bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the take up of public insurance programs improves health care consumption of poor individuals?
Authors: Carré B , Thomas M , Jusot F , Wittwer J , Gastaldi-Ménager C 
Published: November 2019

Abstract

Background
The French health insurance system is universal but 95% of the population is also covered by a complementary private health insurance (CHI). The CHI take up is not uniform across the income distribution and health care access is partly conditioned by its coverage. The Complementary Universal Health Coverage (CMU-C) and the Health Insurance Vouchers Scheme (ACS) are mean tested programs providing CHI to the poor. The former is free while the latter takes the form of a voucher to buy private CHI. Our objective is to study and compare the evolution of health care use and consumption associated with the take up of the CMU-C or the ACS.

Methods
In a nationwide cohort of ACS and CMU-C beneficiaries we compute bi-annual expenditures, out of pockets expenditures and rates of use for different types of care: outpatient, inpatient, dental, optical and audiology. We use panel data regression methods to model the evolution of health care use and expenditures before, during and after the coverage periods of both programs.

Results
Our population is composed with about 10 million individuals benefiting at least once from either the ACS or the CMU-C on the 2012-2017 period. Preliminary results suggest that inpatient expenditures are increasing concomitantly with the take up of any program whereas outpatient expenditures tend to increase after. Results will be provided for the conference on the variations of the consumption according to the program (CMU-C or ACS), type of care, individual characteristics and health status.

Conclusions
Free or subsidized complementary health insurance may play an important role in the access to care for poor population, even in the presence of mandatory coverage. The take up of complementary health insurance for the poor population could be partly driven by the use of inpatient services but coverage may impact positively outpatient expenditures.

Key messages
Unlocking poor individuals financial constraint tends to increase their use of medical services. Generous insurance coverage targeting financially constrained individuals could be a tool to reduce health care use inequalities.
Economic burden of HIV disease from 2012 to 2017 based on the French national claim database (SNDS)
Authors: Pestel L P , Constantinou P C , Nicolas M N , Rivière S R , Rachas A R , Gastaldi-Ménager C G M 
Published: November 2019

Abstract

Background
The aim of this study was to assess the economic burden of HIV disease in France, by analyzing structure and trends of expenditure between 2012 and 2017.

Methods
We identified people with HIV disease among beneficiaries of the health insurance general scheme (covering more than 57 million people, 87% of the French population), applying algorithms combining inpatient and outpatient diagnoses and claims for specific drug treatments or laboratory examinations. The individuals’ expenditure (26 different items) reimbursed for hospitalizations, ambulatory care and cash payments were included. A top-down method was used to attribute expenditure to HIV disease based on the average expenditure calculated for individuals with only HIV disease. To analyze trends, we applied the same methodology from 2012 through 2017.

Results
In 2017, HIV disease was identified for 131 800 individuals (0.2% of the population) and expenditure attributed to HIV disease corresponded to €1.3 billion (1% of the 140.1 billion reimbursed by the general insurance scheme). Drug treatment accounted for 85% of total expenditure reimbursed (1.2 billion). Between 2012 and 2017, the number of HIV patients identified increased steadily (+16,800 patients with an annual growth rate of 2.8%) and expenditure attributed to HIV disease increased by €8 billion. However, annual expenditure growth was variable, as a result of instability in the average annual cost per patient, ranging from 9,700€to 11,100€per year per patient. This reflects changes in practice and drug prices.

Conclusions
The detailed analysis of expenditures attributed to HIV disease showed that drug treatments account for the large majority of total reimbursements. Annual variation in total expenditure could therefore reflect evolution in prescription practices, such as the extension of treatment indications; or in drug prices, with the availability of combined treatments.

Key messages
Drug treatments account for the large majority of total reimbursements among HIV patients. Variation in total expenditure attributed to HIV disease is mainly driven by prescription practices and drug prices.
Being Born during a Flu Pandemic as Risk Factors for Development of Schizophrenia
Authors: Grima F Guillen , Brugos-Larumbe A , Guillen-Aguinaga S , Alvarez-Mon M A , Pereira-Sanchez V , Ortuño F , Al-Rahamneh M J , Onambele L , Aguinaga-Ontoso I 
Published: November 2019

Abstract

Background
Schizophrenia is a neurodevelopmental disorder of complex etiopathogenesis involving genetic and environmental factors. Mother’s exposure to infectious agents during pregnancy has been, implicated in the pathogenesis of schizophrenia. Studies in experimental models support that flu virus can cause embryonic neurodevelopment damage such as that described for embryos that later develop schizophrenia, but epidemiological studies of the association between schizophrenia and gestation in times of a documented flu pandemic) are contradictory.

