Methodological approaches to measuring mental health in a cost-of-living crisis: A rapid review

BACKGROUND

Cost-of-living crises are damaging to population mental health and require a public health response. It is important to assess whether public health interventions are effective. We aimed to identify population-level methods and measures and the appropriateness of the measures for vulnerable populations.

METHODS

A rapid evidence review was undertaken. Nineteen databases, including grey literature, were searched for evidence published between 1970 and April 2023.

RESULTS

Seven reviews, nine primary studies and two reports from grey literature were identified. Methods consisted of analyses of existing data from national or regional cohort studies, household panel surveys, repeated cross-sectional surveys, routine medical data, or data on suicide death rates. Twelve brief validated mental health measurement tools, embedded in population-level surveys, were identified. Two quasi-experimental studies used data from a UK household panel survey to examine the impact of the introduction of specific welfare policies on mental health. Studies identified socio-economic vulnerabilities, but it was not possible to determine whether data were effectively captured from people from minority ethnic groups.

CONCLUSION

Population-level surveys can be used in quasi-experimental studies to measure the effects of a public health initiative with specific roll out dates to tackle cost-of-living impacts. It is unclear as to whether the identified methods and tools are suitable for use with people from minority ethnic groups.

The policy and politics of healthcare corporatisation: The case of the English NHS

RATIONALE

Few accounts of healthcare corporatisation examine the effects of the 2008 financial crisis. New Politics of the Welfare State (NPWS) theories recognise the relevance of crises but give more attention to programmatic than systemic (structural) retrenchment, and little to healthcare corporatisation.

OBJECTIVE

To examine what changes the 2008 financial crisis produced in the pattern of healthcare corporatisation, and the implications for NPWS theories.

METHODS

Using administrative data from the English NHS during 1995-2019 we formulated a multi-dimensional index of corporatisation, tested its validity, and used it to analyse longitudinally how the financial crisis affected the balance between the responsibilization of management and re-commodification (introduction of market-like practices) in provider corporatisation.

RESULTS

The financial crisis influenced NHS corporatisation through the fiscal austerity with which governments responded. The re-commodification of NHS providers stalled but not the responsibilization of NHS managers.

CONCLUSIONS

The corporatisation of NHS providers faltered after the financial crisis. These findings corroborate parts of NPWS theory but also reveal scope for further elaborating its accounts of systemic retrenchment in health systems.

Adherence to treatment and harmful effects of medication shortages in the context of severe crises: scale validation and correlates

BACKGROUND

Medication shortage is a public health problem, affecting patients' outcomes mainly through the difficulty in maintaining adherence, particularly in the context of a severe economic crisis. There is a need for a new scale that assesses the effect of medication shortage on adherence.

AIM

To develop and validate a scale to evaluate the harmful impact of medication shortage among the general Lebanese population and assess its correlates and association with medication adherence.

METHODS

A questionnaire was used to assess medication shortage harmful effects and patients' adherence, allowing to generate the Harmful Impact of Medication Shortage scale (HIMS). The factor analysis, convergent validity and reliability of the generated scale were assessed, followed by multivariable regressions to evaluate its correlates.

RESULTS

The developed HIMS scale is a 9-item tool, used to assess how difficult it was for people to deal with medication shortages and their harmful effects on treatment. It was significantly and inversely linked to treatment adherence and affected by the patients' socioeconomic status and the type of chronic disease.

CONCLUSION

The Harmful Impact of Medication Shortage scale could be an efficient tool to measure the detrimental effects of medication shortages among the Lebanese adult population with chronic diseases, particularly affecting treatment adherence. Future studies and evidence are still needed to confirm our findings and help build global mitigation policies addressing medication shortages.

The relationship between sovereign credit rating changes and firm risk

Sovereign credit ratings, extensively studied for their influence on macroeconomics and country risk, have been less explored in the context of their impact on individual firms. This research delves into the effects of sovereign credit rating changes on firm risk. Our findings suggest that an upgrade in sovereign credit ratings decreases firm risk, while a downgrade amplifies it. Furthermore, the magnitude of a country's rating shift positively correlates with changes in firm risk. We also discern a contagion effect between trade-dependent countries: an elevated rating in one country diminishes the firm risk in its trading partner, and vice versa. When categorizing our data into developed and developing markets, we observe that firm risk in developed markets reacts more acutely to rating upgrades. Conversely, rating downgrades, whether domestic or in trade-associated countries, intensify firm risk in developing markets. A robustness check, which evaluates sovereign credit rating fluctuations outside of financial crises, corroborates our core findings.

This time truly is different: The cyclical behaviour of fiscal policy during the Covid-19 crisis

Fiscal policy was more countercyclical during the Covid-19 crisis than in previous (crisis) episodes. This paper presents empirical evidence in favour of a "this time truly is different" moment based on analysing the cyclical behaviour of fiscal policy for 28 advanced economies over 1995-2021. Discretionary fiscal policy during the Covid-19 crisis (2020-2021) did more to counteract the downturn - especially in the Eurozone -, as we do not find comparable evidence for countercyclicality during the financial crisis or Euro crisis. Automatic fiscal stabilisers, the non-discretionary domain of fiscal policy, significantly contributed to countercyclical stabilisation during the pandemic.

Income inequality and entrepreneurship: Lessons from the 2020 COVID-19 recession

We study entry into entrepreneurship during the COVID-19 recession of 2020 using new data from an extensive survey of more than 24,000 Spanish households, conducted between June and November 2020. We find that while the overall decline in the startup rate in 2020 was large, and of a similar magnitude as that during the Great Recession, the differential impact depending on ex ante income was starkly different. During 2020, the drop in firm entry was entirely concentrated among low- and medium-income households. We show that the entrepreneurship gap between these households and their high-income counterparts is not directly explained by social distancing, since it is mostly driven by the sectors not directly affected by lockdown measures, and it is larger among households that did not suffer a negative income shock during the pandemic. Our results instead indicate that high-income households performed relatively better during the COVID-19 recession because they had the means to exploit new business opportunities, thanks to their larger wealth and better access to external finance.

Multivariate models of commodity futures markets: a dynamic copula approach

We apply flexible multivariate dynamic models to capture the dependence structure of various US commodity futures across different sectors between 2004 and 2022; particular attention is paid to the 2008 financial crisis and the COVID-19 pandemic. Our copula-based models allow for time-varying nonlinear and asymmetric dependence by integrating elliptical and skewed copulas with dynamic conditional correlation (DCC) and block dynamic equicorrelation (Block DECO). Flexible copula models that allow for multivariate asymmetry and tail dependence are found to provide the best performance in characterizing co-movements of commodity returns. We also find that the connectedness between commodities has dramatically increased during the financial distress and the COVID-19 pandemic. The impacts of the financial crisis appear to be more persistent than those of the pandemic. We apply our models to some risk management tasks in the commodity markets. Our results suggest that optimal portfolio weights based on dynamic copulas have persistently outperformed the equal-weighted portfolio, demonstrating the practicality and usefulness of our proposed models.

