Online health information seeking behavior, healthcare access, and health status during exceptional times.

Online health information seeking behavior (e-HISB) is becoming increasingly common and the trend has accelerated as a result of the COVID-19 pandemic when individuals strongly relied upon the Internet to stay informed by becoming exposed to a wider array of health information. Despite e-HISB having become a global trend, very few empirical investigations have analyzed its potential influence on healthcare access and individuals' health status. In this paper, we try to fill this gap. We use data from the second SHARE Corona Survey, supplemented with data from the previous 8th wave of SHARE, and estimate a recursive model of e-HISB, healthcare access, and individuals' health status that accounts for individuals' unobserved heterogeneity. Our findings suggest that e-HISB can empower individuals to better understand health concerns, facilitating improved health condition management. However, e-HISB can also trigger a chain reaction, as navigating vast amonts of online health information can heighten fear and anxiety. This increased anxiety may lead to higher utilization of medical services, adversely affecting individuals' perceptions of their health.

The impact of informal and formal care disruption on older adults' psychological distress during the COVID-19 pandemic in UK.

This paper investigates how formal and informal caregiving disruptions-due to the U.K. government's non-pharmaceutical interventions (NPIs) aimed at reducing transmission of the SARS-CoV-2 virus-may have affected the likelihood of psychological distress among older individuals. We model the association between disruption of formal and informal care and mental health of the elderly during the first wave of the COVID-19 pandemic using a recursive simultaneous - equation model for binary variables. Our findings reveal that public interventions, which are most essential for reducing the pandemic spread, influenced the provision of formal and informal care. The lack of adequate long-term care following the COVID-19 outbreak has also had negative repercussions on the psychological well-being of these adults.

Adherence during COVID-19: The role of aging and socio-economics status in shaping drug utilization.

Our study investigates the potential impact that COVID-19 and lockdown restrictions may have had on drug utilization and the role of patient age and education in reshaping it. We focused on patients affected by diabetes mellitus, who are likely to suffer a higher degree of morbidity and mortality due to COVID-19. We used a bi-monthly administrative panel dataset from January 2019 to December 2020 from Liguria (Italy), one of the regions with the highest number of individuals over the age of 65 in Europe. The results demonstrated that, after the initial shock, when patients tried to increase their personal stock of drugs to overcome the risk of possible additional barriers generated by the coronavirus, the hoarding effect almost disappeared. Adherence has drastically reduced during the COVID-19 pandemic and has never reached pre-COVID levels again. Older and poorly educated patients seem to have suffered more from the restrictions imposed by the lockdown and fear of contagion and they may be the ideal target group when considering possible policy interventions to improve adherence.

Improving health and sustainability: Patterns of red and processed meat consumption across generations.

This study explores whether the widespread dissemination of Western-type culture and the globalization of food production and consumption that have characterized Italy for decades may have influenced red and processed meat consumption across generations. For the purpose of our study, we constructed a pseudo-panel derived from repeated cross-sections of the annual household survey, "Aspects of Daily Life," that was part of the Multipurpose Survey carried out by the Italian National Statistical Office (ISTAT) from 1997 to 2012. We adopted an APC (Age, Period, Cohort) approach that involves age, period, and cohort effects. We followed the experiences of four cohorts: the Silent Generation (born 1926-1945), the Baby Boomer 1 Generation (1946-1955), the Baby Boomer 2 Generation (1956-1965), and Generation X (1966-1980). Our results revealed that increases in disposable income, changes in women's role in society, and urbanization and globalization have had significant effects on consumption patterns. The analysis shows that the older generations have changed their diets more in favor of meat consumption than later generations, with more change in the relatively affluent north of the country compared with the south, while the youngest generations are more likely to adopt more healthful and environmentally sustainable eating patterns.

Visiting parents in times of COVID-19: The impact of parent-adult child contacts on the psychological health of the elderly.

Using the 8th wave of the SHARE and the SHARE Corona Survey, we investigated whether the disruption of parent-adult child contacts due to social distancing restrictions increased the symptoms of depression among old age individuals during the first wave of the COVID-19 pandemic. We model the relationship between the disruption of parent-adult child contacts and the mental health of the elderly using a recursive simultaneous equation model for binary variables. Our findings show that the likelihood of disruption of parent-adult child contacts was higher with adult children who do not live with or close to their parents (i.e., in the same household or in the same building) for whom contact disruption increases about 15 %. The duration of restrictions to movement and lockdowns also has a positive and significant effect on parent-child contact disruption: an additional week of lockdown significantly increases the probability of parent-child contact disruption, by about 1.5 %. The interventions deemed essential to reduce the spread of the pandemic, such as the "stay-at-home" order, necessarily disrupted personal parent-child contacts and the social processes that facilitate psychological well-being, increasing the probability of suffering from a deepening depressed mood by about 17 % for elderly parents.

