ResearchPad - Finance https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Data for understanding the risk perception of COVID-19 from Vietnamese sample]]> https://www.researchpad.co/product?articleinfo=Na5793820-9b52-4a6d-baed-bd8a0cad6a29

This data article describes the risk perception of COVID-190 from 391 Vietnamese respondents aged from 15 to 47 years. These data have been used in Huynh (2020). These data include the socioeconomics, media attention, and risk perception of COVID-19 in Vietnam through a survey conducted on February 1, 2020. In addition, our data might serve as a reference source for further in-depth surveys to understand the risk perception and social media communication across countries.

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<![CDATA[Gender norms and mass deworming program access in Comé, Benin: A qualitative assessment of gender-associated opportunities and challenges to achieving high mass drug administration coverage]]> https://www.researchpad.co/product?articleinfo=N0cbc3c85-9c5e-43fe-983c-4afc7d1b8db3

The World Health Organization’s Neglected Tropical Disease Roadmap has accelerated progress towards eliminating select neglected tropical diseases (NTDs). This momentum has catalyzed research to determine the feasibility of interrupting transmission of soil-transmitted helminths (STH) using community-wide mass drug administration (MDA). This study aims to identify potential gender-specific facilitators and barriers to accessing and participating in community-wide STH MDA, with the goal of ensuring programs are equitable and maximize the probability of interrupting STH transmission. This research was conducted prior to the launch of community-wide MDA for STH in Comé, Benin. A total of 10 focus group discussions (FGDs) were conducted separately among 40 men, 38 women, and 15 community drug distributors (CDDs). Salient themes included: both men and women believe that community-wide MDA would reduce the financial burden associated with self-treatment, particularly for low income adults. Community members believe MDA should be packaged alongside water, sanitation, and other health services. Women feel past community-wide programs have been disorganized and are concerned these distributions will be similar. Women also expressed interest in increased engagement in the implementation of future community-based public health programs. Men often did not perceive themselves to be at great risk for STH infection and did not express a high demand for treatment. Finally, the barriers discussed by CDDs generally did not align with gender-specific concerns, but rather represented concerns shared by both genders. A door-to-door distribution strategy for STH MDA is preferred by women in this study, as this platform empowers women to participate as health decision makers for their family. In addition, involving women in planning and implementation of community-wide programs may help to increase treatment coverage and compliance.

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<![CDATA[Partition dependence in financial aid distribution to income categories]]> https://www.researchpad.co/product?articleinfo=N0611b39b-d559-4542-a5d9-a69c54a62df4

When allocating resources, people often diversify across categories even when those categories are arbitrary, such that allocations differ when identical sets of options are partitioned differently (“partition dependence”). The first goal of the present work (Experiment 1) was to replicate an experiment by Fox and colleagues in which graduate students exhibited partition dependence when asked how university financial aid should be allocated across arbitrarily partitioned income brackets. Our sample consisted of community members at a liberal arts college where financial aid practices have been recent topics of debate. Because stronger intrinsic preferences can reduce partition dependence, these participants might display little partition dependence with financial aid allocations. Alternatively, a demonstration of strong partition dependence in this population would emphasize the robustness of the effect. The second goal was to extend a “high transparency” modification to the present task context (Experiment 2) in which participants were shown both possible income partitions and randomly assigned themselves to one, to determine whether partition dependence in this paradigm would be reduced by revealing the study design (and the arbitrariness of income categories). Participants demonstrated clear partition dependence in both experiments. Results demonstrate the robustness of partition dependence in this context.

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<![CDATA[Can mutual health organisations influence the quality and the affordability of healthcare provision? The case of the Democratic Republic of Congo]]> https://www.researchpad.co/product?articleinfo=Nf97c5072-5c0f-45dc-b83f-09c75045dd0d

Background

In their mission to achieve better access to quality healthcare services, mutual health organisations (MHOs) are not limited to providing health insurance. As democratically controlled member organisations, MHOs aim to make people’s voices heard. At national level, they seek involvement in the design of social protection policies; at local level, they seek to improve responsiveness of healthcare services to members’ needs and expectations.

