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Themed Section: COVID-19| Volume 25, ISSUE 5, P736-743, May 2022
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The Effects of Severe Acute Respiratory Syndrome Coronavirus 2 on the Reported Mental Health Symptoms of Nonprofessional Carers: An Analysis Across Europe
Luz María Peña-Longobardo, PhD
Luz María Peña-Longobardo
Correspondence: Luz María Peña-Longobardo, PhD, Cobertizo San Pedro Martir S/N, Toledo, Spain 45071.
Economic Analysis and Finance Department, University of Castilla-La Mancha, Toledo, Spain
Juan Oliva-Moreno, PhD
Juan Oliva-Moreno
Beatriz Rodríguez-Sánchez, PhD
Beatriz Rodríguez-Sánchez
Department of Applied, Public and Political Economics, Faculty of Law, Complutense University of Madrid, Madrid, Spain
Published:December 11, 2021DOI:https://doi.org/10.1016/j.jval.2021.10.011
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This study tries to analyze how the crisis generated by severe acute respiratory syndrome coronavirus 2 has affected the reported mental health symptoms of informal caregivers in different European countries.
The Survey of Health, Ageing and Retirement in Europe-COVID-19 was used, collecting information from the beginning of June 2020 to August 2020 about individuals' state of health and the care they received. Several probit regression models were used to analyze the differences in the probability of (1) being sad or depressed, (2) being anxious or nervous, (3) having difficulty sleeping, and (4) feeling lonely, between individuals who provided informal care and individuals who did not. Several subanalyses by geographic area, mortality rates due to coronavirus disease 2019 (COVID-19), and long-term care expenditure were also performed.
Since the outbreak of COVID-19, informal caregivers have had a higher probability of being sad or depressed of 8 percentage points (p.p.), a 7.1 p.p. higher probability of being anxious or nervous, and a 5.9 p.p. higher probability of having difficulty sleeping than non-caregivers. Informal caregivers in Southern Europe have had an 8 p.p. higher probability of being sad or depressed than non-caregivers. In Eastern Europe, this difference in probability reaches 9.7 p.p. Finally, in countries with higher mortality rates due to COVID-19, there have been greater differences in terms of being sad or depressed between caregivers and non-caregivers, regardless of expenditure on long-term care.
Since the outbreak of COVID-19, informal caregivers in Europe have had a higher probability of reporting mental health symptoms than non-caregivers.
informal caregivers
mental health symptoms
nonprofessional caregivers
severe acute respiratory syndrome coronavirus 2
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been one of the greatest challenges to public health in decades. At the time of writing (February 1, 2021), according to the World Health Organization,
Coronavirus disease (COVID-19) dashboard.
https://covid19.who.int/
Date accessed: February 15, 2021
102 million confirmed cases of coronavirus disease 2019 (COVID-19) have been recorded so far and 2.2 million people have died in a period of <1 year (March 2020 to January 2020). At the moment, we are experiencing a third wave of increase in the accumulated incidence, and Europe is one of the epicenters of the pandemic. Nevertheless, there are wide variations in incidence between the different European countries.
Apart from the death toll, SARS-CoV-2 is responsible for causing another series of serious health disorders. One of the most relevant is the impact on the mental health of the population because the virus has caused a strong increase in stress among the population, which is a very serious risk for mental health. In fact, we can point to 3 different ways in which this risk has been produced or intensified. In the first place, the virus has changed our day-to-day lives, generating a sense of lack of control over our routines and plunging us into great uncertainty about the immediate future.
Nalleballe K.
Reddy Onteddu S.
Sharma R.
Spectrum of neuropsychiatric manifestations in COVID-19.
Brain Behav Immun. 2020; 88: 71-74
Varatharaj A.
Ellul M.A.
Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study [published correction appears in Lancet Psychiatry. 2020;7:875-882].
Lancet Psychiatry. 2020; 7: 875-882
Wang C.
Pan R.
Wan X.
Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China.
Int J Environ Res Public Health. 2020; 17: 1729
Choi E.P.H.
Hui B.P.H.
Wan E.Y.F.
Depression and anxiety in Hong Kong during COVID-19.
Second, the "social distance" measures implemented by the governments of most countries to prevent the spread of the virus, including the restriction of movements and house confinements, have limited our interpersonal interactions. Thereby, these measures involve an additional burden on the mental health of the population.
Brooks S.K.
Webster R.K.
Smith L.E.
The psychological impact of quarantine and how to reduce it: rapid review of the evidence.
Lancet. 2020; 395: 912-920
Third, the economic crisis that accompanies the spread of the virus and the measures already mentioned are additional sources of stress for many families. The literature describing the effects of the recent Great Recession on people's health warns us that there is strong evidence of the relationship between economic crises and declining mental health.
Forbes M.K.
Krueger R.F.
The great recession and mental health in the United States.
Clin Psychol Sci. 2019; 7: 900-913
Boyce C.J.
Delaney L.
Wood A.M.
The Great Recession and subjective well-being: how did the life satisfaction of people living in the United Kingdom change following the financial crisis?.
PLoS One. 2018; 13e0201215
Oliva J.
López-Varcárcel B.G.
Pérez P.B.
Peña-Longobardo L.M.
Garrido R.
González N.Z.
El impacto de la Gran Recesión en la salud mental en España. Informe SESPAS 2020 [Impact of Great Recession on mental health in Spain [SESPAS Report 2020].
Gac Sanit. 2020; 34: 48-53
Barr B.
Kinderman P.
Whitehead M.
Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004-2013.
Soc Sci Med. 2015; 147: 324-331
Parmar D.
Stavropoulou C.
Ioannidis J.P.
Health outcomes during the 2008 financial crisis in Europe: systematic literature review.
BMJ. 2016; 354: i4588
Van Hal G.
The true cost of the economic crisis on psychological well-being: a review.
Psychol Res Behav Manag. 2015; 8: 17-25
Several recently published works have already pointed towards a deterioration in the mental health of the general population
Holingue C.
Badillo-Goicoechea E.
Riehm K.E.
Mental distress during the COVID-19 pandemic among US adults without a pre-existing mental health condition: findings from American trend panel survey.
Prev Med. 2020; 139: 106231
Qiu J.
Shen B.
Zhao M.
Wang Z.
Xie B.
Xu Y.
A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations [published correction appears in Gen Psychiatr. 2020;33(2):e100213corr1].
Gen Psychiatr. 2020; 33e100213
Rodríguez-Rey R.
Garrido-Hernansaiz H.
Collado S.
Psychological impact and associated factors during the initial stage of the coronavirus (COVID-19) pandemic among the general population in Spain.
Front Psychol. 2020; 11: 1540
Pierce M.
Hope H.
Ford T.
Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population.
and of particular groups, such as healthcare workers.
Caillet A.
Coste C.
Sanchez R.
Allaouchiche B.
Psychological impact of COVID-19 on ICU caregivers.
Anaesth Crit Care Pain Med. 2020; 39: 717-722
Pearman A.
Hughes M.L.
Smith E.L.
Neupert S.D.
Mental health challenges of United States healthcare professionals during COVID-19.
Sun N.
Wei L.
Shi S.
A qualitative study on the psychological experience of caregivers of COVID-19 patients.
Am J Infect Control. 2020; 48: 592-598
Lai J.
Ma S.
Wang Y.
Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.
JAMA Netw Open. 2020; 3e203976
Chew N.W.S.
Lee G.K.H.
Tan B.Y.Q.
A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak.
Brain Behav Immun. 2020; 88: 559-565
Dosil Santamaría M.
Ozamiz-Etxebarria N.
Redondo Rodríguez I.
Jaureguizar Alboniga-Mayor J.
Picaza Gorrotxategi M.
Psychological impact of COVID-19 on a sample of Spanish health professionals. Impacto psicológico de la COVID-19 en una muestra de profesionales sanitarios españoles.
Rev Psiquiatr Salud Ment (Engl Ed). 2021; 14: 106-112
Serrano-Ripoll M.J.
Meneses-Echavez J.F.
Ricci-Cabello I.
Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis.
J Affect Disord. 2020; 277: 347-357
The virus has also resulted in serious overloading in healthcare services worldwide.
Boukhris M.
Hillani A.
Moroni F.
Cardiovascular implications of the COVID-19 pandemic: a global perspective.
Can J Cardiol. 2020; 36: 1068-1080
Fuentes B.
Alonso de Leciñana M.
Calleja-Castaño P.
Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. Impacto de la pandemia de COVID-19 en la organización asistencial del ictus. Plan Ictus Madrid.
Neurologia (Engl Ed). 2020; 35: 363-371
This can have unwanted consequences such as delays, lack of continuity of care for people who have already experienced some type of mental disorder, and organizational changes in mental health services.
Li W.
Yang Y.
Liu Z.H.
Progression of mental health services during the COVID-19 outbreak in China.
Int J Biol Sci. 2020; 16: 1732-1738
Roncero C.
García-Ullán L.
de la Iglesia-Larrad J.I.
The response of the mental health network of the Salamanca area to the COVID-19 pandemic: the role of the telemedicine.
Psychiatry Res. 2020; 291: 113252
Chevance A.
Gourion D.
Hoertel N.
Ensuring mental health care during the SARS-CoV-2 epidemic in France: a narrative review.
Encephale. 2020; 46: 193-201
Wasserman D.
Iosue M.
Wuestefeld A.
Carli V.
Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic.
World Psychiatry. 2020; 19: 294-306
One of the groups most affected by the pandemic is the population that receives care in nursing homes. The figures are conclusive: in many countries, most deaths have occurred in the population living in this type of facilities.
Comas-Herrera A.
Zalakaín J.
Lemmon E.
Mortality associated with COVID-19 in care homes: international evidence. International Long Term Care Policy Network.
https://ltccovid.org/wp-content/uploads/2021/02/LTC_COVID_19_international_report_January-1-February-1-2.pdf
Date accessed: December 2, 2021
Moreover, the workers in these care homes also constitute a group at risk of contagion, to the same extent as the medical staff of a hospital.
Mas Romero M.
Avendaño Céspedes A.
Tabernero Sahuquillo M.T.
COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn.
Ashcroft E.
Lorenz-Dant K.
International examples of measures to prevent and manage COVID-19 outbreaks in residential care and nursing home settings. International Long Term Care Policy Network.
https://ltccovid.org/wp-content/uploads/2020/05/International-measures-to-prevent-and-manage-COVID19-infections-in-care-homes-11-May-2.pdf
Nevertheless, a very important part of the care received by people with limited autonomy takes place within their homes and is mainly provided by nonprofessional caregivers (informal caregivers).
The support received by nonprofessional caregivers was extraordinarily heterogeneous in Europe before the arrival of SARS-COV-2. The investments made by each country in its long-term care (LTC) system, measured as a percentage of the gross domestic product, were as different as the organizational aspects of the systems and as the level of consideration for and support provided to informal caregivers.
Nerlich C.
The 2018 Ageing Report: population ageing poses tough fiscal challenges. Economic. European Central Bank.
https://www.ecb.europa.eu/pub/economic-bulletin/focus/2018/html/ecb.ebbox201804_04.en.html
Oliveira Hashiguchi T.C.
Llena-Nozal A.
The effectiveness of social protection for long-term care in old age. Is social protection reducing the risk of poverty associated with care needs? OECD health working paper no. 117. OECD Publishing.
https://www.oecd-ilibrary.org/docserver/2592f06e-en.pdf?expires=1637085235&id=id&accname=guest&checksum=CEC72DC9C319E53FC192746BBD86A8CF
Muir T.
Measuring social protection for long-term care. OECD health working papers no. 93. OECD Publishing.
https://www.oecd-ilibrary.org/docserver/a411500a-en.pdf?expires=1637085411&id=id&accname=guest&checksum=19CA119B5A00764DF2301D8EA7420D55
Riedel M.
