HEALTHCARE EXPENDITURE AND CARE SEEKING PATTERNS AMONG PEOPLE WITH CHRONIC CONDITIONS DURING THE PANDEMIC

Objective: Public health strategies resorted to world-wide, to reduce the transmission of COVID-19 had economic impacts which led to care seeking changes among people with pre-existing chronic diseases. We aimed to assess the household expenditure and, care seeking among people with chronic diseases due to COVID-19 pandemic in Sri Lanka. Design and Methods: An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants socio-demographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR). Results: 449 respondents completed the survey. Majority (55%;n = 173) responded that they experienced a negative impact on their main income. Nearly 30%(n = 130) of the participants had an additional source of income before the pandemic;and of them majority (74%;n = 97) reported a negative impact on the income. Twenty six percent (n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30)reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. The pandemic led to changes in healthcare utilization patterns among patients. Majority had to obtain the drugs from the pharmacy 65% (n = 70) and the laboratory tests from private labs 58% (n = 62). Forty-eight percent agreed that the pandemic led to delays in healthcare seeking, mostly because they were unaware of the services rendered. The incurred high OOPE during the pandemic. Of the participants, 9% (n = 39) and 3.2% (n = 14) had incurred catastrophic healthcare expenses at 10% and 25% of their total income. Conclusions: Residents of the Western-province were severely economically affected by the COVID-19 pandemic. Participants had incurred high out-of-pocket expenditures which led to changes in care seeking patterns among people chronic conditions. Strategies to ensure continuity of care especially for chronic conditions while protecting people from financial hardships is necessary to move towards Universal Health Coverage.

REDUCED HEALTHCARE UTILIZATION AMONG PATIENTS WITH CHRONIC DISEASES DURING THE PANDEMIC

Objective: Public-health strategies resorted to world-wide, to reduce the transmission of COVID-19 impacted the healthcare-utilization of people with preexisting chronic diseases. We aimed to assess the healthcare utilization, patientexperiences and economic impacts among people with chronic diseases due to COVID-19 pandemic. Design and Methods: An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants sociodemographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR). Results: 449 respondents completed the survey. Majority (55%) responded that they experienced a negative impact on their main income. 26%(n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30) reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. Considering care seeking pattern among people with chronic illness, it declined in all institutions during the lockdown period. However careseeking in the private sector, only margially declined during the pandemic. Considering care seeking at a government hospital, a drastic drop was observed during the lockdown period (n = 13;= 11.3%). Of the respondents who sought healthcare for chronic illness during the pandemic in lockdown (n = 85;74%) and no-lock down (n = 107;93%), a considerable proportion mentioned that clinics were either not functioning on time or not functioning at all. Although the majority agreed that their perceived health despite the chronic illness was good, very good, or excellent, around 38% reported it as fair or poor. Conclusion: Health-care utilization among people with a chronic disease reduced due to supply and demand driven factors in healthcare. Efforts are necessary to ensure continuity of care for people with chronic disease to prevent complications. The government needs to invest in resilient health systems to be better equipped to provide uninterrupted care for NCDs in any circumstances. To support this, primary healthcare strengthening and tele-health options should be explored.

One-year follow-up of immediate postpartum contraceptive implant insertion in adolescents

Purpose: Our study aimed to evaluate the acceptability, adverse effects and continuation rates among adolescents who accepted the etonogestrel (ENG) subdermal implant and compared to adolescents who chose other methods during the immediate postpartum period before hospital discharge, with one year follow-up up. Materials and methods: We conducted a cohort non-randomised study at the Women's Hospital, University of Campinas. All women up to 19 years of age, who gave birth at the hospital between July 2019 and April 2020, were invited to participate and were offered the ENG-implant or the routine contraceptive methods. They were followed for one year postpartum. Results: We included 100 teenagers and 72 accepted the ENG-implant. Students are more likely to accept the ENG-implant than non-students (PR: 1.25 [95%CI 0.99–1.59]). Up to one year of follow-up, survival analysis showed that the time of adherence to the method was longer for the ENG-implant users (p = 0.0049). More than 90% of the adolescents were satisfied with the implant;however, five requested early removal due to menstrual irregularity and local discomfort. Conclusion: Provision ENG-implant for adolescents in the immediate postpartum demonstrated high acceptance and ensured effective contraception. After one year, most of them were satisfied, with a high continuation rate and without unplanned pregnancies.

