Search Results (1,253)

The COVID-19 pandemic triggered unprecedented economic disruptions, raising critical questions about the resilience and adaptability of macroeconomic productivity across countries. This study examines the impact of COVID-19 on macroeconomic efficiency and productivity dynamics in 37 OECD countries using quarterly data from 2018Q1 to 2024Q4. By employing a Slack-Based Measure Data Envelopment Analysis (SBM-DEA) and the Malmquist Productivity Index (MPI), we decompose total factor productivity (TFP) into efficiency change (EC) and technological change (TC) across three periods: pre-pandemic, during-pandemic, and post-pandemic. Our framework incorporates both desirable (GDP) and undesirable outputs (inflation, unemployment, housing price inflation, and interest rate distortions), offering a multidimensional view of macroeconomic efficiency. Results show broad but uneven productivity gains, with technological progress proving more resilient than efficiency during the pandemic. Post-COVID recovery trajectories diverged, reflecting differences in structural adaptability and innovation capacity. Regression analysis reveals that stringent lockdowns in 2020 were associated with lower productivity in 2023–2024, while more adaptive policies in 2021 supported long-term technological gains. These findings highlight the importance of aligning crisis response with forward-looking economic strategies and demonstrate the value of DEA-based methods for evaluating macroeconomic performance beyond GDP. Full article

Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with changes in physical activity and lower exposure to community-acquired infections due to lockdown measures, altered social interaction patterns or reduced access to antenatal care. Assessing seasonal variation may offer insights into whether lifestyle changes during the COVID-19 lockdown period influenced preterm birth rates. Materials and Methods: This retrospective cohort study used data from the electronic medical records of Bihor and Sibiu counties. Preterm deliveries (<37 weeks) and stillbirths during the COVID-19 pandemic (2020 and 2021) were compared with the corresponding pre-pandemic (2018 and 2019) and post-pandemic (2022 and 2023) period. Preterm birth rates during summer and winter in the pre-pandemic, pandemic, and post-pandemic years were analyzed. A comparison with rates during strict lockdown was made. Results: Out of 52,021 newborn infants, 4473 were born preterm. Preterm birth rates remained stable across all three periods (p = 0.13), and no significant seasonal pattern was identified (p = 0.65). In contrast, stillbirth rates increased notably during the strict lockdown period, with the median incidence almost doubling compared to other periods (0.87%, p = 0.05), while remaining unchanged during the rest of the pandemic (p = 0.52). Conclusions: Our study found that preterm birth rates remained unaffected by the pandemic and lockdown periods, while stillbirths increased significantly during the strict lockdown. These findings highlight the importance of maintaining access to timely antenatal care during public health emergencies to prevent adverse perinatal outcomes. Full article

Ride-pooling, as a sustainable mode of ride-hailing services, enables different riders to share a vehicle while traveling along similar routes. The COVID-19 pandemic led to the suspension of this service, but Transportation Network Companies (TNCs) such as Uber and Lyft resumed it after a significant delay following the lockdown. This raises the question of what determinants shape ride-pooling in the post-pandemic era and how they spatially influence shared ride-hailing compared to the pre-pandemic period. To address this gap, this study employs geospatial analysis and machine learning to examine the factors affecting ride-pooling trips in pre- and post-pandemic periods. Using over 66 million trip records from 2019 and 43 million from 2023, we observe a significant decline in shared trip adoption, from 16% to 2.91%. The results of an extreme gradient boosting (XGBoost) model indicate a robust capture of non-linear relationships. The SHAP analysis reveals that the percentage of the non-white population is the dominant predictor in both years, although its influence weakened post-pandemic, with a breakpoint shift from 78% to 90%, suggesting reduced sharing in mid-range minority areas. Crime density and lower car ownership consistently correlate with higher sharing rates, while dense, transit-rich areas exhibit diminished reliance on shared trips. Our findings underscore the critical need to enhance transportation integration in underserved communities. Concurrently, they highlight the importance of encouraging shared ride adoption in well-served, high-demand areas where solo ride-hailing is prevalent. We believe these results can directly inform policies that foster more equitable, cost-effective, and sustainable shared mobility systems in the post-pandemic landscape. Full article

