Salmonella Prevalence and antibiotic resistance profile in raw poultry meat sold in North Lebanon: Insights from the COVID-19 pandemic and economic crisis.

Salmonella-related foodborne illness is a significant public health concern, with the primary source of human infection being animal-based food products, particularly chicken meat. Lebanon is currently experiencing a dual crisis: the COVID-19 pandemic and an unprecedented economic crisis, which has resulted in substantial challenges to the public health system and food safety. This study aims to assess the prevalence and antibiotic resistance profile of Salmonella in raw poultry meat sold in North Lebanon during this dual crisis. A cross-sectional study was carried out between May 2021 and April 2022 across six different districts in North Lebanon. A total of 288 whole, unprocessed chickens were examined. The isolation and identification of Salmonella isolates were done based on cultural and biochemical properties. All isolates were subjected to antimicrobial susceptibility testing and phenotypic assays for Extended-Spectrum Beta-lactamase (ESBL) detection. The prevalence of Salmonella in raw poultry meat purchased in North Lebanon reached 18.05 % (52/288). The dry season and chilled chicken were significantly associated with an increased risk of Salmonella contamination (P < 0.05). Additionally, 34.61 % of the isolates were potential ESBL producers, and 57.69 % exhibited multidrug resistance (MDR). This study highlights the existence of MDR in chicken meat in North Lebanon, posing a potential health risk if undercooked chicken meat is consumed. This emphasizes the importance of the implementation of preventive strategies and hygienic procedures throughout the food chain to reduce the risk of Salmonella spp. contamination in chicken meats and its potential transmission to humans.

Investment Hysteresis: An Empirical Essay Turkish Case.

After the 2008 World Crisis, there is a view that the economic recovery has not been adequate. In this context, the debate on hysteresis and especially investment hysteresis has increased in the last decade. The aim of this study is to analyze the investment hysteresis and the basic dynamics of hysteresis in the Turkish economy. Structural break tests are used to identify hysteresis. Traditional and asymmetric causality tests are used to identify the fundamental dynamics of hysteresis. Investment, GDP, interest rate, and productivity variables are used to analyze investment hysteresis. Structural break tests were applied to the variables, while conventional and asymmetric causality tests were applied between investments and their determinants. Structural break tests prove the existence of hysteresis. According to the Granger causality test, there is no causality from interest rates, GDP and productivity to investments. The fact that interest rates have no effect on investments proves hysteresis. According to the asymmetric causality test, there is no relationship between interest rates and investments. There is an inverse relationship between GDP and investments. There is an asymmetric relationship between productivity and investments. The fact that productivity shocks cause asymmetric effects on investments makes productivity shocks the main dynamic of hysteresis. In addition, there is considerable evidence that the strong hysteresis and high uncertainty of TFP exacerbate investment hysteresis. Therefore, productivity shocks should be taken into account in policymaking for hysteresis.

Impact of the 2008 economic crisis on the burden of hepatitis B and C diseases in Southern European countries.

BACKGROUND: The economic crisis that began in 2008 has severely affected Southern (Greece, Italy, Portugal, Spain) Western European (SWE) countries of Western Europe (WE) and may have affected ongoing efforts to eliminate viral hepatitis. This study was conducted to investigate the impact of the economic crisis on the burden of HBV and HCV disease. METHODS: Global Burden of Diseases 2019 data were used to analyse the rates of epidemiological metrics of HBV and HCV acute and chronic infections in SWE and WE. Time series modelling was performed to quantify the impact of healthcare expenditure on the time trend of HBV and HCV disease burden in 2000-2019. RESULTS: Declining trends in incidence and prevalence rates of acute HBV (aHBV) and chronic HBV were observed in SWE and WE, with the pace of decline being slower in the post-austerity period (2010-2019) and mortality due to HBV stabilised in SWE. Acute HCV (aHCV) metrics and chronic HCV incidence and mortality showed a stable trend in SWE and WE, whereas the prevalence of chronic HCV showed an oscillating trend, decreasing in WE in 2010-2019 (p < 0.001). Liver cancer due to both hepatitis infections showed a stagnant burden over time. An inverse association was observed between health expenditure and metrics of both acute and chronic HBV and HCV. CONCLUSIONS: Epidemiological metrics for HBV and HCV showed a slower pace of decline in the post-austerity period with better improvement for HBV, a stabilisation of mortality and a stagnant burden for liver cancer due to both hepatitis infections. The economic crisis of 2008 had a negative impact on the burden of hepatitis B and C. Elimination of HBV and HCV by 2030 will be a major challenge in the SWE countries.

