Development of Voluntary Private Health Insurance in Nordic Countries - An Exploratory Study on Country-specific Contextual Factors

The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors

Evaluation of infectivity and transmission of different Asian foot-and-mouth disease viruses in swine

Most isolates of foot-and-mouth disease virus (FMDV) display a broad host range. Since the late 1990s, the genetic lineage of PanAsia topotype FMDV serotype O has caused epidemics in the Far East, Africa, the United Kingdom, France, the Netherlands, and numerous other countries throughout Europe and Asia. In contrast, there are several FMDV isolates that exhibit a more restricted host range. A Cathay topotype isolate of FMDV serotype O from the 1997 epizootic in Taiwan (O/TAW/97) demonstrated restricted host specificity, only infecting swine. Methods used to evaluate infectivity and pathogenicity of FMDV isolates in cattle are well-documented, but there has been less progress studying transmission and pathogenicity of FMDV isolates in pigs. In previous studies designed to examine pathogenicity, various chimeric viruses derived from O/TAW/97 were intradermally inoculated in the heel bulb of pigs. Subsequent quantitative scoring of disease and evaluation of virus released into nasal secretions and blood was assessed. Here we prove the usefulness of this method in direct and contact inoculated pigs to evaluate infectivity, pathogenicity and transmission of different Asian FMDV isolates. Virus strains within the Cathay topotype were highly virulent in swine producing a synchronous disease in inoculated animals and were efficiently spread to in-contact naive pigs, while virus strains from the PanAsia topotype displayed more heterogeneous properties

Evolutionary and network analysis of virus sequences from infants infected with an Australian recombinant strain of human parechovirus type 3

We present the near complete virus genome sequences with phylogenetic and network analyses of potential transmission networks of a total of 18 Australian cases of human parechovirus type 3 (HPeV3) infection in infants in the period from 2012–2015. Overall the results support our previous finding that the Australian outbreak strain/lineage is a result of a major recombination event that took place between March 2012 and November 2013 followed by further virus evolution and possibly recombination. While the nonstructural coding region of unknown provenance appears to evolve significantly both at the nucleotide and amino acid level, the capsid encoding region derived from the Yamagata 2011 lineage of HPeV3 appears to be very stable, particularly at the amino acid level. The phylogenetic and network analyses performed support a temporal evolution from the first Australian recombinant virus sequence from November 2013 to March/April 2014, onto the 2015 outbreak. The 2015 outbreak samples fall into two separate clusters with a possible common ancestor between March/April 2014 and September 2015, with each cluster further evolving in the period from September to November/December 2015

OSSOS XXV: Large Populations and Scattering-Sticking in the Distant Transneptunian Resonances

There have been 77 TNOs discovered to be librating in the distant transneptunian resonances (beyond the 2:1 resonance, at semimajor axes greater than 47.7~AU) in four well-characterized surveys: the Outer Solar System Origins Survey (OSSOS) and three similar prior surveys. Here we use the OSSOS Survey Simulator to measure their intrinsic orbital distributions using an empirical parameterized model. Because many of the resonances had only one or very few detections, $j$:$k$ resonant objects were grouped by $k$ in order to have a better basis for comparison between models and reality. We also use the Survey Simulator to constrain their absolute populations, finding that they are much larger than predicted by any published Neptune migration model to date; we also find population ratios that are inconsistent with published models, presenting a challenge for future Kuiper Belt emplacement models. The estimated population ratios between these resonances are largely consistent with scattering-sticking predictions, though further discoveries of resonant TNOs with high-precision orbits will be needed to determine whether scattering-sticking can explain the entire distant resonant population or not.Comment: Accepted for publication in Planetary Sciences Journal (PSJ

OSSOS: XIII. Fossilized Resonant Dropouts Tentatively Confirm Neptune's Migration was Grainy and Slow