Background/Objectives: This study aimed to determine whether the movement patterns and mental health of university teachers changed after returning to on-site class activities following the COVID-19 lockdown. Specifically, it compared levels of physical activity (PA), sedentary behavior time (SBT), active breaks (ABs), and symptoms of depression, anxiety, and stress among university teachers during online and on-site teaching periods. We also analyzed the association between movement patterns with psychological and anthropometric variables. Methods: University teachers who engaged in online teaching activities because of the COVID-19 restrictions and returned to on-site classes were included. Each teacher wore an accelerometer and answered the Depression Anxiety Stress Scales. The following parameters were assessed: SBT, light (LPA), moderate (MPA), and vigorous (VPA) (min/day); moderate–vigorous PA (MVPA) (min/week); steps/day and ABs/day. Results: Thirty-seven teachers with complete data from both phases were included. Once the on-site teaching activities resumed, LPA (9 min/day), MPA (6 min/day), total PA (20 min/day), MVPA (49 min/week), and steps/day (1100) significantly increased. While SBT showed no changes, ABs/day bouts increased. Depression and stress symptoms improved upon returning to on-site teaching activities. A positive association was identified between SBT and waist circumference (WC). There were negative associations between steps/day and MVPA with body mass index (BMI), steps/day with WC, and LPA with stress symptoms. Conclusions: Upon returning to on-site teaching activities, PA levels, steps/day, and ABs/day bouts all increased, although SBT remained elevated compared with during the lockdown. The teachers’ psychological symptoms improved. PA was associated with better health markers, while SBT was associated with increased WC. Full article

Background: Suicide in older adults represents an insufficiently addressed public health problem, despite the aging population and the increase in mental disorders in this group. The COVID-19 pandemic and associated measures, such as lockdown, could have exacerbated this phenomenon. This study aimed to analyze the impact of the confinement decreed during the state of alarm in Spain on the incidence of deaths by suicide in people over 70 years of age in Extremadura. Methods: An observational and retrospective study was carried out, using data from the Institutes of Legal Medicine and Forensic Sciences, comparing the figures for 2020 with the years 2019, 2021, along with the average for the period 2015–2019. Statistical analyses included Chi-square tests and calculation of Relative Risk with 95% CI. Results: The results revealed a significant increase in deaths by suicide in the third quarter of 2020 compared to the periods compared, especially among men. Conclusions: It is concluded that confinement may have negatively influenced the mental health of older adults, which underscores the need for specific interventions and attention to regional contextual factors. Full article

Surface ozone (O₃) is a multifaceted threat that not only deteriorates the environment but also poses risks to human health. Here, we estimated the seamless hourly surface O₃ in China using Extreme Gradient Boosting (XGBoost) with multisource data fusion to investigate spatiotemporal differences in O₃ during multistage COVID-19, and the response of O₃ variation to meteorology and emissions were explored using Shapley Additive Explanations (SHAP) and WRF-Chem. The results indicate that the optimized model demonstrated higher accuracy, with CV-R² of 0.96–0.97 and RMSE of 4.58–5.00 μg/m³. Benefitting from the full coverage of the dataset, the underestimated O₃ was corrected and hotspots of short-term O₃ pollution events were successfully captured. O₃ increased by 16.8% during the lockdown, with high values clustered in the north and west, attributed to the weakened urban NOx titration resulting from reduced emissions. During the control and regulation period, O₃ levels declined year by year. O₃ exhibited significant fluctuations in the Pearl River Delta but remained stable in western China, with both regions demonstrating high sensitivity to meteorological variability. Among these, solar radiation and temperature were the key meteorological factors. The seamless high-resolution O₃ datasets will enable more insightful analyses regarding the spatiotemporal characterization and cause analysis. Full article