Psychological distress and sleep quality among Sri Lankan medical students during an economic crisis.

OBJECTIVES: This study examined the evidence of the prevalence of psychological distress and poor sleep among medical students and its associations during an economic crisis. DESIGN: This was a cross-sectional study using an online questionnaire. It included the Depression Anxiety Stress Scales and Pittsburgh Sleep Quality Index (PSQI). SETTING AND PARTICIPANTS: This study included medical undergraduates from a large metropolitan university in Sri Lanka. PRIMARY AND SECONDARY OUTCOME MEASURES: We assessed the prevalence of psychological distress, sleep quality, and factors associated with psychological distress. To evaluate the associations, we used logistic regression. RESULTS: The majority (69.2%) had some form of distress (depression, anxiety or stress), while 23% had distress in all three. Anxiety was the most prevalent (50.7%). Poor sleep quality was reported in 41%. The highest contribution to global PSQI was from sleep latency, duration, and daytime dysfunction subscales. In bivariate analysis, sleep quality was directly related to depression (t245.65 = -6.75, p<0.001)., anxiety (t313.45 = -6.45, p <0.001), and stress (t94.22 = -5.14, p <0.001). In multinomial logistic regression models, sleep quality was independently associated with depression, anxiety and stress. In addition, frequent contact with friends was inversely associated with depression and anxiety. Also, social media use was inversely linked to depression, anxiety and stress. Clinical-year students had lower depression and anxiety than non-clinical students. Engaging in mindfulness activities was inversely associated with depression. However, models explained only a moderate amount of variance (Nagelkerke R-squared values were 0.21, 0.18, and 0.13 for depression, anxiety and stress, respectively). CONCLUSIONS: Poor sleep quality and psychological distress are high among the undergraduates. The findings emphasize the importance of addressing sleep quality and psychological wellbeing in medical undergraduates. Further research with larger and more diverse samples is needed for a more comprehensive understanding of the factors associated with psychological distress among undergraduates.

[Homicides in southern South American cities: educational inequalities and economic fluctuations]. / Homicidios en ciudades del sur de Sudamérica: desigualdades educativas y fluctuaciones económicas.

Information on how economic fluctuations affect educational inequalities in homicides in Latin America is scarce. This study aimed to: (a) analyze the temporal variations of educational inequalities related to homicide mortality and (b) compare these inequalities between years of economic growth and recession in southern South America cities from 2000 to 2019. Data from seven urban areas in three countries in the Southern Cone of South America were used: Mendoza and Rosario (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro, and São Paulo (Brazil); and Santiago (Chile). Poisson models were estimated by using age, sex, city of residence, year of economic growth or recession, and schooling level as explanatory variables. Results showed significant differences in the temporal evolution of homicide rates in the seven cities, although populations with a low schooling level always showed the most vulnerability. The four Brazilian cities, analyzed together, showed greater educational inequalities related to homicides in years of economic recession when compared to those of economic growth. On the one hand, the indiscriminate use of force by the State against criminal groups seems to increase social inequality in homicide mortality. On the other hand, criminal fragmentation and economic crisis can exacerbate these inequalities by increasing territorial disputes between criminal groups.

