Search Results (28)

In 1961, Los Angeles experienced the disastrous Bel Air fire, which swept through an affluent neighborhood situated in a hilly, WUI (wildland–urban interface) location. In January 2025, the city was devastated again by a nearly-simultaneous series of wildfires, the most severe of which took place close to the 1961 fire location. Disastrous WUI fires are, unfortunately, an anticipatable occurrence in many U.S. cities. A number of issues identified earlier remained the same. Some were largely solved, while other new ones have emerged. The paper examines the Palisades Fire of January, 2025 in this context. In the intervening decades, the population of the city grew substantially. But firefighting resources did not keep pace. Very likely, the single-most-important factor in causing the 2025 disasters is that the Los Angeles Fire Department operational vehicle count shrank to 1/5 of what it was in 1961 (per capita). This is likely why critical delays were experienced in the initial attack on the Palisades Fire, leading to a runaway conflagration. Two other crucial issues were the management of vegetation and the adequacy of water supplies. On both these issues, the Palisades Fire revealed serious problems. A problem which arose after 1961 involves the unintended consequences of environmental legislation. Communities will continue to be devastated by wildfires unless adequate vegetation management is accomplished. Yet, environmental regulations are focused on maintaining the status quo, often making vegetation management difficult or ineffective. House survival during a wildfire is strongly affected by whether good vegetation management practices and good building practices (“ignition-resistant” construction features) have been implemented. The latter have not been mandatory for housing built prior to 2008, and the vast majority of houses in the area predated such building code requirements. California has also suffered from a highly counterproductive stance on insurance regulation. This has resulted in some residents not having property insurance, due to the inhospitable operating conditions for insurance firms in the state. Because of the historical precedent, the details in this paper focus on the Palisades Fire; however, many of the lessons learned apply to managing fires in all WUI areas. Policy recommendations are offered, which could help to reduce the potential for future conflagrations. 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

The Solvency II regulatory framework requires European insurance companies to guarantee their solvability and stability by retaining enough Own Funds to cover future unexpected losses at a given confidence level. A Standard Formula approach is provided to estimate the capital requirement needed. Still, Solvency II allows internal methodologies to quantify the capital absorption arising from specific risk types or even to replace the Standard Formula with a full internal model. This work proposes a new internal model approach to measure the Catastrophe Recession Risk. The Recession Risk implies a mandatory capital absorption component for the insurance companies operating in the credit and suretyship business. The proposed model is based on the CreditRisk⁺ model and designed to behave countercyclically, aligning with the original intent of the European supervisory authority when first introducing this risk into the Solvency II risks’ taxonomy. Additionally, the model is applied to define an index for monitoring future recession crises based on the time series of past default rates. Full article

This article advocates smart mixes of mechanisms of post-disaster recovery in terms of boosting resilience and sustainability through liability rules, government intervention, insurance, and their combinations. Liability rules can provide compensation to victims and, in theory, also reduce disaster risks, while they have their limits in practice. The government widely intervenes in disaster compensation in many countries, but it faces challenges in how it can intervene fairly and efficiently, whether through informal channels, such as ad hoc charity, or structured approaches, such as compensation funds. As governments may struggle to provide efficient and effective compensation ex post, insurance may offer proactive solutions with models of first-party catastrophe insurance and third-party liability insurance ex ante. Where market failure, liability failure, and government failure may all arise, a smart mix of mechanisms is often preferable from a law and economic perspective, rather than relying solely on one framework. However, upon examining empirical evidence regarding the effectiveness of these instruments in China, the UK, France, Germany, and Turkey, it becomes apparent that a mix of mechanisms is not always applied in an effective manner. Models of mandatory comprehensive disaster insurance, and Public–Private Partnership (PPP), which both receive government intervention as a last resort to the market and liability failures, can reach the goal of more effective compensation for disaster victims, risk prevention and resilience when faced with disaster recovery, and should therefore be substantially implemented beyond the current levels. To be clear, the proposed mix of solutions mainly focuses on legal and economic dimensions which are rather limited, ignoring, for example, building codes for structures and physical interventions. Full article