Impact of COVID-19 on the Latin American Insurance and Reinsurance Market

As elsewhere in the world, the Latin American region and its diverse economies have been heavily affected by the COVID-19 pandemic, and, particularly, by the different government measures adopted by each country. The region's insurance and reinsurance markets have not been exempted from these effects, notwithstanding their less developed nature compared to the large world economies. The smaller extent of insurance coverage offered, the regulatory and legislative features of each country, and the uninsurable nature of the pandemic, are some of the aspects to be considered when studying the market in the region and, together with this, account for the impossibility of applying, in most cases, the caselaw criteria of the more developed markets in the Latin American region. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

In vitro high-content tissue models to address precision medicine challenges

The field of precision medicine allows for tailor-made treatments specific to a patient and thereby improve the efficiency and accuracy of disease prevention, diagnosis, and treatment and at the same time would reduce the cost, redundant treatment, and side effects of current treatments. Here, the combination of organ-on-a-chip and bioprinting into engineering high-content in vitro tissue models is envisioned to address some precision medicine challenges. This strategy could be employed to tackle the current coronavirus disease 2019 (COVID-19), which has made a significant impact and paradigm shift in our society. Nevertheless, despite that vaccines against COVID-19 have been successfully developed and vaccination programs are already being deployed worldwide, it will likely require some time before it is available to everyone. Furthermore, there are still some uncertainties and lack of a full understanding of the virus as demonstrated in the high number new mutations arising worldwide and reinfections of already vaccinated individuals. To this end, efficient diagnostic tools and treat-ments are still urgently needed. In this context, the convergence of bioprinting and organ-on-a-chip technologies, either used alone or in combination, could possibly function as a prominent tool in addressing the current pandemic. This could enable facile advances of important tools, diagnostics, and better physiologically repre-sentative in vitro models specific to individuals allowing for faster and more accurate screening of therapeutics evaluating their efficacy and toxicity. This review will cover such technological advances and highlight what is needed for the field to mature for tackling the various needs for current and future pandemics as well as their relevancy towards precision medicine.

TEACHING-EDUCATING AND PROFESSORALITY/PROFESSORSHIP: unfolding conversation in station rotation turns

This paper pursues the production of subjectivities during the process of teaching -educating developed in Teaching and Diversity, a curricular component offered by a multiprofessional graduate program in a Bahia Public University. It aims at presenting experience as education/formation in the constitution of professorality, intertwined with diversity, as a formative ontological and epistemic principle. Conversation is the elected method, founded on Freire's dialogical presuppositions, interfacing with online education during covid 19 pandemic context. The assessment-formation dispositives proposed were: online station rotation and conversation circles registered in collective and individual journals, which have spread themselves as a rhizome via hyperlinks. The findings point to evidence of learning, creation and co authorship embodied in diverse strategies to appropriate the concepts and provocations posed, such as: creation of a co authorial metaphor, anti-art intervention, and the production of narratives In Derrida's supplement perspective. The organizative and epistemological principles as well as the didactic design allowed students and professors to immerse in hybrid environments to exercise and experiment teaching collectively. Conversation circles, also, were pointed as triggers to experiences-experiments as a way to confer new meanings to the nostalgia of traditional (face-to-face) teaching and initial resistances, such as cameras in off and low student-student and student-professors interaction. However, Self and hetero assessment emerged as a fragility since moral aspetcts (interest and effort) took the role of main parameters, and gaps in teaching-educating backgrounds were viewed as flaws and projected onto other aspects (professors, the readings, the theories etc), avoinding the assumption of corresponsability towards self and collective formative processes.

