Public Health Expenditures and Health Outcomes in Pakistan: Evidence from Quantile Autoregressive Distributed Lag Model

Internet financial services, environmental technology, and happiness: Implications for sustainable development

Integrating the internet and financial services gives people the luxury to reduce financial stress and anxiety by giving consumers more power over their financial situation. Likewise, the adoption of environmental technologies helps improve environmental quality, which positively impacts mental and physical health and thus increases the sense of well-being and happiness. Therefore, the main focus of the study is to analyze the influence of financial services and environmental technologies on happiness. For analyzing the short and long-run impacts of financial services and environmental technologies on happiness, we have utilized the ARDL model and QARDL models. The findings of the ARDL model confirm the positive influence of financial services, environmental technologies, national income, financial development, and education on happiness in the short and long term. Similarly, the QARDL model also suggests the favorable long-run effects of financial services and environmental technologies on happiness at most quantiles. The long-run Wald test confirms the asymmetric influence of all variables on happiness, while in the short-term, excluding education, all other variables exert asymmetric impacts on happiness. Thus, to promote happiness, policymakers should try to increase the role of internet-based financial services and increases investment in research and development activities to enhance environment-related technologies. However, the study is limited to China, it should be expanded to other regions.

Impact of Postoperative Antibiotic Prophylaxis on Surgical Site Infections Rates After Mastectomy with Drains but Without Immediate Reconstruction: A Multicenter, Double-Blinded, Randomized Control Superiority Trial

BACKGROUND

There is no consensus on the use of postoperative antibiotic prophylaxis (PAP) after mastectomy with indwelling drains. We explored the utility of continued PAP in reducing surgical site infection (SSI) rates after mastectomy without immediate reconstruction and with indwelling drains.

PATIENTS AND METHODS

A multicenter, two-armed, randomized control superiority trial was conducted in Pakistan. We enrolled all consenting adult patients undergoing mastectomy without immediate reconstruction. All patients received a single preoperative dose of cephalexin within 60 min of incision, and postoperatively were randomized to receive either continued PAP using cephalexin (intervention) or a placebo (control) for the duration of indwelling, closed-suction drains. The primary outcome was the development of SSI within 30 days and 90 days postoperatively. Secondary outcomes included study-drug-associated adverse events. Intention-to-treat analysis was performed using multivariable Cox regression.

RESULTS

A total of 369 patients, 180 (48.8%) in the intervention group and 189 (51.2%) in the control group, were included in the final analysis. Overall cumulative SSI rates were 3.5% at 30 days and 4.6% at 90 days postoperatively. PAP was not associated with SSI reduction at 30 (hazard ratio, HR 1.666 [95% confidence interval CI 0.515-5.385]) or 90 (1.575 [0.558-4.448]) days postoperatively, or with study-drug-associated adverse effects (0.529 [0.196-1.428]).

CONCLUSIONS

Continuing antibiotic prophylaxis for the duration of indwelling drains after mastectomy without immediate reconstruction offers no additional benefit in terms of SSI reduction. There is a need to update existing guidelines to provide clearer recommendations regarding use of postoperative antibiotic prophylaxis after mastectomy in the setting of indwelling drains.

Understanding the relationships between health spending, treatable mortality and economic productivity in OECD countries

Introduction

Population health is one of the highest priorities for countries, which can translate into increased economic prosperity. This encourages research on health in an economic context.

Methods

The objective was to assess the relationships between health spending, treatable respiratory mortality, and gross domestic product (GDP) in countries of the Organization for Economic Co-operation and Development (OECD). The research was conducted with respect to health systems (tax-based, insurance-based) and gender differentiation of the productive population (aged 25-64 years). Descriptive analysis, regression analysis, and cluster analysis were used to achieve the main objective. The data covered the period from 1994 to 2016.

Results

The results of the regression analysis revealed negative relationships between health spending and treatable respiratory mortality in countries with a tax-based health system for male and female working-age populations, as well as in countries with an insurance-based health system for male population. This means that higher health spending was associated with lower treatable respiratory mortality. Also, lower treatable mortality was associated with higher GDP, especially in the male productive population from countries with an insurance-based health system. In this study, countries with a tax-based health system were characterized by higher health spending, lower rates of treatable mortality from respiratory system diseases, and higher GDP compared to countries with an insurance-based health system. Males reported a higher mortality rate than females. Among the countries with a tax-based health system, the United Kingdom and Latvia showed less positive outcomes, while Italy and Iceland were the countries with the most positive outcomes. Among the countries with an insurance-based health system, Hungary and Slovakia reported poor outcomes, while France, Switzerland and Luxembourg were characterized by very positive outcomes. The United States showed a high mortality rate despite its high economic outcomes, i.e., health spending and GDP.

Discussion

Health care financing in particular is one of the instruments of health policy. It seems that the leaders of countries should ensure a sufficient level of health financing, as higher health spending can contribute to lower mortality rates in a country. This may translate into higher productivity. Especially countries with underfunded health systems should increase their health spending.