Financial and economic uncertainties and their effects on the economy

We estimate new indices measuring financial and economic uncertainty in the euro area, Germany, France, the United Kingdom and Austria, following the approach of Jurado et al. (Am Econ Rev 105:1177-1216, 2015), which measures uncertainty by the degree of predictability. We perform an impulse response analysis in a vector error correction framework, where we focus on the impact of both local and global uncertainty shocks on industrial production, employment and the stock market. We find that global financial and economic uncertainties have significant negative effects on local industrial production, employment, and the stock market, while we find hardly any influence of local uncertainty on these variables. In addition we perform a forecasting analysis, where we assess the merits of uncertainty indicators for forecasting industrial production, employment and the stock market, using different performance measures. The results suggest that financial uncertainty significantly improves the forecasts of the stock market in terms of profit-based measures, while economic uncertainty gives, in general, more insight when forecasting macroeconomic variables.

Using gravity model to make store closing decisions: A data driven approach

Many studies propose methods for finding the best location for new stores and facilities, but few studies address the store closing problem. As a result of the recent COVID-19 pandemic, many companies have been facing financial issues. In this situation, one of the most common solutions to prevent loss is to downsize by closing one or more chain stores. Such decisions are usually made based on single-store performance; therefore, the under-performing stores are subject to closures. This study first proposes a multiplicative variation of the well-known Huff gravity model and introduces a new attractiveness factor to the model. Then a forward-backward approach is used to train the model and predict customer response and revenue loss after the hypothetical closure of a particular store from a chain. In this research the department stores in New York City are studied using large-scale spatial, mobility, and spending datasets. The case study results suggest that the stores recommended being closed under the proposed model may not always match the single store performance, and emphasizes the fact that the performance of a chain is a result of interaction among the stores rather than a simple sum of their performance considered as isolated and independent units. The proposed approach provides managers and decision-makers with new insights into store closing decisions and will likely reduce revenue loss due to store closures.

Disastrous consequence of coronavirus pandemic on the earning capacity of individuals: an emerging economy perspective

This study aims to explore the consequence of COVID-19 pandemic on the income flow of individuals in Bangladesh from sociodemographic perspective. Multinomial logistic regression model has been applied to achieve the objectives using primary data which were collected from respondents covering different professions, income levels, education, marital status, age and area. The results indicate employees of informal sectors and daily labors are the worst sufferers having no income followed by private sector employees with partial income loss and public sector employees with either slight or no income loss. It is further observed that individuals with higher education and people living in rural areas are less affected. This study recommends a few short-term policies to resolve immediate crisis caused by pandemic and long-term policies to alleviate inequality by providing necessary facilities to the marginalized and vulnerable population in the society.

A comparative analysis of the financialization of commodities during COVID-19 and the global financial crisis using a quantile regression approach

The paper aims at studying the financialization of commodities during coronavirus pandemic, thereafter referred as COVID19 and comparing the same with global financial crisis, thereafter referred as GFC. The connectedness among energy commodities particularly after 2020 was found strong, the effect is medium in case of metals and least in case of agriculture commodities. The findings proved that the financialization of commodities during COVID 19 was much strong as compared to GFC. An investigation of comparative analysis of financialization in developed countries and developing countries is also made, which indicates that connectedness is strong in developed countries as compared to developing countries. The findings reveal the effects were less significant from 2010 to 2019. Gold has significant effect with stock market during COVID 19 and GFC period, marking it a safe haven asset during crisis. Overall, the findings cast doubt on the hedging properties of energy commodities. The finding also indicates the COVID 19 had a deeper impact as compared to GFC.

Implications for health system reform, workforce recovery and rebuilding in the context of the Great Recession and COVID-19: a case study of workforce trends in Ireland 2008-2021

BACKGROUND

Workforce is a fundamental health systems building block, with unprecedented measures taken to meet extra demand and facilitate surge capacity during the COVID-19 pandemic, following a prolonged period of austerity. This case study examines trends in Ireland's publicly funded health service workforce, from the global financial crisis, through the Recovery period and into the COVID-19 pandemic, to understand resource allocation across community and acute settings. Specifically, this paper aims to uncover whether skill-mix and staff capacity are aligned with policy intent and the broader reform agenda to achieve universal access to integrated healthcare, in part, by shifting free care into primary and community settings.

METHODS

Secondary analysis of anonymised aggregated national human resources data was conducted over a period of almost 14 years, from December 31st 2008 to August 31st 2021. Comparative analysis was conducted, by professional cadre, across three keys periods: 'Recession period' December 31st 2008-December 31st 2014; 'Recovery period' December 31st 2014-December 31st 2019; and the 'COVID-19 period' December 31st 2019-August 31st 2021.

RESULTS

During the Recession period there was an overall decrease of 8.1% (n = 9333) between December 31st 2008 and December 31st 2014, while the Recovery period saw the overall staff levels rebound and increase by 15.2% (n = 16,789) between December 31st 2014 and December 31st 2019. These figures continued to grow, at an accelerated rate during the most recent COVID-19 period, increasing by a further 8.9% (n = 10,716) in under 2 years. However, a notable shift occurred in 2013, when the number of staff in acute services surpassed those employed in community services (n = 50,038 and 49,857, respectively). This gap accelerated during the Recovery and COVID-19 phase. By August 2021, there were 13,645 more whole-time equivalents in acute settings compared to community, a complete reverse of the 2008 situation. This was consistent across all cadres. Workforce absence trends indicate short-term spikes resulting from shocks while COVID-19 redeployment disproportionately impacted negatively on primary care and community services.

CONCLUSIONS

This paper clearly demonstrates the prioritisation of staff recruitment within acute services-increasing needed capacity, without the same commitment to support government policy to shift care into primary and community settings. Concerted action including the permanent redistribution of personnel is required to ensure progressive and sustainable responses are learned from recent shocks.

COVID-19 and credit risk: A long memory perspective

The COVID-19 pandemic shows significant impacts on credit risk, which is the key concern of corporate bond holders such as insurance companies. Credit risk, quantified by agency credit ratings and credit default swaps (CDS), usually exhibits long-range dependence (LRD) due to potential credit rating persistence. With rescaled range analysis and a novel affine forward intensity model embracing a flexible range of Hurst parameters, our studies on Moody's rating data and CDS prices reveal that default intensities have shifted from the long-range to the short-range dependence regime during the COVID-19 period, implying that the historical credit performance becomes much less relevant for credit prediction during the pandemic. This phenomenon contrasts sharply with previous financial-related crises. Specifically, both the 2008 subprime mortgage and the Eurozone crises did not experience such a great decline in the level of LRD in sovereign CDS. Our work also sheds light on the use of historical series in credit risk prediction for insurers' investment.