Kraus M.
Mayer S.
Organization and supply of long-term care services for the elderly: a bird's-eye view of old and new EU Member States.
Soc Policy Admin. 2016; 50: 824-845
Mot E.
Performance of long-term care systems in Europe. Centre for European Policy Studies.
https://core.ac.uk/download/pdf/148868717.pdf
During the first few months after the arrival of COVID-19, many countries offered various kinds of guidance and resource documents oriented to supporting the non-professional home caregivers. Nevertheless, it is very difficult to know the degree of their usefulness and the extent to which caregivers have received resources to meet their needs and help them carry out their work.
How COVID-19 has affected informal caregivers and their lives in Germany. Care Policy and Evaluation Centre.
https://ltccovid.org/2020/09/20/how-covid-19-has-affected-informal-caregivers-and-their-lives-in-germany/
We have far less information about home care and non-professional care than about the situation in nursing homes. In fact, informal caregivers have been identified as "the forgotten healthcare workers during the COVID-19 pandemic."
Chan E.Y.Y.
Gobat N.
Kim J.H.
Informal home care providers: the forgotten health-care workers during the COVID-19 pandemic.
Lancet. 2020; 395: 1957-1959
Then, this study tries to fill one of the gaps in the information about non-professional caregivers in the first months of the crisis generated by SARS-COV-2, by analyzing how their mental health has been affected throughout Europe.
The Survey of Health, Ageing and Retirement in Europe (SHARE) is a longitudinal survey that includes detailed information about 120 000 people, aged ≥50 years, in 27 European countries plus Israel, from the period 2006 to 2017. Nevertheless, due to the situation caused by COVID-19 in Europe, SHARE started the fieldwork for a SHARE-COVID19 survey, collecting information from the beginning of June 2020 to August 2020.
SHARE - COVID19
Survey of Health, Ageing and Retirement in Europe.
http://www.share-project.org/share-covid19.html
The sample was composed of 52 310 individuals. Nevertheless, even though SHARE is a longitudinal survey, the number of individuals who are collected in this special SHARE-COVID19 survey who are followed up for, at least, 2 moments in time (before and during the pandemic) is low (<3% both for the overall and the informal caregivers' samples). Therefore, the data cannot be treated as longitudinal.
The information collected was related to state of health, health behavior, mental health before and after the COVID-19 outbreak, infections, healthcare and non-healthcare use, and changes in employment status, in the economic situation, and in social networks during the COVID-19 pandemic.
The questionnaire is publicly available at http://www.share-project.org/data-documentation/questionnaires/corona-questionnaire.html.
Main Variables Used
To define informal caregivers, the answers to the following question were used: "Since the outbreak of Corona, did you provide personal care to others (family or friends) outside your home?". If the answer was "Yes," this individual was identified as an informal caregiver. Hence, throughout the article, when reading informal caregivers, we refer to informal caregivers providing care outside their homes.
To discover whether or not the individuals had reported any of the mental symptoms considered, we collected information about whether or not they had been sad or depressed, anxious, or nervous and whether they had difficulty sleeping or had felt lonely during the month immediately preceding the survey.
The main aim of the statistical analysis was to analyze the differences in the probability of reported mental health symptoms between informal caregivers and non-caregivers. More precisely, the analysis studied the differences in the probability of (1) being sad or depressed, (2) being anxious or nervous, (3) having difficulty sleeping, and (4) feeling lonely between individuals who provided informal caregiving and individuals who did not. Thus, we used several probit regression models where the dependent variable was assigned a value of "1" if the person was reported to have had any of the aforementioned mental symptoms and "0" otherwise.
The specification of the model was as follows:
probi(mentalhealthsymptomsj)=ø(α1−β1′Xi−εi)
probi(mentalhealthsymptomsj)=ø(αj−βj′Xi)−ø(αj−1−βj−1′Xi)−εi,
j=2,…,j−1probi(mentalhealthsymptomsj)=1−∑j=1j−1probi(mentalhealthsymptomsj)
where probi (mental health symptoms j) is the probability that subject i (i = 1, …, I) has reported a mental health symptom where j = 1 (being sad or depressed), 2 (being anxious or nervous), 3 (having had difficulty sleeping), and 4 (feeling lonely). ø denotes the standard normal density function with values ranging between zero and one; Xi represents the vector of explanatory variables, which were, in model 1, the individual's age and its square, sex, years of education, whether people had financial difficulties and experienced major illness or health conditions, and whether a close relative had died due to COVID-19. In model 2, the country dummies were also added, and in model 3, the country dummies were replaced by geographical area (North, Center, South, and East), β is the vector of coefficients parameters assigned to each explanatory variable included in the vector X', and εi is the standard error. All the estimations performed were nested by country-level factors by clustering standard errors at country level.
Given that the differences in the probability of reported mental health symptoms between informal caregivers and non-caregivers might be affected by other important factors such as the intensity of the pandemic and by the type of LTC systems in each country, 2 different subanalyses were performed. On the one hand, we performed the analysis by geographic area (North, Center, South, and East). By this method, it would be possible to assess whether the differences in mental health between caregivers and non-caregivers depended on the area considered and also whether these differences were greater or lesser depending on the geographic area. On the other hand, we also performed the analysis by considering whether the country in which the individuals lived had high, moderate, or low mortality rates due to COVID-19 and also considering whether the country in which the individuals lived had high, moderate, or low public expenditure on LTC.
OECD database.
https://data.oecd.org/
To do this, the mortality rate due to COVID-19 in each country included in the analysis was calculated taking into account both the accumulated deaths caused by COVID-19 in each country at week 53 of the year 2020 and the total population of each country in 2019 (last data available)
The World Bank database.
https://databank.worldbank.org/home.aspx
(for more information, see Appendix Table 1 in Supplemental Materials found at https://doi.org/10.1016/j.jval.2021.10.011). This would show whether the intensity of the pandemic or the public LTC expenditure of each country altered the differences in mental health symptoms reported between caregivers and non-caregivers.
Since the outbreak of COVID-19, 1727 individuals in the survey in Europe have reported that they have provided informal caregiving (out-of home caregiving), that is, 3.32% of everyone included in the survey. Approximately 71% were females, whose age is lower in comparison with noncaregivers (67 vs 75 years old). The number of years of education was >12 for informal caregivers (11 in the case of noncaregivers). Approximately 41% of caregivers and 36% of noncaregivers had financial difficulties. Regarding mental health symptoms, >33.12% of caregivers felt sad or depressed, 37.60% were nervous, anxious, or "on edge," 31.86% had difficulty sleeping, and 34.72% felt lonely. All of these mental symptoms were statistically more numerous than those found among non-caregivers (Table 1).
Table 1Sociodemographic characteristics of caregivers and non-caregivers.
Caregivers in 2020 n = 1727
Non-caregivers in 2020 n = 50 279
Comparison of means
Comparison of means was performed for caregivers in 2020 and no caregivers in 2020.
Age (SD) 67.74 (1.970) 75.44 (0.43) .0012
Female (%) 70.58 57.45 .0000
Years of education (SD) 12.08 (0.097) 11.18 (0.02) .0000
Whether a close relative has died due to COVID-19 (%) 2.83 2.65 .6425
Having economic difficulties (%) 41.27 36.63 .0010
Experiencing major illness or health conditions (%) 8.92 10.87 .0103
Nervous, anxious or on edge (%) 37.60 30.01 .0000
Sad or depressed (%) 33.12 25.80 .0000
Trouble sleeping (%) 31.86 27.75 .0002
Feeling lonely (%) 34.72 28.86 .0030
Mortality rate due to COVID-19 (10 000 habitants)
High: >10; middle: between 6 and 9. Low: <5.
People living in a country with low mortality rates due to COVID-19 39.55 36.85 .0224
People living in a country with middle mortality rates due to COVID-19 24.96 19.75 .0000
People living in a country with high mortality rates due to COVID-19 35.49 43.40 .0000
LTC expenditure
High: >2%, middle: between 1% and 2%. Low: <1%.
People living in a country with low LTC expenditure 64.38 60.88 .0033
People living in a country with moderate LTC expenditure 13.04 15.18 .014
People living in a country with high LTC expenditure 22.58 23.97 .1958
North: Sweden, The Netherlands, Denmark, Finland. Centre: Germany, France, Switzerland, Belgium, Luxembourg. South: Spain, Portugal, Italy, and Greece. East: Israel, Czech Republic, Poland, Hungary, Slovenia, Estonia, Croatia, Lithuania, Bulgaria, Cyprus, Latvia, Malta, Romania, and Slovakia.
North 10.07 10.73 .3841
Center 19.57 21.47 .0308
South 23.21 20.05 .0013
East 47.13 47.59 .7900
Note. Low LTC expenditure: <1% of the GDP; mid LTC expenditure: ≥1% and 2% of the GDP; high LTC expenditure: >2% of the GDP. Regarding mortality rate, the cut points were classified as follows; low incidence: ≤5 per 10 000 habitants; mid incidence: between 6 and 9 per 10 000 habitants; high incidence: >9 per 10 000 habitants.
Source: own elaboration.
GDP indicates gross domestic product; LTC, long-term care.
∗ Comparison of means was performed for caregivers in 2020 and no caregivers in 2020.
† High: >10; middle: between 6 and 9. Low: <5.
‡ High: >2%, middle: between 1% and 2%. Low: <1%.
§ North: Sweden, The Netherlands, Denmark, Finland. Centre: Germany, France, Switzerland, Belgium, Luxembourg. South: Spain, Portugal, Italy, and Greece. East: Israel, Czech Republic, Poland, Hungary, Slovenia, Estonia, Croatia, Lithuania, Bulgaria, Cyprus, Latvia, Malta, Romania, and Slovakia.
With regards to geographic area, 39.55% of caregivers lived in a country with a low mortality rate due to COVID-19, a statistically significant figure that is higher than that for non-caregivers (36.85%). Conversely, the percentage of caregivers living in a country with a high mortality rate was 35.49%, a figure significantly lower than the 43.40% of non-caregivers who lived in a country with a high mortality rate. Finally, most of the caregivers (64.38% of them) lived in a country with low expenditure on LTC, whereas only 22.58% of them lived in a country with high expenditure on LTC (Table 1).
Main Statistical Analysis
Taking into account the statistical analysis (Table 2), it is observed that since the outbreak of COVID-19, informal caregivers in Europe have had a higher probability of reported mental health symptoms than non-caregivers. More precisely, when geographic localization was not considered (model 1), informal caregivers had a higher probability by 8.2 percentage points (p.p.) of being sad or depressed than non-caregivers. Moreover, they had a higher probability by 7.1 p.p. of being anxious or nervous than non-caregivers and by 6.3 p.p. of having difficulty sleeping. By country (model 2), the main results remained the same, but the marginal effects differed slightly, as the higher probability of caregivers being sad or depressed fell to 6.3 p.p., of their being anxious or nervous to 6.6 p.p., and of their having difficulty sleeping to 5.3 p.p. Finally, by geographic area (model 3), the main results again remained the same, but the marginal effects slightly increased, and showed a higher probability of being sad or depressed of 8 p.p., of being anxious or nervous of 7.1 p.p., and of having difficulty sleeping of 5.9 p.p.