β-thalassemia, a life-threatening inheritable hemoglobin disorder caused by mutations in the HBB gene, poses a significant public health challenge in the world. Although no comprehensive work has been carried out in Bangladesh, the world prevalence and small-scale works indicated the possibility of a high prevalence of this disease in the country. Therefore, this review aims to explore the present situation of β-thalassemia in Bangladesh and propose approaches to mitigate its impact in the future. Limited awareness, a high incidence of consanguineous marriage, and inadequate access to healthcare are possible factors responsible for the high prevalence of thalassemia in Bangladesh, while the absence of public health policy and a national health insurance system further exacerbate the situation. The understanding of the genetic landscape and modern treatment strategies for β-thalassemia is hindered by the lack of comprehensive data on the mutation spectrum. In addition to conventional therapy such as blood transfusion, advanced practices such as splenectomy, hematopoietic stem cell transplantation, and emerging therapies such as gene therapy show promise for future cures but have yet to be widely implemented in this country. To effectively address the challenges of β-thalassemia, it is crucial to adopt comprehensive strategies, including a public awareness campaign, public health intervention, mandatory premarital screening, genetic counselling, and a national thalassemia prevention program. Additionally, understanding the spectrum of mutations and new therapeutic interventions is crucial for advanced healthcare strategies. Full article

Shared kitchens, where users share kitchen space, are becoming popular worldwide due to the economic cost savings of startup businesses. This study conducted monitoring of microbial and chemical hazards from prepared foods and the environment of shared kitchen facilities, surveyed shared kitchen operators, and compared shared kitchen regulations between Korea and other countries. The monitoring results indicate that the hygiene status of the facilities and the microbial and chemical hazards in the prepared foods were all within the standard specifications, showing significantly lower levels compared to regular restaurants (p < 0.05). In particular, concurrent-use and time-division types of open shared kitchens showed significantly lower levels of both hazards than separated-individual kitchens. Survey results of hygiene inspection also confirmed better hygiene management in concurrent-use and time-division types of open shared kitchens in Korea. However, more frequent cleaning and disinfection, hygiene inspections, and training are high economic burdens in the operation of shared kitchens compared to regular restaurants. Moreover, mandatory insurance subscriptions, the operator’s responsibility in hygiene-related incidents, and high operational costs collectively challenge shared kitchens’ competitiveness in the food service market. Critical reassessments of regulations utilizing the benefits of shared kitchens are needed to promote a safe dining culture and the growth of shared kitchen startup businesses. Full article

Background: Contemporary evidence supports the cardiovascular and renal benefits of sodium-glucose co-transporter-2 inhibitors (SGLT2is) in patients with diabetes. While metformin has traditionally been recommended as a first-line treatment, its exact role in improving cardiovascular outcomes remains uncertain. This study aims to evaluate the impact of combination therapy with metformin on the cardiovascular and renal outcomes in high-risk, treatment-naïve diabetic patients who have undergone SGLT2i therapy. Methods: Using the National Health Insurance Research Database in Taiwan, a retrospective cohort study was conducted. Treatment-naïve patients with diabetes and established atherosclerotic cardiovascular disease (ASCVD) undertaking SGLT2i therapy from 1 January 2016 to 31 December 2021 were included. Patients were categorized based on the concomitant use of metformin. Propensity score matching was employed to minimize confounding factors. The primary outcome was major adverse cardiovascular events (MACEs), with secondary outcomes including cardiovascular death, hospitalization for heart failure, and renal outcomes. Results: In total, 10,151 treatment-naïve diabetic patients with ASCVD were identified, with 2570 in the only SGLT2i therapy group and 7581 in the SGLT2i plus metformin group. In total, 2262 pairs were analyzed after propensity score adjustment. The risk of MACEs (36.6 vs. 42.1 events per 1000 person-years; hazard ratio 0.87, 95% confidence interval 0.70–1.09) and other outcomes did not significantly differ between the two treatment groups. Conclusions: In high-risk, treatment-naïve diabetic patients, initiating SGLT2i therapy alone or in combination with metformin resulted in comparable cardiovascular and renal outcomes. These findings suggest that metformin might not be mandatory as a first-line treatment for achieving cardiovascular benefits in such patients. Full article