Austerity, Short-term Economic Recovery and Public Perception of Immigration in Ireland

The economic crisis of 2007/2008 did not affect all members of the European Union (EU) to the same extent. In the Irish case, the economic crisis and subsequent period of austerity paralleled an erosion in public support for immigration. However, little is known about how public perception changed during a period of short-term economic recovery, like that experienced in Ireland from 2014 to 2018. Using repeated cross-sectional survey data unique to Ireland, this work captures change in attitudes towards immigrants during the pre-crisis and late-austerity periods. Moreover, this research evaluates the importance placed on two immigrant attributes intimately linked to the labour market - education and skills. We provide evidence of an emergence of more moderate views of immigration during the recovery period, but only in the perceived importance of educational qualifications. Perception of skills remains notably unchanged. Of note, both attributes remain more important in the public eye relative to before the economic crisis. In other words, short-term economic recovery does not automatically translate into a more welcoming reception. We confirm that crises and periods of austerity erode public perception of newcomers, particularly when immigration is framed in terms of skill-based economic contribution. However, this work reveals some of the scars of a rapid and deep economic downturn alter the context of reception in a durable way, which remains notably resistant to short-term recovery.

The impact of the coronavirus on African American unemployment: lessons from history

In this article, our fundamental research question is to investigate the effect of the Coronavirus (named COVID-19) on the African American labor market. More specifically, we attempt to examine the potential economic impact of COVID-19 on the state of racial disparities among the African American labor market by examining two effects, namely, employment and income differentials, using national, state, and city level data (using data for all 77 neighborhood areas of the City of Chicago). Our central finding is that the labor market does not appear to treat black and white laborers as homogeneous, as attested by the finding that African American workers suffer from higher unemployment rates with higher volatility, lower median incomes, and they are more likely to work in the service sector, compared to their white counterparts, and we find this condition to be even larger in the City of Chicago. These findings have important policy implications.

Is the COVID-19 pandemic more contagious for the Asian stock markets? A comparison with the Asian financial, the US subprime and the Eurozone debt crisis

The ongoing COVID-19 pandemic has sent shock waves across the global stock markets. Several financial crises in the past too have had a global impact with their reach extending beyond the country of origin. The current study compares the contagion effect of four such crises viz. the Asian financial crisis, the US subprime crisis, the Eurozone debt crisis, and the currently ongoing Covid-19 crisis on Asian stock markets to understand which of these has had the most severe impact. It finds that among all the four crises, the US subprime crisis has been the most contagious for the Asian stock markets. The study also highlights the difference between severities of a liquidity crisis versus a real crisis and identifies the markets that remained insulated from all these crises, a finding which will be useful for portfolio managers in devising their asset allocation.

[What does systemic relevance mean in times of the pandemic?Que signifie la notion d' « activité essentielle » en temps de pandémie ?]

This article explores the question of what systemic relevance means in times of the pandemic and to what extent "systemic relevance" could become a component of the socio-political semantics of the 21st century. To answer this question, empirical, theoretical, and thought-experimental considerations are being combined. The first part understands systemic relevance as an actor category and examines the term's career and shifting meanings in different discursive contexts. The second part understands systemic relevance as an analytical category and discusses three theoretical perspectives that accompany the establishment of quasi-sociological observational schemes in everyday life and politics. Finally, the third part is devoted to the conceptual challenges for sociology during and after the pandemic. Starting from a conceptual gap in the discourse of systemic relevance, it is argued that we cannot talk meaningfully about systemic relevance without at the same time considering the expected or planned duration with which certain institutions are being closed down or put into minimal operation in critical situations.

Impact of implementation of the Dependency Act on the Spanish economy: an analysis after the 2008 financial crisis

The aim of this paper is to assess the industry-wide impact of Long-Term Care (LTC) spending on the Spanish economy. LTC spending includes beneficiaries' copayment and the impact is quantified in terms of output, employment and value added. To this purpose, we use an input-output model of the Spanish economy that allows us to further describe how the value added generated is distributed throughout the economy according to the existing benefit-mix (in kind services, cash benefit for informal care and cash benefit for personal assistance). Additionally, the model provides results on how the return on LTC spending would improve by using only in-kind services instead of the benefit mix currently in place. The 2012 Spanish Input-Output Table at current prices was extracted from the WIOD Database's 2016 Release. Consumption data for dependent, employed, and unemployed households were collected from the Spanish Household Budget Survey for 2012. The findings reveal that the total annual costs are 7,205.43 million €, with total costs from in-kind services being almost 71% higher than total costs from cash benefits. Each million euros invested in in-kind services and CBPA would create 41.91 jobs (68.41% direct, 9.16% indirect and 22.43% induced). However, each million euros spent on cash benefits would result in 16.88 jobs overall (53.02% direct, 24.53% indirect and 22.45% induced). The total number of jobs is 151,353 at the aggregate level, being 46,840 depending on cash-benefits and 104,513 on in-kind services.

US QE and the Indian Bond Market

This paper examines the long- and short-run spillover effects of US quantitative easing (QE) on the benchmark 10-year Indian government bond (IGB) yield by Autoregressive Distributed Lag (ARDL) bounds testing co-integration approach using monthly data from September 2008 to June 2019. The results show that a 10%-point rise in US QE led to a 4 bp rise in yields. The counterfactual analysis shows that volatility of the yields would have been less without the QE. During the episodes of QE, the Reserve Bank of India (RBI) had to alter its policy rate and engage in open-market operations (OMOs) to simultaneously maintain liquidity in the system and reduce the volatility of interest rates. Spillover on the debt yield leads to mispricing of assets and partial loss of the monetary-policy autonomy of the RBI.

A multi-level governance response to the Covid-19 crisis in public transport

This paper examines the Dutch policy reaction to the financial crisis in the public transport sector caused by Covid-19. Using the multi-level governance theory complemented with the notion of informal governance, the analysis explains the decision-making that defined a State-aid scheme to public transport operators following a process of consultation and concertation between state and non-state actors across governance tiers. To agree on a financial rescue package, these actors engage in front-stage and back-stage political interactions, constrained and enabled by formal and informal governance structures and practices. By analyzing how the interplay between the political mobilization of actors, policy-making arrangements, and existing polity structures shapes political alignment around the financial support scheme, the paper concludes that the crisis did not change customary governance and policy-making practices. Stakeholders sought their usual partners and followed existing routines in path-dependent ways to address the policy challenge brought by Covid-19. Despite being triggered by a major exogenous shock, the policy response to the crisis was driven mainly by endogenous forces; the decision-making mechanism remained the same and the network of actors did not shrink or expand.

Does responsible investing pay during economic downturns: Evidence from the COVID-19 pandemic

We investigate the performance of SRI/ESG investments against conventional investments during the COVID-19 pandemic. Although previous studies have examined the performance of SRI during financial crises, little is known about their performance during the COVID-19 crisis. Applying asset-pricing models, we analyze returns, abnormal returns, and the Sharpe ratio of the ESG ETFs in the US and the MSCI SRI indices for the world, the US, Japan, and Europe before and during the pandemic period vis-à-vis conventional investments. Our results confirm the greater outperformance of SRI indices during the pandemic. These findings have academic and practical implications.