Table 2Differences in mental health symptoms reported between caregivers versus no caregivers.
Control variables: sex, age, age squared, years of education, whether people have had economic difficulties and experienced major illness or health conditions, and whether a close relative has died due to COVID-19.
Control variables: sex, age, age squared, years of education, whether people have had economic difficulties and experienced major illness or health conditions, and whether a close relative has died due to COVID-19 and country dummies.
Control variables: sex, age, age squared, years of education, whether people have had economic difficulties and experienced major illness or health conditions, whether a close relative has died due to COVID-19, incidence of deaths due to COVID-19, and LTC expenditure as a share of GDP.
dy/dx (Std. Err)
P>|z|
Sad/depressed 0.082 (0.015) .000 0.074 (0.014) .000 0.080 (0.017) .000
Anxious/nervous 0.071 (0.015) .000 0.066 (0.012) .000 0.071 (0.013) .000
Trouble sleeping 0.063 (0.015) .000 0.058 (0.016) .000 0.059 (0.015) .000
Feeling lonely 0.015 (0.024) .526 0.014 (0.022) .512 0.023 (0.024) .340
COVID-19 indicates coronavirus disease 2019; GDP, gross domestic product; LTC, long-term care; Std. Err, standard error.
∗ Control variables: sex, age, age squared, years of education, whether people have had economic difficulties and experienced major illness or health conditions, and whether a close relative has died due to COVID-19.
† Control variables: sex, age, age squared, years of education, whether people have had economic difficulties and experienced major illness or health conditions, and whether a close relative has died due to COVID-19 and country dummies.
‡ Control variables: sex, age, age squared, years of education, whether people have had economic difficulties and experienced major illness or health conditions, whether a close relative has died due to COVID-19, incidence of deaths due to COVID-19, and LTC expenditure as a share of GDP.
Subanalysis by Geographic Area
Focusing the analysis on the geographic area (Northern, Central, Southern, and Eastern Europe), it is observed that only in Southern and Eastern Europe there were differences in reporting mental health symptoms between caregivers and non-caregivers (Table 3). Thus, informal caregivers in Southern Europe had a 8 p.p. higher probability of being sad or depressed than non-caregivers in this area. In Eastern Europe this probability reached 9.7 p.p. In Southern Europe, the probability of caregivers being anxious or nervous was 1.4 p.p. higher than among non-caregivers, whereas in Eastern Europe this probability was 9.3 p.p. higher. No differences were found in relation to sleeping difficulty or to feelings of loneliness, irrespective of the geographic area.
Table 3Differences in mental health symptoms reported between caregivers and no caregivers depending on the geographic area.
Sad/depressed
Anxious/nervous
North countries 0.054 (0.062) .370 0.015 (0.035) .574 0.082 (0.046) .059 0.092 (0.061) .093
Central countries 0.050 (0.052) .320 0.022 (0.025) .364 0.047 (0.018) .013 −0.036 (0.029) .188
South countries 0.080 (0.023) .000 0.092 (0.013) .000 0.026 (0.039) .488 −0.000 (0.014) .969
East countries 0.097 (0.021) .000 0.093 (0.019) .000 0.084 (0.025) .000 0.029 (0.029) .308
Note. Control variables: sex, age, age squared, years of education, whether people have had economic difficulties and experienced major illness or health conditions, and whether a close relative has died due to COVID-19.
Source: own elaboration
COVID-19 indicates coronavirus disease 2019; Std. Err, standard error.
Subanalysis by Mortality Rate Due to COVID-19 and by Expenditure on LTC
The results obtained would highlight the fact that higher mortality rates due to COVID-19 were associated with greater differences in terms of being sad or depressed between caregivers and non-caregivers, regardless of the level of spending on LTC in their country (Table 4). Moreover, the differences in the probability of being anxious or nervous were similar in countries with high and medium levels of spending on LTC, although countries with low spending on LTC broke this pattern (there were greater differences between caregivers and noncaregivers in those countries with low mortality rates). Nevertheless, in countries with low mortality rates, the differences were greater when spending on LTC was high. Finally, in countries with high mortality rates, there were no differences in the probability of feeling lonely, regardless of their level of spending on LTC.
Table 4Differences in mental health symptoms reported between caregivers and no caregivers depending on the deaths caused by COVID-19 and LTC expenditure as a share of GDP.
High rate in deaths due to COVID-19 and low LTC expenditure 0.114 (0.056) .081 0.080 (0.012) .000 0.059 (0.024) .013 −0.003 (0.046) .932
High rate in deaths due to COVID-19 and mid LTC expenditure 0.056 (0.056) .321 0.051 (0.019) .006 0.031 (0.026) .234 -0.002 (0.006) .000
High rate in deaths due to COVID-19 and high LTC expenditure 0.165 (0.042) .000 0.095 (0.003) .000 0.035 (0.024) .090 −0.044 (0.052) .403
Mid rate in deaths due to COVID-19 and low LTC expenditure 0.055 (0.149) .689 0.076 (0.027) .004 0.077 (0.051) .129 0.047 (0.055) .374
Mid rate in deaths due to COVID-19 and mid LTC expenditure −0.200 (0.067) .082 −0.070 (0.108) .531 -0.070 (0.103) .531 0.124 (0.303) .660
Mid rate in deaths due to COVID-19 and high LTC expenditure 0.056 (0.078) .478 −0.063 (0.063) .399 0.045 (0.100) .129 −0.000 (0.000) .675
Low rate in deaths due to COVID-19 and low LTC expenditure 0.067 (0.045) .102 0.138 (0.022) .000 0.054 (0.035) .095 0.079 (0.055) .104
Low rate in deaths due to COVID-19 and mid LTC expenditure 0.083 (0.047) .085 0.009 (0.069) .797 0.060 (0.008) .000 −0.066 (0.099) .484
Low rate in deaths due to COVID-19 and high LTC expenditure 0.093 (0.013) .000 0.003 (0.006) .605 0.087 (0.067) .220 0.071 (0.019) .000
Note. Control variables: sex, age, age squared, years of education, whether people have had economic difficulties and experienced major illness or health conditions, and whether a close relative has died due to COVID-19. Low LTC expenditure: <1% of the GDP; mid LTC expenditure: ≥1% and 2% of the GDP; high LTC expenditure: >2% of the GDP. Regarding mortality rate, the cut-off points were classified as follows; low incidence: ≤5 per 10 000 habitants; mid incidence: between 6 and 9 per 10 000 habitants; high incidence: >9 per 10 000 habitants.
COVID-19 indicates coronavirus disease 2019; GDP, gross domestic product; LTC, long-term care.
This article has tried to analyze how the crisis generated by SARS-COV-2 affected the presence of self-reported mental health symptoms of informal caregivers in different European countries. To the best of our knowledge, this is the first article that has analyzed the impact of the pandemic on non-professional caregivers throughout Europe, taking into account different symptoms of mental health.
Broadly, the results obtained highlight the fact that, since the outbreak of COVID-19, informal caregivers in Europe have had a higher probability of reporting mental health symptoms than non-caregivers. In fact, the differences were even higher when outcomes such as being sad or depressed and being anxious or nervous were considered. Nevertheless, different factors affected the mental health of non-professional caregivers during the pandemic: first of all, the geographic area, given that the differences in mental health symptoms reported between informal caregivers and noncaregivers were only found in Southern and Eastern Europe. However, differences between countries should be interpreted with caution, because some variables might have been omitted from the analysis (eg, differences in culture or social networks), and these omissions could influence the results obtained. Nevertheless, we aimed to correct the omission bias by including country dummies, which could also reflect the influence that the implementation of several policies may have had. Second, other factors to be considered are the intensity of the pandemic (measured through mortality rates caused by COVID-19) and the strength of the LTC systems (measured through public LTC expenditure as a share of gross domestic product) in each country. Thus, higher mortality rates due to COVID-19 were associated with greater differences in terms of being sad or depressed between caregivers and non-caregivers. Furthermore, the differences in the probability of being anxious or nervous were similar in countries with high and medium levels of spending on LTC and greater in countries with low mortality rates.
Another fact that needs to be considered is that LTC policies implemented due to COVID-19 in Europe have been very diverse. Although the information about care support policies is highly fragmented, and although specific interventions aimed at supporting informal caregivers may have been implemented in certain countries, but not included in international scientific publications, it does seem clear that some countries have been more active than others. For example, in countries such as Finland, Sweden, and Latvia, financial support has been provided to community-based care services. In Finland, some temporary financial help for users of basic and social care assistance was provided by the middle of the year 2020 and a further €75 per person per month as temporary help for those who expected to receive basic social assistance during the period of restrictions and to continue receiving that type of care in autumn 2020.
COVID-19 health system response monitor - Finland. COVID-19 health system.
https://www.covid19healthsystem.org/countries/finland/livinghit.aspx?Section=6.1%20Measures%20in%20other%20sectors&Type=Section
In Sweden, during the last quarter of the year 2020, the government approved a supplement of 4 billion Swedish Krona for the municipalities that aimed to strengthen care for the elderly during the year 2021 and the addition of the same amount for those areas with postponed care duties.
COVID-19 health system response monitor - Sweden
COVID-19 health system.
https://www.covid19healthsystem.org/countries/sweden/livinghit.aspx?Section=6.1%20Measures%20in%20other%20sectors&Type=Section
In Latvia, the government provided a grant equal to 50% of the amount of the benefit paid to any person in a crisis situation, which could never be higher than €120 per person per household, over a 3-month period.
COVID-19 health system response monitor - Latvia. COVID-19 health system.
https://www.covid19healthsystem.org/countries/latvia/livinghit.aspx?Section=6.1%20Measures%20in%20other%20sectors&Type=Section
Moreover, since the outbreak of coronavirus, some countries have implemented measures to protect or support informal caregivers. It seems that most of those measures were related to virtual support activities, which were present in >80% of the countries considered.
International examples of measures to support unpaid carers during the COVID-19 pandemic. Care Policy and Evaluation Centre.
https://ltccovid.org/2020/06/17/updated-report-international-examples-of-measures-to-support-unpaid-carers-during-the-covid-19-pandemic/
Such virtual meetings aimed to facilitate social contact for those bearing a caregiving burden or to offer structured interventions, which included psychological support sessions and virtual caregiving training meetings. Nevertheless, these virtual meetings were sometimes not considered enough as supporting measures for informal caregivers.
Forma L.
Aaltonen M.
Pulkki J.
COVID-19 and clients of long-term care in Finland – impact and measures to control the virus. Care Policy and Evaluation Centre.
https://ltccovid.org/2020/06/14/new-report-covid-19-and-clients-of-long-term-care-in-finland-impact-and-measures-to-control-the-virus/
Van Houtven C.H.
Boucher N.A.
Dawson W.D.
Impact of COVID-19 outbreak on long term care in the United States. Care Policy and Evaluation Centre.
https://ltccovid.org/2020/04/24/impact-of-the-covid-19-outbreak-on-long-term-care-in-the-united-states/
Specific policies to support those providing care to relatives in need of it were implemented in some countries, ranging from specific movement allowances such as those in Estonia
COVID-19 health system response monitor - Estonia