The impact of the COVID-19 pandemic on accounting information systems and organizations' performance

This paper empirically examines the impact of COVID-19 on accounting information systems and organizations' performance. It follows a quantitative approach. For data collection, an online questionnaire was developed and tested. The final version of the questionnaire was applied to the 2556 largest companies in Portugal. The 3 research hypotheses under study were tested with 101 valid answers. The results reveal a high rate of implementation of accounting and performance measurement instruments during the COVID-19 pandemic. Regarding the dynamics of the updates of organizations' performance measurement systems, the impact of the COVID-19 pandemic was confirmed and described as primarily positive. In turn, the performance of the companies was negatively impacted by the COVID-19 pandemic. This study contributes to a better understanding of the role of accounting and performance instruments in organizations under a high level of organizational uncertainty. Copyright © 2023 by Author/s and Licensed by IADITI.

Operacao Luz Verde: A new light for patients during COVID-19 pandemic

Background: During coronavirus disease (COVID-19) pandemic, avoiding hospital visits only to obtain medication was crucial to protect patients and to ensure hospital responsiveness. Portuguese pharmacies have national coverage. Purpose(s): To establish a nationwide response that allows patients to receive their specialty medicines (SM) in a community pharmacy of their convenience or at home, ensuring treatment continuity and avoiding unnecessary travelling to and from a hospital. Method(s): Community pharmacies, hospitals and pharmaceutical wholesalers collaborated in a structured, multidisciplinary operation, involving healthcare professionals and pharmaceutical stakeholders, endorsed by Pharmaceutical and Medical Societies: Operacao Luz Verde (OLV). Hospitals, patient associations, community pharmacies and patients themselves can ask for the dispensing of SM at a community pharmacy. Requests are received by a pharmacist specialised support line (LAF), which ensures communication between all stakeholders. Hospital pharmacists prepare the medicines and wholesalers provide transportation to ensure good practice. Community pharmacists scheduled for medicines to be dispensed with patients, ensuring electronic records and reports of eventual problems were sent to the hospital. OLV is free of charge for patients and hospitals, at least until the end of May 2020. Result(s): From the 23rd March until the 15th May 15, 12,229 patient requests were approved by a total of 33 hospitals;2,189 participating pharmacies and 20 patient associations endorsed the initiative. Final results will be presented at a later date. Conclusion(s): Community pharmacies may have an important role in the dispensing of SM. OLV may improve access to these medicines and reinforce potential for reducing inequities.

Liquid biopsy on serum samples: Fourier-Transform Infrared Spectroscopy as fatality predictor for COVID-19

The fatality prediction in hyperinflammation diseases like COVID-19 is a challenge. We show here that FTIR could probe the degree of IgG glycosylation discriminating subpopulations of COVID-19 patients depending on their degree of severity. © Optica Publishing Group 2022 The Authors.

Mild-to-moderate COVID-19 impact on the cardiorespiratory fitness in young and middle-aged populations.

The goal of the present study was to compare pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) performance in COVID-19 survivors with a control group (CG). This was a cross-sectional study. Patients diagnosed with COVID-19, without severe signs and symptoms, were evaluated one month after the infection. Healthy volunteers matched for sex and age constituted the control group. All volunteers underwent the following assessments: i) clinical evaluation, ii) PTF; and iii) CPET on a cycle ergometer. Metabolic variables were measured by the CareFusion Oxycon Mobile device. In addition, heart rate responses, peak systolic and diastolic blood pressure, and perceived exertion were recorded. Twenty-nine patients with COVID-19 and 18 healthy control subjects were evaluated. Surviving patients of COVID-19 had a mean age of 40 years and had higher body mass index and persistent symptoms compared to the CG (P<0.05), but patients with COVID-19 had more comorbidities, number of medications, and greater impairment of lung function (P<0.05). Regarding CPET, patients surviving COVID-19 had reduced peak workload, oxygen uptake (V̇O2), carbon dioxide output (V̇CO2), circulatory power (CP), and end-tidal pressure for carbon dioxide (PETCO2) (P<0.05). Additionally, survivors had depressed chronotropic and ventilatory responses, low peak oxygen saturation, and greater muscle fatigue (P<0.05) compared to CG. Despite not showing signs and symptoms of severe disease during infection, adult survivors had losses of lung function and cardiorespiratory capacity one month after recovery from COVID-19. In addition, cardiovascular, ventilatory, and lower limb fatigue responses were the main exercise limitations.