Examining changes in recreation participation on the Monongahela National Forest over five years following the global financial crisis: An activity-based segmentation approach

Research on recreational use market segments and trends are essential for determining how tourism businesses can better meet the needs of their customers and find new target markets especially during challenging times. The purpose of this study was to determine how recreation participation has changed over five years on the Monongahela National Forest following the world financial crisis of 2008-2009. Data used for this research were collected with the National Visitor Use Monitoring (NVUM) surveys for fiscal years 2009 and 2014. NVUM surveys are on-site interviews conducted at the end of a visit. The surveys produce descriptive information about visitors. NVUM uses a stratified random sampling methodology to collect data for each use level (e.g., low, medium, high, or very high) and site type (e.g., Day Use Developed Sites, Overnight Use Developed Sites, General Forest Areas, and Wilderness Sites). Data were collected during a 12-month period and a total of 1,851 interviews were completed. Two step cluster analysis of 18 activity participation variables (binary data) was conducted with 5 clusters specified. The clusters include Relaxing in Nature Package, Backpacking and Hiking Package, Viewing Nature and Hunting Package, Picnicking Package, and Purely Fishing, and they were compared with an activity package typology. Changes in demographics, trip spending, nights away from home, and overall satisfaction were examined for each market segment. Potential market winners and losers during the financial crisis were identified helping tourism providers develop more efficient strategies.

Rating Announcements, CDS Spread and Volatility During the European Sovereign Crisis

This paper analyzes the evolution of CDS spread and CDS volatility around European sovereign rating announcements over the period 2008-13. We show that the effect of the announcement differs depending on the credit quality of the issuer (Investment Grade versus Speculative). The downgrading and negative credit watch of an investment grade country stabilize the market, as volatility decreases right after their release. By contrast, the announcements regarding speculative grade countries trigger an increase in both CDS spread and volatility. Lastly, we show that these announcements not only affect the CDS of the country, but spill over the German CDS.

External financial dependence and firms' crisis performance across Europe

How do financial market conditions affect real economic performance? Empirical investigations of this question have often relied on measures of external financial dependence (EFD) that are constructed using US data and applied to other countries under the assumption of a stable industry ranking across countries. This paper exploits unique, comparable survey data from seven European countries to show that correlations of EFD across countries are weak, casting some doubt on this assumption. We then use the novel survey-based EFD index to show that the global financial crisis had a disproportionately negative impact on the real performance of financially dependent firms. Further investigations highlight the importance of supply chains in propagating the credit shock.

The role of ESG performance during times of financial crisis: Evidence from COVID-19 in China

We examine the role of ESG performance during market-wide financial crisis, triggered in response to the COVID-19 global pandemic. The unique circumstances create an inimitable opportunity to question if investors interpret ESG performance as a signal of future stock performance and/or risk mitigation. Using a novel dataset covering China's CSI300 constituents, we show (i) high-ESG portfolios generally outperform low-ESG portfolios (ii) ESG performance mitigates financial risk during financial crisis and (iii) the role of ESG performance is attenuated in 'normal' times, confirming its incremental importance during crisis. We phrase the results in the context of ESG investment practices.

Exploring the triggering factors for mental stress of university students amid COVID-19 in Bangladesh: A perception-based study

After the emergence of the COVID-19 pandemic in Bangladesh, the Government decided for lockdown over two months lasting until 30 May 2020. All the universities, along with other educational institutions, are closed down until 19 December 2020. Such measures, however, have the potential to cause and exacerbate the mental stress in people, especially the students. The study aimed to explore the triggering factors which increase the mental stress of the students of both public and private universities amid COVID-19 pandemic. To that end, 1000 students of different public and private universities of the country were surveyed online. Under this study, a quantitative approach was undertaken to infer information from relevant variables through the use of descriptive analysis. Moreover, several virtual Key Informant Interview (KII) sessions were conducted with university teachers, education scholars and psychosocial counselor to get expert views on an effective education system, safeguard of the students and suggestions to reduce the stress of them. The survey result shows that students of private universities (80.6%) were found more mentally stressed than students of public universities (77%). Students of public universities were particularly stressed because of financial crisis and looming university session jam whereas, students of private universities were mentally stressed because of uncertainties of online classes/or activities and high tuition fees. Therefore, it is indispensable to bring in time-oriented policy and plan for the management of education system as well as safeguard of the students amid this pandemic and implement with strong monitoring may decrease the mental stress of them.

Testing Age Differences in the links between Recent Financial Difficulties and Cognitive Deficits: Longitudinal Evidence from the PATH Through Life Study

OBJECTIVE

This study investigates whether the within-person associations between a recent major financial crisis and deficits in cognitive performance vary across the lifecourse.

METHOD

Four waves of data from 7442 participants (49% men) spanning 12-years and comprising three narrow age birth cohorts (baseline age: 20-25, 40-45, and 60-65) were drawn from a representative prospective survey from Canberra, Australia (1999-2014). Cognitive performance was assessed by the California Verbal Leaning Test (CVLT) immediate recall trails, Symbol Digit Modalities Test (SDMT), Backwards Digitspan (BDS), and Trail Making Test B (TMT B). A single item from the Threatening Life Experiences Questionnaire assessed self-reported major financial crisis in the past 6-months. Multi-variable adjusted fixed effect regression models tested the time-dependent association between financial crisis and cognition.

RESULTS

A recent financial crisis coincided with contemporaneous declines in CVLT (Mean change = -0.14, 95% CI = -0.262, -0.025), SDMT (Mean change = -0.08, 95% CI = -0.147,-0.004) and TMT-B (Mean change = -0.17, 95% CI = -0.293,-0.039) for adults in the oldest age group, and these associations were larger than in the younger age groups. In contrast, there was an overall association between financial crisis and deficits in BDS (Mean change = -0.06, 95% CI = -0.105, -0.007), with weak evidence of stronger associations in mid-life relative to other age groups. These associations were independent of changes in health and socio-economic circumstances.

DISCUSSION

This study provides important new evidence that financial difficulties in later life are potent stressors associated with occasion specific deficits in cognitive performance.

Risk aversion connectedness in developed and emerging equity markets before and after the COVID-19 pandemic

This study investigates the dynamic connectedness across the variance risk premium in international developed and emerging equity markets based on a Bayesian time-varying parameter vector autoregressive methodology. The empirical results indicate that the total spillover index is on average 65.6%, indicating a high, albeit declining, level of interconnectedness across the investor sentiment in the three markets under review until early 2020. Following the COVID-19 outbreak though, the total investors' risk aversion connectedness - as expected - strengthens, but more importantly, its dynamics alter, indicating that the risk aversion of emerging markets is an important contributor to the connectedness of international markets.