The role of education in psychological response to adverse health shocks.

The prevalence of common mental disorders is on the rise: in the last decade mental disorders have become one of the major contributors to the global burden of disease and the leading cause of disability worldwide. While the association between depressive symptoms and physical health has been the subject of many studies, little is known about the potential pathways through which physical health affects mental health and how this relationship varies across different socioeconomic groups. This study aims at investigating on the role that a higher educational level may have not only in protecting people from depressive and anxiety symptoms but also on its role in mediating the relationship between mental and physical health shocks. For the scope of our analysis, we relied on hospital administrative records collected from Liguria, a north-western Italian region. We evaluate the impact of education in protecting individuals from mental disorders when they experienced an adverse health event, such as severe hospitalization or an onset of a chronic condition. Our results suggest that among those who suffer from severe physical health issues, highly educated individuals are less likely to experience depressive and anxiety symptoms compared to those with a lower level of education, even though, in presence of an adverse health shock, the protecting role of education slightly decreases.

Older patients and geographic barriers to pharmacy access: When nonadherence translates to an increased use of other components of health care.

This paper studies whether geographic barriers can influence nonadherence to prescription drugs and its effect on patients' health. We used a multivariate probit model estimated by maximum simulated likelihood that considers individual unobserved heterogeneity, which may characterize the relationship between adherence, medical care utilization, and health outcome. We used administrative data from Liguria, Italy, the region with the highest rate of individuals over the age of 65 in Europe. Our sample included older individuals affected by cardiovascular diseases, which remain one of the leading causes of death in most OECD countries. Our results showed that geographic barriers to pharmacies negatively influence patients' adherence. According to our results, patients' nonadherence to pharmacological therapy is responsible for an increased probability of patients' mortality and the overuse of other medical services, namely, hospitalizations and emergency department visits. Nonadherence may thus represent a potential source of waste for the health care system.

The smoking epidemic across generations, genders, and educational groups: A matter of diffusion of innovations.

This study determines whether the temporal variations in smoking habits across generations and genders and among groups with differing levels of education fit the pattern proposed by the theory of the diffusion of innovations (TDI) (Rogers, 2003). We focus on the Italian case and employ a pseudo-panel derived from repeated cross-sections of the annual household survey, "Aspects of Daily Life," that was part of the Multipurpose Survey carried out by the Italian National Statistical Office (ISTAT) for the period 1997 to 2012. The results confirm Rogers' TDI and show that smoking prevalence has declined over time and across age cohorts: Younger men of all educational levels and women with higher education are less likely to smoke than are those in other cohorts, while less-educated women who entered the smoking-diffusion process later than others are more likely to smoke. Hence, socio-economic differences in smoking continue to persist, especially for women. According to Rogers' TDI, smoking prevalence is expected to continue to decline, particularly among little-educated women.

Do healthcare tax credits help poor-health individuals on low incomes?

In several countries, personal income tax permits tax credits for out-of-pocket healthcare expenditure. Tax credits benefit taxpayers at all income levels by reducing their net tax liability and modify the price of out-of-pocket expenditure. To the extent that consumer demand is price elastic, they may influence the amount of eligible healthcare expenditure for which taxpayers may claim a credit. These effects influence, in turn, income distributions and taxpayers' health status and therefore income-related inequality in health. Redistributive consequences of tax credits have been widely investigated. However, little is known about the ability of tax credits to alleviate health inequality. In this paper, we study the potential effects that tax credits for health expenses may have on income-related inequality in health status with reference to the Italian institutional setting. The analysis is performed using a tax-benefit microsimulation model that reproduces the personal income tax and incorporates taxpayers' behavioral responses to changes in tax credit rate. Our results suggest that the current healthcare tax credit design tends to favor the richest part of the population.

Scale Effects and Expected Savings from Consolidation Policies of Italian Local Healthcare Authorities.