Methods
The study is a cross-sectional study within the APNA Study (Navarre primary health care prospective cohort) that included 470942 people over 18 years old in Navarre (Spain). Date of birth, sex, and schizophrenia diagnoses made by psychiatrist on the basis of ICD-10 were extracted. People were classified according if their birth dates occurred within or around periods of flu pandemics in the second half of the 20th century: 1957, 1968 and 1977. The dates for these groups were from January of the year of the pandemic until December of the subsequent year. Logistic regression of adjusted by sex, age, and month of birth was performed. Because the cohort only includes people over 18 years of age, data for patients born during the influenza A subtype H1N1 outbreak of 2009 were not available.

Results
Males have a higher prevalence of schizophrenia than females (OR = 1.516, 95% CI:
1.388-1.655), Adjusting by gender, month of birth and age, subjects born during (or the year after) years of flu pandemic relative to subjects born in non-pandemic years (OR = 1.335, 95% CI = 1.199-1.486). The latter relationship held for each pandemic studied in isolation of the others, with ORs of 1.476 (95% CI: 1.244-1.750) for the 1957-59 pandemic, 1.261 (95% CI: 1.060-1.493) for the 1968-70 pandemic and 1.280 (95% CI: 1,072- 1,528) for the 1977-78 pandemic.

Conclusions
Been born during a flu pandemic may increase the risk of developing schizophrenia.

Key messages
Exposure to the influenza virus during gestation may increase the risk of schizophrenia. Flu Vaccination in pregnant women may reduce the risk of schizophrenia in their children.
The role of unjust treatment for experienced unmet need for health care among Finnish Roma
Authors: Kuusio H , Lämsä R , Laalo M , Castaneda A 
Published: November 2019

Abstract

Background
Finland is currently undergoing a major reform of social and health care, one aim of which, is to reduce inequalities between different population groups in access to care. Previous studies showed that Finnish Roma minority are more likely to experience unjust treatment in health services and other public services in comparison to other minorities in Finland. Unjust treatment may influence health behaviors, including the use of health services, by decreasing trust towards health professionals as well as decreasing social, emotional, and physical resources. This study examined the association between experienced unjust treatment in public services and self-assessed unmet need for health care among Roma in Finland.

Methods
We used data from the Roma health and wellbeing study (Roosa), conducted in Finland (2017-2018). The data was collected by the snowball method in different areas of Finland including a health examination and a structured interview. It covers 365 adults, and of those 223 (61.1%) were women. The outcome measure for unmet health care need was based on the question: “Do you feel that you have adequately received primary care services during the past 12 months?” Logistic regression was used to test the association between unjust treatment and unmet need for health care. Potential confounders were gender, age, marital status, education, employment and self-estimated health.

Results
The prevalence of unmet need for health care was 37.8 percent among men and 43.7 percent among women. Those who experienced unjust treatment in public services had higher odds (OR = 6.23; p &lt; 0,001) for unmet need for health care than those who felt treated just. This association remained after adjustments for the confounders.

Conclusions
Over every third of the Finnish Roma experienced unmet need for health care. Unjust treatment seems to be a significant risk factor in access to care among Finnish Roma and its role needs further studies.

Key messages
Unjust treatment in public services is an indirect indicator of systematic and/or institutional discrimination. It is important to study the extent, nature and consequences of unjust treatment and discrimination to allow vulnerable groups to be taken into account better when renewing health services.
Pharmacist to improve hypertension management: concordance between Europe and North America
Authors: Anker D , Tsuyuki R T , Paradis G , Chiolero A , Santschi V 
Published: November 2019

Abstract

Problem
Hypertension is highly prevalent but remains poorly controlled, notably in European countries where control rates are frequently worse than in Canada and the United States. One innovative solution for improving hypertension management is team-based care (TBC) with the involvement of a pharmacist.

Description of the problem
We systematically compared recommendations for TBC in hypertension management in recent European (ESC/ESH), American (ACC/AHA), and Canadian (Hypertension Canada) guidelines and pinpointed potential roles and responsibilities of pharmacists.

Results
The three guidelines recommend TBC for the management of hypertension, with the ACC/AHA Guidelines giving a stronger emphasis by providing a more exhaustive definition of TBC and by describing the composition of the team. The three guidelines assign roles and responsibilities in hypertension management at the team level, but no firm role is defined for each specific team member. The three guidelines also refer to evidence showing that the pharmacist’s involvement can embrace several activities, that is, diagnosis of hypertension, blood pressure monitoring, medication management, education of patient and health care providers, and communication and organization within the care team. Recent systematic reviews have shown that a pharmacist’s involvement in these steps in hypertension management improves hypertension control compared to standard of care.

Lessons
International guidelines, including European ones, recommend using TBC in hypertension management, based on strong evidence that a pharmacist’s involvement improves hypertension control.