The long-term effects of labor market entry in a recession: Evidence from the Asian financial crisis

This study investigates the long-term effects of initial labor market conditions by comparing cohorts who graduated from college before, during, and after the 1997-1998 Asian financial crisis in South Korea. We measure the overall welfare effect by examining their labor market activities, family formation, and household finances. Using data from 20 waves of the Korean Labor and Income Panel Study, we find a substantial and persistent reduction in employment, earnings, marriage, fertility, and asset building among men who graduated during the recession. For women, limited job opportunities at graduation resulted in an increase in childbearing. We also find evidence that family provides a risk-sharing mechanism for recession graduates. Our results suggest that labor market entry in a large-scale recession has prolonged effects on a young worker's life course even after the penalties in the labor market have disappeared.

Does style investing uniformly affect correlations in small and large markets?

Empirical and theoretical research concurs to show that style investing increases return correlations within assets that are classified into the same style. The theoretical model presented in this study addresses the question of how the correlation increases due to style investing depend on market size, and how they respond to economic downturns and to the incidence and awareness of style investing. The results show that correlation distortions caused by style investing are more robust for smaller markets. Further, the effect of style investing on correlations strengthens risk aversion, and hence during downturns. Market awareness, and incidence, of style investing also increase correlation distortions. The model yields closed-form analytical expressions for the correlation distortions caused by style investing, as well as for the effects of changes in risk aversion and in the incidence and awareness of style investing. Given the surge ETF-based style investing over the last two decades, the results have implications for portfolio risk diversification. This study predicts that the ability of risk mitigation through portfolio diversification diminishes particularly for small-market domestic investors as a result of the growing relevance of country-based ETF-based.

Co-movements and spillovers of oil and renewable firms under extreme conditions: New evidence from negative WTI prices during COVID-19

We test for the existence of volatility spillovers and co-movements among energy-focused corporations during the outbreak of the COVID-19 pandemic, inclusive of the April 2020 events where West Texas Intermediate (WTI) oil future prices became negative. Employing the spillover index approach of Diebold and Yilmaz (2012); as well as developing a DCC-FIGARCH conditional correlation framework and using estimated spillover indices built on a generalised vector autoregressive framework in which forecast-error variance decompositions are invariant to the variable ordering, we examine the sectoral transmission mechanisms of volatility shocks and contagion throughout the energy sector. Among several results, we find positive and economically meaningful spillovers from falling oil prices to both renewable energy and coal markets. However, this result is only found for the narrow portion of our sample surrounding the negative WTI event. We interpret our results being directly attributed to a sharp drop in global oil, gas and coal demand, rather than because of a sudden increase in oil supply. While investors observed the US fracking industry losing market share to coal, they also viewed renewables as more reliable mechanism to generate long-term, stable and low-cost supply.

Covid-19: implications for insurer risk management and the insurability of pandemic risk

This paper analyzes the insurability of pandemic risk and outlines how underwriting policies and scenario analysis are used to build resilience upfront and plan contingency actions for crisis scenarios. It then summarizes the unique "lessons learned" from the Covid-19 crisis by baselining actual developments against a reasonable, pre-Covid-19 pandemic scenario based on the 2002 SARS epidemic and 1918 Spanish influenza pandemic. Actual developments support the pre-Covid-19 hypothesis that financial market developments dominate claims losses due to the demographics of pandemics and other factors. However, Covid-19 "surprised" relative to the pre-Covid-19 scenario in terms of its impact on the real economy as well as on the property and casualty segment as business interruption property triggers and exclusions are challenged, something that may adversely impact the insurability of pandemics as well as the perception of the industry for some time to come. The unique lessons of Covid-19 reinforce the need for resilience upfront in solvency and liquidity, the need to improve business interruption wordings and re-underwrite the book, and the recognition that business interruption caused by pandemics may not be an insurable risk due to its large accumulation potential and the threat of external moral hazard. These insurability limitations lead to a discussion about the structure and financing of protection against the impact of future pandemics.

Any port in a storm: Cryptocurrency safe-havens during the COVID-19 pandemic

Controlling for the polarity and subjectivity of social media data based on the development of the COVID-19 outbreak, we analyse the relationships between the largest cryptocurrencies and such time-varying realisation as to the scale of the economic shock centralised within the rapidly-escalating pandemic. We find evidence of significant growth in both returns and volumes traded, indicating that large cryptocurrencies acted as a store of value during this period of exceptional financial market stress. Further, cryptocurrency returns are found to be significantly influenced by negative sentiment relating to COVID-19. While not only providing diversification benefits for investors, results suggest that these digital assets acted as a safe-haven similar to that of precious metals during historiccrises.

Assessing health outcomes in the aftermath of the great recession: a comparison of Spain and the Netherlands

Background

Across time and space, financial security has been shown to impact health outcomes, with the acute loss of financial security being particularly detrimental. We compare financial security’s association with health in Spain and the Netherlands. These countries respectively exemplify low and high levels of financial security, general trends that have been exacerbated by the Great Recession of the 2010s.

Methods

We exploit the Spanish (n = 1001) and Dutch (n = 1010) editions of the European Social Survey 7, conducted in 2014, and condense relevant financial security- and health-related survey questions into latent variables using factor analyses. Using the component loadings as quasi-weightings, we generate one financial security variable and three health variables (mental, physical and social). Then, we run ordinary least squares regressions interacting financial security and nationality, for each of the three health outcomes.

Results

In unadjusted models, we find that financial security (p < 0.01) is positively associated with the three health outcomes, while being Spanish relative to being Dutch (p < 0.01) is associated with worse health outcomes. However, the results of the interaction term show that being Spanish relative to being Dutch weakens the relationship between physical health and social health, although not mental health.

Conclusions

We find evidence that financial security’s influence on health outcomes may vary in different contexts. This may be an important aspect of determining the Great Recession’s influence on health outcomes. Our study is a first step in understanding how the relationships between financial security and health may differ in countries with different experiences of the Great Recession.

Innovative strategies and corporate profitability: the positive resources dependence from political network

This research investigates the join effects of political network and innovation strategies on corporate profitability. By using the qualified survey sample of over 2600 firms, located in around 10 provinces of Vietnam, during the 10 year from 2005 to 2015 of UN-WIDER, the results reveal that the political network, estimated from number of political connection and the time of interaction, has significantly mitigated the innovative activities' inefficiency toward firm's performance that it can positively foster the innovative capacity, then encourage more profit margin. However, the study figured out that innovative activities by itself, in the small-medium enterprise, is not good for corporate performance even three different aspects of new products, improvement, or new technology. Indeed, this issue is also the same for political connection as increasing more number of political contacts or time of interaction, the firm's value will be more detrimental.

