Italian responses to the COVID-19 emergency: Overthrowing 30 years of health reforms?

This paper discusses the measures adopted by the Italian government to face the COVID-19 emergency after the first wave in March/April 2020. This study places these measures in light of the massive reform process based on the “managerialism” of healthcare, which started in the 1990s. These reforms, which were inspired by the ideas of ‘New Public Management’, introduced managerialism, regionalization and quasi-markets to the Italian National Health System. As a result, dramatic changes have been made in public healthcare, and the responsibility for healthcare was decentralized to regions, introducing a multi-level governance structure. The COVID-19 emergency has drawn the results of this approach into question. With the enactment of new decrees, the central government directly intervened in the management of the health system by introducing specific measures aiming to increase the number of hospital beds and personnel, which w previously downsized. We describe the main content of the new measures adopted to face the COVID-19 emergency and discuss how key points of the managerialization process in Italy are being questioned as a result of these measures. The COVID-19 emergency will likely redesign the trajectory of health reforms in Italy and other countries in Europe.     

An integer programming model to assign patients based on mental health impact for tele-psychotherapy intervention during the Covid–19 emergency

The Covid–19 pandemic challenges healthcare systems worldwide while severely impacting mental health. As a result, the rising demand for psychological assistance during crisis times requires early and effective intervention. This contributes to the well-being of the public and front-line workers and prevents mental health disorders. Many countries are offering diverse and accessible services of tele-psychological intervention; Ecuador is not the exception. The present study combines statistical analyses and discrete optimization techniques to solve the problem of assigning patients to therapists for crisis intervention with a single tele-psychotherapy session. The statistical analyses showed that professionals and healthcare workers in contact with Covid–19 patients or with a confirmed diagnosis had a significant relationship with suicide risk, sadness, experiential avoidance, and perception of severity. Moreover, some Covid–19-related variables were found to be predictors of sadness and suicide risk as unveiled via path analysis. This allowed categorizing patients according to their screening and grouping therapists according to their qualifications. With this stratification, a multi-periodic optimization model and a heuristic are proposed to find an adequate assignment of patients to therapists over time. The integer programming model was validated with real-world data, and its results were applied in a volunteer program in Ecuador.

     

Do mandates requiring insurers to pay for emergency care influence the use of the emergency department?

Many states have "prudent layperson" mandates that require health plans to reimburse hospitals for emergency department (ED) care delivered to patients who believe that they have symptoms warranting emergency treatment. Increased, and possibly unnecessary, ED use has often been attributed to these policies. We use data from thirty-five states to study relationships between passage of prudent layperson policies in the late 1990s and ED use among the privately insured. None of the analyses show evidence that the mandates are associated with increased use. We conclude that prudent layperson mandates are not associated with increases in ED visits among privately insured patients.     

How effective has the Spanish lockdown been to battle COVID-19? A spatial analysis of the coronavirus propagation across provinces

This paper examines the propagation of COVID-19 across the Spanish provinces and assesses the effectiveness of the Spanish lockdown of the population implemented on March 14, 2020 in order to battle this pandemic. To achieve these objectives, a standard spatial econometric model used in economics is adapted to resemble the popular reproduction models employed in the epidemiological literature. In addition, we introduce a counterfactual exercise that allows us to examine the Gross domestic product (GDP) gains of bringing forward the date of the Spanish Lockdown. We find that the number of COVID-19 cases would have been reduced by 70.4% in the absence of spatial propagation between the Spanish provinces. We also determine that the lockdown prevented the propagation of the virus within and between provinces. As such, the Spanish lockdown reduced the number of potential COVID-19 cases by 82.8%. However, the number of coronavirus cases would have been reduced by an additional 11.6% if the lockdown had been brought forward to March 7, 2020. Finally, an earlier lockdown would have saved approximately 26,900,000,000 euros.     

Can the Covid19 pandemic affect the achievement of the ‘Zero Hunger’ goal? Some preliminary reflections

The European Journal of Health Economics - The ongoing Covid19 pandemic is producing dramatic effects on the economic and social life of many countries, which in turn may further undermine...     