https://www.covid19healthsystem.org/countries/estonia/livinghit.aspx?Section=6.1%20Measures%20in%20other%20sectors&Type=Section
or Germany
COVID-19 health system response monitor – Germany. COVID-19 health system.
https://www.covid19healthsystem.org/countries/germany/livinghit.aspx?Section=6.1%20Measures%20in%20other%20sectors&Type=Section
to programs that considered benefits for carers, such as the "MECUIDA" program in Spain
COVID-19 health system response monitor - Spain. COVID-19 health system.
https://www.covid19healthsystem.org/countries/spain/livinghit.aspx?Section=6.1%20Measures%20in%20other%20sectors&Type=Section
or #RestaACasa in Italy,
COVID-19 health system response monitor - Italy. COVID-19 health system.
https://www.covid19healthsystem.org/countries/italy/livinghit.aspx?Section=6.1%20Measures%20in%20other%20sectors&Type=Section
which also consisted of a call center to provide emotional support or help with shopping for food or pharmaceuticals. Nevertheless, some of these policies were applied after the data collection process, so they may have modified or alleviated the negative burden borne by informal caregivers after the coronavirus outbreak compared with that of noncaregivers.
Some limitations also need to be mentioned. First of all, the data used in the study were cross-sectional and did not allow us to establish causality or to explore heterogeneity within and between individuals. SHARE has planned to provide a second collection of data in the near future, which we aim to use to assess whether the associations observed in the current analysis are maintained or modified after some time. Second, the available information about caregivers and the care provided is limited. We only have information about informal caregivers who provided care outside the household. This fact does not permit to include in the analysis those who provided care to coresident care-recipients. Additionally, the intensity of the care provided was not known. A recent survey conducted in the United Kingdom has actually shown an increase in the time spent and the intensity of caring due to the pandemic, which might be a result of the closure of community services
Caring behind closed doors. Forgotten families in the coronavirus outbreak. CarersUK.
https://www.carersuk.org/images/News_and_campaigns/Behind_Closed_Doors_2020/Caring_behind_closed_doors_April20_pages_web_final.pdf
forcing them to look after those in need for care, of restrictions on movement,
Maccora J.
Ee N.
Hosking D.
McCallum J.
Who cares? Older Australians do. National Seniors Australia.
https://nationalseniors.com.au/uploads/NSA-ResearchReport-Whocares.pdf
or of a fear that external personnel (such as domiciliary care staff) who provided assistance before the COVID-19 outbreak could spread the virus and withdraw their services.
Germany and the COVID-19 long-term care situation. International Long Term Care Policy Network.
https://ltccovid.org/wp-content/uploads/2020/04/Germany_LTC_COVID-19-23-April-2020_updated.pdf
Third, it would have been interesting that SHARE had included validated patient-related outcome measures specifically designed to identify mental health symptoms or even preference based generic questionnaires that include a mental dimension. Despite this fact, the existing literature has already identified a relevant correlation between declared symptoms, even when they are asked in a simple way, and mental health.
Hays R.D.
Stewart A.L.
The structure of self-reported health in chronic disease patients.
Psychol Assess J Consult Clin Psychol. 1990; 2: 22
Capone V.
Patient communication self-efficacy, self-reported illness symptoms, physician communication style and mental health and illness in hospital outpatients.
J Health Psychol. 2016; 21: 1271-1282
Andersson L.M.
Moore C.D.
Hensing G.
Krantz G.
Staland-Nyman C.
General self-efficacy and its relationship to self-reported mental illness and barriers to care: a general population study.
Community Ment Health J. 2014; 50: 721-728
Another issue to be mentioned is the fact that we have used the mortality data provided by official sources.
This measure might not be perfect and may not reflect the real impact of COVID-19, as several studies point towards the existence of problems in the records that would lead to an underestimation of the number of deaths from COVID-19, especially during the first months of the pandemic.
Bone A.E.
Finucane A.M.
Leniz J.
Higginson I.J.
Sleeman K.E.
Changing patterns of mortality during the COVID-19 pandemic: population-based modelling to understand palliative care implications.
Palliat Med. 2020; 34: 1193-1201
Strang P.
Fürst P.
Schultz T.
Excess deaths from COVID-19 correlate with age and socio-economic status. A database study in the Stockholm region.
Ups J Med Sci. 2020; 125: 297-304
Vieira A.
Peixoto V.R.
Aguiar P.
Abrantes A.
Rapid estimation of excess mortality during the COVID-19 pandemic in Portugal -Beyond reported deaths.
J Epidemiol Glob Health. 2020; 10: 209-213
Gibertoni D.
Adja K.Y.C.
Golinelli D.
Patterns of COVID-19 related excess mortality in the municipalities of Northern Italy during the first wave of the pandemic.
Health Place. 2021; 67: 102508
New York City Department of Health and Mental Hygiene. (DOHMH) COVID-19 response team. Preliminary estimate of excess mortality during the COVID-19 outbreak - New York City, March 11-May 2, 2020.
MMWR Morb Mortal Wkly Rep. 2020; 69: 603-605
An alternative measure would have been the excess mortality produced in each country. The excess mortality measures the difference between the expected deaths, in relation to those produced in previous years in the country, and the deaths registered in the year considered. Therefore, it would not only collect the excess deaths that SARS-CoV-2 has directly produced, but also those indirectly attributable to delays in acute emergency care, exacerbations of chronic diseases, and greater psychological distress caused by lockdowns and the economic and social situation.
Woolf S.H.
Chapman D.A.
Sabo R.T.
Weinberger D.M.
Hill L.
Excess deaths from COVID-19 and other causes, March-April 2020.
JAMA. 2020; 324: 510-513
Vandoros S.
Excess mortality during the COVID-19 pandemic: early evidence from England and Wales.
Soc Sci Med. 2020; 258: 113101
Given the group of countries studied, we did not consider that the use of excess death significantly changed the results or the conclusions of our work, although this question could be explored in future studies.
Nevertheless, and despite all the limitations mentioned earlier, this is the first analysis that provides information about the impact that COVID-19 pandemic might be causing on the mental health of "the forgotten workers" in different European countries. Thus, our work provides information about a population group that has become invisible during the crisis generated by COVID-19 and confirms our preliminary hypothesis about mental health in that group. This information should be useful for the implementation of additional measures to support their care and also for their identification as a vulnerable group that requires reinforced provision of psychological care. Taking into account the great effect on mental health symptoms reported by caregivers who provide care out of home, in the case of the caregivers who usually reside in the home of the person cared for (who tend to provide more intense support in terms of hours of care and complexity of the tasks performed), our results might also suggest that this group may require additional care of their mental health.
The coronavirus outbreak has highlighted the importance of informal caregivers and the heavy load that they bear, which was already a concern before the COVID-19 pandemic and which jeopardizes their mental health. The support structures available for unpaid caregivers have always been scarce, but since the surge of the pandemic, many informal caregivers have been ceaselessly providing the same amount of care, or even with a higher intensity, without their usual support structures, which might have stopped their care provision activities completely. Although some countries have implemented specific measures to support unpaid caregivers, some surveys have shown that >50% of the interviewed caregivers felt exhausted and worried about "burning out" in the near future
and have claimed more financial support, among other kinds of assistance.
Some future lines of research could entail rerunning the current analysis by using a follow-up questionnaire. Future SHARE waves will include some sections of the SHARE COVID-19 poll to assess the long-term impact of COVID-19 among older European populations, and this will allow us to fill in some information gaps identified in our study, for example, by providing some longitudinal associations in terms of mental health, including the appropriate patient-related outcome measures and informal caregiving, or an in-depth profile of the informal caregiver (including the caregiving trajectory, presence of caregivers within their households). Likewise, it is necessary to analyze the situation of caregivers residing in the home of the person being cared for to know whether the impact of COVID-19 on their physical and mental health is similar or even greater than that identified in our study. Moreover, we might be able to evaluate or, at least, to infer how the national healthcare and LTC systems have responded to the pandemic situation and which lessons for the future could be drawn from the very different national political responses to the challenge of managing the burden of coronavirus.
Since the outbreak of COVID-19, informal caregivers in Europe have had a higher probability of reporting mental health symptoms than non-caregivers. This result is more intense in Southern and Eastern European countries. In countries with higher mortality rates due to COVID-19, there have been greater differences in terms of being sad or depressed between caregivers and non-caregivers. To the best of our knowledge, this is the first study evaluating the short-term effect that the COVID-19 outbreak has posed on mental health symptoms among informal caregivers versus non-caregivers. Although some supporting policies and programs were implemented for informal caregivers during the initial stage of the pandemic, those interventions widely varied between countries, implying that some areas provided no support for non-professional carers, and most of those measures were implemented after the data collection used in the study, motivating future lines of research.
Author Contributions: Concept and design: Peña-Longobardo, Oliva-Moreno
Acquisition of data: Peña-Longobardo, Rodríguez-Sánchez
Analysis and interpretation of data: Oliva-Moreno, Rodríguez-Sánchez
Drafting of the manuscript: Peña-Longobardo, Oliva-Moreno, Rodríguez-Sánchez
Critical revision of the paper for important intellectual content: Peña-Longobardo, Oliva-Moreno, Rodríguez-Sánchez
Statistical analysis: Peña-Longobardo
Obtaining funding: Oliva-Moreno
Supervision: Oliva-Moreno, Rodríguez-Sánchez
Conflict of Interest Disclosures: The authors reported no conflicts of interest.
Funding/Support: This work has received funding from the Spanish Ministry of Economy (ECO2017-83771-C3-1-R).
Role of Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
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Appendix Table 1
Accepted: October 21, 2021
DOI: https://doi.org/10.1016/j.jval.2021.10.011
© 2021 The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc.
Linked Article
COVID-19 Health Economics: Looking Back and Scoping the Future
Value in HealthVol. 25Issue 5
As of March 2022, nearly 6 million people have died of COVID-19 globally.1 The COVID-19 pandemic has already gone through several distinct stages during the first 2 years, with noticeable health and health economics impact at each stage. The initial emergency stage resulted in lockdowns that incurred enormous societal costs, concerning gross domestic product reductions as well as (mental) health damages. Diagnostic tests were implemented on a never-before-seen scale in many healthcare systems, without health economics justification,2,3 as exemplified in a systematic review in this themed section.
2/2017: "Mapping Studies" In Cost-Utility Analyses: New Recommendations From ISPOR Task Force
VHRI


