bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of immunization campaign triggered by meningococcal outbreak – Tuscany, 2014-2018
Authors: Bisordi C , Mariotti T , Fornili M , De Vita E , Innocenti F , Baglietto L , Tavoschi L , Lopalco P 
Published: October 2020

Abstract
In 2015-2016, an outbreak of invasive meningococcal disease due to Neisseria meningitidis C/cc11 occurred in Tuscany, Italy, and caused 62 cases. Regional Health Authority launched an immunization campaign using quadrivalent meningococcal conjugate vaccine (MEN) in April 2015. We assessed the impact of meningococcal outbreak on population vaccination coverage, considering a pre-outbreak (2014), outbreak (2015-2016) and a post-outbreak period (2017-2018) for MEN and other vaccinations (HPV and MMR). We included all individuals (&gt;1 year) resident in Tuscany, who received at least one vaccination dose (MEN, HPV, MMR) in the study period. We sourced anonymous data from the regional centralised register on vaccine administered, date, place and dose (for multiple-dose vaccines); birth cohort; city of residence. We analysed vaccine administration by age, time, vaccine type. We modelled MEN vaccination rate as a function of number of cases in the previous month by a quasi-Poisson model (2015-2018), and HPV and MMR vaccination using an interrupted time series analysis (2014-2018).
MEN vaccinations increased significantly in 2015-2016 (average doses/month were 3400 in 2014; 25492 in 2015; 47290 in 2016). MEN immunization coverage increased during the outbreak period, peaking for age class 20-45: from 3,7% in 2014 to 10,7% in 2015 and 20,7% in 2016. MEN vaccination uptake showed a 50% increase (95% CI = 37 to 65%, P &lt; 0.001) in the rate for each new case diagnosed in the previous month. HPV vaccination rate showed statistically significant decreasing trend in before the campaign (-3% per month, 95% CI = -1 to -5%, P = 0.004) disappearing afterwards (0%, 95% CI = -2 to 1%, P = 0.96); with no trend for MMR.
The campaign successfully increased MEN coverage mostly among young adults, although vaccination demand was associated with occurrence of cases. The campaign did not affect routine vaccination programmes, and likely contributed positively to HPV uptake.

Key messages
The immunization campaign triggered by meningococcal outbreak in Tuscany in 2015-2016 successfully increased coverage, mostly among young adults, without affecting routine vaccination programmes. During response campaign triggered by meningitis outbreak in Tuscany in 2015-2016, meningococcal vaccine uptake was influenced by the occurrence of cases.
Gender-related treatment gap in depression among the elderly: a study on 18 European countries
Authors: Roxo L , Perelman J 
Published: October 2020

Abstract

Background
Depression is largely unrecognized and untreated, particularly among men. Help-seeking behaviors are known to differ between genders, yet, these discrepancies are expected to vary along the socioeconomic distribution. This study assesses the gender-related treatment gap for depression and analyzes how it varies with the socioeconomic status.

Methods
We used data from the Wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) from 56,931 participants aged 50-80 from 18 European countries. Among those depressed (assessed by the EURO-D scale), we modelled previous diagnosis of an emotional problem by a doctor, as proxy for the treatment gap. First, a logistic regression with gender as the explanatory variable was performed, adjusting for age and country. Afterwards, employment and education were factored in and interacted with gender, to assess the differential association of these variables for men and women.

Results
Depression was more prevalent among women (35.5%) than men (19.8%). Among those depressed, women (18.9%) were more likely than men (13.9%) to have been previously diagnosed for an emotional problem (OR = 1.43, 95%CI=1.42-1.43). Compared to men, women had a lower likelihood of diagnosis among homemakers (OR = 0.50, 95%CI=0.49-0.52) and a higher likelihood when unemployed (OR = 2.18, 95%CI=2.16-2.20), employed (OR = 1.10, 95%CI=1.10-1.11), disabled (OR = 1.20, 95%CI=1.19-1.21) with low (OR = 1.26, 95%CI=1.25-1.27) or middle educational level (OR = 1.67, 95%CI=1.66-1.68).

Conclusions
Although depression is more frequent among women, results suggest a larger treatment gap among men. Low- and medium-educated men seem less likely to have been previously diagnosed, as well as those unemployed. Among women, those homemakers are less likely to have been diagnosed with depression.