Problem Gambling in Greece: Prevalence and Risk Factors During the Financial Crisis

In Greece no study has ever been conducted on the prevalence of problem gambling. Therefore, a cross-sectional survey was carried out amid the recession aiming to (1) estimate past year prevalence of problem gambling, (2) explore socio-economic and demographic differences among gamblers and non gamblers, (3) explore socio-economic and demographic differences among gamblers who started gambling prior and during the downturn and (4) identify its risk factors with a special interest in the influence of the recession. To this end, data emanating from a telephone and patron survey were combined. A random and representative sample of 3.404 people participated in the telephone survey and 2.400 in the patron survey. The interview schedule was the same in both studies. The presence of problem gambling was assessed with the Canadian Problem Gambling Index. Information on participants' socio-economic and demographic characteristics as well as their ways of dealing financially with the crisis were collected. Findings indicated that 2.4% of respondents met criteria for problem gambling. Male gender, minority status, living with family of origin, low educational level and low to zero income were found to constitute the risk factors of the disorder. Moreover, having started gambling during the recession increased the odds of suffering from problem gambling; however this finding was gender-specific. Thus, people end up in problem gambling through various pathways, with these trajectories being different for men and women. Any intervention should address the complexity of the issue and be tailored by gender.

The Impact of the Economic Recession in Greece on Assisted Reproduction Demand: A Retrospective Longitudinal Study

BACKGROUND AND OBJECTIVES

Since 2009, the decline of the Greek economy has been in the spotlight of the world's financial agenda. This study assesses the economic crisis' impact on assisted reproduction demand dynamics.

MATERIALS AND METHODS

Patient records were recruited between 2005-2017. In 2013 the clinic proceeded with a cost reduction. The studied time-frames were defined accordingly: Period A: Prior to economic crisis, Period B: During the economic crisis-prior to cost reduction, and Period C: During the economic crisis-following cost reduction. Analysis focused on parameters reflecting on patient characteristics, decision to inquire on IVF treatment, embarking on it, and proceeding with multiple cycles.

RESULTS

The mean annual number of first visit patients was significantly decreased during Period B (1467.00 ± 119.21) in comparison to period A (1644.40 ± 42.57) and C (1637.8 ± 77.23). Furthermore, Period C in comparison to B and A, refers to women of more advanced age (37.27 ± 5.62 vs 36.04 ± 5.76 vs 35.53 ± 5.28), reporting a longer infertility period (8.49 ± 6.25 vs 7.01 ± 5.66 vs 6.46 ± 5.20), being inclined to abandon IVF treatment sooner (2.78 ± 2.51 vs 2.60 ± 1.92 vs 4.91 ± 2.28).

CONCLUSIONS

A decline regarding assisted reproduction techniques (ART) demand was noted as anticipated. Redefining the cost of infertility treatments may contribute towards overcoming the troubling phenomenon of postponing pregnancy due to financial concerns.

Health-related quality of life in adult population before and after the onset of financial crisis: the case of Athens, Greece

PURPOSE

Trends of person-oriented indices with respect to the general population have not been adequately investigated. In Athens, two Health Surveys in 2003 and 2016 provide the opportunity to analyze HRQL in the general adult population. The objectives of this study were to investigate changes in HRQL of adults in the broader area of Athens between 2003 and 2016 and their association with certain socio-demographic determinants.

METHODS

We compared participants from pre- and during-crisis cross-sectional surveys. We used data from 982 and 1060 adult residents of Athens from 2003 and 2016 surveys, respectively. Income-related missing data were treated using three alternative methods. Subscale and summary component SF-36 scores were compared with Mann-Whitney tests and linear regression analyses were used to estimate the effect of demographic and socio-economic variables on HRQL before and after the onset of crisis.

RESULTS

The analysis was based on the results of the procedure of handling missing income data as a separate income group and showed that physical component summary score (PCS) has improved and Mental Component Summary score has deteriorated. The most important predictors of HRQL were being widowed and during the crisis not being employed. Additionally, socio-demographic characteristics explained a higher proportion of variance of HRQL after the onset of crisis, especially for PCS.

CONCLUSION

Decline in mental and improvement in physical HRQL were observed between 2003 and 2016. HRQL has been certainly affected by the recession, but it is difficult to estimate the exact impact of the financial crisis on HRQL.

The impact of financial crisis and austerity policies in Andalusia, Spain: disentangling the mechanisms of social inequalities in health through the perceptions and experiences of experts and the general population

Background

Andalusia has been one of the regions most damaged by the economic crisis in Spain. A qualitative study of the effects of the economic crisis and austerity policies in this region has been conducted within the framework of the IMPACT-A project. This research seeks to analyse the perceived impact of the crisis upon the health of the Andalusian population through the first-hand discourses of professionals from the health and social sectors on the one hand, and citizens of different socioeconomic status (SES) on the other.

Methods

A total of five focus groups and ten semi-structured interviews were conducted and analysed following an inductive process based on Grounded Theory (GT).

Results

Our results show a general perception among professionals: the financial crisis has either directly or indirectly affected population health in Andalusia, though mostly impacting low-income individuals who were already at risk of social exclusion. Professionals’ perceptions have been confirmed through the discourses of citizens of a lower SES, which differ from those of middle and upper SES.

Conclusion

Findings reveal some of the most salient consequences on the socially vulnerable groups and people at risk of social exclusion. In particular, our study highlights the importance of addressing three areas of priority action: mental health, unmet (basic and medical) needs, and decline in the health system.

The burden on public emergency departments during the economic crisis years in Greece: a two-center comparative study

OBJECTIVES

The effects of the Greek economic crisis on the emergency departments (EDs) of public hospitals have not been evaluated. The study aims to evaluate the burden of the financial crisis on public hospital's EDs.

STUDY DESIGN

The present study is a retrospective two-center comparative study.

METHODS

ED visits, related admissions per year, and the admissions/visits ratio at two public Greek hospitals, the Sismanogleio of Athens (SHA) and the University Hospital of Crete (UHC), from 2008 to 2016 were retrospectively studied. A linear model was fitted for each variable, and the slope values of the linear equations were calculated and compared between the two institutions.

RESULTS

ED visits of the UHC exhibited 8.9% increase during the study period, whereas related admissions and admissions/visits ratio increased by 23.4% and 12.5%, respectively. ED visits at the SHA exhibited 5.4% increase, whereas related admissions showed 6% decrease and the admissions/visits ratio was decreased by 8%. Significant differences between the rates of admissions (P < 0.001) and admissions/visits ratio (P = 0.001) among the two hospitals were observed.

CONCLUSIONS

Both institutions showed similarly increased ED visits. However, the UHC serving mainly rural, but also suburban and urban population, exhibited different changes regarding admissions and admissions/visits ratio compared with the SHA serving mainly an urban and suburban one, reflecting the way the crisis affected each social group. Depression has amplified the Greek National Health System structural problems and exposed the problematic urban primary health care. Improvement of primary urban health care, autonomy of EDs, and establishment of emergency medicine as independent specialty in Greece could serve better patients seeking care in public hospitals' EDs.