Background/Objectives: The outbreak of coronavirus disease 2019 (COVID-19) has restricted access to healthcare, increasing the risk of poor disease control among patients with COPD (Chronic Obstructive Pulmonary Disease). This study aimed to compare adherence to inhalers in patients with COPD before and during the COVID-19 lockdown and determine the characteristics of patients who were adherent to inhaler medications. Method: A retrospective analysis was conducted on a cohort of patients with severe COPD aged 40 or older using South Korea’s National Health Insurance Service (NHIS) database, which documents all healthcare utilization covered for insured individuals. Medication adherence, measured by the proportion of days covered (PDC), was compared before and during the COVID-19 lockdown using a paired t-test. A multivariable logistic regression model was conducted to identify the characteristics of the adherent patients (socio-demographic, including age, sex, income level, insurance type, and residential area), health-conditions (disease severity, underlying diseases, and disability), and pharmacotherapy characteristics (prescriber practice setting, polypharmacy, medication treatment duration, and inhaler type). Result: A total of 15,971 COPD patients were identified (79.2% men). During the COVID-19 lockdown in 2020, there was a significant decrease in medication adherence to COPD inhalers compared to 2019 (49.8% in 2020 vs. 56.3% in 2019, respectively; p < 0.001). Moreover, the proportion of those adherent (≥80%) during the COVID-19 lockdown decreased (22.0% → 18.0%). Patients who remained adherent to inhaler therapy during the COVID-19 lockdown were typically aged in their 60s, beneficiaries of Medical Aid, residents of rural areas, clinic users, and patients without cardiovascular disease. Conclusions: Patients with COPD encountered significant challenges in accessing inhalers during the COVID-19 lockdown. Healthcare authorities should develop targeted strategies to ensure continued medication access for patients at increased risk of poor medication adherence, particularly during periods of restricted healthcare access, such as public health emergencies or pandemic lockdowns. Full article

Ozone (O₃) and fine particulate matter (PM_2.5) are critical atmospheric pollutants whose complex chemical coupling presents significant challenges for multi-pollutant control strategies. This study investigated the spatiotemporal variations and driving mechanisms of O₃ and PM_2.5 in Jiaxing, China, during different COVID-19 lockdown periods from November 2019 to January 2024. Using high-resolution monitoring data, random forest modeling, and HYSPLIT backward trajectory analysis, we quantified the relative contributions of anthropogenic emissions, meteorological conditions, and regional transport to the formation and variation of O₃ and PM_2.5 concentrations. The results revealed a distinct inverse relationship between O₃ and PM_2.5, with meteorologically normalized PM_2.5 decreasing significantly (−5.0 μg/m³ compared to the pre-lockdown baseline of 0.6 μg/m³), while O₃ increased substantially (15.2 μg/m³ compared to the baseline of 5.3 μg/m³). Partial dependency analysis revealed that PM_2.5-O₃ relationships evolved from linear to non-linear patterns across lockdown periods, while NO₂-O₃ interactions indicated shifts from VOC-limited to NO_x-limited regimes. Regional transport patterns exhibited significant temporal variations, with source regions shifting from predominantly northern areas pre-lockdown to more diverse directional contributions afterward. Notably, the partial lockdown period demonstrated the most balanced pollution control outcomes, maintaining reduced PM_2.5 levels while avoiding O₃ increases. These findings provide critical insights for developing targeted multi-pollutant control strategies in the Yangtze River Delta region and similar urban environments. Full article

Since the establishment of the State of Alarm resulting from the current COVID-19 pandemic, lockdown, and quarantine have been imposed in most countries, with serious health, social, economic, and educational consequences. The health emergency caused by COVID-19 led to the closure of schools, forcing students from all over the world to stop attending schools and compromising the quality of care offered to students with autism spectrum disorder (ASD). In order to examine how teachers supervised students with ASD virtually during the lockdown period, and to determine whether families considered the support provided by teachers to be adequate, a cross-cultural study design was adopted. An ad hoc questionnaire was administered to 415 families in Spain and Mexico in April 2020. We calculated frequencies and carried out descriptive analyses, parametric inferential analyses, and correlations. Families reported that educational monitoring and contact with the family member with ASD during home lockdown was scarce, despite the provision of activities appropriate to their needs. Significant differences were found as a function of country, age of participant, age of family member with ASD, type of ASD, type of schooling, and length of lockdown. This study highlights the need to train teachers in inclusive digital education and to establish effective protocols for communication and follow-up with the families of students with ASD. Full article