Methods

In this qualitative study, we investigated whether MHOs in the Democratic Republic of Congo (DRC) succeed in defending members’ rights by improving healthcare quality while minimising expenses. The data originate from an earlier in-depth investigation conducted in the DRC in 2016 of the performance of 13 MHOs. We re-analysed this existing dataset and more specifically investigated actions that the MHOs undertook to improve quality and affordability of healthcare provision for their members, using a framework for analysis based on Hirschman’s exit-voice theory. This framework distinguishes four mechanisms for MHO members to use in influencing providers: (1) ‘exit’ or ‘voting with the feet’; (2) ‘co-producing a long voice route’ or imposing rules through strategic purchasing; (3) ‘guarding over the long voice route of accountability’ or pressuring authorities to regulate and enforce regulations; and (4) ‘strengthening the short voice route’ by transforming the power imbalance at the provider–patient interface.

Results

All studied MHOs used these four mechanisms to improve healthcare provision. Most healthcare providers, however, did not recognise their authority to do so. In the DRC, controlling quality and affordability of healthcare is firmly seen as a role for the health authorities, but the authorities only marginally take up this role. Under current circumstances, the power of MHOs in the DRC to enhance quality and affordability of healthcare is weak.

Conclusion

On their own, mutual health organisations in the DRC do not have sufficient power to influence the practices of healthcare providers. Greater responsiveness of the health services to MHO members requires cooperation of all actors involved in healthcare delivery to create an enabling environment where voices defending people’s rights are heard.

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<![CDATA[Mapping the coevolution, leadership and financing of research on viral vectors, RNAi, CRISPR/Cas9 and other genomic editing technologies]]> https://www.researchpad.co/product?articleinfo=N5b989351-f842-4a35-9237-928ff4c9c806

Genomic editing technologies are developing rapidly, promising significant developments for biomedicine, agriculture and other fields. In the present investigation, we analyzed and compared the process of innovation for six genomic technologies: viral vectors, RNAi, TALENs, meganucleases, ZFNs and CRISPR/Cas including the profile of the main research institutions and their funders, to understand how innovation evolved and what institutions influenced research trajectories. A Web of Science search of papers on viral vectors RNAi, CRISPR/Cas, TALENs, ZFNs and meganucleases was used to build a citation network of 16,746 papers. An analysis of network clustering combined with text mining was performed. For viral vectors, a long-term process of incremental innovation was identified, which was largely publicly funded in the United States and the European Union. The trajectory of RNAi research included clusters related to the study of RNAi as a biological phenomenon and its use in functional genomics, biomedicine and pest control. A British philanthropic organization and a US pharmaceutical company played a key role in the development of basic RNAi research and clinical application respectively, in addition to government and academic institutions. In the case of CRISPR/Cas research, basic science discoveries led to the technical improvements, and these two in turn provided the information required for the development of biomedical, agricultural, livestock and industrial applications. The trajectory of CRISPR/Cas research exhibits a geopolitical division of the investigation efforts between the US, as the main producer and funder of basic research and technical improvements, and Chinese research institutions increasingly leading applied research. Our results reflect a change in the model for financing science, with reduced public financing for basic science and applied research on publicly funded technological developments in the US, and the emergence of China as a scientific superpower, with implications for the development of applications of genomic technologies.