The influence and mechanism of health expenditures on investment of financial assets decisions: A case study of China's economy

Policymakers worldwide have been actively involved in the past few decades to ensure that human diseases are kept to a minimum. A new econometric technique, dynamic ARDL simulations, was used in this study to estimate and model the influence of health expenditures on investment in non-financial assets in China from 1990 to 2019. An economic growth framework, gross capital formation, information and communication technologies, foreign direct investment, and carbon emissions are all considered in the empirical model-the analysis produced interesting results. First, the estimates show that health expenditures and foreign direct investment have a significant long-run decreasing impact on non-financial assets in China by 0.451 and 0.234%. Second, economic growth and gross capital formation significantly affect the economy's non-financial assets. Likewise, ICT and carbon emissions also positively correlate with an explained variable in China. The findings show that the economy is becoming less investment-intensive as health spending and foreign direct investment rise. The study develops important policy implications for the selected country to achieve desired targets based on the empirical results.

Relationship between health spending, life expectancy and renewable energy in China: A new evidence from the VECM approach

There has been a growing trend in health spending and renewable energy consumption in China over the past few decades, which has positive implications for health outcomes, such as life expectancy. Therefore, the main objective of this study is to empirically analyze the impact of health expenditures and renewable energy on life expectancy in China. We used the time series data from 2000Q1 to 2020Q4 and applied the VECM approach for the data analysis. The results of this study suggest a long run association between health spending, life expectancy and renewable energy. The increase in health spending improves life expectancy, while renewable energy consumption also positively affects life expectancy in China. Therefore, the government should allocate sufficient funding to the health sector in order to attain higher life expectancy in the country. In addition, the government should also provide incentives for the consumption and production of renewable energy, which could help to achieve the sustainable development goal and life expectancy.

Cost of Illness Analysis of Type 2 Diabetes Mellitus: The Findings from a Lower-Middle Income Country

BACKGROUND

Diabetes is a major chronic illness that negatively influences individuals and society. Therefore, this research aimed to analyze and evaluate the cost associated with diabetes management, specific to the Pakistani Type 2 diabetes population. Research scheme and methods: A survey randomly collected information and data from diabetes patients throughout Pakistan out-patient clinics. Direct and indirect costs were evaluated, and data were analyzed with descriptive and inferential statistics.

RESULTS

An overall of 1839 diabetes patients participated in the study. The results have shown that direct and indirect costs are positively associated with the participants' socio-demographic characteristics, except for household income and educational status. The annual total cost of diabetes care was USD 740.1, amongst which the share of the direct cost was USD 646.7, and the indirect cost was USD 93.65. Most direct costs comprised medicine (USD 274.5) and hospitalization (USD 319.7). In contrast, the productivity loss of the patients had the highest contribution to the indirect cost (USD 81.36).

CONCLUSION

This study showed that direct costs significantly contributed to diabetes's overall cost in Pakistan and overall diabetes management estimated to be 1.67% (USD 24.42 billion) of the country's total gross domestic product. The expense of medications and hospitalization mostly drove the direct cost. Additionally, patients' loss of productivity contributed significantly to the indirect cost. It is high time for healthcare policymakers to address this huge healthcare burden. It is time to develop a thorough diabetes management plan to be implemented nationwide.

The impact of public health events on green economy efficiency in the context of environmental regulation

Public health crises have become one of the greatest threats to sustainable global economic development. It is therefore important to explore the impact of public health events on green economic efficiency. However, few studies have specifically examined the relationship between public health security and green economic efficiency. Based on the relevant data of 30 Chinese provinces from 2011 to 2019, this paper explores the impact of public health on green economic efficiency by establishing a four-stage SBM-DEA model to construct green economic efficiency indicators and using a panel model. A moderating effect model is established to explore the moderating effect of environmental regulation on the impact of public health on green economic efficiency. In addition, this paper examines the heterogeneity of public health impact on green economic efficiency in terms of geographic location, carbon pilot, and transportation level. It is found that, first, public health events have a significant hindering effect on green economic efficiency. Second, environmental regulation has a significant moderating effect on the impact of public health events on green economic efficiency. Third, the impact of public health events on green economic efficiency changes from hindering to facilitating as the intensity of environmental regulation increases. Fourth, the impact of public health events on green economic efficiency is heterogeneous in terms of geographic location, carbon pilot, and transportation level. The above studies have implications for how to balance economic development and environmental protection in case of a public safety event.

Assessing the impact of governance and health expenditures on carbon emissions in China: Role of environmental regulation

The current study tries to summarize the leading factors and their behavior toward the environmental quality. Therefore, this study investigates the environment-development linkage in China's economy covering the period of 1984-2018. In order to investigate the proposed objectives, the current study uses the dynamic ordinary least square, fully modified ordinary least square and canonical co-integration regression with granger causality test. The results reveal that there exists an inverted U-shaped relationship in China's economy. Likewise, urbanization positively contributes to environmental deterioration. Furthermore, the health expenditures also cause to deteriorate the environmental quality. In contrast, there exists the negative association between good governance and carbon emissions, while the rule of law in China's economy does not secure the environmental quality. Therefore, environmental regulation policies need to be revised in order to achieve a sustainable environment. As a result, we recommend that China continue to expand its economy and invest in health care and environmental initiatives.