In the period between 2021 and 2022 immediately following the COVID-19 lockdowns, there were 37 professional or academic productions of The Tempest in the United States. The play was by far the most produced of Shakespeare’s works in this timespan, and those 37 productions represent a 280% increase compared to 2019, in which there were 13 such productions. Considering The Tempest’s hyper-popularity within the context of the Black Lives Matter Movement and the birth of We See You White American Theatre’s calls for reform in 2020, this paper seeks to understand anew the way in which Shakespeare constructs blackness in the play. Indeed for all of its beauty and magic, The Tempest stages a violent anti-blackness in its treatment of Caliban. In particular, I argue an unexplored connection between The Tempest and Ben Jonson’s 1605 court masque, The Masque of Blackness, itself an exploration of the construction of race for a particular early modern audience. My exploration here began as a partial answer to a question posed by Robin Alfriend Kello: “how do you balance [an] attraction to the richness of Shakespearian verse against these layered histories of racial violence and exclusion?” A deeper understanding of Shakespeare’s version of blackness may grant insights into areas of intervention for those theaters reaching for The Tempest amidst national calls for anti-racist theatrical work. Full article

This longitudinal study investigated the incidence and characteristics of injuries among U9, U11, and U13 male football players in an academy setting over a six-season period, from 2016/17 to 2021/22. A total of 374 injuries were analyzed, with a particular focus on muscle injuries, including Delayed Onset Muscle Soreness (DOMS), muscle ruptures, and contusions. The study revealed that the highest injury incidence occurred in the U13 group, with quadriceps injuries being most prevalent in both the U13 and U11 groups. The study found that muscle injuries accounted for a significant proportion of all injuries, particularly in the U13 group, where muscle injuries increased over time. Intrinsic factors such as physical development during puberty and extrinsic factors like training intensity and psychological pressures may contribute to the higher injury rates in older age groups. Additionally, seasonal fluctuations in injury rates were observed, with a notable decline during the COVID-19 lockdowns in 2019/20 and 2020/21, followed by an increase post-lockdown due to deconditioning. The study highlights the vulnerability of young athletes to muscle injuries, particularly during growth spurts, and calls for further research into training methods and injury prevention strategies to mitigate these risks. Full article

Background/Objectives: This study introduces the Multi Group Cost Malmquist Index ($CM{g}_m$), a novel tool for comparing and ranking the cost efficiency of multiple groups of similar decision-making units operating in different contexts. It was applied to Greek public hospitals to assess productivity change between 2009 and 2021, covering the period before the economic recession and after the second lockdown during the COVID-19 pandemic. The study aimed to determine the impact of these external shocks on hospital efficiency and to identify differences in cost productivity based on hospital size and regional location. Methods: Data envelopment analysis was employed to compute the Malmquist indices for productivity change and ranking. Overall, 109 Greek public hospitals were analysed using three models: as a single group, classified by bed capacity, and classified by regional health authority (RHA). Cost productivity was decomposed into its core measures. Results: During the economic crisis, hospitals improved their cost productivity by 13.2%, whereas during the pandemic, it declined by 32.1%, primarily due to cost frontier deterioration resulting from increased healthcare demand and strained resources. Medium-sized hospitals exhibited higher cost efficiency than small and large hospitals. Regional disparities were also observed, with hospitals in the 5^th and 7^th RHAs outperforming those in 1^st and 2^nd RHAs. Conclusions: The findings highlight the pandemic’s disruptive impact on hospital cost productivity compared to the efficiency gains during the economic crisis. It is encouraging, though, that hospitals are recovering again after the lifting of strict lockdown measures. The $CM{g}_m$ is a valuable tool for policymakers, offering insights into hospital performance across multiple groups. Future healthcare policies should prioritise resource optimisation and address regional disparities to enhance system-wide efficiency and resilience in times of crisis. Full article

