between July 2019 to April 2020. Details of all visiting children were recorded in database. Information on date of birth and past immunization history was used by the DSS-API to determine an individualized age-appropriate immunization schedule. These schedules were compared to the gold standard's outputs calculated by an immunization expert. Results A total of 6,241 vaccination events were recorded from all the sites. Using area under the curve, the calculated sensitivity of DSS to determine age-appropriate immunization schedule was found between 99-100% for the individual EPI vaccines, while the specificity of the DSS algorithm was found between 98-100%. Conclusions DSS is a feasible feature that can be incorporated in Digital Immunization Registries to accurately schedule routine and catch-up immunizations and can effectively reduce Missed Opportunities for Immunizations by assisting FHWs through automatic construction of immunization schedules. Key messages DSS-API is a unique application that can improve process efficiencies of frontline health workers by automatic generation of accurate age-appropriate catch-up vaccine schedules. DSS has the potential to reduce missed opportunities for immunization (MOI) and improve immunization coverage and timeliness among children aged under 2 years.