Se sabe poco sobre cómo las fluctuaciones económicas afectan las desigualdades educativas en homicidios en países latinoamericanos. Los objetivos de este estudio fueron (a) analizar las variaciones temporales de las desigualdades relativas educacionales de la mortalidad por homicidio, y (b) comparar estas desigualdades entre años de crecimiento económico y años de recesión en ciudades del sur sudamericano durante el período 2000-2019. Se utilizaron datos de siete áreas urbanas, en tres países del Cono Sur Sudamericano: Mendoza y Rosario (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro y São Paulo (Brasil); y Santiago (Chile). Se estimaron modelos de Poisson, utilizando como variables explicativas la edad, sexo, año, ciudad de residencia, año de expansión o recesión económica y nivel educativo. Encontramos diferencias marcadas en la evolución temporal de las tasas de homicidio entre las siete ciudades, aunque siempre las poblaciones de nivel educativo bajo fueron las más vulnerables. Las cuatro ciudades de Brasil, analizadas en conjunto, tuvieron desigualdades educativas relativas de homicidios mayores en años de recesión económica, con respecto a años de crecimiento económico. Por un lado, el uso de la fuerza indiscriminado por parte del Estado enfocado hacia grupos criminales parece haber llevado a una creciente desigualdad social de la mortalidad por homicidio. Por el otro, en un contexto de fragmentación criminal y crisis económica se podrían agravar estas desigualdades a través de mayores disputas territoriales entre grupos criminales.

São escassas as informações sobre como as flutuações econômicas afetam as desigualdades educacionais em homicídios na América Latina. Os objetivos deste estudo foram: (a) analisar as variações temporais das desigualdades educacionais relacionadas à mortalidade por homicídio, e (b) comparar essas desigualdades entre os anos de crescimento econômico e os anos de recessão nas cidades do sul da América do Sul no período de 2000 a 2019. Foram utilizados dados de sete áreas urbanas, em três países do Cone Sul da América do Sul: Mendoza e Rosário (Argentina); Belo Horizonte, Curitiba, Rio de Janeiro e São Paulo (Brasil); e Santiago (Chile). Os modelos de Poisson foram estimados utilizando como variáveis explicativas a idade, sexo, ano, cidade de residência, ano de expansão ou recessão econômica e nível de escolaridade. Os resultados mostraram diferenças significativas na evolução temporal das taxas de homicídio entre as sete cidades, apesar de que as populações com baixo nível de escolaridade sempre foram as mais vulneráveis. As quatro cidades brasileiras, analisadas em conjunto, apresentaram maiores desigualdades educacionais relacionadas a homicídios em anos de recessão econômica em relação aos anos de crescimento econômico. Por um lado, o uso indiscriminado da força pelo Estado contra grupos criminosos parece ter levado ao aumento da desigualdade social na mortalidade por homicídio. Por outro lado, em um contexto de fragmentação criminal e crise econômica, essas desigualdades podem ser exacerbadas pelo aumento das disputas territoriais entre grupos criminosos.

Relationship between profitability and financial factors of hospitals after a period of austerity and health care reforms: evidence from Greece.

PURPOSE: The reduction of government expenditure in the healthcare system, the difficulty of finding new sources of funding and the reduction in disposable income per capita are the most important problems of the healthcare system in Greece over the last decade. Therefore, studying the profitability of health structures is a crucial factor in making decisions about their solvency and corporate sustainability. The aim of this study is to investigate the effect of economic liquidity, debt and business size on profitability for the Greek general hospitals (GHs) during the period 2016-2018. DESIGN/METHODOLOGY/APPROACH: Financial statements (balance sheets and income statements) of 84 general hospitals (GHs), 52 public and 32 private, over a three-year period (2016-2018), were analyzed. Spearman's Rs correlation was carried out on two samples. FINDINGS: The results revealed that there is a positive relationship between the investigated determinants (liquidity, size) and profitability for both public and private GHs. It was also shown that debt has a negative effect on profitability only for private GHs. PRACTICAL IMPLICATIONS: Increasing the turnover of private hospitals through interventions such as expanding private health insurance and adopting modern financial management techniques in public hospitals would have a positive effect both on profitability and the efficient use of limited resources. ORIGINALITY/VALUE: These results, in conjunction with the findings of the low profitability of private hospitals and the excess liquidity of public hospitals, can shape the appropriate framework to guide hospital administrators and government policymakers.