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<![CDATA[Bridging between economy-wide activity and household-level consumption data: Matrices for European countries]]> https://www.researchpad.co/product?articleinfo=N195aa1ea-44cd-4794-a839-8705095d94e3

This dataset represents bridging matrices between two different data classification systems: consumption by purpose (COICOP) and products by activity (CPA). While the former classification is used in household budget and expenditure surveys, the latter represents the industry sector dimension that is typically adopted in national accounts and input–output tables. We collect input data from Eurostat on total household consumption for 35 COICOP and 63 CPA categories for the year 2015. Based on these data, we construct bridging or concordance tables for 30 European countries using recently developed matrix balancing techniques. The resulting tables enable data conversion between consumption- and production-based statistics, facilitating research that integrates macroeconomics, multi-sectoral international trade and heterogeneous agents in household-level expenditure micro-data. Although they are a necessary input in several types of research, they are often constructed on an ad hoc and region-specific basis and not shared publicly. As such, making this dataset available will be useful for computable general equilibrium and input–output models and for carbon footprint and life cycle analyses that incorporate rich consumption micro-data, for instance to shed light on distributional aspects of climate and energy policies. Furthermore, by eliminating a barrier raised by differences in statistical classifications, this dataset may foster collaboration between different research teams and may facilitate soft-linking between complementary analytical tools used for policy support.

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<![CDATA[Improved calibration estimators for the total cost of health programs and application to immunization in Brazil]]> https://www.researchpad.co/product?articleinfo=5c8977b1d5eed0c4847d3333

Multi-stage/level sampling designs have been widely used by survey statisticians as a means of obtaining reliable and efficient estimates at a reasonable implementation cost. This method has been particularly useful in National country-wide surveys to assess the costs of delivering public health programs, which are generally originated in different levels of service management and delivery. Unbiased and efficient estimates of costs are essential to adequately allocate resources and inform policy and planning. In recent years, the global health community has become increasingly interested in estimating the costs of immunization programs. In such programs, part of the cost correspond to vaccines and it is in most countries procured at the central level, while the rest of the costs are incurred in states, municipalities and health facilities, respectively. As such, total program cost is a result of adding these costs, and its variance should account for the relation between the totals at the different levels. An additional challenge is the missing information at the various levels. A variety of methods have been developed to compensate for this missing data. Weighting adjustments are often used to make the estimates consistent with readily-available information. For estimation of total program costs this implies adjusting the estimates at each level to comply with the characteristics of the country. In 2014, A National study to estimate the costs of the Brazilian National Immunization Program was initiated, requested by the Ministry of Health and with the support of international partners. We formulate a quick and useful way to compute the variance and deal with missing values at the various levels. Our approach involves calibrating the weights at each level using additional readily-available information such as the total number of doses administered. Taking the Brazilian immunization costing study as an example, this approach results in substantial gains in both efficiency and precision of the cost estimate.

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<![CDATA[The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: Overcoming the challenges of stewardship and governance]]> https://www.researchpad.co/product?articleinfo=5c8acc3bd5eed0c48498f23f

In an Essay, Blake Angell and colleagues discuss ambitious reforms planned to expand coverage of the health system in India.

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<![CDATA[Issue framing in online voting advice applications: The effect of left-wing and right-wing headers on reported attitudes]]> https://www.researchpad.co/product?articleinfo=5c785013d5eed0c484007c38

Voting Advice Applications (VAAs) provide voting recommendations to millions of people. As these voting recommendations are based on users’ answers to attitude questions, the framing of these questions can have far-reaching consequences. The current study reports on a field experiment in which the framing of the header above VAA statements (N = 17) was manipulated (condition 1: no header; condition 2: a right-wing header, e.g., finance; condition 3: a left-wing header, e.g., nature and environment). Visitors of a VAA developed for Utrecht, the fourth largest municipality in the Netherlands, were randomly guided to one of the versions of the tool in which the header type was varied. Results (based on Nrespondents = 27,404) show that providing a header (left-wing or right-wing) leads to more left-wing answers as compared a condition where there is no header above the attitude statement. This effect, however, is only observed for respondents with lower levels of political sophistication.