Key messages
Depressed men are less likely to have been diagnosed, particularly those unemployed and less-educated. Among women, depression diagnosis is less frequent when they are homemakers.
Objective understanding of the front-of-pack nutrition label Nutri-Score by European consumers
Authors: Egnell M , Talati Z , Galan P , Andreeva V , Vandevijvere S , Gombaud M , Dréano-Trécant L , Hercberg S , Pettigrew S , Julia C 
Published: October 2020

Abstract

Background
The effectiveness of Front-of-Pack nutrition Labels (FoPL) may be influenced by national context. In light of the ongoing efforts to harmonize nutrition labelling across Europe, the study aimed to compare the effectiveness of five FoPLs (Health Star Rating system [HSR], Multiple Traffic Lights [MTL], Nutri-Score, Reference Intakes [RIs], Warning symbol) in 12 European consumers.

Methods
In 2018-2019, for three food categories, approximately 1,000 participants per country were asked to select which food they would prefer to purchase between three products with distinct nutritional quality, and then to rank the products nutritional quality. Participants completed these tasks first with no FoPL and then, after randomization to one of the five FoPLs, with a FoPL on food packages. Associations between FoPLs and change in (i) nutritional quality of food choices, and (ii) ability to correctly rank the products nutritional quality were assessed with multivariable logistic regression models.

Results
Compared with the RIs, the Nutri-Score (OR = 3·23[2·75-3·81]; p &lt; 0.0001), followed by the MTL (OR = 1·68[1·42-1·98]; p &lt; 0.0001), was the most effective FoPL in helping participants identify the foods nutritional quality, overall and in each of the 12 countries. Differences between FoPLs regarding food choice modifications were smaller, but the effect of the Nutri-Score was slightly higher in eliciting healthier food choices overall compared with the RIs, followed by the Warning symbol, MTL and HSR.

Conclusions
These findings from an online experiment provide insights on the Nutri-Score's effectiveness in multiple European countries in the context of FoPL harmonization in Europe.

Key messages
The comparison of the effectiveness of front-of-pack labels highlighted the relative performance of various types of labels, the Nutri-Score showing a higher performance than other schemes. The higher performance of the Nutri-Score was identified for objective understanding and to a lesser extent food choices.
Co-designing a virtual community of practice (VCoP) for maternal and child health in Burkina Faso
Authors: Lapierre J , Ouellet M , Goyer-Pétrin G , Gagnon M-P , Dupéré S , Guillaumie L , Abdoulaye A , Côté A , Leblanc N , Uwineza V 
Published: October 2020

Abstract

Background
In Burkina Faso, maternity is a risk. Global Affairs Canada funded the initiative PASME-2 with World University Service of Canada, Laval University and Farm Radio International to improve maternal outcomes. A preventative program was co-developed. Phase 1 included to train the Health Ministry training coordinators. Phase 2 related to the training of nearly 100 health professionals. Phase 3 received funding from Social Sciences and Humanities Research Council in partnership with the Centre for International Cooperation in Health and Development and TIESS, a liaison and transfer expert in Québec, to support local teams towards sustainable practice changes.

Results
On the first objective, to describe the co-development of this living lab are presented. We share our perspective of the co-designing challenges, tools, and solutions. We will demonstrate the VCoP platform and environment. Method. A participative co-design approach, allowed the engagement of several stakeholders in the process. Results. Four workshops were organised. Seventeen maternal and child care health professionals took part in the initial 8-month development phase.

Results
Four steps of the six phases of Gusche innovation design are presented with associated products and results. Implementation challenges, critical decisions, role of face-to-face meetings, technology factors, digital literacy and solutions are presented.

Conclusions
Implementing a technology innovation in low income setting with limited access to the web and to technologies is a challenge. Its advantages are greater: access to evidenced-base care, facilitating professional development, creating a safe space and leading to emerging problem-solving collective solutions. Conceived as a capacitating environment (Sen) and supporting strength-based (Gottlieb) care through partnership, this VCoP becomes a driver of action to maintain preventative health competence and to share experiences and ways of knowing.

Key messages
The digital space crosses the borders and can contribute to human development and expansion of safe, evidenced-based and culturally appropriate professional practices. Working in partnerships, interprofessional and intersectoral, with public and community groups can create synergies that will unfold in greater health equity.
Financial risk protection of individuals with private health insurance
Authors: Blümel M , Achstetter K , Köppen J , Busse R 
Published: October 2020

Abstract

Background
Financial Protection is a key dimension of universal health coverage and health system performance assessment and is also monitored within the framework of the sustainable development goals. Analyses of financial hardship among people who have out-of-pocket (OOP) spending through the use of health services in Germany usually focus solely on households with statutory health insurance due to the peculiarities of private health insurance (PHI) data. This study aims to analyse financial protection among privately insured in Germany.