Measures that increase social equality are effective in improving life satisfaction in times of economic crisis

BACKGROUND

The financial crisis of 2008/2009, for some also in 2011, was accompanied by increasing social inequality and unemployment, which strained the welfare generosity systems in many countries. Welfare generosity redistributes internal resources to decrease poverty and increase equal opportunities. This was used by many countries to combat the crisis. We investigated the effects of increased social inequality, unemployment and welfare generosity on life satisfaction (LS) before and after the crisis.

METHODS

A representative sample from the European Social Survey (2002 to 2014) with data from 26 countries was used (N = 301,559). Time from start of crisis (either 2008 or 2010-2012) was determined separately for each case. LS was measured with a single question with 11 response alternatives. Social inequality was measured using the Gini index. Unemployment was measured by a single question (No/Yes). Welfare generosity was measured using expenditure on social protection (PPS) per inhabitant (Eurostat). Data were analyzed by multilevel analysis and multilevel mediation analysis.

RESULTS

Welfare generosity was associated with decreased levels of social inequality. The negative relationship between social inequality and LS was weakened when controlling for welfare generosity after the financial crisis. This effect of welfare generosity was not seen for the negative impact of unemployment on LS.

CONCLUSION

The financial crisis stimulated the use of welfare generosity in Europe and strengthened the positive relationship between welfare generosity and LS. Social inequality, unemployment and welfare generosity played significant mediator roles between the crisis and LS, with increased welfare generosity far more strongly associated with increased LS. Measures that increase social equality in a country and thereby increase equal opportunity for all social classes, may be assumed to be effective in improving the general LS of the population in a country in times of economic crisis.

Cardiovascular disease in Greece; the latest evidence on risk factors

Cardiovascular disease (CVD) is a significant and ever-growing problem in Europe, accounting for nearly 45% of all deaths and leading to significant morbidity. Greece is one of the European Union member states that top the list of deaths due to ischemic heart disease and stroke, a fact that is mainly attributed to unfavorable changes in modifiable risk factors. The aim of this review is to examine the latest evidence on the most important CVD risk factors. According to studies conducted during the last two decades, the prevalence of arterial hypertension, hypercholesterolemia, diabetes mellitus, and obesity remained relatively stable or increased. The decrease in the prevalence of active smokers and the increase in physical activity, during the last few years, are the main favorable risk modifications in the Greek population. Nevertheless, citizens of Greece seem to gradually adopt unhealthy dietary habits by moving away from Mediterranean diet, as issue that is intensified after the outbreak of the Greek debt crisis. Furthermore, the inability of some patients to afford their medications and the possible health care deficiencies as well as the increasing prevalence of depression may make the situation even worse. During the financial crisis, CVD mortality seems to have remained unaffected, but there is evidence that the incidence of cardiovascular events is increasing. More effort is needed to control established and emerging CVD risk factors among the Greek population.

Perceptions of pharmacists and physicians on generic substitution in a financial crisis context in Northwestern Spain: A qualitative study

In Spain, the use of generics has considerably evolved in a short period of time through different anti-crisis legislation changes. Before the financial crisis the proposal of generics was an option for patients. Nowadays its use is actively enforced by Health authorities.

OBJECTIVE

To explore the perceptions of pharmacists and physicians regarding the generic substitution driven by new Spanish drugs policies as well as their adaptive strategies intended to lessen the impact of changes to their patients' treatment.

METHODS

Pharmacists (16) and physicians (13) from Ferrol and A Coruña participated in a qualitative study using semi-structured in-depth interviews.

RESULTS

Qualitative analysis allowed identification of nine key components in the substitution process: Enabling factors: 'Adequate information to patients', 'Acute treatments', 'Bioappearance', 'Prescription by Estate Official Denomination followed by laboratory name', 'Personalized dosage systems'. Obstructing factors: 'Generics/Authorities distrust', 'Lack of time', 'Patient characteristics', 'Pharmacy financial management'.

CONCLUSIONS

Pharmacists and physicians in our economic crisis context perceive different barriers resulting in difficulties in the generic substitution process. They have implemented strategies to capitalize on the enablers and overcome the additional budget-cut barriers imposed by the Administration that had prevented them from maintaining their patient's treatment preferences. Spanish health authorities could improve current legislation either by reducing the number of new laboratories of authorized generic manufacturers or by extending the pharmacist capability for equivalent drugs substitution.

[Impact of the financial crisis on activity and efficiency at a high-technology university hospital]

OBJECTIVE

The financial crisis that begun in 2008 significantly decreased the budget of the public health system on Spain. The aim of this study was to evaluate the impact of the financial crisis on the activity, quality and efficiency of a high-technology university hospital.

METHODS

We retrospectively analyzed the outcomes of four sets of hospital management indicators between 2007 and 2016 (A: activity; B: quality and complexity of inpatientcare; C: staff, global production and budget expenses; D: patients satisfaction survey). The data were obtained from the center's information systems and treated as longitudinal series of descriptive type. The impact of the crisis was assessed by analyzing the percentage deviations of the different indicators in relation to the values of the year 2009, the year before initial budget adjustments.

RESULTS

The overall activity of the hospital, adjusted for complexity, decreased 9% during the first two years of the crisis and recovered later. Inpatient complexity increased 14%. Quality set indicators did not deteriorate. Expenses decreased 16% between the years 2009 and 2014, and efficiency and global productivity improved by 13%. Patient satisfaction survey results did not change.

CONCLUSIONS

The financial crisis and the subsequent decrease of budget provoked an initial reduction of hospital activity, associated with a complexity increase. It was progressively made up for with increased efficiency and global productivity. The financial crisis did not have negative effects on quality of care or patient satisfaction.

Distress and burnout in young medical researchers before and during the Greek austerity measures: forerunner of a greater crisis?

PURPOSE

Distress and burnout are strongly correlated with austerity and financial recessions. Aim of this study was to assess distress and burnout among young medical researchers (YMR) in Greece before and during the financial crisis.

METHODS

In total 2050 YMR affiliated in all the nursing and medical departments of Greece were enrolled (1025 in Period A: 2008 and 1025 in Period B: 2017). Distress and burnout were measured via DASS-21 and Maslach Burnout Inventory (MBI) questionnaires.

RESULTS

Before the crisis, prevalence of distress and burnout among young medical researchers was 24 and 20%, respectively. During the financial crisis distress prevalence increased significantly (56%), while there has also been a tremendous increase in burnout occurrence (60%). Specific sociodemographic characteristics presented significantly increased rate of change (females, singles and divorced/widowers, living with family members, volunteers, smokers and heavy alcohol consumers). Distress and burnout scales were positively correlated (Spearman's r = 0.81; p = 0.01). Depression scores shifted from normal to moderate (rate of change = 13.1%), anxiety levels increased from normal to severe (rate of change = 14.3%) and tension/stress scores elevated from normal to severe (rate of change = 20.2%).

CONCLUSIONS

It is evident that the current financial crisis and working conditions have a strong impact on health status of young medical researchers in Greece. The observed increased trends and the identified predictors could guide targeted and comprehensive interventions towards tackling distress among the medical researchers not only in Greece but also in other countries suffering from financial crisis.