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<![CDATA[The time-varying relationship between economic globalization and the ideological center of gravity of party systems]]> https://www.researchpad.co/product?articleinfo=5c803c63d5eed0c484ad8866

Does economic globalization influence the positioning of parties and, as a consequence, the ideological characteristics of party systems? Answering this question is important because we need to understand the constraints that parties face in formulating policies from which voters have to choose. In our paper, we take a systemic perspective and conceptualize a party system’s ideological center of gravity as the outcome of interest. We define the center of gravity as the weighted mean position of all parliamentary parties in a country that represents the position to which parties gravitate. We start by formulating static hypotheses on the effect of imports and exports on the center of gravity and derive their underlying mechanisms. We further derive dynamic hypotheses stipulating varying effects over time based on the premise that partisan attitudes toward globalization have undergone multiple changes over the last decades. A time-series cross-section analysis of 129 elections in 15 Western European countries from 1974 to 2015 finds evidence for opposite effects of exports and imports in the pooled data. Additionally, a moving-window analysis indicates that the relationship between globalization and the center of gravity varies over time. This is a significant finding because it suggests that economic globalization has an influence on party systems and that it is important to test for time-varying effects.

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<![CDATA[Cost of illness and program of dengue: A systematic review]]> https://www.researchpad.co/product?articleinfo=5c76fe4bd5eed0c484e5b846

Background

Studies on dengue related to the cost of illness and cost of the program are factors to describe the economic burden of dengue, a neglected disease that has global importance in public health. These studies are often used by health managers in optimizing financial resources. A systematic review of studies estimating the cost of dengue was carried out, comparing the costs between the studies and examining the cost drivers regarding the methodological choices.

Methods

This study was done according to the guidelines of the Centre for Reviews and Dissemination (CRD). Several databases were searched: Medline, Virtual Health Library and CRD. Two researchers, working independently, selected the studies and extracted the data. The quality of the methodology of the individual studies was achieved by a checklist of 29 items based on protocols proposed by the British Medical Journal and Consolidated Health Economic Evaluation Reporting Standards. A qualitative and quantitative narrative synthesis was performed.

Results

A literature search yielded 665 publications. Of these, 22 studies are in accordance with previously established inclusion criteria. The cost estimates were compared amongst the studies, highlighting the study design, included population and comparators used (study methodology). The component costs included in the economic evaluation were based on direct and indirect costs, wherein twelve studies included both costs, twelve studies adopted the societal perspective and ten studies used the perspective of the public health service provider, or of a private budget holder.

Conclusion

This study showed that the cost of dengue in 18 countries generated approximately US$ 3.3 billion Purchasing Power Parity (PPP) in 2015. This confirms that the burden of dengue has a great economic impact on countries with common socioeconomic characteristics and similarities in health systems, particularly developing countries, indicating a need for further studies in these countries.

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<![CDATA[Assessment of factors affecting diabetes management in the City Changing Diabetes (CCD) study in Tianjin]]> https://www.researchpad.co/product?articleinfo=5c6c758cd5eed0c4843cfe89

Objective

This study aimed to identify the local levels of vulnerability among patients with Type-II diabetes (T2DM) in Tianjin. The study was aimed at curbing the rise of T2DM in cities.

Methods

229 participants living with T2DM were purposively sampled from hospitals in Tianjin. Collected data were coded and analysed following well-established thematic analysis principles.

Results

Twelve themes involving 29 factors were associated with diabetes patients’ vulnerability: 1. Financial constraints (Low Income, Unemployment, No Medical Insurance/Low ratio reimbursement); 2. Severity of disease (Appearance of symptoms, complications, co-morbidities, high BMI, poor disease control); 3. Health literacy (No/Low/Wrong knowledge of health literacy); 4. Health beliefs (Perceived diabetes indifferently, Passively Acquire Health Knowledge, Distrust of primary health services); 5. Medical environment (Needs not met by Medical Services); 6. Life restrictions (Daily Life, Occupational Restriction); 7. Lifestyle change (Adhering to traditional or unhealthy diet, Lack of exercise, Low-quality sleep); 8. Time poverty (Healthcare-seeking behaviours were limited by work, Healthcare-seeking behaviours were limited by family issues); 9. Mental Condition (Negative emotions towards diabetes, Negative emotions towards life); 10. Levels of Support (Lack of community support, Lack of support from Friends and Family, Lack of Social Support); 11. Social integration (Low Degree of Integration, Belief in Suffering Alone); 12. Experience of transitions (Diet, Dwelling Environment).