It never rains but it pours: Austerity and mortality rate in peripheral areas.

This study examines the impact of austerity measures on mortality rates across Italian regions from 2003 to 2018. Since 2007, regions experiencing substantial healthcare financial deficits have been required to implement recovery plans (RPs). We use a recent difference-in-differences staggered matching estimator to assess the effects of this austerity policy on municipal-level monthly mortality rates. This allows us to evaluate the policy's spatial heterogeneity across treated municipalities, accounting for their distance from the nearest hospital. The analysis reveals a significant negative impact of austerity measures on health, particularly in peripheral areas and among vulnerable populations. Mortality rates are higher in regions under RPs, with this effect escalating with increasing distance from hospitals. The policy's impact is also more pronounced among vulnerable populations, with differences observed between genders and across seasons.

Perceived advantages and drawbacks of teleworking during the economic crisis and COVID-19: A cross-sectional study among university degree holders.

This study aimed to identify the perceived advantages and drawbacks of teleworking and their correlates, including health problems, among Lebanese workers holding a university degree. A web-based cross-sectional self-report questionnaire created on Google Forms was used to survey 230 participants through snowball sampling between October 2022 and March 2023. The majority of respondents recognized both the advantages (67.03%) and drawbacks (66.34%) associated with teleworking, suggesting mixed feelings toward this format. Despite the limited satisfaction with teleworking, respondents acknowledged the advantages associated with remote working; in particular, younger, less physically active, and more educated participants valued teleworking more than their counterparts. The mean perception of advantages and drawbacks of telework did not significantly change with participants' work status (hybrid, online, and in-person). The study revealed a high prevalence of consistent sleeping difficulty (35.7%), limited regular physical activity (60.4%), work-related musculoskeletal disorders (48.7%), back pain (5.7%), and visual disorders (48%) among Lebanese workers. Despite the limited satisfaction with teleworking, respondents acknowledged advantages such as cost and time savings. Older workers showed a preference against teleworking, potentially due to its impact on well-being. Factors such as education, career satisfaction, and prior teleworking experience influenced individuals' perceptions of telework benefits.

Business cycles and healthcare employment.

Is healthcare employment recession-proof? We examine the long-standing hypothesis that healthcare employment is stable across the business cycle. We explicitly distinguish between negative aggregate demand and supply shocks in studying how healthcare employment responds to recessions, and show that this response depends largely on the type of the exogenous shock triggering the recession. First, aggregate healthcare employment responds procyclically during demand-induced recessions but remains stable during supply-induced recessions. Second, healthcare utilization drops significantly during demand-induced recessions, explaining the decline in healthcare employment during these periods. Finally, there is significant heterogeneity in the employment responses of the healthcare sub-sectors. While healthcare employment in most sub-sectors responds procyclically during recessions caused by both negative demand and supply shocks, it responds countercyclically in nursing-dominant sectors. Importantly, by isolating the recessionary impact of negative aggregate demand shocks from supply shocks on healthcare employment, we provide new empirical evidence that healthcare employment, in general, is not recession-proof.

How do labour market conditions explain the development of mental health over the life-course? a conceptual integration of the ecological model with life-course epidemiology in an integrative review of results from the Northern Swedish Cohort.