COVID-19: The forgotten cases of hidden exiles.

PURPOSE OF THE RESEARCH: We describe two interventions to screen for SARS-CoV-2 in two squats of exiled persons in France following the diagnosis of symptomatic COVID-19 cases. PRINCIPAL RESULTS: In squat A, 50 (25%) persons were screened; 19 were found positive, and three accepted a transfer. In squat B, 65 (54%) persons were screened at three different times, and only two were found positive. MAJOR CONCLUSIONS: Discrepant outcomes may reflect different levels of sanitation, prevention, and acceptance of interventions. Refusal to be transferred to specific COVID-19 homes if tested positive underscores the importance of local sanitary solutions for all. Cross-curricular strategies addressed to exiled persons are essential means of providing medical and public health solutions designed to deter COVID-19 outbreaks in these populations.

Oral Manifestations in Patients with COVID-19: A Living Systematic Review.

This living systematic review aims to summarize evidence on the prevalence of oral signs and symptoms in patients with COVID-19. The review was reported per the PRISMA checklist, and the literature search was conducted in 6 databases and in gray literature. Studies published in any language mentioning oral symptoms and signs in patients with COVID-19 were included. The risk of bias was assessed by the Joanna Briggs Institute appraisal tools. The certainty of evidence was evaluated through GRADE assessment. After a 2-step selection, 40 studies were included: 33 cross-sectional and 7 case reports. Overall, 10,228 patients (4,288 males, 5,770 females, and 170 unknown) from 19 countries were assessed. Gustatory impairment was the most common oral manifestation, with a prevalence of 45% (95% CI, 34% to 55%; I2 = 99%). The pooled eligible data for different taste disorders were 38% for dysgeusia and 35% for hypogeusia, while ageusia had a prevalence of 24%. Taste disorders were associated with COVID-19 (odds ratio [OR], 12.68; 95% CI, 6.41 to 25.10; I2 = 63%; P < 0.00001), mild/moderate severity (OR, 2.09; 95% CI, 1.25 to 3.49; I2 = 66%; P = 0.005), and female patients (OR, 1.64; 95% CI, 1.23 to 2.17; I2 = 70%; P = 0.0007). Oral mucosal lesions presented multiple clinical aspects, including white and erythematous plaques, irregular ulcers, small blisters, petechiae, and desquamative gingivitis. Tongue, palate, lips, gingiva, and buccal mucosa were affected. In mild cases, oral mucosal lesions developed before or at the same time as the initial respiratory symptoms; however, in those who required medication and hospitalization, the lesions developed approximately 7 to 24 d after onset symptoms. Therefore, taste disorders may be common symptoms in patients with COVID-19 and should be considered in the scope of the disease's onset and progression. Oral mucosal lesions are more likely to present as coinfections and secondary manifestations with multiple clinical aspects (PROSPERO CRD42020184468).

COVID-19 and gastroenterology: clinical insights and recommendations for gastroenterology care providers.

While the COVID-19 pandemic evolves, we are beginning to understand the role the gastrointestinal tract plays in the disease and the impact of the infection on the care of patients with gastrointestinal (GI) and liver diseases. We review the data and understanding around the virus related to the digestive tract, impact of the pandemic on delivery of GI services and daily gastroenterology clinical practice, and the effects on patients with pre-existing GI diseases.