Conclusion

Based on our findings, specific interventions targeting individual patients, family, community and society are needed to improve diabetes control, as well as patients’ mental health care and general living conditions.

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<![CDATA[“Even if she’s really sick at home, she will pretend that everything is fine.”: Delays in seeking care and treatment for advanced HIV disease in Kinshasa, Democratic Republic of Congo]]> https://www.researchpad.co/product?articleinfo=5c6dc9efd5eed0c48452a55d

Introduction

HIV prevalence in the Democratic Republic of Congo (DRC) is estimated to be 1.2%, and access to HIV testing and treatment remains low across the country. Despite advances in treatment, HIV continues to be one of the main reasons for hospitalisation and death in low- and middle-income countries, including DRC, but the reasons why people delay seeking health-care when they are extremely sick remain little understood. People in Kinshasa, DRC, continue to present to health-care facilities in an advanced stage of HIV when they are close to death and needing intensive treatment.

Methods

This qualitative study was conducted in one health-care facility in Kinshasa. A total of 24 in-depth interviews with purposively selected health-care workers, patients and care-givers were conducted. Patients were currently or previously hospitalised with advanced HIV, defined as CD4 count <200 cells/μl. Patients included those who had previously started antiretroviral treatment (ART), and those who had not. Participant observation was also carried out. Interviews were audio-recorded, translated from French and Lingala into English, transcribed, coded and thematically analysed using NVivo.

Results

The main reasons for delaying access to health-care were stigmatisation, religious beliefs and limited economic resources. Stigmatisation meant that people feared disclosing their HIV status and thus did not receive support from their families. Religious leaders were reported to have encouraged people not to take ART. Patients delayed seeking treatment as they could not afford it, and health-care workers believed that staff at other facilities in Kinshasa were delaying HIV diagnoses for economic benefit.

Conclusions

Delays in accessing care and treatment linked to stigma, religious beliefs and economic factors contribute to explaining the persistence of advanced HIV within this context. Access to free HIV-testing, ART and treatment of opportunistic infections; counselling; training of health-care workers; support for care-givers and stigma reduction strategies are urgently needed to prevent unnecessary deaths.

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<![CDATA[Public finances and tobacco taxation with product variety: Theory and application to Senegal and Nigeria]]> https://www.researchpad.co/product?articleinfo=5c6f14b2d5eed0c48467a641

This study endeavors to answer two questions: which category of excise taxes is more appropriate for Senegal and Nigeria and which consequences an increase of the tobacco taxes would have on the price, the demand and the tax revenues in each one of the two countries? To answer these questions, we adopt a double approach: first, a theoretical model of taxation with variety; and second, a simulation model to answer the second question. The results of the theoretical model indicate that, in the context of excise taxation, the number of products variety—or that of cigarette brands—directly affects both the degree of market concentration and the marginal effects of specific and ad valorem excise taxes on the price of tobacco. In addition, the comparison of the marginal effects of ad valorem and specific excise taxes depends on the marginal costs of production of different varieties weighted by the tax rates and the number of varieties. Our empirical results first show that the specific excise taxes are more adapted to Senegal while ad valorem excise taxes fit best Nigeria. This result crucially matters for the excise taxes are exclusively of an ad valorem nature in both Senegal and Nigeria. It is perfectly possible to envisage a situation where the two main forms of excise taxes could co-exist. It also appears from our results that tax development does not have the same implications for the two countries. Increasing tobacco taxes in Senegal strongly reduces the demand, but also induces a decrease in the tax revenues, while this will imply a lesser decline in demand in Nigeria accompanied however by a sharp increase of the country’s tax revenues. This difference stems from the fact that the price-elasticity of tobacco demand is very high in Senegal, contrary to Nigeria. Finally, it is important to mention that there is a specific threshold beyond which the tax increases cease to have a positive effect on tax revenues in Nigeria.

