[Taking in charge of chronicity in Lombardy: balance sheet and revision perspectives after the pandemic.] / Presa in carico della cronicità in Lombardia: bilancio e prospettive di revisione dopo la pandemia.

At the end of the first three years of experimentation of the Lombard reform of the Taking in Charge (PiC) of chronicity and frailty, it is possible to draw up a first summary balance. The covid-19 pandemic in the two-year period 2020-2021 had a negative impact on the implementation process of the PiC so much that its revision was necessary. The changes envisaged by Mission 6 of the PNRR, in synergy with the reform of Regional Law 22 and with the renewal of the primary care ACNs, open a new phase for the management of chronicity in Lombardy. The article proposes the revision of the reform, in line with the indications of the National Chronicity Plan, to overcome the limitations that emerged in the first two years of application, in the sign of overcoming the quasi-market that inspired the first version of the PiC.

Cash stock strategies during regular and COVID-19 periods for bank branches by deep learning.

Determining the optimal amount of cash stock reserved in each bank branch is a strategic decision. A certain level of cash stock must be kept and ready for cash withdrawal needs at a branch. However, holding too much cash not only forfeits opportunities to make profit from the exceeding amount of cash in the stock but also increases insurance cost. This paper presents cash stock strategies for bank branches by using deep learning. Deep learning models were applied to historical data collected by a retail bank to predict the cash withdrawals and deposits. Data preparation and feature selection to identify important attributes from the bank branch data were performed. In the prediction process, two Recurrent Neural Network techniques-Long Short-Term Memory and Gated Recurrent Units methods-were compared. Then prediction errors were measured and statistically tested for their probability distributions. These distributions together with the predicted values were used in determining the lower and upper bounds for holding the cash stock. These bounds were employed to recommend the cash stock level strategies by having two options for different situations. The impacts of COVID-19 were also tested and discussed. According to the bank under this study, the proposed strategies can reduce the amount of cash stock by more than 10% for which was their initial target. Hence, the costs of cash management such as insurance cost and cash transportation cost were reduced. Moreover, the excess cash could be used for other purposes of the bank.

Cash transfer during the COVID-19 pandemic: a multicentre, randomised controlled trial.

OBJECTIVE: To evaluate the effect of a one-time cash transfer of $C1000 in people who are unable to physically distance due to insufficient income. DESIGN: Open-label, multi-centre, randomised superiority trial. SETTING: Seven primary care sites in Ontario, Canada; six urban sites associated with St. Michael's Hospital in Toronto and one in Manitoulin Island. PARTICIPANTS: 392 individuals who reported trouble affording basic necessities due to disruptions related to COVID-19. INTERVENTION: After random allocation, participants either received the cash transfer of $C1000 (n=196) or physical distancing guidelines alone (n=196). MAIN OUTCOME MEASURES: The primary outcome was the maximum number of symptoms consistent with COVID-19 over 14 days. Secondary outcomes were meeting clinical criteria for COVID-19, SARS-CoV-2 presence, number of close contacts, general health and ability to afford basic necessities. RESULTS: The primary outcome of number of symptoms reported by participants did not differ between groups after 2 weeks (cash transfer, mean 1.6 vs 1.9, ratio of means 0.83; 95% CI 0.56 to 1.24). There were no statistically significant effects on secondary outcomes of the meeting COVID-19 clinical criteria (7.9% vs 12.8%; risk difference -0.05; 95% CI -0.11 to 0.01), SARS-CoV-2 presence (0.5% vs 0.6%; risk difference 0.00 95% CI -0.02 to 0.02), mean number of close contacts (3.5 vs 3.7; rate ratio 1.10; 95% CI 0.83 to 1.46), general health very good or excellent (60% vs 63%; risk difference -0.03 95% CI -0.14 to 0.08) and ability to make ends meet (52% vs 51%; risk difference 0.01 95% CI -0.10 to 0.12). CONCLUSIONS: A single cash transfer did not reduce the COVID-19 symptoms or improve the ability to afford necessities. Further studies are needed to determine whether some groups may benefit from financial supports and to determine if a higher level of support is beneficial. TRIAL REGISTRATION NUMBER: NCT04359264.

The Impact of COVID-19 on Health Behavior, Stress, Financial and Food Security among Middle to High Income Canadian Families with Young Children.

The COVID-19 pandemic has disrupted many aspects of daily life. The purpose of this study was to identify how health behaviors, level of stress, financial and food security have been impacted by the pandemic among Canadian families with young children. Parents (mothers, n = 235 and fathers, n = 126) from 254 families participating in an ongoing study completed an online survey that included close and open-ended questions. Descriptive statistics were used to summarize the quantitative data and qualitative responses were analyzed using thematic analysis. More than half of our sample reported that their eating and meal routines have changed since COVID-19; most commonly reported changes were eating more snack foods and spending more time cooking. Screen time increased among 74% of mothers, 61% of fathers, and 87% of children and physical activity decreased among 59% of mothers, 52% of fathers, and 52% of children. Key factors influencing family stress include balancing work with childcare/homeschooling and financial instability. While some unhealthful behaviors appeared to have been exacerbated, other more healthful behaviors also emerged since COVID-19. Research is needed to determine the longer-term impact of the pandemic on behaviors and to identify effective strategies to support families in the post-COVID-19 context.