Metabolic syndrome (MetS) can be resolved through active control. We aimed to examine the effect of changes in MetS status on colorectal cancer (CRC) risk. A total of 5,704,611 Korean national insurance beneficiaries that received two consecutive biennial mandatory health exams (2009–2011) were followed-up until 2017. MetS was determined as the presence of at least three of five components. Participants were categorized into four groups according to the change in MetS status; MetS-never, -resolved, -developed, or -persistent. A Cox proportional hazards model adjusted for age, sex, smoking, alcohol drinking, and physical exercise was used. Participants who recovered from MetS had a higher risk of CRC than those free of MetS but had a lower risk than those with persistent MetS (HR: 0.91, 95% CI: 0.86–0.95 vs. HR: 0.75, 95% CI: 0.73–0.78; reference: persistence group). Among the five MetS components, resolving high blood pressure, abdominal obesity, and blood sugar had a preventive effect on CRC prevention, while normalization of lipid profile did not reduce CRC risk independently. Resolving MetS could reduce CRC risk compared to having persistent MetS, indicating the necessity of considering control of MetS as a CRC prevention policy. Full article

The number of laparoscopic sleeve gastrectomies (LSGs) performed in patients with obesity who are eligible for bariatric and metabolic surgery is currently much lower in Japan than in other countries. Considering the large number of potential patients with obesity and type 2 diabetes and the unique Japanese national health insurance system that guarantees fair healthcare delivery, there is room to increase the number of LSGs in Japan in the near future. However, strict health insurance regulations may limit access to mandatory devices needed to treat postoperative complications, such as staple line leakage, which can cause severe morbidity and even mortality. Therefore, understanding the pathogenesis and treatment options for this complication is crucial. This article examined the current situation in Japan and its impact on staple line leakage management, including the role of endoscopic treatment in reducing reoperation. The authors suggest increasing education and collaboration between healthcare professionals to optimize management and improve patient outcomes. Full article

For the last 70 years, we did not move beyond the monoamine hypothesis of depression until the approval of the S-enantiomer of ketamine, an N-methyl-D-aspartate (NMDA) receptor blocker and the first non-monoaminergic antidepressant characterized by rapid antidepressant and antisuicidal effects. A similar profile has been reported with another NMDA receptor antagonist, dextromethorphan, which has also been approved to manage depression in combination with bupropion. More recently, the approval of a positive allosteric modulator of GABA-A receptors, brexanolone, has added to the list of recent breakthroughs with the relatively rapid onset of antidepressant efficacy. However, multiple factors have compromised the clinical utility of these exciting discoveries in the general population, including high drug acquisition costs, mandatory monitoring requirements, parenteral drug administration, lack of insurance coverage, indirect COVID-19 effects on healthcare systems, and training gaps in psychopharmacology. This narrative review aims to analyze the clinical pharmacology of recently approved antidepressants and discuss potential barriers to the bench-to-bedside transfer of knowledge and clinical application of exciting recent discoveries. Overall, clinically meaningful advances in the treatment of depression have not reached a large proportion of depressed patients, including those with treatment-resistant depression, who might benefit the most from the novel antidepressants. Full article

The mandatory confinement caused by the COVID-19 pandemic has significantly affected the older adult population. The main objective of this study is to assess independence in basic activities of daily living (BADL) and instrumental activities of daily living (IADDL) of people over 65 years of age during social, preventive, and compulsory isolation due to COVID-19, identifying and quantifying the activities of personal independence that present difficulties in their execution. Design: A cross-sectional study. Settings: Private’s health insurance Hospital, Córdoba, Argentina. Participants: A total of 193 participants with mean age of 76.56 years (121 women and 72 men) who met inclusion criteria were included in the study. Interventions: A personal interview was conducted between July and December 2020. Sociodemographic data were collected, and perceived independence was assessed. Outcomes measures: The Barthel index and the Lawton and Brody scale were used to assess independence of basic and instrumental activities of daily living. Results: Minimal limitations were noted with function. The activities that represented the greatest difficulties were going up and down stairs (22%) and moving around (18%), and the greatest difficulties in instrumental activities of daily living were shopping (22%) and preparing food (15%). Conclusions: COVID-19 has caused isolation, leading to functional limitations for many, especially older adults. Perceived declines in function and mobility may lead to decreased independence and safety for the older adult; therefore, preventative planning and programming should be considered. Full article