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<![CDATA[CEO traits, dynamic compensation and capital structure]]> https://www.researchpad.co/product?articleinfo=5c6dca25d5eed0c48452a840

This paper studies the impact of managerial traits, i.e. optimism, confidence and risk aversion, on capital structure using a principle-agent framework. We discover that optimistic manager perceives equity as more undervalued than debt, while, confident manager perceives debt as more undervalued than equity. We also find that there exists the level of risk aversion eliminating the impact of optimism and confidence on the leverage. Furthermore, in contrast to rational manager, the optimistic/confident manger has higher level of effort. And then, the increasing in risk aversion reduces the level of effort. Our results are in line with some empirical findings.

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<![CDATA[Modeling financial interval time series]]> https://www.researchpad.co/product?articleinfo=5c6f148ad5eed0c48467a270

In financial economics, a large number of models are developed based on the daily closing price. When using only the daily closing price to model the time series, we may discard valuable intra-daily information, such as maximum and minimum prices. In this study, we propose an interval time series model, including the daily maximum, minimum, and closing prices, and then apply the proposed model to forecast the entire interval. The likelihood function and the corresponding maximum likelihood estimates (MLEs) are obtained by stochastic differential equation and the Girsanov theorem. To capture the heteroscedasticity of volatility, we consider a stochastic volatility model. The efficiency of the proposed estimators is illustrated by a simulation study. Finally, based on real data for S&P 500 index, the proposed method outperforms several alternatives in terms of the accurate forecast.

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<![CDATA[Selection of the optimal trading model for stock investment in different industries]]> https://www.researchpad.co/product?articleinfo=5c6dc9d9d5eed0c48452a2e0

In general, the stock prices of the same industry have a similar trend, but those of different industries do not. When investing in stocks of different industries, one should select the optimal model from lots of trading models for each industry because any model may not be suitable for capturing the stock trends of all industries. However, the study has not been carried out at present. In this paper, firstly we select 424 S&P 500 index component stocks (SPICS) and 185 CSI 300 index component stocks (CSICS) as the research objects from 2010 to 2017, divide them into 9 industries such as finance and energy respectively. Secondly, we apply 12 widely used machine learning algorithms to generate stock trading signals in different industries and execute the back-testing based on the trading signals. Thirdly, we use a non-parametric statistical test to evaluate whether there are significant differences among the trading performance evaluation indicators (PEI) of different models in the same industry. Finally, we propose a series of rules to select the optimal models for stock investment of every industry. The analytical results on SPICS and CSICS show that we can find the optimal trading models for each industry based on the statistical tests and the rules. Most importantly, the PEI of the best algorithms can be significantly better than that of the benchmark index and “Buy and Hold” strategy. Therefore, the algorithms can be used for making profits from industry stock trading.

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<![CDATA[Financial risk protection at the bedside: How Ethiopian physicians try to minimize out-of-pocket health expenditures]]> https://www.researchpad.co/product?articleinfo=5c6c7593d5eed0c4843cfec0

Background

Out-of-pocket health expenditures can pose major financial risks, create access-barriers and drive patients and families into poverty. Little is known about physicians’ role in financial protection of patients and families at the bedside in low-income settings and how they perceive their roles and duties when treating patients in a health care system requiring high out-of-pocket costs.

Objective

Assess physicians’ concerns regarding financial welfare of patients and their families and analyze physicians’ experiences in reducing catastrophic health expenditures for patients in Ethiopia.

Method

A national survey was conducted among physicians at 49 public hospitals in six regions in Ethiopia. Descriptive statistics were used.

Results

Totally 587 physicians responded (response rate 91%) and 565 filled the inclusion criteria. Health care costs driving people into financial crisis and poverty were witnessed by 82% of respondants, and 88% reported that costs for the patient are important when deciding to use or not use an intervention. Several strategies to save costs for patients were used: 37–79% of physicians were doing this daily or weekly through limiting prescription of drugs, limiting radiologic studies, ultrasound and lab tests, providing second best treatments, and avoiding admission or initiating early discharge. Overall, 75% of the physicians reported that ongoing and future costs to patients influenced their decisions to a greater extent than concerns for preserving hospital resources.