High level of infection by toxoplasma gondii in pigs slaughtered in the city of são luís, maranhão

The article presents an exploratory, descriptive study on Bad News Communication skills (CMN) of medical interns. The student’s perception was on learning for the CMN was investigated with a cross-sectional design and a mixed approach. A questionnaire was applied, 176 participants were obtained, and a focus group was held with 12 students. The data were analyzed through the calculation of means and standard deviations for quantitative variables and the focus group reports were subjected to Content Analysis. It was observed that in the group that had training, compared to the one who did not, ocurred twice frequency with more skill for CMN. In the CMN’s management, it was considered harder to be “honest without taking away hope” (69%) and “to deal with the patient’s emotion” (59%). 99.4% knew the SPIKES protocol, of which 41.5% considered the expression of emotions as its most difficult stage. Communication and handling of emotions were pointed out as the main difficulties in the doctorpatient relationship, with deficits in the teaching of CMN. It was found that CMN is not limited to the technical issue, but it involves attitudes that need to be addressed with different methodologies, as well as the implementation of educational policies in the medical field, especially given the demands that emerges with the covid-19 pandemic. © 2021, Brazilain Coll Veterinary Parasitology. All rights reserved.

Prevalence of anemia and vitamin A deficiency and iron and vitamin A intake in children that use the Brazilian Unified National Health System in Rio de Janeiro, Brazil

Brazilian national strategies for the control of anemia and vitamin A deficiency in children are based on estimates of their nationwide prevalence rates in 2006 with methods not validated for this age group and with disaggregation at the level of major geographic regions. To back local administrations in (re)directing control measures for these two disorders, the current study presents estimates of their prevalence and markers of dietary intake of sources of micronutrients and use of vitamin and mineral supplements in a probabilistic sample of children 6 to 59 months of age, users of primary healthcare in the city of Rio de Janeiro, Brazil (n = 536). Venous blood samples were drawn for analysis of hemoglobin, ferritin, and serum retinol, besides collection of data on food consumption, use of vitamin and mineral supplements, and sociodemographic characteristics. Prevalence rates for anemia, iron deficiency anemia, and vitamin A deficiency were 13.7%, 5.5%, and 13%, respectively. Nearly all the children had consumed ironrich food the day before the interview, with high prevalence of animal sources. Only 49.4% had consumed foods high in vitamin A. The prevalence rates for use of any supplement, iron supplements, and vitamin A supplements were 51%, 14.7%, and 24.4%, respectively. The findings point to the need to redirect the strategies for prevention and control of anemia and vitamin A deficiency. Future studies are necessary to examine trends in these indicators, focusing on austerity policies implemented in recent years and the economic crisis resulting from the COVID-19 pandemic.

Skin-to-skin contact and breastfeeding in the first hour of life during COVID-19

Objective: to determine the prevalence and analyze the factors associated with early skin-to-skin contact and breastfeeding in the first hour of life in times of COVID-19. Method: cross-sectional study carried out in a municipal hospital in the coast of Rio de Janeiro, using data from medical records. The Chi-Square Test and Logistic Regression were used. Research ptotocol approved by the Ethic Committee. Results: among 187 medical records, the prevalence rates of skin-to-skin contact and breastfeeding in the first hour were, respectively, 36.7% and 63.2%. Postpartum women with one or two children and female newborns had more chances of the baby not being placed at the breast. Breastfeeding in the first hour was approximately 4.5 times greater among newborns placed in skin-to-skin contact. Conclusion: the prevalence of the analyzed practices was not satisfactory. Number of previous children and the baby's sex remained associated with skin-to-skin contact. The practices analyzed were associated with each other. © 2021, Centro de Estudos da Faculdade de Enfermagem da UERJ. All rights reserved.