The coronavirus (COVID-19) pandemic has profoundly affected public health and socio-economic structures globally. This research conducted a post-COVID-19 analysis of the role of fiscal support interventions on COVID-19 health regulations such as mandatory non-pharmaceutical interventions like face masks, social distancing, periodic lockdowns which include restrictions on movement, and socio-economic dimensions. This quantitative research obtained 302 responses from different households in the Eastern Cape, Gauteng, Kwa-Zulu Natal, and Limpopo Provinces in South Africa. The results reveal that the relief fund (R350 unemployment grant, unemployment insurance fund claim, and food parcel distribution, among others) mediated the relationship between COVID-19 health regulations and poverty levels and the relationship between COVID-19 health regulations and health and well-being. The relief fund also mediated the relationship between COVID-19 health regulations and employment levels. Support packages from the R500 billion government support, which included loan guarantees, job support, tax and payment deferrals and holidays, social grants, wage guarantees, health interventions, and municipalities support, moderate the relationship between COVID-19 health regulations and the family and social support. These results validate the impact of the fiscal support intervention by the government in mitigating its emergency intervention with COVID-19 health regulations. This strengthens the theory of intervention, highlighting that multiple dynamics make interventions complex as shown by mediation and moderation results. Furthermore, this study highlights intervention being central to the management of the crisis. The study highlights the importance of comprehensive intervention for future preparedness, thus advancing the crisis–intervention perspective. Advances in these areas are critical to mitigate the impact of the next pandemic or similar major events in society. This can be achieved through improved pandemic timely response with effective economic stimulus, social relief, strong legal framework, and anti-corruption policies. Full article

This study examines the spatial and temporal evolution of obesity among adults in Italian regions. In Italy, regional administrative areas are responsible for providing health services. Moreover, Italian regions present different socioeconomic conditions and health and nutritional habits. As a result, a regional analysis of the spatiotemporal evolution of obesity allows the identification of key areas for prevention and control, enabling the design of more targeted and effective interventions. In this study, the geographic clustering of obesity in Italy was explored by analyzing the local spatial autocorrelation of regional-level prevalence rates of adulthood obesity between 2010 and 2022, updating and expanding the existing literature. Data from the Health For All repository are analyzed to determine distribution patterns and trends, employing choropleth maps, Moran’s Index and Welch’s t-test. Gender inequalities have been underlined both in the spatial and temporal distribution. Results show that obesity exhibits spatial clustering, with greater severity in the south. During the period under analysis, obesity prevalence rates in Italy show a tendency to grow, with a sharp increase during the COVID-19 lockdown. Full article

Background: The COVID-19 pandemic has exacerbated mental health challenges across occupational sectors, disproportionately affecting workers in essential and public-facing roles. Objectives: This study ai to identify the occupational sectors in Spain most affected by mental health-related Temporary Work Incapacity due to Common Contingencies during the first COVID-19 lookdown (14 March–21 June 2020) to examine sex-based differences and to analyze the associate economic burden. Methods: A descriptive, retrospective cross-sectional study was conducted using data from salaried workers affiliated with Asepeyo, a major Social Security mutual insurance provider in Spain. The sample comprised 5135 workers granted Temporary Work Incapacity due to mental health diagnoses during the lockdown period. Variables analyzed included sex, age, ICD-10 diagnosis, occupational sector, duration of medically certified leave, and estimated direct economic cost. A focused subsample of 2123 workers from the ten most affected sectors was also examined. Results: Generalized Anxiety Disorder was the most prevalent diagnosis (69.17%), followed by adjustment disorders and depressive episodes. Women accounted for 63.5% of the total sample and 80.6% of the most affected sectors, which included elderly care, retail, education, cleaning, and healthcare. The average cost per episode was EUR 2465.7, with longer leave durations observed in sectors characterized by high emotional and social exposure. Conclusions: Mental health-related disorders during the COVID-19 lockdown revealed marked sex-based disparities and sectoral vulnerabilities. Public-facing and care-related occupations experienced a disproportionate burden. These findings support the need to recognize certain mental health conditions as occupational diseases to develop targeted, gender-informed workplace mental health strategies. Full article