Food insecurity and Mediterranean diet adherence among Greek university students

AIM

To assess Mediterranean diet (MD) adherence and food insecurity (FI) among university students in Greece.

METHODS AND RESULTS

A non-probability sample of 236 students was recruited from Athens and Thessaloniki during 2016. FI was assessed with the Household Food Insecurity Access Scale and MD adherence with the MEDAS questionnaire. Mean MEDAS score of the sample was 6.4 ± 1.9, with women demonstrating greater MD adherence compared to men (p = 0.016) and Dietetics students exhibiting increased score compared to the rest (p ≤ 0.001). A low proportion of participants were food-secure (17.8%), 45.3% were severely food-insecure, 22.0% experienced moderate FI and the remaining 14.8% had low FI. Participants studying in the city they grew up exhibited lower FI compared to those studying in other cities (p = 0.009), while, additionally, a trend was noted for increased FI among students with an unemployed family member (p = 0.05). Students working night shifts had lower MD adherence and increased FI compared to the rest (p = 0.004 and p = 0.003, respectively). The same pattern was observed among participants who smoked (p = 0.003 for MD adherence and p = 0.009 for FI, respectively). Multivariate regression analyses did not reveal any connections between FI categories, waist circumference or BMI, but showed an inverse relationship between severe FI and MD adherence.

CONCLUSIONS

The majority of the surveyed university students from Greece demonstrate some degree of FI, with a great proportion being severely food-insecure. Increased FI is inversely associated with MD adherence.

Have bailouts shifted the burden of paying for healthcare from the state onto individuals?

BACKGROUND/AIMS

The financial crisis that enveloped Europe in 2009 created financial pressure for governments and required a number of countries to obtain a financial bailout from the IMF. The purpose of this paper is to examine the effect of the financial crisis on public health expenditure in bailout countries and if bailouts shift the burden of paying for healthcare from the state onto individuals.

METHODS

Quantitative health expenditure data were collected from the WHO and OECD for the period 2004-2015 and evaluated using a comparison of means Welch's t test.

RESULTS

The majority of bailout countries recorded a decrease in public health expenditure as a percentage of total government expenditure, with Ireland recording the largest decrease with government health expenditure as a percentage of total government expenditure, falling by 22% (P < .01). In addition, the results also suggest that the burden of paying for healthcare shifted from the state onto individuals in three countries, namely Hungary, Ireland and Portugal, where public health expenditure declined and private expenditure increased significantly.

CONCLUSIONS

The ramifications of shifting the burden of paying for healthcare from the state onto individuals at this point remain unclear with further research required to identify the long-term consequences for healthcare.

The impact of financial crisis on coronary artery disease burden in Greece

BACKGROUND

Economic crisis poses an immense threat to public health worldwide and has been linked to cardiovascular morbidity and mortality. Greece is facing a distinctive recession over the recent years. However, the exact impact on coronary artery disease (CAD) burden has not been adequately addressed.

METHODS

Demographic, clinical, and angiographic data of 3895 hospitalized patients were retrospectively studied. Patients were classified into two groups: those before crisis (2006-2007, n = 1228) and those during crisis (2011-2015, n = 2667).

RESULTS

All data before and during crisis were compared. During crisis, patients presented with less acute coronary syndrome (ACS - 45.5% vs. 39.9%, p < 0.001). Subsequently, there were more patients without CAD (23.7% vs. 35.1%, p < 0.001) or one-vessel disease (20.5% vs. 23%, p < 0.001). The prevalence of traditional risk factors decreased significantly or remained stable except obesity (26.3% vs. 31.4%, p = 0.002). A significant increase in the examined females (23.6% vs. 26.7%, p = 0.04) was also observed.

CONCLUSIONS

The burden of CAD in Greece was partially affected during the financial crisis. Even though the incidence of ACS was decreased, more women and more patients with no- or single-vessel disease were referred for cardiac catheterization. In addition, the prevalence of traditional risk factors for CAD did not increase except obesity confirming the "obesity paradox." It seems that the impact of traditional risk factors for CAD is not an immediate process and is somewhat related to living conditions or other exogenous and social factors.

Trends in cancer mortality in Spain: the influence of the financial crisis

OBJECTIVE

To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends.

METHOD

We conducted a longitudinal ecological study based on all cancer-related deaths and on specific types of cancer (lung, colon, breast and prostate) in Spain between 2000 and 2013. We computed age-standardised mortality rates in men and women, and fit mixed Poisson models to analyse the effect of the crisis on cancer mortality and trends therein.

RESULTS

After the onset of the economic crisis, cancer mortality continued to decline, but with a significant slowing of the yearly rate of decline (men: RR = 0.987, 95%CI = 0.985-0.990, before the crisis, and RR = 0.993, 95%CI = 0.991-0.996, afterwards; women: RR = 0.990, 95%CI = 0.988-0.993, before, and RR = 1.002, 95%CI = 0.998-1.006, afterwards). In men, lung cancer mortality was reduced, continuing the trend observed in the pre-crisis period; the trend in colon cancer mortality did not change significantly and continued to increase; and the yearly decline in prostate cancer mortality slowed significantly. In women, lung cancer mortality continued to increase each year, as before the crisis; colon cancer continued to decease; and the previous yearly downward trend in breast cancer mortality slowed down following the onset of the crisis.

CONCLUSIONS

Since the onset of the economic crisis in Spain the rate of decline in cancer mortality has slowed significantly, and this situation could be exacerbated by the current austerity measures in healthcare.

The impacts of the global financial crisis on hospitalizations due to depressive illnesses in Taiwan: A prospective nationwide population-based study

BACKGROUND

In the third quarter of 2008, a major financial crisis hit many developed countries. Taiwan suffered its own share: a rise in unemployment and a severe decline in gross domestic product. This study is to address the health consequences of this crisis on different socioeconomic populations in Taiwan.

METHODS

A sample of 6,225,766 men and 5,417,651 women, was obtained and their admissions data over 2007-2012 were retrieved. Stratified into three income levels, the sample was examined on the 147,921 episodes of hospitalization due to depressive illnesses (DIs) over that period by an interrupted time series analysis for monthly incidence rates of DI hospitalizations RESULTS: The adjusted incidence rates of hospitalization (AIRH) for DIs among the low income were 10 times that of the high income group. The AIRHs were generally higher in all of three female income groups than they were in the three male income groups. The low income men and women showed increases (of 18.0% and 14.2%, respectively) beginning in April 2008 that sustained for two years. The high income women exhibited a 5.0% monthly rise in the rate of DI hospitalizations.

LIMITATIONS

Our time series models can control some confounding factors, but the ecological fallacy remained.

CONCLUSIONS

This study provides evidence that the economic recession resulted in increased rates of DI hospitalization in Taiwan, especially among the low income population. Women of higher incomes may have suffered a more enduring impact.