COVID-19 : l’épidémie cachée des squats

Introduction Les personnes vivant dans des squats représentent une population vulnérable et difficilement accessible aux mesures de prévention. Le confinement y est particulièrement difficile. Nous rapportons l’expérience et l’efficacité d’un dépistage du SARS-CoV-2 dans deux squats. Matériels et méthodes L’association médecins du monde réalisait des maraudes auprès des personnes vivant dans des squats, en accord avec les référents associatifs des lieux. Quatre cas de COVID-19 furent ainsi diagnostiqués dans un squat A, et deux cas dans un squat B fin mars 2020, habités majoritairement par des migrants. À l’initiative de médecins du monde, un groupe de travail a organisé un dépistage massif des squats, dans l’objectif de limiter la dissémination virale, en proposant notamment l’isolement de cas COVID-19 dans un hébergement et de renforcer les mesures barrières. Ce groupe était constitué de référents du squat, de médecins du monde, de l’équipe mobile de dépistage du CHU, de l’Agence régionale de santé et pour le squat B, de la Mairie. Préalablement aux actions de dépistage, des médecins informaient les squatteurs des objectifs du dépistage, de la nécessité de respecter les mesures barrières, et évaluaient les besoins pour améliorer les conditions sanitaires. Résultats La population du squat A était évaluée à 200 personnes. Il n’existait aucune douche et trois toilettes fonctionnelles, avec des points d’eau extérieurs. Cinquante (25 %) personnes ont donné leur accord pour un dépistage organisé le 20 avril. L’âge moyen des personnes dépistées était de 31 (±16) ans, 26 étaient francophones (52 %) et vivaient à 1,8 (±0,7) personnes par chambre. Dix-neuf personnes (38 %) ont été testées positives, et trois personnes ont accepté d’être transférées dans un centre d’hébergement COVID-19. Il n’a pas été possible de revenir sur site, par opposition de certains squatteurs. Cependant, le 5 juin, une action inter-associative a permis l’installation de 6 toilettes et 6 douches. Le squat B était composé de 120 personnes, et avait quatre toilettes et trois douches fonctionnelles. Après trois passages sur 14jours, 74 (62 %) personnes furent dépistées, et deux cas supplémentaires furent diagnostiqués. L’âge moyen des personnes dépistées était de 30 (±13) ans, 82 % (51/62) étaient francophones avec 2,2 (±1,4) personnes par chambre. L’intervention était concomitante au don de deux toilettes chimiques, et à la distribution de 200 masques en tissu. Dans ces deux squats, aucun cas n’a nécessité une hospitalisation. Conclusion La prévalence élevée de circulation du SARS-CoV-2 dans les squats impose un dépistage rapide et massif dès le diagnostic d’un cas avéré, puisque tout retard pourrait engendrer une forte dissémination du virus, comme pour le squat A. L’acceptabilité du dépistage, et la possibilité d’intervenir de façon répétée, pourraient dépendre de l’amélioration rapide des conditions sanitaires, comme pour le squat B. Une coordination locale médico-sociale et politique pour ce type d’action est indispensable.

Prevalence of anemia and vitamin A deficiency and iron and vitamin A intake in children that use the Brazilian Unified National Health System in Rio de Janeiro, Brazil

Brazilian national strategies for the control of anemia and vitamin A deficiency in children are based on estimates of their nationwide prevalence rates in 2006 with methods not validated for this age group and with disaggregation at the level of major geographic regions. To back local administrations in (re)directing control measures for these two disorders, the current study presents estimates of their prevalence and markers of dietary intake of sources of micronutrients and use of vitamin and mineral supplements in a probabilistic sample of children 6 to 59 months of age, users of primary healthcare in the city of Rio de Janeiro, Brazil (n = 536). Venous blood samples were drawn for analysis of hemoglobin, ferritin, and serum retinol, besides collection of data on food consumption, use of vitamin and mineral supplements, and sociodemographic characteristics. Prevalence rates for anemia, iron deficiency anemia, and vitamin A deficiency were 13.7%, 5.5%, and 13%, respectively. Nearly all the children had consumed iron-rich food the day before the interview, with high prevalence of animal sources. Only 49.4% had consumed foods high in vitamin A. The prevalence rates for use of any supplement, iron supplements, and vitamin A supplements were 51%, 14.7%, and 24.4%, respectively. The findings point to the need to redirect the strategies for prevention and control of anemia and vitamin A deficiency. Future studies are necessary to examine trends in these indicators, focusing on austerity policies implemented in recent years and the economic crisis resulting from the COVID-19 pandemic.