Evaluating an illness’s economic impact is critical for developing and executing appropriate policies. South Korea has mandatory national health insurance in the form of NHIS that provides propitious conditions for assessing the national financial burden of illnesses. The purpose of our study is to provide a comprehensive assessment of the economic impact of PM_2.5 exposure in the subway and a comparative analysis of cause-specific mortality outcomes based on the prevalent health-risk assessment of the health effect endpoints (chronic obstructive pulmonary disease (COPD), asthma, and ischemic heart disease (IHD)). We used the National Health Insurance database to calculate the healthcare services provided to health-effect endpoints, with at least one primary diagnosis in 2019. Direct costs associated with health aid or medicine, treatment, and indirect costs (calculated based on the productivity loss in health effect endpoint patients, transportation, and caregivers, including morbidity and mortality costs) were both considered. The total cost for the exposed population for these endpoints was estimated to be USD 437 million per year. Medical costs were the largest component (22.08%), followed by loss of productivity and premature death (15.93%) and other costs such as transport and caregiver costs (11.46%). The total incurred costs (per 1000 persons) were accounted to be USD 0.1771 million, USD 0.42 million, and USD 0.8678 million for COPD, Asthma, and IHD, respectively. Given that the economic burden will rise as the prevalence of these diseases rises, it is vital to adopt effective preventative and management methods strategies aimed at the appropriate population. Full article

Intimate partner violence is characterized by violent actions against a person perpetrated by his or her former or current partner, regardless of cohabitation. It most frequently affects women, and one of its most relevant outcomes is the health problems associated with the experience of repeated violence. Thus, the main objective of this study is to analyse the prevalence of health problems among women for whom there was a medical suspicion of being victims of intimate partner violence. The specific objectives are to analyse the prevalence of (a) health risk behaviours; (b) traumatic injuries and intoxications; (c) mental health conditions; and (d) somatic diseases. We conducted a real-world, retrospective, observational, cross-sectional and multicentric study based on secondary data analyses of electronic health records and health care register data in patients of the Local Healthcare Unit of Matosinhos (between 2001 and 2021). The identified data were extracted from electronic health records corresponding to the Health Insurance Portability and Accountability Act Safe Harbor Standard. Information was obtained considering the International Classification of Diseases, the International Classification of Primary Care, and the Anatomical Therapeutic Chemical Classification System, as well as clinical notes (according to previously defined keywords). Considering all information sources, 1676 cases were obtained. This number means that just 2% of the women observed at this health care unit were suspected of being victims of intimate partner violence, which is far from the known statistics. However, we found much higher rates of all health risk behaviours, trauma and intoxication cases, mental health conditions, and somatic disorders we looked for, when compared to the general population. Early detection of these cases is mandatory to prevent or minimize their related health outcomes. Full article

As the understanding of the role of palliative care in neurology increases, there is the need to ensure that these developments include not only care at home and in hospitals but also in clinics. There are no reports on palliative care from neurology clinics in Japan, and this paper considers the problems and proposed solutions for improving palliative care provided at neurology clinics in Japan. In Japan, physicians in neurology clinics are extremely busy both during and after office hours with medical treatment and the preparation of various documents and are unable to conduct case conferences. Moreover, the education system for palliative care, especially for lifelong education, is not sufficient, and multidisciplinary cooperation is difficult due to the lack of specialists and their scattered locations. To improve the care provided for patients and their families, general palliative care should be included in the health insurance system with incentives and recognition, and mandatory lifelong education should be established so that all neurologists can provide palliative care. These proposals may be appropriate for other countries as palliative care in neurology is established. Full article

Upper limb loss alters individuals’ private and professional life. Prosthetic devices are thus a solution to supply the missing upper limb segments. Nevertheless, commercial prostheses are often unaffordable, or inaccessible, to underprivileged individuals (e.g., no health insurance, low incomes, warzone). Among potential affordable alternatives, additive manufacturing, commonly “3D printing”, has been increasingly employed. This technology offers higher availability and accessibility, and can produce complex geometrical and highly customized products, which are essential features for prostheses manufacturing. Therefore, this study aims to portray an overview of reliable open-source upper limb 3D-printed prostheses currently available. We thus searched the scientific literature and online repositories hosting 3D-printable designs. We extracted data relative to mechanical and kinematic properties, 3D printing process and efficacy for each device. We found six studies implementing open-source 3DP upper limb prostheses and twenty-five open-source designs from online databases meeting selection criteria. Devices’ technical specifications were not systematically reported. In conclusion, though open-source 3D-printed upper limb prostheses can perform some functional tasks and grasps, and are widely employed to supply limb differences, further research is mandatory to validate their usage and to prove their clinical efficacy. More guidelines are required to unify contributions from private makers and non-governmental organizations with scientific groups. Full article