BACKGROUND: Consolidation is often considered by policymakers as a means to reduce service delivery costs and enhance accountability. OBJECTIVE: The aim of this study was to estimate the potential cost savings that may be derived from consolidation of local health authorities (LHAs) with specific reference to the Italian setting. METHODS: For our empirical analysis, we use data relating to the costs of the LHAs as reported in the 2012 LHAs' Income Statements published within the New Health Information System (NSIS) by the Ministry of Health. With respect to the previous literature on the consolidation of local health departments (LHDs), which is based on ex-post-assessments on what has been the impact of the consolidation of LHDs on health spending, we use an ex-ante-evaluation design and simulate the potential cost savings that may arise from the consolidation of LHAs. RESULTS: Our results show the existence of economies of scale with reference to a particular subset of the production costs of LHAs, i.e. administrative costs together with the purchasing costs of goods (such as drugs and medical devices) as well as non-healthcare-related services. CONCLUSIONS: The research findings of our paper provide practical insight into the concerns and challenges of LHA consolidations and may have important implications for NHS organisation and for the containment of public healthcare expenditure.

Analyzing disparity trends for health care insurance coverage among non-elderly adults in the US: evidence from the Behavioral Risk Factor Surveillance System, 1993-2009.

OBJECTIVE: To explore the changing disparities in access to health care insurance in the United States using time-varying coefficient models. DATA: Secondary data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1993 to 2009 was used. STUDY DESIGN: A time-varying coefficient model was constructed using a binary outcome of no enrollment in health insurance plan versus enrolled. The independent variables included age, sex, education, income, work status, race, and number of health conditions. Smooth functions of odds ratios and time were used to produce odds ratio plots. RESULTS: Significant time-varying coefficients were found for all the independent variables with the odds ratio plots showing changing trends except for a constant line for the categories of male, student, and having three health conditions. Some categories showed decreasing disparities, such as the income categories. However, some categories had increasing disparities in health insurance enrollment such as the education and race categories. CONCLUSIONS: As the Affordable Care Act is being gradually implemented, studies are needed to provide baseline information about disparities in access to health insurance, in order to gauge any changes in health insurance access. The use of time-varying coefficient models with BRFSS data can be useful in accomplishing this task.

Vacuum-based preservation of surgical specimens: an environmentally-safe step towards a formalin-free hospital.

Formalin as a fixative has no practical substitutes, but is toxic and potentially carcinogenic, so caution of its use in hospitals and elsewhere is mandatory. In our hospital, preservation of surgical specimens into formalin to be transferred to pathology labs was replaced by under-vacuum sealing (UVS) tissues into plastic bags and preservation at 4 degrees C until transfer. Data analysis showed UVS processing to be superior in terms of staff satisfaction and of gross anatomic preservation; no problems in terms of technical feasibility or histopathologic preservation were encountered. Formalin was confined to pathology labs while its use on hospital premises was vastly reduced.

The influence of traffic-related pollution on individuals' life-style: results from the BRFSS.

This paper employs the Behavioral Risk Factor Surveillance System (2001) data in conjunction with the Environmental Protection Agency's Air Quality System data to investigate how air pollution caused by motor vehicle emissions affects the likelihood of good health and the amount of health investments. Models are estimated using three different measures of overall health: a measure of self-assessed health and two health outcome indicators (asthma and blood pressure). A multivariate probit approach is used to estimate recursive systems of equations for self-assessed health, health outcomes and life-styles. The most interesting result concerns the influence of pollution on health-improving life-style choices: only if traffic pollution is in the 'satisfactory range' (AQI level at or below 100), individuals will have incentive to invest in health.

A comparative costs analysis of brachytherapy and radical retropubic prostatectomy therapies for clinically localized prostate cancer.

OBJECTIVES: The aim of this study is to perform a comparative costs analysis of brachytherapy (BT) and radical retropubic prostatectomy (RRP) for clinically localized prostate cancer and to shed light on the difficulties of comparing their relative economic effectiveness. METHODS: A systematic literature review of costing studies available in the Medline, Embase, DARE, and INAHTA databases. RESULTS: There is a lack of homogeneity among published studies in this field. Differences in the reported costs are related to different environments in which the two techniques (BT and RRP) are applied, and in particular due to the use of different methodology, cost items included, time frames, and different price levels in different settings. CONCLUSION: Published studies of costing data of BT and RRP do not provide clear-cut evidence for a conclusion about which treatment may be more effective from an economic point of view.