text:
Repossession American Cars Auto Parts and Repairs Rules of the Road All Topics
How could somebody get an extended warranty on their automobile?
One can acquire an extended warranty on their automobile when they first purchase it, this is always available at that time. When buying a used vehicle from a car dealer, one can usually purchase extended warranty at this time as well. If you are looking for it after the purchase, there are companies who will sell you extended warranty, usually at a higher price than if you bought it when you purchased the vehicle.
Where can one get an extended car warranty?
You could purchase an extended warranty on your vehicle by the company that manufactures your car. You should be able to find a number for that company inside your car guide.
Is it worth it to buy a 5 year 72K mile extended warranty on a 2006 Saturn Vue for 1700?
Very much so?YES There is something to be aware of: We had a 2003 Bonneville that was totalled in an accident. It was still under the factory warranty. Thankfully someone mentioned that we could get the money back for the extended warranty. It turned out to be somewhat true - I don't remember the numbers, but I believe that we got back less than one-half of what we paid for the extended warranty even though… Read More
How can one get extended warranty insurance in the UK?
If one wishes to get extended warranty auto or home insurance in the United Kingdom, one could visit their local insurance companies. Alternatively, one could also visit their local financial institutions to see what plans they may be able to offer.
Should you buy an Extended warranty on laptops?
Yes you should, laptops are very sensitive and could break down out of nearly nothing. My laptops hard drive broke down from having dust in the fan. If i would of bought the extended warranty then i could of replaced my old laptop with a free new one, but no. Now i have to buy a whole new laptop!!
If an American car has a 3 year 36K mile factory warranty is it worth it to buy a 5 year 72k extended warranty?
READ THE FINE PRINT. Do EVERY required maintenence required or else your claim will be rejected. Also if you sell the vehicle before the extended warranty runs out you can request a prorated refund on the unused months !!!!! It all depends on what American car you are talking about. Some cars have a dismal reliability record and in that case the extended warranty may be a good buy. In most instances I would never… Read More
If you bought a car with an extended warranty but the seller is now out of business what company services your vehicle?
You could try calling a dealership of the company that makes the car. Extended warranty's are ususally honored at any franchised dealer. Or call the company d customer service dept. you might be able to get info online also. Contact whatever company wrote the extended warranty and ask them who in your area can service the car.
Where could one obtain HP support?
Support from Hewlitt Packard can be obtained online or by telephone at their 1-800 number. Most computers carry a one year warranty during which support will be offered for free. Extended warranties can be purchased which will prolong the length of the warranty but these are often costly and not generally necessary.
Why does the LCD screen go blank within seconds of turning on TV no problem with sound cooling fans still operating?
Sounds like your projection lamp or ballast may be failing. I really hope you have an extended warranty in force on your TV, as it could get expensive.
Where could one go to purchase household appliance insurance?
You can purchase household appliance insurance from many places. Typically, the manufacturer provides a 1+ year warranty for appliances. However, the store you bought your appliance from may also provide extended warranties.
Should you buy an extended warranty?
Is a transmission covered by a warranty?
It could be. You need to contact the warranty company for specific coverages.
Is an automobile a good or a service?
An automobile is a good, if.you are leasing a car.it could also be seen as a service.
What is the opposite of the word extended?
The opposite of extended (moved out) could be retracted (moved in). The opposite of extended (relaxed, as with a muscle) is contracted.
Is a Belt Pulley part of the Power train?
It probably depends on the pully in question. A power steering pump pully for example would probably not be considered part of the powertrain. A water pump pully on the other hand may be. Really there is no true definition of what is "powertrain". If you are referring to a warranty issue though that is different. Someplace somewhere a team of lawyers for warranty companies decide what is and isn't included under different warranty packages… Read More
Where can one find the best automobile lease deals?
There are many places where one could find the best automobile lease deals. One could check sites such as Cars Direct for information regarding obtaining the best lease deal on an automobile.
Would the slave cylinder be under powertrain warranty?
It could be. The manufacturer decides what is part of there "powertrain warranty".
What could be the reason my speed odometer stopped working on my 2004 Tahoe?
There has been either a TSB or recall on this. Happened to my 04. I had extended warranty and fixed for nothing. Call your dealer. My speedo was very erratic, usually reading 30-80 MPH higher than actual or reading 0.
Could you assure an automobile?
Yea, look at it and study it.
Is motorbikes an automobile?
No, a motorbike would be a motorcycle or dirt bike type of thing. Or a bicycle with a engine. A automobile would be a car, truck or semi. But it could possibly be a automobile if you think about it, but i'd say no.
Where can one donate to automobile companies?
One can donate to automobile companies on their websites. Every automobile company should have a website. If not to be found, one could call to the company and see what donations are available.
Do used farm tractors come with a warranty?
While most new equipment come with a manufacturer's warranty some of the used tractors unfortunately are sold as is. However depending on where you buy the used tractor you could recieve a rebuilt tractor and it could come with a warranty from the seller.
What cities would one have to live in to warranty ones car through AA Warranty?
One could live in almost any city in the United States of America in order to warranty one's car through AA Warranty. AA Warranty will not insure a car outside of the US.
If VW passat 2003 The coolant temperature needle is fluctuating between 50 and 90 degree and sometimes it doesn't rises from 50 what is the problem even though water pump was changes?
Coolant temp sensor. There is an extended warranty on them. It could also be the thermostat but that should have been changed with your water pump.
Is there a way to ensure that your used backhoe works?
Depending on where you purchased the used backhoe, you could get a warranty that pays you back if it doesnt work. But if you do not have a warranty, then you could go to the seller and inspect it to see that it does work.
Henry Ford did what?
He was the first to make an automobile He was not the first to make an automobile, far from it. He was however the first auto manufacture to perfect the assembly line concept of auto production. This lowered the price of a car to the level where the average family could own a car. Prior to this only the rich could own an automobile.
Under roman law how long could a dictator hold the power?
Under Roman law, a dictator was appointed for six months. However this appointment could be extended by vote of the senate. In the case of Julius Caesar it was extended for ten years and then extended for life.
What is a reason a President could be removed from his job?
he could shoot somebody
What is an extended minor program?
An extended minor program can be a few different things. An extended minor program could mean that students over 18 are admitted into the program as well.
Can you buy an Xbox 360 warranty if you've never had a warranty before?
Yes u can u, call xbox or u could got to xbox.com and purchase a warranty that is how my friend did it hope this helped u
What happens when you grind with somebody?
You could get pregnant.
A story using indefinite pronouns?
Everybody, Somebody, Anybody, Nobody That's Not My Job! This is a story about four people named Everybody, Somebody, Anybody and Nobody. There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that… Read More
Is it possible to do mtech automobile engineering after complete btech in mechanical?
i think you shold go for mtech in machine design it covers all automobile parts design except engine which could be learnt in automobile company very easily.
How did the automobile change where people lived in the 1950's?
The automobile created the suburbs. People could commute into the cities to work without having to live there.
How did the invention of the automobile influence where people could live?
socail change
Could an automobile dealership is a distributor?
If they have a parts dept. they can be for just about anything
Could somebody write a detailed recount on Inkheart?
Yes, someone could
Where can one find various automobile insurance ratings?
There are many places where one could find various automobile insurance ratings. One could check online sites such as iZito for information regarding insurance rates of automobiles.
How long is the legal warranty for laptops in the United States?
The legal warranty time for laptops in the United States has no set rule. Different companies have different legal warranties. The warranty could last from a week to 2 years.
What do people buy on credit?
To get things they do not have the cash to pay for. For example, I have an automobile that is paid for , but it will not run, so I could buy an automobile on credit that would run. But then, I would be in dept.
Is automobile a suitable name for a motor vehicle?
no i don't think so it could be
In the United States which industry could best be defined as an oligopoly?
Automobile manufacturing.
Does home warranty cover flooding from leaks?
It depends on what kind of warranty coverage you bought, They are not all written the same. Some warranties are better than others. You could read your warranty papers your self to see the coverage terms or just call the warranty company and ask them to explain the coverage terms.
What causes an electrical fire in an automobile?
An electrical fire in an automobile is usually caused by a short circuit. For example, If there are exposed wires somewhere, touching metal, that could start a fire.
Execrate in a sentence?
To execrate somebody is to feel loathing for somebody. An example sentence would be: He could not possibly execrate her any more.
How much does it cost to replace a shift solenoid in a Toyota corolla?
I did not have an extended warranty but i had a typical warranty covering ur car up to 60,000 miles. I called the dealership about the soelnoid and found out its a regular problem with the corollas a computer malfunction so u dont need a new solenoid just a new computer chip. The dealership covers it for free woo-hoo and a free car wash cant beat that but i know it could range to 500$… Read More
Somebody called you and hung up could it be a stalker?
It could be. It also could be someone who dialed the wrong number.
What are some companies which provide automobile insurance in California?
Some of the companies which provide automobile insurance in California are All State and Progressive. Some other companies that provide automobile insurance in California are Liberty Mutual, Geico, and State Farm. These are a few of the different companies that one could find insurance coverage for an automobile in California.
Could the controlled process that causes the automobile engine to move could be produced by other means?
Are you talking about starting it or running it?
Example of brain twister?
Whose Job Is It? This is a story about four people named Everbody, Somebody, Anybody and Nobody. There was an important job to be done and Everybody was asked to do it. Everybody was sure Somebody would do it. Anybody could have done it but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it but Nobody realized that Everybody wouldn't do it. It ended up… Read More
What is an example of a short story using indefinite pronouns?
That's Not My Job! This is a story about four people named Everybody, Somebody, Anybody and Nobody. There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when… Read More