Key messages
International guidelines recommend TBC and the involvement of pharmacists to improve hypertension management. Programs and policies to improve hypertension control in European countries should consider the involvement of pharmacists.
Parental health literacy and health behaviors in children: a 2017 cross-sectional survey in Germany
Authors: de Buhr E , Tannen A 
Published: November 2019

Abstract

Background
Health literacy (HL) is closely associated with leading health indicators. Parents represent a critical subgroup among the adult population since they are not only responsible for their own health but also for the health of their children. Previous research suggests that parents with low HL are less likely to meet the preventive and health care needs of their children but the relationship between parental HL and child health is not yet well understood.

Methods
A cross-sectional survey was implemented in 2017 in 28 public schools in Germany. The parent questionnaire was completed by 4217 caregivers and included the short form of the HLS-EU-Q16. The child questionnaire examined health knowledge, behaviors and outcomes. For children under 11 years, the caregiver reported on behalf of their children (N = 1518). In all other cases, the children completed the questionnaires (N = 2776). Bivariate and multivariate analyses were carried out.

Results
Among the interviewed parents, 45.8% showed a problematic or inadequate HL. Parents with higher HL reported a better subjective health and quality of life, and they judged their children as being healthier. The major determinant of high parental HL was socio-economic status (r=.088***). High parental HL was associated with positive health behaviors in children including higher consumption of fruits and vegetables, fewer sweetened beverages, regular tooth brushing and more physical activity. The relationships between parental HL and smoking, alcohol consumption, sexual activity among children and children’s weight were not significant.

Conclusions
The results confirm a relationship between low parental HL, SES and some problematic health behaviors in children. Strengthening the HL of vulnerable parents may contribute to improved health outcomes particularly in the areas of children’s nutrition, exercise and dental health, and parents should be integrated in school-based activities of health promotion and prevention.

Key messages
There is a strong statistical relationship between parental health literacy and socio-economic status. Parental health literacy is associated with child health behaviors (e.g., nutrition, exercise).
Associations between mental illnesses and acute cardiovascular events and cancers in France in 2016
Authors: Lesuffleur T , Coldefy M , Rachas A , Gastaldi-Ménager C , Tuppin P 
Published: November 2019

Abstract

Background
People with a mental illness have higher risks of somatic diseases and higher mortality, but this has been poorly documented in France. We studied the associations between mental illnesses and acute cardiovascular events (ACEs) and cancers in the French national health data system (SNDS).

Methods
We included all health insurance general scheme beneficiaries ≥18 years-of-age in 2016. Mental illnesses (psychotic disorder, neurotic or mood disorder, mental retardation and addictive disorder), ACEs (acute coronary syndrome (ACS), stroke, acute heart failure and pulmonary embolism) and cancers (breast, colorectal, lung and prostate) were identified using algorithms based on long-term disease registry, hospitalization diagnoses and specific drug deliveries. The associations were measured using morbidity ratios standardized by age and gender when appropriate (SMRs).

Results
ACEs were more frequent in the subjects with a mental illness than in the general population: ACS (SMR: 1.6), stroke (2.3), acute heart failure (1.9), pulmonary embolism (2.4). Similar results were found for each mental illness, except for ACS, which were less frequent in those with a mental retardation (SMR: 0.5) and were not associated with psychotic disorder (SMR: 1.0). Mental illness was also associated with more frequent breast (SMR: 1.3), colorectal (1.3), lung (2.0) and prostate (1.2) cancers, in particular for those with a neurotic or mood disorder (SMRs: 1.3, 1.5, 2.3, 1.2, respectively) and, for lung cancer, those with an addictive disorder (SMR: 2.6).

Conclusions
Globally, ACEs and cancers were more frequent in patients with a mental illness relative to the general population after standardization by age and gender, which could be related to adverse effects of certain psychotropic drugs or behaviours or risk factors related to the mental illness. Healthcare professionals should be aware of this to more adequately account for the specificities of the patients with a mental illness.

Key messages
ACEs and cancers were more frequent in patients with a mental illness relative to the general population after standardization by age and gender. Healthcare professionals should be aware of this to more adequately account for the specificities of the patients with a mental illness.
Piloting Sexual Assault Care Centers in Belgium: Who do they reach and what care is offered?
Authors: Baert S , Roelens K , Gilles C , Bay V , Keygnaert I 
Published: November 2019

Abstract

Background
Care for victims of sexual violence is fragmented in Belgium. Therefore, sexual assault care centers (SACCs) were piloted in three cities from November 2017 onwards. The SACCs offer forensic, medical and acute psychological care through a forensic nurse, while vice inspectors perform an interrogation at the SACC for those wishing to report. The nurse coordinates the follow-up care and a psychologist provides mental health support. A quantitative prospective study was carried out assessing the characteristics of SACC patients, the sexual violence they experienced and the care received, in order to inform the national scale-up of the model.