The migration of Neptune's resonances through the proto-Kuiper belt has been imprinted in the distribution of small bodies in the outer Solar System. Here we analyze five published Neptune migration models in detail, focusing on the high pericenter distance (high-q) trans-Neptunian Objects (TNOs) near Neptune's 5:2 and 3:1 mean-motion resonances, because they have large resonant populations, are outside the main classical belt, and are relatively isolated from other strong resonances. We compare the observationally biased output from these dynamical models with the detected TNOs from the Outer Solar System Origins Survey, via its Survey Simulator. All of the four new OSSOS detections of high-q non-resonant TNOs are on the Sunward side of the 5:2 and 3:1 resonances. We show that even after accounting for observation biases, this asymmetric distribution cannot be drawn from a uniform distribution of TNOs at 2sigma confidence. As shown by previous work, our analysis here tentatively confirms that the dynamical model that uses grainy slow Neptune migration provides the best match to the real high-q TNO orbital data. However, due to extreme observational biases, we have very few high-q TNO discoveries with which to statistically constrain the models. Thus, this analysis provides a framework for future comparison between the output from detailed, dynamically classified Neptune migration simulations and the TNO discoveries from future well-characterized surveys. We show that a deeper survey (to a limiting r-magnitude of 26.0) with a similar survey area to OSSOS could statistically distinguish between these five Neptune migration models.Comment: Accepted for publication in the Astronomical Journa

OA phenotypes, rather than disease stage, drive structural progression – identification of structural progressors from 2 phase III randomized clinical studies with symptomatic knee OA

SummaryBackground/PurposeThe aim of this study was to identify key characteristics of disease progression through investigation of the association of radiographic progression over two years with baseline Joint Space Width (JSW), Kellgren–Lawrence (KL) grade, Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, Joint Space Narrowing (JSN), and BMI.MethodsData from 2206 subjects (4390 knees) were combined for this post-hoc analysis of two randomized, double-blind, multi-center, placebo-controlled phase III trials (NCT00486434 and NCT00704847) that evaluated the efficacy and safety of 2-years treatment with oral salmon calcitonin of subjects with painful knee osteoarthritis (OA).ResultsThere was a clear positive and significant correlation between KL grade and WOMAC pain and total WOMAC, albeit the variance in pain measures was from min-to-max for all KL categories, emphasizing the heterogeneity of this patient population and pain perception. 32% of target knees did not progress, and only 51% had changes over minimum significant change (MSC). BMI, KL-Score and WOMAC pain was diagnostic, but only KL-score and pain had prognostic value, albeit pain in a non-linear manner.ConclusionThese data clearly describe significant associations between KL grade, JSW, pain and BMI in patients with symptomatic knee OA. KL grade, BMI and WOMAC pain were diagnostically associated with OA based on JSW but only KL-score and pain in a non-linier fashion was prognostic. 50% of patients did not progress more than MSC, highlighting the importance for identification of structural progressors and the phenotypes associated with these. These results suggest that disease phenotypes, rather than disease status, are responsible for disease progression

OSSOS. V. Diffusion in the Orbit of a High-perihelion Distant Solar System Object

We report the discovery of the minor planet 2013 SY$_{99}$, on an exceptionally distant, highly eccentric orbit. With a perihelion of 50.0 au, 2013 SY$_{99}$'s orbit has a semi-major axis of $730 \pm 40$ au, the largest known for a high-perihelion trans-Neptunian object (TNO), well beyond those of (90377) Sedna and 2012 VP$_{113}$. Yet, with an aphelion of $1420 \pm 90$ au, 2013 SY$_{99}$'s orbit is interior to the region influenced by Galactic tides. Such TNOs are not thought to be produced in the current known planetary architecture of the Solar System, and they have informed the recent debate on the existence of a distant giant planet. Photometry from the Canada-France-Hawaii Telescope, Gemini North and Subaru indicate 2013 SY$_{99}$ is $\sim 250$ km in diameter and moderately red in colour, similar to other dynamically excited TNOs. Our dynamical simulations show that Neptune's weak influence during 2013 SY$_{99}$'s perihelia encounters drives diffusion in its semi-major axis of hundreds of astronomical units over 4 Gyr. The overall symmetry of random walks in semi-major axis allow diffusion to populate 2013 SY$_{99}$'s orbital parameter space from the 1000-2000 au inner fringe of the Oort cloud. Diffusion affects other known TNOs on orbits with perihelia of 45 to 49 au and semi-major axes beyond 250 au, providing a formation mechanism that implies an extended population, gently cycling into and returning from the inner fringe of the Oort cloud.Comment: First reviewer report comments incorporated. Comments welcom