BACKGROUND: The aim of this study was to contribute to the theoretical development within the field of labour market effects on mental health during life by integrating Bronfenbrenner's ecological model with mainly earlier theoretical work on life-course theory. METHODS: An integrative review was performed of all 52 publications about labour market conditions in relation to mental health from the longitudinal Northern Swedish Cohort study. Inductive and deductive qualitative content analysis were performed in relation to Bronfenbrenner's ecological framework combined with life-course theories. RESULTS: The following nine themes were identified: 1. Macroeconomic recession impairs mental health among young people. 2. The mental health effects on individuals of youth unemployment seem rather insensitive to recession. 3. Small but consistent negative effect of neighbourhood unemployment and other work-related disadvantaged on individuals' mental health over life. 4. Youth unemployment becomes embodied as scars of mental ill-health over life. 5. Weak labour market attachment impairs mental health over life. 6. Bidirectional relations between health and weak labour market attachment over life. 7. Macrolevel structures are of importance for how labour market position cause poor health. 8. Unequal gender relations at work impacts negatively on mental health. 9. The agency to improve health over life in dyadic relations. Unemployment in society permeates from the macrolevel into the exolevel, defined by Bronfenbrenner as for example the labour market of parents or partners or the neighbourhood into the settings closest to the individual (the micro- and mesolevel) and affects the relations between the work, family, and leisure spheres of the individual. Neighbourhood unemployment leads to poor health among those who live there, independent of their employment status. Individuals' exposure to unemployment and temporary employment leads to poorer mental health over the life-course. Temporal dimensions were identified and combined with Bronfenbrenner levels into a contextual life-course model CONCLUSION: Combining the ecosocial theory with life-course theories provides a framework for understanding the embodiment of work-related mental health over life. The labour market conditions surrounding the individual are of crucial importance for the embodiment of mental health over life, at the same time as individual agency can be health promoting. Mental health can be improved by societal efforts in regulations of the labour market.

Factors affecting major depression in Iran: a mixed-method study.

Depression is a major cause of disability and, if left untreated, can increase the risk of suicide. Evidence on the determinants of depression is incomplete, making it challenging to interpret results across studies. This study aims to identify the social, economic, environmental, political, and technological factors influencing the great recession in Iran. The study was conducted in two parts. The first step involved a literature review to identify the factors, using PubMed, Scopus, and Web of Science for the search. The reference lists of all identified articles were reviewed to find relevant studies, and the extracted information was summarized and reported descriptively. The second steps involved compiling and consulting 14 experts from different fields, using a framework analysis method. Twenty-four articles were used as primary sources of information, and a total of 28 factors were found to exist. After removing duplicates and related factors, 19 of these were subsequently declared as factors, resulting in a total of 36 determinants being identified. Most of these factors belong to the social category. The health policies implemented have a significant impact on disease risk factors and ultimately their occurrence. Political decisions and policy-making processes play a crucial role in all areas, particularly in addressing disease risk factors. Severe depression can disrupt all aspects of the healthcare system, underscoring the importance of access to care. Policies concerning physical education, transportation, nutrition, employment, green spaces, recreational facilities, and tobacco are vital in this context. The influence of health policies on disease risk factors and disease occurrence is profound. Severe depression can have far-reaching effects on the healthcare system, emphasizing the critical need for access to care. The formulation of policies to combat depression must be thoroughly evaluated in terms of economic, political, social, technological, and environmental factors. The findings suggest that addressing social inequalities and emphasizing the role of political action, as highlighted by the social determinants of health, should be top priorities in addressing depression. Efforts to prevent depression should incorporate ecological approaches that consider the impact of the socioeconomic environment on depressive symptoms.

Association of cigarette smoking with changes in macroeconomic conditions.

This study uses data from the 1987-2022 Behavioral Risk Factor Surveillance System and state-level employment rates from the US Bureau of Labor Statistics to estimate the association between macroeconomic conditions and cigarette smoking. Our finding suggests a positive association, which constantly declined with time after the 2001 recession. We find that a one percentage point increase in the employment rate is associated with a 1.4% higher likelihood of smoking cigarettes in the overall sample but declined to 0.4% among cohorts surveyed from 2011 to 2022. We also find strong positive and heterogeneous associations among sociodemographic groups, except among Blacks and persons aged 65 years and older, among whom there is no association; however, the positive associations consistently decreased among these sociodemographic groups. Consequently, the strong positive association disappeared in several sociodemographic groups in cohorts surveyed over the last decade.

Evaluating the influence of taxation and social security policies on psychological distress: A microsimulation study of the UK during the COVID-19 economic crisis.