Methods
A cross-sectional survey was conducted in 2018 with 20,000 privately insured in Germany. The survey comprised questions on household net-income, OOP spending on health, unmet needs, perceived financial burden). Catastrophic expenditure was analysed and defined as share of households with OOP spending greater than 10% of household income. Further results on financial protection and access are based on descriptive analyses.

Results
A total of 3,601 participants (18.0%) completed the survey (58.6 years ± 14.6; 64.6% male). 82.2% of households reported OOP spending, mostly on OTC drugs, deductibles and medical aids. Median OOP spending was €300-499 per year. Average OOP spending as share of household income was 1.3% and 0.6% of households have catastrophic OOP spending. In total, 6.6% of respondents reported unmet needs due to financial barriers, of which 5.3% had no OOP spending. 11.2% of all respondents reported to feel strongly financially burdened by OOP spending with a gap between the lowest (26.2%) and highest income group (9.9%).

Conclusions
PHI insured have comparatively low OOP spending with less than 1% of households having catastrophic expenditures on health. However, 6.2% of respondents reported to forgo care due to financial reasons which supports the assumption that OOP payments can create a barrier to access. Unmet needs and financial burden are higher in lower income groups which raises concerns about equity.

Key messages
Financial protection is good among privately insured in Germany with only few households reporting catastrophic expenditures which indicates a broad and sufficient benefit coverage under PHI. Although out-of-pocket spending is low, privately insured perceive a strong financial burden (particularly in lower income groups) and face financial barriers to access care mirrored in forgone care.
Economic burden of noncommunicable diseases attributable to risk factors in the Russian Federation
Authors: Kontsevaya A , Myrzamatova A , Mukaneeva D , Balanova Y u , Khudyakov M , Drapkina O 
Published: October 2020

Abstract

Aim
to estimate the economic burden of major chronic noncommunicable diseases (NCDs) attributable to risk factors in the Russian Federation in 2016

Material and Methods
The following risk factors were included in the analysis: smoking, high alcohol intake, high salt intake, low intake of fresh vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension, which reliably have a causal relationship with major NCDs: cardiovascular diseases(CVD),type 2 diabetes, chronic obstructive pulmonary disease(COPD), cancer of 10 localizations. The relative risks (RR)of morbidity and mortality from major NCDs associated with risk factors are identified through a literature search. Based on the data on the prevalence of risk factors in the Russian population and RR, the population attributable risk (PAR)was calculated for each analyzed disease. Statistical analysis calculations using descriptive statistics methods were performed in the MSExcel 10.0 program.

Results
The largest burden from the four main NCDs is associated with hypertension - 10.9 billion€, which is equivalent to 1.01% of GDP. The next largest contribution to the burden from NCDs was the burden from obesity 7.6 billion€ 0.7% of GDP, smoking over 5.2 billion €, 0.49% of GDP and the low physical activity 3.4 billion€, 0.32% of GDP. Of all the analyzed risk factors, the least contribution to total costs in connection with NCDs was determined by the burden from high alcohol intake 1.1 billion€, 0.1% of GDP, due to the low prevalence of high alcohol intake in the Russian population.

Conclusions
In this study, for the first time, the assessment of the economic burden of risk factors by the share (contribution) to the morbidity and mortality of main NCDs (CVD, T2DM, COPD and 10 cancer localizations) in the Russian Federation for 2016 was performed. Such the significant economic burden is a strong argument for increasing investments in the prevention and treatment of risk factors of NCDs.

Key messages
In Russia the largest burden from the four main NCDs is associated with hypertension. Such the significant economic burden is a strong argument for increasing investments in the prevention and treatment of risk factors of NCDs.
Impact of financial incentives for primary care to give long acting reversible contraceptive advice
Authors: Ma R , Cecil E , French R , Bottle A , Saxena S 
Published: October 2020

Abstract

Background
Long acting reversible contraceptives (LARC) are cost-effective but uptake remains poor even in high income settings. In 2009/10, a pay-for-performance (P4P) scheme in the United Kingdom was introduced for primary care physicians to offer advice about LARC to women attending for contraceptive care. We examined the equity and impact of this scheme on LARC uptake and abortions

Methods
We examined records of women aged 13 to 54 years registered with a primary care practice in the UK Clinical Practice Research Datalink from 2004/05 to 2013/14. We used interrupted time series analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age, region and deprivation groups, before and after P4P was introduced in 2009/10.