Decision to evacuate a hospital during an emergency: the safe way or the leader's way?

Hospitals have frequently been evacuated because of natural or man-made disasters. In this article, we identify elements to be considered when confronted with the possibility of hospital evacuation. Hospital evacuation may have a significant impact on the surrounding community and the overall population. When the patients in a hospital are placed at risk, hospital leadership often decides to evacuate the facility to safeguard the well-being of both patients and staff. Such a decision is not likely to be criticized. We present various considerations. The effect of evacuation on patients, hospital staff, family members, the community, and even the nation as a whole, as well as repercussions affecting potential patients should be integral to the decision-making process and parallel to the risk assessment.     

Proximal, distal, and the politics of causation: what's level got to do with it?

Causal thinking in public health, and especially in the growing literature on social determinants of health, routinely employs the terminology of proximal (or downstream) and distal (or upstream). I argue that the use of these terms is problematic and adversely affects public health research, practice, and causal accountability. At issue are distortions created by conflating measures of space, time, level, and causal strength. To make this case, I draw on an ecosocial perspective to show how public health got caught in the middle of the problematic proximal-distal divide--surprisingly embraced by both biomedical and social determinist frameworks--and propose replacing the terms proximal and distal with explicit language about levels, pathways, and power.     

Facing the facelessness of public health: what's the public got to do with it?

Despite compelling statistics that show we could eliminate 80%of all heart disease and strokes, 90% of all diabetes, and 60% of all cancers with basic lifestyle changes, we have failed to motivate the public to make these changes and failed to motivate policy makers to make healthy choices the easiest choice. Dr. Katz suggests we have failed because we have focused too much on statistics and too little on passion. He implores all of us to tap into people's passion by connecting each of these statistics with a human story.     

Did the introduction of general practice fundholding change patterns of emergency admission to hospital?

OBJECTIVES: To test the hypothesis that the introduction of general practice fundholding was associated with a change in the proportion of emergency admissions to hospital. METHODS: Before and after natural experiment with control group. The experimental group was first-wave fundholding general practices in the South Western Regional Health Authority, the control group was all practices that remained non-fundholding as of April 1993. Data were collected on episodes of care in hospitals in the South Western region involving cholecystectomy, hernia repair, intervertebral disc operation and prostatectomy. The additional impact of fundholding status on any underlying changes in proportions of emergency admissions was examined using multiple logistic regression. RESULTS: There was no evidence of an interaction between fundholding status and before/after time period. Odds ratios and confidence intervals for the interaction of general practice fundholding status and time were: prostatectomy 1.02 (0.77 to 1.34); hernia repair 0.94 (0.7 to 1.24); intervertebral disk operations 1.67 (0.8 to 3.47); prostatectomy 0.94 (0.69 to 1.27). CONCLUSIONS: The results provide no evidence that, in the first 2 years of the scheme, fundholding had an impact on the proportion of emergency admissions to hospital.     

“Together in a pressure cooker”: Parenting children with disabilities during the COVID-19 lockdown

BackgroundCOVID-19 has had a disproportionate and unprecedented impact on children with disabilities, their parents and families. This impact has been particularly evident during periods of lockdowns and severe restrictions.ObjectiveThis study employed the social model of disability to illuminate negative and positive experiences of Israeli parents of children with disabilities during the first COVID-19 lockdown, as well as the way social environments, particularly educational and welfare services, shape that experience.MethodsThe study draws upon thematic analysis of written responses of 80 Israeli parents to open-ended questions.ResultsThree main themes were found: (1) lack of responsiveness of both informal and formal supports to family needs, mainly in the educational and welfare systems; (2) juggling multiple roles and tasks along with the parents' routinely intensive caregiving role; and (3) the impact on the family's wellbeing and relationships.ConclusionThese results are discussed in light of the social model of disability, showing how social restrictions and barriers affect both negative and positive experiences of these families. Also discussed are practical implications for future crises.     

Did the European suspension of the AstraZeneca vaccine decrease vaccine acceptance during the COVID-19 pandemic?