Methods
Data on SACC patients was routinely collected in the electronic patient files by the SACC personnel between November 1st 2017 and October 31th 2018. Data was analyzed in SPSS.

Results
Within the first year SACCs were attended by 930 victims. Mean age was 24,5 years (SD = 12.8), and one third were minors. Eighty-eight percent of victims was female and 67% presented for rape. Fifty-seven percent of the assailants were known to the victim. Thirty-five percent of the victims self-referred to SACC, 41% were referred by the police, and 66% of victims attended services within 72 hours. Respectively 75%, 61%, 47% and 68% of victims received medical care, a forensic examination, psychological care and reported to the police.

Conclusions
Without big publicity the SACCs received a higher than expected number of victims. Expansion of the collaboration with police and targeted communication strategies should further increase the number of victims receiving appropriate care. Qualitative research assessing the acceptability of the SACC model will further inform the scale-up of the model.

Key messages
The quantitative study led to a better understanding of the population using the SACCs. The study allowed to improve the training of the staff members, adapt the SACC procedures before scale-up and define targeted service-promotion strategies.
Adolescent’s substance use and suicidal thoughts in Tunisia
Authors: El Ghardallou M , Sahli J , Mellouli M , Limam M , Zedini C , Mezougui L , Mtiraoui A , Ajmi T , Mannai J 
Published: November 2019

Abstract

Background
Experimentation with substance use is common during adolescence. Substance use may result in many health-related problems and contribute to adolescent suicidal behavior. We conducted this study to examine the relationship between substance use and suicidal ideation.

Methods
This is a cross sectional study conducted among a representative sample of 2020 adolescents enrolled in Tunisian secondary schools using a self-administered questionnaire.

Results
The prevalence of tobacco, alcohol and cannabis use was respectively 3.7% (95% CI [2.87%-4.52%]), 4.4% (95% CI [3.5%-5.29%]) and 0.8% (95% CI [0.40%-1.18%]) Overall, 17.0% (95% CI [15.3%-18.6%]) reported having suicide ideation during the past 12 months. Tobacco (Odds Ratio = 2.61; 95% CI = 1.59–4.29), alcohol (Odds Ratio = 2.77; 95% CI = 1.76–4.36), and cannabis use (Odds Ratio = 4.98; 95% CI = 1.85–13.96) were significantly associated with suicidal thoughts among adolescents (p &lt; 10-3).

Conclusions
This cross study has shown a significant association between substance use and suicidal ideation. This relationship can be bidirectional and suicidal ideation and substance use may affect each other.

Key messages
In his study, the prevalence of substance use was relatively low and was associated with suicidal ideations. The reciprocal link between the two problems and their co-occurrence should be taken into account when planning preventive substance use and suicide programs.
Addressing & understanding citizens’ perceptions of homelessness: a cross-European study
Authors: Taylor O , Loubiere S , Tinland A , Loundou A , Auquier P , EU HOME , Ornelas Jose 
Published: November 2019

Abstract

Objective
Addressing Citizen’s perspectives on homelessness is crucial for the design of effective and durable policy responses, and available research in Europe is not yet substantive. We aim to explore citizens’ opinion about homelessness and to explain the differences in attitudes within the general population of eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden.

Methods
A nationally representative telephone survey of European citizens was conducted in 2017. Three domains were investigated: Knowledge, Attitudes, and Practices about homelessness. Based on a multiple correspondence analysis, a generalized linear model for clustered and weighted sample was used to probe the associations between groups with opposing attitudes, adjusted for sociodemographic characteristics.

Results
The response rate ranged from 30.4% to 33.5% (N = 5,295). Most respondents (57%) had poor knowledge about homelessness. Respondents who thought the government spent too much on homelessness, homeless people should be responsible for housing, people remain homeless by choice, or homelessness keeps capabilities/empowerment intact clustered together (negative attitudes, 30%). Respondents who were willing to pay taxes, welcomed a shelter, or acknowledged homeless people may lack some capabilities (i.e. agreed on discrimination in hiring) made another cluster (positive attitudes, 58%). Older respondents (OR = 0.99; p=.011), those living in rural areas (OR = 0.78, p&lt;.001), those with a poor level of knowledge about homelessness (OR = 0.68, p=.007), and those from France and Poland (p&lt;.001) were less likely to report positive attitudes.

Conclusions
Although it is clear that there is strong support for increased government action and more effective solutions for Europe’s growing homelessness crisis, there also remain public opinion barriers rooted in enduring negative perceptions.

Key messages
A majority of European citizens reported positive attitudes towards Homelessness. There is strong support for increased government action and more effective solutions for Europe’s growing homelessness crisis.