International medical electives during and after the COVID-19 pandemic - current state and future scenarios: a narrative review

Background

International medical electives are an important and popular component of the academic curriculum in many medical schools and universities worldwide. The purpose of abroad electives is to provide medical students with an opportunity to gain a better understanding of education and healthcare in an international context. The COVID-19 pandemic, however, has substantially changed the international elective landscape. Travel restrictions, closures of international elective programs and the expansion of virtual methods for education caused a widespread disruption to abroad electives. A comprehensive analysis with regard to other consequences for abroad electives, however, has not been done before. Thus, we sought to a) summarize the current transformation of the international medical elective and b) to address potential challenges for post-pandemic international medical electives.

Methods

The methodology employed is a multidisciplinary narrative review of the published and grey literature on international electives during the last two years of the COVID-19 pandemic.

Results

Students worldwide had electives postponed or canceled. Apart from evident immediate pandemic-related consequences (such as the substantial decline in global electives and impaired elective research opportunities for educators), there are other several problems that have received little attention during the last two years. These include challenges in the elective application process, poorly-understood consequences for host institutions, and growing global (ethical) disparities that are likely to increase once elective programs will gradually re-open. There is ample evidence that the post-pandemic elective landscape will be characterized by increasing elective fees, and a more competitive seat-to-applicant ratio. Ethical problems for international electives arising from an unequal global vaccine distribution will pose an additional challenge to students and elective coordinators alike.

Conclusion

The COVID-19 pandemic transformed the international medical elective landscape in an unprecedented way, and future generations of medical students will face a series of additional challenges when applying for global medical electives.

Work-Family Conflict, Emotional Intelligence, and General Self-Efficacy Among Medical Practitioners During the COVID-19 Pandemic

PURPOSE

In Pakistan, medical professionals face multiple challenges comprising long, fixed working hours and workload overburdening, which leads to emotional fatigue. These conflicts in work-life scenarios, brought about by high work demands causing emotional exhaustion, can create a state of distress among the medical professionals. The present study investigates the association between work-family conflict (WFC), emotional intelligence (EI), and self-efficacy (SE) among medical practitioners during COVID-19 in Pakistan.

PATIENTS AND METHODS

The study sample included 140 medical professionals from Rawalpindi and Islamabad. Cross-section correlational research design was used, and information was gathered employing online surveys through a purposive sampling technique. The scales utilized were the WFC, EI, and SE Scale.

RESULTS

The current study hypothesized a significant relationship between work-family conflict, general self-efficacy (GSE) and emotional intelligence among medical practitioners during COVID-19 in Pakistan. The results showed that those with more family-to-work conflict had less EI and GSE. Furthermore, findings uncovered that there is a significant positive relationship between EI and GSE.

CONCLUSION

The findings propose that it is important for medical professionals to have a high level of EI and GSE to navigate through the WFC more healthily. In future, awareness seminars could be arranged related to EI and its significance to stimulate the psychological well-being of medical professionals. Future studies could also consider other healthcare workers, including nurses and internees doing house jobs and other medical staff, as they are also exposed to several stresses due to the workload and family demands.

Exploring the Role of Health Expenditure and Maternal Mortality in South Asian Countries: An Approach towards Shaping Better Health Policy

Accomplishing unremitting favorable health outcomes, especially reducing maternal mortality, remains a challenge for South Asian countries. This study explores the relationship between health expenditure and maternal mortality by using data set consisting of 18 years from 2000 to 2017. Fully modified ordinary least squares (FMOLS) and dynamic ordinary least squares (DOLS) models were employed for the empirical analysis. The outcomes revealed that a 1% rise in health expenditure increased the maternal mortality rate by 1.95% in the case of FMOLS estimator and 0.16% in the case of DOLS estimator. This reflects that the prevailing health care system is not adequate for reducing maternal mortality. Moreover, the meager system and the priorities established by an elitist system in which the powerless and poor are not considered may also lead to worsen the situation. In addition, the study also added population, economic growth, sanitation, and clean fuel technology in the empirical model. The findings revealed that population growth has a significant long-term effect on maternal mortality-an increase of 40% in the case of FMOLS and 10% in the case of DOLS-and infers that an increase in population growth has also dampened efforts towards reducing maternal mortality in the South Asian panel. Further, the results in the case of economic growth, sanitation, and clean fuel technologies showed significant long-term negative effects on maternal mortality by 94%, 7.2%, and 11%, respectively, in the case of the FMOLS estimator, and 18%, 1.9%, and 5%, respectively, in the case of the DOLS estimator. The findings imply that GDP and access to sanitation and clean fuel technologies are more nuanced in declining maternal mortality. In conclusion, the verdict shows that policymakers should formulate policies considering the fundamental South Asian aspects warranted to reduce maternal mortality.