Conclusion

In Ethiopia, a low-income country aiming to move towards universal health coverage, physicians view themselves as both stewards of public resources, patient advocates and financial protectors of patients and their families. Their high concern for family welfare should be acknowledged and the economic and ethical implications of this practice must be further explored.

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<![CDATA[Mental health in individuals with spinal cord injury: The role of socioeconomic conditions and social relationships]]> https://www.researchpad.co/product?articleinfo=5c76fe0dd5eed0c484e5b386

Objectives

To evaluate socioeconomic inequalities in social relationships, and to assess whether socioeconomic conditions and social relationships are independently related to mental health problems in individuals with a physical disability due to spinal cord injury (SCI).

Methods

We analyzed cross-sectional data from 511 individuals with SCI aged over 16 years who participated in the community survey of the Swiss SCI Cohort Study (SwiSCI). Indicators for socioeconomic conditions included years of formal education, household income, and financial strain. Social relationships were operationalized by three structural (partner status; social contact frequency; number of supportive relationships) and four functional aspects (satisfaction with: overall social support; family relationships; contacts to friends; partner relationship). General mental health was assessed by the Mental Health Inventory (MHI-5) of SF-36 and depressive symptoms were measured by the Hospital Anxiety and Depression Scale (depression subscale, HADS-D). Established cut-offs for general mental health problems (MHI-5 ≤56) and depressive symptomatology (HADS-D ≥8) were used to dichotomize outcomes. Associations were assessed using logistic regressions.

Results

Lower household income was predominantly associated with poor structural social relationships, whereas financial strain was robustly linked to poor functional social relationships. Financial strain was associated with general mental health problems and depressive symptomatology, even after controlling for social relationships. Education and household income were not linked to mental health. Poor structural and functional social relationships were related to general mental health problems and depressive symptomatology. Notably, trends remained stable after accounting for socioeconomic conditions.

Conclusion

This study provides evidence for socioeconomic inequalities in social relationships as well as for independent associations of financial strain and poor social relationships with mental health problems in individuals with SCI. Further research may develop strategies to improve mental health in SCI by strengthening social relationships. Such interventions may be especially beneficial for individuals with low income and financial strain.

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<![CDATA[Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa]]> https://www.researchpad.co/product?articleinfo=5c6b2632d5eed0c484289528

Purpose

To quantify costs to patients of accessing HIV care prior to ART initiation.

Materials and methods

Using a cross-sectional study design, costs incurred by HIV-positive patients prior to ART initiation were estimated at urban primary healthcare facilities in South Africa. Costs included direct costs, indirect (productivity) costs, carer and coping costs (value of assets sold and money borrowed). The percentage of individual income spent on healthcare was calculated and compared by patient income tertiles and CD4 count strata.

Results

289 patients (69% female, mean age 37 (SD: 10) years, median CD4 317 (IQR: 138–494) cells/mm3) were interviewed. The total mean monthly cost of pre-ART care was US$15.71. Indirect costs accounted for $2.59 (16.49%) of this when time was valued using the patient’s reported income. The mean monthly patient costs were $31.61, $12.78, $12.65 and $11.93 for those with a CD4 count <100, 101–350, 351–500 and >500 cells/mm3 respectively. The percentage of individual income spent on healthcare was 7.25% for those with a CD4 count <100 cells/mm3 and 4.05% for those with a CD4 count >500 cells/mm3.

Conclusions

Despite the provision of charge-free services at public clinics, care prior to ART initiation can be costly, particularly for the poor and unemployed. Our study adds to the growing body of evidence that highlights the need to consider policies to reduce the economic barriers to HIV service access, particularly for low income or unwell patient groups, such as improving access to disability grants.

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