Results
LARC uptake among women of all ages increased immediately after P4P with step change of 5.36 per 1,000 women (95% CI 5.26 to 5.45). Largest increase was in women aged 20 to 24 years (8.40, 8.34 to 8.47). NLHC uptake fell in all women with a step change of -22.9 (-24.5 to -21.2). Among LARC methods, contraceptive injection and implant had the greatest increase after P4P; step changes were 1.68 (1.67 to 1.70) and 1.64 (1.63 to 1.65) respectively. Abortion rates fell across all 12 regions in UK and in all women immediately after P4P with a step change of -2.28 (-2.99 to -1.57). The largest falls occurred in women aged 13 to 19 years (step change -5.04, -7.56 to -2.51) and women from the most deprived group (step change -4.40, -6.89 to -1.91).

Conclusions
Pay-for-performance scheme for primary care physicians to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion.
LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile.

Key messages
Pay-for-performance scheme for primary care practitioners to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion. LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile.
Out of pocket spending of deceased cancer patients in 5 European countries and Israel
Authors: Tur-Sinai A , Urban D , Bentur N 
Published: October 2020

Abstract

Background
Cancer imposes a substantial economic burden on society, health and social care systems, patients and their families. This study aims to examine the out-of-pocket spending of cancer patients in their last year of life, in six countries with health insurance systems that have a defined benefits package.

Methods
Data from SHARE and SHARE End-of-Life surveys, conducted between 2006 and 2015 among people aged 50+ were analyzed. Family members of deceased persons were interviewed in order to learn about the circumstances of their relative's death.

Results
This study found that out-of-pocket spending of cancer patients during their last year of life, in six developed countries with universal health insurance systems, is 4.5% on average of the total household income at that time. The results also show differences among the countries in out-of-pocket expenditures of the total household income: 2.2% in the Netherlands, 4.3% in Israel, 5% in Germany, 5.1% in Austria, 5.1% in Belgium and 8.2% in Switzerland. Whereas the out-of-pocket spending on nursing home care was 7.8% of the total household income in Switzerland, in the Netherlands and in Israel it was negligible. In contrast, the out-of-pocket spending for home care due to disability surged to 5.6% in Israel and 3.7% in Austria, whereas in other countries it was very low.

Conclusions
This is probably due to the split between the health and the social systems in Israel. The social security administration in Israel is responsible for financing personal care, and the patients have to apply for it themselves. Since the deterioration in functional ability of cancer patients might be quite rapid, many of them pay for professional assistance themselves, until they are approved as eligible for public funds, a process that may last a few weeks. This information is important to health and social policy makers, in order to better adapt the benefits package to the patients' needs.

Key messages
Cancer imposes a substantial economic burden during the last year of life. The economic burden varies across European countries with health insurance systems. Even countries with a universal benefits package take different approaches to prioritizing services and drugs for cancer care and leave some components of care to individual out-of- pocket payment.
Socioeconomic differences in metabolic syndrome remission in adults: mediation of health behaviors
Authors: Hoveling L A , Liefbroer A C , Bültmann U , Smidt N 
Published: October 2020

Abstract

Introduction
Metabolic syndrome (MetS) incidence strongly varies by socioeconomic status (SES). Each SES measure comprises different resources of an individual, including cultural, economic and social resources. To date, no studies have examined the SES - MetS remission relationship. Understanding the role of each SES measure for MetS remission could shed light on resources needed to reverse adverse health conditions. The aim is to longitudinally assess the associations between the SES measures years of education, household equivalent income and occupational prestige and remitted MetS and whether these associations are mediated by health behaviors, including physical activity, smoking, alcohol drinking and diet quality.

Methods
A subsample of the adult Lifelines Cohort Study, including 16,818 participants with MetS at baseline was used. MetS remission was measured at the second assessment (follow-up time 3.8 years) defined according to the NCEP-ATPIII criteria. Direct associations between SES, health behaviors and remitted MetS were estimated using multivariable logistic regression analyses. The mediating percentages of health behaviors explaining the associations between SES and remitted MetS were estimated using the Karlson-Holm-Breen method. Analyses were independent of age, sex, the other SES measures and follow-up time.

Results
At the second assessment MetS remitted for 42.7% of the participants. Education (OR 1.04, 99% CI: 1.02-1.06) and income (OR 1.01, 99% CI: 1.00-1.02) were associated with MetS remission, occupational prestige was not. Health behaviors (11.9%) only explained the association between education and MetS remission. For the explanation of the association between income and MetS remission, health behaviors played no role.

Conclusions
More education years increase MetS remission, mainly because higher educated are more likely to have healthier behaviors. Higher income increases MetS remission, regardless of the health behaviors.

Key messages
Education and income are positively associated with MetS remission. Health behaviors explain a relatively small part of the SES – MetS remission pathway.