Economic determinants are important for population health, but actionable evidence of how policies can utilise these pathways remains scarce. This study employs a microsimulation framework to evaluate the effects of taxation and social security policies on population mental health. The UK economic crisis caused by the COVID-19 pandemic provides an informative context involving an economic shock accompanied by one of the strongest discretionary fiscal responses amongst OECD countries. The analytical setup involves a dynamic, stochastic, discrete-time microsimulation model (SimPaths) projecting changes in psychological distress given predicted economic outcomes from a static tax-benefit microsimulation model (UKMOD) based on different policy scenarios. We contrast projections of psychological distress for the working-age population from 2017 to 2025 given the observed policy environment against a counterfactual scenario where pre-crisis policies remained in place. Levels of psychological distress and potential cases of common mental disorders (CMDs) were assessed with the 12-item General Health Questionnaire (GHQ-12). The UK policy response to the economic crisis is estimated to have prevented a substantial fall (over 12 percentage points, %pt) in the employment rate in 2020 and 2021. In 2020, projected psychological distress increased substantially (CMD prevalence increase >10%pt) under both the observed and the counterfactual policy scenarios. Through economic pathways, the policy response is estimated to have prevented a further 3.4%pt [95%UI 2.8%pt, 4.0%pt] increase in the prevalence of CMDs, approximately 1.2 million cases. Beyond 2021, as employment levels rapidly recovered, psychological distress returned to the pre-pandemic trend. Sustained preventative effects on poverty are estimated, with projected levels 2.1%pt [95%UI 1.8%pt, 2.5%pt] lower in 2025 than in the absence of the observed policy response. The study shows that policies protecting employment during an economic crisis are effective in preventing short-term mental health losses and have lasting effects on poverty levels. This preventative effect has substantial public health benefits.

Can primary health care mitigate the effects of economic crises on child health in Latin America? An integrated multicountry evaluation and forecasting analysis.

BACKGROUND: Latin American and Caribbean countries are dealing with the combined challenges of pandemic-induced socicoeconomic stress and increasing public debt, potentially leading to reductions in welfare and health-care services, including primary care. We aimed to evaluate the impact of primary health-care coverage on child mortality in Latin America over the past two decades and to forecast the potential effects of primary health-care mitigation during the current economic crisis. METHODS: This multicountry study integrated retrospective impact evaluations in Brazil, Colombia, Ecuador, and Mexico from 2000 to 2019 with forecasting models covering up to 2030. We estimated the impact of coverage of primary health care on mortality rates in children younger than 5 years (hereafter referred to as under-5 mortality) across different age groups and causes of death, adjusting for all relevant demographic, socioeconomic, and health-care factors, with fixed-effects multivariable negative binomial models in 5647 municipalities with an adequate quality of vital statistics. We also performed several sensitivity and triangulation analyses. We integrated previous longitudinal datasets with validated dynamic microsimulation models and projected trends in under-5 mortality rates under alternative policy response scenarios until 2030. FINDINGS: High primary health-care coverage was associated with substantial reductions in post-neonatal mortality rates (rate ratio [RR] 0·72, 95% CI 0·71-0·74), toddler (ie, aged between 1 year and <5 years) mortality rates (0·75, 0·73-0·76), and under-5 mortality rates (0·81, 0·80-0·82), preventing 305 890 (95% CI 251 826-360 517) deaths of children younger than 5 years over the period 2000-19. High primary health-care coverage was also associated with lower under-5 mortality rates from nutritional deficiencies (RR 0·55, 95% CI 0·52-0·58), anaemia (0·64, 0·57-0·72), vaccine-preventable and vaccine-sensitive conditions (0·70, 0·68-0·72), and infectious gastroenteritis (0·78, 0·73-0·84). Considering a scenario of moderate economic crisis, a mitigation response strategy implemented in the period 2020-30 that increases primary health-care coverage could reduce the under-5 mortality rate by up to 23% (RR 0·77, 95% CI 0·72-0·84) when compared with a fiscal austerity response, and this strategy would avoid 142 285 (95% CI 120 217-164 378) child deaths by 2030 in Brazil, Colombia, Ecuador, and Mexico. INTERPRETATION: The improvement in primary health-care coverage in Brazil, Colombia, Ecuador, and Mexico over the past two decades has substantially contributed to improving child survival. Expansion of primary health-care coverage should be considered an effective strategy to mitigate the health effects of the current economic crisis and to achieve Sustainable Development Goals related to child health. FUNDING: UK Medical Research Council. TRANSLATIONS: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Assessment of dietary-lifestyle patterns and adherence to the USDA recommendations in Lebanese pregnant women amid the economic crisis: Findings from a national representative cross-sectional study.