redpajama_set_name: RedPajamaCommonCrawl


Will Smiley is an assistant professor in the Humanities Program. He is a historian of the Middle East, Eurasia, the Ottoman Empire and international law. He received his Ph.D. from the University of Cambridge, his J.D. from the Yale Law School, his master's degree from the University of Utah and his bachelor's degree from Hillsdale College. His first book, "From Slaves to Prisoners of War: The Ottoman Empire, Russia, and International Law" (Oxford University Press, 2018), examines the emergence of rules of warfare surrounding captivity and slavery in the context of the centuries-long rivalry between two empires, the Ottoman and Russian, which defined the future of the Middle East and Eurasia. His other publications include articles in Law and History Review, International Journal of Middle East Studies, Journal of the History of International Law, Journal of the Ottoman and Turkish Studies Association, Journal of Ottoman Studies, Turkish Historical Review and International History Review. He comes to UNH from Reed College, where he was assistant professor of history and humanities, and he previously held fellowships in Near East Studies (Princeton University) and legal history (New York University).


43 items matched your search.
2 x 1/12th scale Handmade gift bags. These bags are foldable and come flat.
3 x 1/12th scale Handmade gift bags made from brown paper. These bags are foldable and come flat.
2 x Handmade gift bags with fun Father Christmas scenes. These bags are foldable and come flat.
The Wiltshire country house is one of MyTinyWorlds growing range of quality mid-level dolls houses.
The house is externally painted in blue and cream, and comes as a self assembly kit with full instructions. It comes with a separate ground floor extension as show in the picture which has its own independent access.
The Wiltshire has two main floors accessed through the two part opening front and a further level in the roof accessed through lifting the front of the roof which is hinged.
Front steps are removable, the chimneys are fixed.
Price is for 1 self assembly, flatpacked house Postage is to UK only and is £12.00 by UPS Courier.
We can make the house for you and deliver anywhere in the mainland UK via UPS next day tracked Courier Service for £50.00. Please add the Construct Our House service to the shopping basket. This is perfect for bestowing a dream gift without the hassle of having to make it!
Size: House : 67cm High, 62mm Wide x 37mm Deep.
The Tradesman is a visually stunning very pale pink and house shop in one.
The lower half of the building has a beautiful shop front, small bay shop front and two separate entrances - one for the shop and one for the house.
The main house is externally painted in a pale pink and grey roof tiles. Internally the house is painted white and has wood effect flooring already fitted to save you time and give extra value for money. The Tradesman comes as a self assembly kit with full instructions.
Each of the two main floors are accessed through the beautifully styled two part opening front and a further level in the roof is accessed through lifting the front of the roof which is hinged.
The Merchant town house is one of MyTinyWorlds growing range of quality mid-level dolls houses.
The house is externally painted in blue, internally in white and comes as a self assembly kit with full instructions.
The Merchant has three main floors accessed through the two part opening front and a further level in the roof accessed through lifting the front of the roof which is hinged.
The chimneys are are removable to enable roof access.
The house is externally painted in Pink, internally in white and comes as a self assembly kit with full instructions.
The Apothecary is a visually stunning half Tudor house that immediately transports you to times gone by.
This house can easily be used as a house, part house part shop, or even as its name suggests an old style apothecary. This is a truly flexible building that has a wealth of beautiful external features.
The main house is externally painted in white with the lower half finished with an old style brick pattern. The roof has the mock Tudor beams and is finished with a tile effect. Internally the house has been left unfinished to give you maximum flexibility. The Apothecary comes as a self assembly kit with full instructions.
Each of the two main floors are accessed through the beautifully styled two part opening front and a further level in the roof is accessed through lifting the front of the roof which is hinged. This exceptionally well designed, well made and beautiful house has windows on both ends allowing for naturally light rooms.
Each and every flower is handmade from air dried clay and is made around a metal wire so they can be bent and arranged to personal preference. The Wreath of miniature flowers is arranged on a hand woven ring made from Rattan and comes complete in a clear bag finished with a bow. A perfect gift!
Each and every flower is handmade from air dried clay and is made around a metal wire so they can be bent and arranged to personal preference. The Wreath of miniature flowers is arranged on a hand woven ring made from Rattan and comes complete in a clear bag finished with a bow. A perfect gift!!
Each of the dolls house miniature flower kits in our range has everything required to make up to 10 complete flower beds. You can use the colours provided to make your flowers in whatever colour you wish.
Included in each kit is an A3 step by step instruction sheet with clear, large pictures, 25g of air dried clay, 6 bottles of powder to colour the clay, two brushes, one metal shaping tool, a pack of base clay, a tube of glue, wire stems, pollen, stamens and green binding tape.
Each kit also has the relevant petal and leaf cutters.
As part of the promotion of these kits we are giving you a free sample of a made up flower to match your kit!
These miniature flower kits are perfect to give as gifts and are available in 5 skill levels. The flowers you produce can also be used for many other activities such as jewellery making, general crafts, sugar craft and scrap booking .
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These moulds are made from a flexible transparent plastic which is long lasting, easy to for demoulding and can be frozen.
All FIMO clays are compatible and you can also use with casting powders, soaps and even chocolate.
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NOTE: the free gift shown in the picture is no longer available as this promotion has ended.
1/12th scale Handmade gift bag made from brown paper. These bags are foldable and come flat.


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Hasanabad (, also Romanized as Ḩasanābād; also known as Ḩasanābād-e Sarjām) is a village in Sarjam Rural District, Ahmadabad District, Mashhad County, Razavi Khorasan Province, Iran. At the 2006 census, its population was 867, in 235 families.

References

Populated places in Mashhad County

redpajama_set_name: RedPajamaWikipedia


Oh dear Lord of all that is good- we are on our tenth snow day.
I'm worried I am going to go stark raving mad. Or maybe I'm already there.
I've determined there are five types of snowday play in my house.
1) The Mommy is CruiseDirector play- where I come up with engaging, creative, and meaningful activities that require lots of materials, prep, and clean up. The actual activity lasts about fifteen minutes. I spend the rest of my day posting pictures of these activities on social media, making it look like the fifteen minutes of fun was actually three hours.
2) The 'Let's see if we can get out all the toys' play. This rarely involves actual play, just a lot of throwing all the toys around the room, taking the couch cushions off, and dumping baskets of books on the floor.
3) The Repeated Play-Scheme Play- where we act out one scenario over and over and over and over again. The current favorite with my three year old is "coronation day!" where we pretend to be Ana and Elsa, lay down on pillows, say goodnight, then wake up, yell, "it's coronation day!" stand up, run around the room and then go back to sleep on the cushions to do it all over again. I try to tell myself this is my cardio for the day. Sometimes I refuse to get up. Those cushions are just too comfy. This usually ends up with Elsa yelling at me, but it's her snow that got us into this mess so I don't really care about her opinion.
4) The "Mommy, can I crawl back into the womb" play- where both girls fight to see how much of me they can take for themselves at the expense of their sister. This is particularly fun for me when I need to go to the bathroom. It also involves lots of yelling and crying.
5) The "Mommy is done" play- which involves Netflix, opening presents I didn't give them at Christmas, or just ignoring the fact they are pulling all the tissues out of the box because it is giving me ten silent minutes. The mommy guilt from this one may be what drives the wine intake in the evening.
I just laughed so hard that my husband is now staring at me with a worried look. You described my day perfectly!


An energiser session is a high energy session that is used to energise delegates at a conference or event.
An energiser session makes the event interesting, enhances the level of engagement displayed by attendees, and creates a powerful metaphor for unity among attendees.
These energiser sessions are one of the most powerful corporate event ideas and have been proven to be extremely successful.
Energiser sessions are perfect as Ice Breakers for meetings and must be relevant to the message, fun and energising at the same time.
Drum Cafe has the experience to deliver all this and more for your next event or conference!