On March 11, 2021, the AstraZeneca vaccine against COVID-19 was suspended in three Nordic countries and, on subsequent days, in other European countries. Using data on vaccine acceptance in eight Western countries obtained on a daily basis, we show that these decisions - and associated news - decreased public vaccine acceptance in several countries and part of this decrease happened in response to suspensions in other countries. The findings demonstrate the importance of international coordination between health authorities during a pandemic such that local authorities are able to put the decisions of foreign authorities into perspective.     

Drink and drug driving: what's the skipper up to?

OBJECTIVE: Since the introduction of random breath testing (RBT) in Australia there has been a significant reduction in drink driving, as measured by alcohol-related crashes. In contrast, the prevalence of drug-related road fatalities is on the increase. One strategy that targets drink- and/or drug-driving is the promotion of a designated driver or 'skipper'. This paper determines to what extent the 'skipper' is driving alcohol or drug-free. METHODS: A convenience sample of university students from The University of Western Australia completed a questionnaire that included questions on drug and alcohol use while driving as the designated 'skipper'. RESULTS: The mean age of the 286 participants was 21 years. Among the students who reported acting as the designated 'skipper' during the past 12 months, 26% of the students drove, as the designated 'skipper,' while feeling the effects of alcohol. Similarly, 18% of students who reported using drugs drove, as the 'skipper', while feeling the effects of the drug. Multivariate analysis identified that the presence of random drug testing would act as a deterrent for drug driving while the designated 'skipper'. CONCLUSION: Although three-quarters of designated 'skippers' do not drink and/or drug drive, a sizeable proportion of young drivers continue to place themselves and, more importantly, their passengers and the entire community at an elevated risk of injury. IMPLICATIONS: Campaigns that target the responsibility of the 'skipper' and that are included as part of drink-driving campaigns would be beneficial. It is premature to be making recommendations on random drug testing for drivers.     

Estimating the efficacy of emergency contraception--how reliable are the data?

Ninety-four women attending a family planning clinic for emergency contraception (EC) were asked how certain they were of the date of their last menstrual period (LMP), of the timing of intercourse, and how many times in the cycle they had had sex. Urinary pregnanediol concentrations were analyzed in 64 women to assess whether they had ovulated before they used EC. Forty-five women were certain of the date of the LMP, the rest were not. Only four women could not accurately recall the timing of intercourse, and 60% had had intercourse more than once in the cycle. Twenty-one women had urinary pregnanediol concentrations that were inconsistent with their cycle day. Calculations of the efficacy of EC depend on knowing the timing of intercourse in relation to the estimated day of ovulation. The results of this study suggest that these calculations are likely to be inaccurate for a significant minority of women.     

Colonic metabolites of berry polyphenols: the missing link to biological activity?

The absorption of dietary phenols, polyphenols and tannins (PPT) is an essential step for biological activity and effects on health. Although a proportion of these dietary bioactive compounds are absorbed intact, depending on their chemical structure and the nature of any attached moiety (e.g. sugar, organic acid), substantial amounts of lower molecular weight catabolites are absorbed after biotransformation by the colon microflora. The main products in the colon are (a) benzoic acids (C6-C1), especially benzoic acid and protocatechuic acid; (b) phenylacetic acids (C6-C2), especially phenylacetic acid per se; (c) phenylpropionic acids (C6-C3), where the latter are almost entirely in the dihydro form, notably dihydrocaffeic acid, dihydroferulic acid, phenylpropionic acid and 3-(3'-hydroxyphenyl)-propionic acid. As a result of this biotransformation, some of these compounds can each reach mm concentrations in faecal water. Many of these catabolites are efficiently absorbed in the colon, appear in the blood and are ultimately excreted in the urine. In the case of certain polyphenols, such as anthocyanins, these catabolites are major products in vivo; protocatechuic acid is reported to represent a substantial amount of the ingested dose of cyanidin-3-O-glucoside. The major catabolites of berries, and especially blackcurrants, are predicted based on compositional data for polyphenols from berries and other sources. Since microbial catabolites may be present at many sites of the body in higher concentration than the parent compound, it is proposed that at least a part of the biological activities ascribed to berry polyphenols and other PPT are due to their colonic catabolites.