As Lebanon's economic crisis become uncontrollable, Lebanese pregnant women face malnutrition, with many having to skip meals and switch to resort to cheap and unhealthy alternatives altogether. The objectives of the study were to assess the dietary and lifestyle patterns of Lebanese pregnant women and to evaluate their diets compliance with the United States Department of Agriculture (USDA) pregnancy recommendations, before and during the Lebanese escalating economic crisis. A cross-sectional study was conducted between April 2021 and January 2022. A validated self-administrated questionnaire was administered during the first, second and third trimesters of pregnancy among 363 women in all Lebanese governorates. Most of the pregnant women were free of diseases. While the majority did not smoke, 14.1% smoked hookah / shisha during pregnancy. The adherence to the USDA recommendations in our sample did not significantly vary prior to and throughout the socioeconomic crisis, and it was generally low. Only the mean consumption of vegetables increased during the socioeconomic crisis (p<0.05). Regarding physical activity, while the proportion of active women slightly decreased during the socioeconomic crisis, around 55% were still active. In conclusion, higher attention should be given to the dietary habits and health of this critical population, through effective interventions that increase awareness and achieve measurable improvements.

The dynamics of international health system reforms: Evidence of a new wave in response to the 2008 economic crisis and the COVID-19 pandemic?

Global economic and health shocks, such as the 2008 global financial crisis and the COVID-19 pandemic typically impact healthcare financing and delivery. Cutler found that profound societal changes in the 20th century induced three waves of healthcare reform across seven major OECD countries. Our study investigates whether major crises in the 21st century induced similar reform waves. Through thematic analysis, we systematically compared health system changes in response to these shocks, using data from the Observatory on Health Systems and Policies and the OECD. Our analysis reveals similar overarching reform trends across countries in response to the 2008 economic crisis: a tendency toward re-centralization of health system governance to control and leverage the efficient rationalization of public health resources. This, to some extent, countered the effects of the market-based reforms of the previous wave. The reforms induced by the 2008 crisis were mediated by its repercussions on the countries' economies. In contrast, reforms in response to the pandemic aimed primarily to address the direct impact of the shock on the health system. Despite its negative economic impact, the pandemic resulted in a substantial but temporary increase in public health spending. A better understanding reform dynamics and their impact on overarching conflicting health system objectives may prevent unintended consequences and enhance health systems' resilience in response to future shocks.

Impact of the economic crisis, COVID-19 and the Beirut explosion on ophthalmology training in Lebanon: an observational cohort survey-based study.

OBJECTIVES: The objective of the study is to investigate the effects of the COVID-19 pandemic, the economic crisis and the Beirut explosion on the training and work of ophthalmology residents and faculty in Lebanon. DESIGN: This is an observational cohort survey-based research conducted between January and December 2022. SETTING: The study targeted all ophthalmology residents and core faculty in Lebanon. PARTICIPANTS: A total of 52 participants, including 27 residents and 25 core faculty members, completed the survey. PRIMARY OUTCOME MEASURE: Primary outcomes comprised the subjectively reported effect of the three major external stressors on the training and well-being of ophthalmology trainees and educators in Lebanon. RESULTS: The study found that the majority of ophthalmology residents and core faculty members were significantly affected by the COVID-19 pandemic, Beirut explosion and the economic crisis in Lebanon. Significant percentage reported financial burden, decrease in outpatient and surgical load and educational activities. Furthermore, most participants reported higher levels of stress, anxiety and depression during the time of crises. CONCLUSIONS: This study emphasises the need to support healthcare professionals during times of crisis, as they are on the frontlines and can experience high levels of stress, anxiety and depression. By providing support and resources to healthcare professionals, they can better cope with the challenges they face and continue to provide essential care to their patients.