If you have had the opportunity to try the IPA-Nut beer that was a collaboration between Planters and Noon Whistle Brewing from Lombard, IL then you'll have to tell us how it tasted because we haven't gotten to try it.
Planters is not the first corporate company to partner up with an independent brewery and probably won't be the last. We talked about this recently on the Life Behind Beer podcast, but we decided to ask some other cousins for their thoughts on partnering with corporate companies.
To read the full article about the new collab beer click here.
What are your thoughts on this partnership and breweries partnering up with corporate companies like Planters?
What corporate collaboration would you like to see happen with Iron Horse?
Are collaborations like these bad for the indie beer business?
What do you think about corporations partnering with indie beer companies to create specialty beers? What companies would you like to see Iron Horse Brewery partner with?
Great ideas! We did partner up with a cheesemaker, Blain Hages of Zauhars Cheese (http://www.zauhars.com/), who created some cheeses using our beers. You can pick them up at [ the pub ]. Maybe our own cheese sauce is the next step. The future doesn't look as bright for loco red, but never say never.


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Graham wins, but Democrats pick up Colorado in Senate battle
Published 10:58 pm Tuesday, November 3, 2020
By LISA MASCARO and MARY CLARE JALONICK Associated Press
WASHINGTON (AP) — Republicans suffered a first setback in the battle for Senate control Tuesday as Democrats picked up a seat in Colorado, but the GOP ousted a Democrat in Alabama. Well-known Republicans held on in South Carolina and Texas.
Republicans sought to retain their Senate majority against a surge of Democrats challenging President Donald Trump's allies across a vast political map. Both parties saw paths to victory, and the outcome might not be known on election night.
In Colorado, Republican Cory Gardner was among the most endangered senators. His state had shifted leftward in the Trump era, and Democrat John Hickenlooper, a former governor, won the seat.
"It's time for a different approach," Hickenlooper said in an live video message posted on Facebook.
White House confidant Lindsey Graham survived the fight of his political life in South Carolina against Democrat Jamie Harrison, whose campaign stunned Washington by drawing more than $100 million in small-scale donations. In Texas, Sen. John Cornyn turned back Democrat MJ Hegar, a former Air Force helicopter pilot, in his hardest-fought election in almost two decades.
Republicans also flipped the seat in Alabama that Democrat Doug Jones had won in a special election as former Auburn football coach Tommy Tuberville was elected in the Trump stronghold.
From New England to the Deep South and the Midwest to the Mountain West, Republicans are defending seats in states once considered long shots for Democrats. The Trump administration's handling of the COVID-19 crisis, its economic fallout and the nation's uneasy mood all seemed to be on the ballot.
Trump loomed large over the Senate races as did Democratic presidential nominee Joe Biden. They swooped into key states, including Iowa, Georgia and Michigan, in the final days of the campaigns. Voters ranked the pandemic and the economy as top concerns, according to AP VoteCast, a national survey of the electorate.
Securing the Senate majority will be vital for the winner of the presidency. Senators confirm administration nominees, including the Cabinet, and can propel or stall the White House agenda. With Republicans now controlling the chamber, 53-47, three or four seats will determine party control, depending on who wins the presidency because the vice president can break a tie.
Polls closed in key states where some of the nation's most well-known senators were on the ballot. In Kentucky, Senate Majority Leader Mitch McConnell fended off Democrat Amy McGrath, a former fighter pilot in a costly campaign, but he acknowledged his GOP colleagues face tougher races.
"We don't know which party will control the Senate," McConnell said from Louisville. "But some things are certain already. We know grave challenges will remain before us, challenges that could not care less about our political polarization. We know our next president will need to unite the country, even as we all continue to bring different ideas and commitments to the table."
In Georgia, two Senate seats were being contested. They could easily be pushed to a Jan. 5 runoff if no candidate reaches the 50% threshold to win.
The Senate will welcome some newcomers as others retire. In Tennessee, Republican Bill Hagerty won the seat held by Sen. Lamar Alexander, who is retiring. Republican Cynthia Lummis, the former congresswoman from Wyoming, won the Senate seat opened by retiring GOP Sen. Mike Enzi.
So far, incumbent senators in less competitive races easily won.
Several Democrats were reelected, including No. 2 leader Dick Durbin of Illinois, Mark Warner in Virginia and Ed Markey, who survived a primary challenge in Massachusetts. Chris Coons kept the Delaware seat once held by Biden, defeating a Republican who previously promoted the baseless QAnon conspiracy theory.
Among Republicans, Tom Cotton in Arkansas, Ben Sasse in Nebraska, Shelley Moore Capito in West Virginia and James Inhofe in Oklahoma won.
Stuck in Washington to confirm Trump's Supreme Court nominee Amy Coney Barrett a week before Election Day, senators quickly fanned out — some alongside the president — for last-ditch tours, often socially distanced in the pandemic, to shore up votes.
Republican Sen. Thom Tillis joined Trump's rally in Fayetteville, North Carolina, on Monday. Tillis has struggled against Cunningham, despite the married challenger's sexting scandal with a public relations strategist. Cunningham traveled around the state Tuesday, talking to voters in Efland, near Durham.
Democrats have more than one route to secure the three or four seats needed to capture the majority, and GOP strategists privately acknowledged that the incumbents will almost certainly suffer defeats in some races.
Arizona could see two Democratic senators for the first time since last century if former astronaut Mark Kelly maintains his advantage over GOP Sen. Martha McSally for the seat once held by the late Republican John McCain.
Even the open seat in Kansas, which hasn't elected a Democrat to the Senate since 1932, was being contested as the most costly in state history.
In the presidential battleground of Michigan, Republicans have made an aggressive push for John James, a Black Republican businessman, against Democratic Sen. Gary Peters.
In Georgia, GOP Sen. David Perdue, the former business executive Trump calls his favorite senator, tried to stave off Democrat Jon Ossoff, another candidate who has benefited from the "green wave" of campaign donations.
Separately, GOP Sen. Kelly Loeffler faced Republican Rep. Doug Collins, as well as Democrat Raphael Warnock, in a special election for the seat she was appointed to fill after the retirement of GOP Sen. Johnny Isakson.
The Maine race between GOP Sen. Susan Collins and Democrat Sara Gideon was another contest that could push past Election Day if no candidate breaks the 50% threshold. Collins has typically rallied support as a centrist with an independent streak, but the tight contest shows the difficulty GOP senators have appealing to Trump's most ardent backers while also retaining support from more moderate voters.
The political landscape is quickly changing from six years ago, when most of these senators last faced voters. It's a reminder of how sharply the political climate has shifted in the Trump era.
In Montana, Republican Sen. Steve Daines was trying to hold off Democrat Steve Bullock, the governor, in a state where Trump was popular.
Iowa Sen. Joni Ernst was fighting for a second term against Democrat Theresa Greenfield.
And in Alaska, newcomer Al Gross, a doctor, broke state fundraising records in part with viral campaign ads as he took on GOP Sen. Dan Sullivan.
More BREAKING NEWS
Piedmont Natural Gas has restored service to about 2,000 customers
Piedmont Natural Gas has restored service to about 650 customers as of Thursday afternoon
Stanly County moves inmates after natural gas outage, anticipates PNG assistance
County reveals more info for people seeking emergency shelter


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SimplySxy
Blogger & Influencer Jasmine Elias
Canadian Blogger & Instagrammer Jennifer Ng
Czech Model, Fashion Lover & Traveler Kris Prihodova
San Diego Model Mimi Truong
Internationally Published Model, Bella Smiles
How To Meet And Mingle With Link-Minded Couples
5 Illogical Assumptions About Paying For Sex
My Experience As A Sex Worker
What Is The Kinky GFE?
How To Avoid Feeling Nervous Before Sex
What One Should Know About Domestic Discipline
What To Know About Poppers Training
Advantages of Seeing A Cougar
What It Takes To Be A Hotwife
What To Know About Fetish Modeling
Tips for Finding the Perfect Match with Online Dating
Why Do Men Hire Escorts?
5 Things You Should Know About Online Hookup
Take Your Online Relationship To The Next Level!
Hottest Dating Trends in 2019
Virectin Reviews: Is Virectin An Ultimate Male Enhancement Supplement?
G Series Toy Review: Part 1 (General Feel And The Dildo)
Sex Toy Review: Iroha Uma-Anzu and Iroha Midori by Tenga
Tokyo Night Style: Helping foreigners navigate Japan's sex scene
Sex Toy Review: Zini Zook V.2
San Jose Glamour & Import Natasha Cynn
Artist & Model Paige Biro From Canada
SimplySxy Editorial Team
My name's Natasha. I'm a Leo. I was born and raised in San Jose, California. I'm a first generation Asian-American that's half-Vietnamese and half-Filipino. I grew up watching America's Next Top Model & Project Runway as a teenager. My desire to be a part of that world led me to pursue a career in fashion first!
I have two associate's degrees in Fashion Design & Liberal Arts. I also have two fashion styling certificates from the School of Style & Elite Fashion Academy where I trained in San Francisco, Los Angeles, and New York.
Eventually, I wanted to be a model behind the camera instead of a wardrobe stylist. I'm really glad I decided to chase my dreams as a glamour and import model, as it's taken me all over the world and I feel like I can truly be myself!
How did you get started into being a model?
When I was in high school, my friend used me for her photo class's portrait assignment. I was maybe 15 or 16 years old.
We took a lot of photos using natural light during "golden hour" and some with me walking through the leaves during fall season. They're very innocent photos compared to now (laughs). You can see the rawness and unrefined talent in the pics.
A lot can change in ten years! My look, style, and demeanour are much more polished. So for new models not born in entertainment or money; be patient and keep working on your portfolio. You'll figure it out.
What do you love about being a model and is it a lot harder than it looks?
Modeling has brought great joy and purpose into my life. I think others might underestimate my career choice or the lack of stability a modeling career can hold, but I've really lived quite an interesting life.
I love how every job is different. It's given me something to look forward to in the future. It challenges me to adapt to the situation and evolve myself. By making my own schedule instead of having a typical routine 9-5, it gives me freedom to work as much as I want or take time towards other interests – typically my health/training, hobbies , friends and family.
I love how modeling has taken me around the world. I've been to Fiji, South Africa, Thailand and other countries through modeling! I've done ring girl, promo gigs, and even had my own model feature while working around the US. I'm really grateful to experience that. As a kid, I used to read about other people's adventures because I wasn't well off and I had a hard time making friends… but modeling has brought my own adventures and friends! I've witnessed some beautiful and fun moments that wouldn't have been possible if I wasn't a model.
But the thing I love the most about modeling, is it makes me happy when I see that people genuinely enjoy my work.
I'm no doctor, but I can make people smile. I get such nice feedback when I go to the import shows. I'm glad my work has brought something positive to the world. Growing up in Asian culture, positive reinforcement such as compliments or talking about your feelings isn't a thing… so it's nice to feel appreciated and be good at something.
This career isn't always glamorous…
Well, of course there's a lot of pressure to maintain how you look… comes with the territory (laughs).
Sometimes people can be critical about your look– and I've learned to be kind to myself.
I'm bi-racial and exotic looking. I don't necessarily fit a cookie-cutter Asian look. My skin isn't that dark, but it's dark to some Asian cultures. I have a curvy figure and bottom. I always wished I was more petite because I'd get made fun of… now the slim thick/hourglass figure is in (laughs). It can be stressful when there's a lot of pressure to be a certain look, but that's just the norm of the industry.
Some people will love your look.. and some won't (laughs).
By far the worst part of modeling is when I've been put in awkward situations or when I'm dealing with sleazebags. And the strange photo shoot requests… eww..
There are some shady people in entertainment! People definitely take advantage of young models. You have to learn how to navigate the politics of entertainment and hold your own ground. Whether you're a freelance or agency model, that's one of the hardest things with being a model is the sleazebags. Also, photographers that don't return images or manipulate girls into drinking, pressuring them to do things to get photos, posing overly provocative photos are scumbags to the industry!! A fashion photographer asked if he could do a nude trade shoot…. for free. I told him absolutely not. Yeah… some people are just cheap and gross…. (laughs).
Which is a memorable or unforgettable event or photoshoot you have done before?
I'm supposed to just give one? (laughs) Hmm… there's so many "unforgettable" shoots.
When I first started modeling, I was really excited to work with these pro skaters… I taught myself how to skate at 16 so ya… I was super stoked! I wasn't really used to being around celebrities back then… I was definitely brand new.
Louie Barletta and Roger Bagley are such nice people to work with… I'm glad they were professional (not some gross sleazebags) and didn't scare me off from the entertainment industry (laughs).
Oh, a really funny and memorable shoot was when I did this one in Vegas. It was a typical lingerie shoot… except one of the models was not typical… SHE HAD A HOUSE ARREST BRACELET ON. She proceeded to talk about how she crashed into five cars a month or two before she had the bracelet. And she that was her second or third DUI? Like whoa homegirl…. TMI!
Do you have any quotes or mottos that you always use regularly?
I guess I don't really use a quote or motto regularly, but I refer to literary posts philosophically. I have a few tattoos on me that go along with my attitude towards life.
They are: "Live Fast", "Trust No One", "Love Hurts", and "Veni Vidi Vixi".
"Veni Vidi Vixi" (I came, I saw, I lived) is not to be confused with the more popular Latin quote "Veni Vidi Vici" (I came, I saw, I conquered).
"Veni Vidi Vixi" is poem by French writer Victor Hugo written after the death of his daughter Leopoldine. She was 19 years old at the time of her death. I guess you could say they're kinda like scars instead of tattoos.
I also believe in the law of attraction to manifest the life you want. Under the sunflowers tab in my Instagram, I post about it and other philosophies I feel deeply about.
Where have you always wanted to travel to but have yet to find the time for it?
I want to go to Paris, London, Tokyo, Seoul, and Vietnam. Ummm… Hawaii.. Australia.. honestly, the whole world!
A world tour would be the dream… I'd start with an Asia tour (laughs). My bucket list includes doing a photo shoot in traditional clothing in my father's land (Vietnam) and mother's land (Philippines).
If you could learn anything, what will it be?
I wish I was fluent in many languages. Spoken and written language helps connect with others stronger than body language. I have a few language apps and I love watching foreign films… so I'm trying!
As far as my knowledge on languages goes…
My primary language is American English.
Japanese would be my second language since I taught myself Hiragana when I was 11/12. I'm a huge anime nerd so I try my best to sing the anime songs in Japanese (laughs). I'm pretty sure I can do Ranma karaoke version (laughs).
Third language is French. I took it in high school. I know some slang and can read but I can't speak on a conversational level. You can also find me in a French rapper's video, so that's kind of a good reason to know some français (laughs).
If you want some thing romantic to say to your bf/gf, tell them "Envie de toi! Je t'aime et tu me manques beaucoup! Bisous."
I wish I could talk in Vietnamese since there's a big community in San Jose. I get a lot of slack for not understanding and looking Vietnamese enough (but I'm biracial so I'll never look full). Vietnam is a homogeneous country where it's a big deal in the community to not understand the language or look "Vietnamese". My mom actually put me in Vietnamese school, but it was hard… like learning and fitting in with other kids was no bueno. It's just such a hard language to learn cause it has a combination of Chinese and French influence.
I don't feel as pressured to learn Tagalog or Bisaya (my mom's dialect) as there's not many Filipinos in my area. The national language in Philippines is Tagalog and English, so I'm gucci (laughs). I feel there's more of ethnic diversity and acceptance since Filipinos have many different looks but most notable are the Chinita, Mestiza, and Morena/Kayumangi look. I fall under the Chinita category.
If I was a genius, I'd learn it out of respect for my mother. I think it would also be useful to know some Chinese, Korean, and Spanish.
What is a lame or funny attempt a guy has tried to know you?
A really funny time a guy has tried to get to know me was when I posted a Facebook status about how hard it is to cut a pineapple.
He then solo chain commented three times in a row about how he wish he lived near me and would cut my pineapples for me. And then he ended it with a fart joke about cutting cheese (laughs).
Thank you for taking the time to answer our questions Natasha. One question before we end, how do you define "sexy"?
I find it very "sexy" when you don't have to talk about something – you just do it. Self-confidence without all that extra fluff. When your work speaks for itself, and you reach that moment when you no longer have to introduce yourself. That's sexy.
People that are beautiful, fun, kind, and rich don't have to always say they are because that's just who they are. I strive to be around people like that, which falls into the principles of law and attraction.
Don't talk about it, just be about it!
Follow the beautiful Natasha Cynn on:
Website: Natashacynn.com
Instagram: Instagram.com/natashacynn
Facebook: Facebook.com/natashacynn
Twitter: Twitter.com/natashacynn
Images from Natasha Cynn
Like to be featured on SimplySxy? Drop us an email at editorial@SimplySxy.com!
Related Topics:Import model, Model, Natasha Cynn, SimplySxy
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Home » Where to get help in wake of damaging severe storms in SE Texas
Where to get help in wake of damaging severe storms in SE Texas
HOUSTON, Texas (KTRK) — It became clearer with every image captured by Eyewitness News that folks who were in the path of damaging severe storms and tornadoes Tuesday will need help going forward.
Places like Deer Park and Pasadena were among the hardest hit, with roofs blown off, trees uprooted, and property either damaged or destroyed.
That's not to mention whether any home left standing is livable. Thankfully, there were no major injuries in the immediate aftermath, but people in these neighborhoods should know that help is on standby.
Just the day before, Gov. Greg Abbott directed the Texas Division of Emergency Management, or TDEM, to prepare state emergency response resources ahead of the severe weather.
That enables TDEM to mobilize all members of the Texas Emergency Management Council to support response and recovery operations across the state.
What that looks like at the state level isn't immediately clear.
But outside of the state's help, nonprofits are already on the frontlines.
The Texas Gulf Coast Red Cross said it is working with emergency managers and community partners in response to the storms in the region. It directs anyone who may have been affected to call 1-800-RED-CROSS for help.
The city of Pasadena is also informing residents about a Salvation Army-supported relief station at the corner of Burke and Yellowstone, where meals and assistance information are being provided.
Check back with this page for additional assistance information in the immediate aftermath of Tuesday's storms.


It'll soon be the 6th year anniversary of IE8, are you ready to Break Up with it?
Free Ebook: Web UI Design for the Human Eye.
How to get started with CSS Shapes by Rachel Andrew.
Create a simple and easy CSS Contact Form by CodyHouse.
A set of examples that use a gooey SVG filter for creating a variety of different effects by Codrops.
Shipping Side Projects by Patrik Göthe.
Sass Mixins vs Extends: The Data by Shay Howe.
Critical Mistakes To Avoid When Quoting A Web Design Project by Kate Dagli.
Things to Think About Before Setting Your Freelance Rates by Patrick Dodd.
Growing Your Design Business the Right Way by Katherine Halek.
A Roundup of Free & Beautifully Designed UI Kits.
Free Font: Blogger Sans (Regular & Italic).
Freebie: Vector Line Icons (30 Icons, AI & EPS).
Freebie: Major Websites Icon Set (Sketch).


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Home News Decline Of The I Premiere New Single 'Enslaved By Existence'
Decline Of The I Premiere New Single 'Enslaved By Existence'
French post-black metallers Decline Of The I premiere a new track Enslaved By Existence in the form of a lyric video. The track comes from the band's third studio album 'Escape', due out on the 27th of July via Agonia Records. Listen to the song here:
'Escape' will feature six varied, original compositions replete with artwork from David Fitt, who filmed the new video.
The band commented: "After a heavy and neurasthenic first chapter, and an epileptic, dirty and violent second one, here's the last part of the Decline of the I's trilogy: 'Escape'. It's now time to leave, to avoid this perpetual aggression of the outside world. All the other reactions leaded to a dead end. Running away is the only possible move for the subject to preserve its entity. There are many forms of escape: madness, suicide, technology, spirituality. This third album explores all of them. Musically, it's the synthesis of all the previews works; it's contemplative and slow but also very fast, dark and brutal."
'Escape' was recorded, mixed and mastered at Blacksun Recording by Junior Rodriguez. The album will be available in CD, LP and digital formats.
PRE-ORDER YOUR COPY OF 'ESCAPE' RIGHT HERE!
Agonia Records
Decline Of The I
Enslaved By Existence
Lyric Video
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