Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries.

INTRODUCTION: It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries. METHODS: The SHARE dataset for individuals aged 50+ and their households, collected in 2010-2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model. RESULTS: We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure. DISCUSSION: Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases

Galectin-3 Deficiency Facilitates TNF-α-Dependent Hepatocyte Death and Liver Inflammation in MCMV Infection

Galectin-3 (Gal-3) has a role in multiple inflammatory pathways. Various, opposite roles of Gal-3 in liver diseases have been described but there are no data about the role of Gal-3 in development of hepatitis induced with cytomegalovirus infection. In this study we aimed to clarify the role of Gal-3 in murine cytomegalovirus (MCMV)-induced hepatitis by using Gal-3-deficient (Gal-3 KO) mice. Here we provide the evidence that Gal-3 has the protective role in MCMV-induced hepatitis. Enhanced hepatitis manifested by more inflammatory and necrotic foci and serum level of ALT, enhanced apoptosis and necroptosis of hepatocytes and enhanced viral replication were detected in MCMV-infected Gal-3 deficient mice. NK cells does not contribute to more severe liver damage in MCMV-infected Gal-3 KO mice. Enhanced expression of TNF-α in the hepatocytes of Gal-3 KO mice after MCMV infection, abrogated hepatocyte death, and attenuated inflammation in the livers of Gal-3 KO mice after TNF-α blockade suggest that TNF-α plays the role in enhanced disease in Gal-3 deficient animals. Treatment with recombinant Gal-3 reduces inflammation and especially necrosis of hepatocytes in the livers of MCMV-infected Gal-3 KO mice. Our data highlight the protective role of Gal-3 in MCMV-induced hepatitis by attenuation of TNF-α-mediated death of hepatocytes

Comparison of hydrodistillation (HD), microwave-assisted hydrodistillation (MHD) and supercritical fluid extraction (SFE) for the isolation of volatiles from chamomile flower

Chamomile flower (Matricariae flos) is a herbal drug used mainly because of antiphlogistic, spasmolytic and antimicrobial properties, which are related to the presence of volatile essential-oil constituents (α-bisabolol and its oxides, chamazulene, spiroethers) and non-volatile compounds, such as sesquiterpene lactones, flavonoids, and coumarins.                In the present work, we used hydrodistillation (HD; sample-to-solvent ratio 1:20, 2 h), microwave-assisted HD (MHD; sample-to-solvent ratio 1:20, 2 h, microwave power 180 W) and supercritical CO2 extraction (SFE; 40 °C, 100 bar, 3 h) to obtain isolates, from a commercially available chamomile flower tea. The composition of the isolates was analyzed using GC-MS. The obtained results of the relative content of the selected pharmacologically relevant constituents were as follows.                HD and MHD yielded 0.2% and 0.3% of isolates, respectively. A much higher yield was obtained in the case of SFE (3%). In HD and MHD isolates, which were qualitatively and quantitatively similar, oxygenated sesquiterpenes dominated (64.4-67.4%), with bisabolol oxides comprising 54.2-54.4% of the isolates. Among non-terpene constituents (17.0-19.9%), spiroethers were present with 10.0% and 11.7% of HD and MHD isolates, respectively. Chamazulene (4.8-4.9%) was the most abundant among sesquiterpene hydrocarbons (8.8-9.7%). On the other hand, non-terpene compounds (57.4%) were the most abundant class of constituents in SFE extract, and among them hydrocarbons comprised 45.0% of the extract, followed by 10.2% of spiroethers. Among the oxygenated sesquiterpenes (32.2%), SFE extract contained 25.8% of bisabolol oxides. In contrast to HD and MHD, SFE resulted in a low amount of chamazulene, but the extract contained 3.2% of valuable sesquiterpene lactones.                Having in mind that HD and MHD resulted in similar yields and compositions of the isolates, and that SFE gave a higher amount of the isolate with a unique composition, the choice of traditional vs modern technique for the preparation of chamomile isolates should be strongly dependent on the specific use of the final product and in that sense carefully evaluated

Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review

STUDY QUESTION: What are the direct costs of assisted reproductive technology (ART), and how affordable is it for patients in low- and middle-income countries (LMICS)? SUMMARY ANSWER: Direct medical costs paid by patients for infertility treatment are significantly higher than annual average income and GDP per capita, pointing to unaffordability and the risk of catastrophic expenditure for those in need. WHAT IS KNOWN ALREADY: Infertility treatment is largely inaccessible to many people in LMICs. Our analysis shows that no study in LMICs has previously compared ART medical costs across countries in international dollar terms (US$PPP) or correlated the medical costs with economic indicators, financing mechanisms, and policy regulations. Previous systematic reviews on costs have been limited to high-income countries while those in LMICs have only focussed on descriptive analyses of these costs. STUDY DESIGN SIZE DURATION: Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA), we searched PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, EconLit, PsycINFO, Latin American & Caribbean Health Sciences Literature, and grey literature for studies published in all languages from LMICs between 2001 and 2020. PARTICIPANTS/MATERIALS SETTING METHODS: The primary outcome of interest was direct medical costs paid by patients for one ART cycle. To gauge ART affordability, direct medical costs were correlated with the GDP per capita or average income of respective countries. ART regulations and public financing mechanisms were analyzed to provide information on the healthcare contexts in the countries. The quality of included studies was assessed using the Integrated Quality Criteria for Review of Multiple Study designs. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 4062 studies identified, 26 studies from 17 countries met the inclusion criteria. There were wide disparities across countries in the direct medical costs paid by patients for ART ranging from USD2109 to USD18 592. Relative ART costs and GDP per capita showed a negative correlation, with the costs in Africa and South-East Asia being on average up to 200% of the GDP per capita. Lower relative costs in the Americas and the Eastern Mediterranean regions were associated with the presence of ART regulations and government financing mechanisms. LIMITATIONS REASONS FOR CAUTION: Several included studies were not primarily designed to examine the cost of ART and thus lacked comprehensive details of the costs. However, a sensitivity analysis showed that exclusion of studies with below the minimum quality score did not change the conclusions on the outcome of interest. WIDER IMPLICATIONS OF THE FINDINGS: Governments in LMICs should devise appropriate ART regulatory policies and implement effective mechanisms for public financing of fertility care to improve equity in access. The findings of this review should inform advocacy for ART regulatory frameworks in LMICs and the integration of infertility treatment as an essential service under universal health coverage. STUDY FUNDING/COMPETING INTERESTS: This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). The authors declare no competing interests. TRIAL REGISTRATION NUMBER: This review is registered with PROSPERO, CRD42020199312

Funding mechanisms for health promotion in Europe:A lack of money or a lack of information?

PRO HEALTH 65+ : Health Promotion and Prevention of Risk – Action for Seniors PROJECT POLICY BRIEF

Physical activity on prescription schemes (PARS): do programme characteristics influence effectiveness? Results of a systematic review and meta-analyses

BACKGROUND: Physical activity on prescription schemes (PARS) are health promotion programmes that have been implemented in various countries. The aim of this study was to outline the differences in the design of PARS in different countries. This study also explored the differences in the adherence rate to PARS and the self-reported level of physical activity between PARS users in different countries. METHOD: A systematic literature review and meta-analyses were conducted. We searched PubMed and EBASCO in July 2015 and updated our search in September 2015. Studies that reported adherence to the programme and self-reported level of physical activity, published in the English language in a peer-reviewed journal since 2000, were included. The difference in the pooled adherence rate after finishing the PARS programme and the adherence rate before or during the PARS programme was 17% (95% CI 9% to 24%). The difference in the pooled physical activity was 0.93 unit score (95 CI −3.57 to 1.71). For the adherence rate, a meta-regression was conducted. RESULTS: In total, 37 studies conducted in 11 different countries met the inclusion criteria. Among them, 31 reported the adherence rate, while the level of physical activity was reported in 17 studies. Results from meta-analyses show that PARS had an effect on the adherence rate of physical activity, while the results from the meta-regressions show that programme characteristics such as type of chronic disease and the follow-up period influenced the adherence rate. CONCLUSIONS: The effects of PARS on adherence and self-reported physical activity were influenced by programme characteristics and also by the design of the study. Future studies on the effectiveness of PARS should use a prospective longitudinal design and combine quantitative and qualitative data. Furthermore, future evaluation studies should distinguish between evaluating the adherence rate and the self-reported physical activity among participants with different chronic diseases

Physical activity on prescription:moving slowly towards healthy ageing

PRO HEALTH 65+: Health Promotion and Prevention of Risk – Action for Seniors PROJECT POLICY BRIEF

Does household help prevent loneliness among the elderly? An evaluation of a policy reform in the Netherlands

Abstract Background Household help is a community intervention in the Netherlands. Its primary goal is to provide professional help in doing domestic work. A secondary goal of the intervention is to alleviate loneliness. In 2007, a major health care reform and budget cut changed household help. After the reform alleviating loneliness is no longer an aim of the intervention. In this study we evaluate the effects of the policy change in household help on loneliness among older adults in the Netherlands. Methods We use SHARE data collected during the period 2004–2013 to compare levels of loneliness among older adults in the Netherlands and those in 9 other European countries (Austria, Belgium, Germany, Denmark, Italy, France, Sweden, Spain and Switzerland). We use a synthetic control method (SCM) based on aggregate data. To check the robustness of our results we also apply a difference-in-differences (DiD) estimator that allows us to estimate the effects of policy changes using individual level data. Results In 2004, the prevalence of loneliness ranged between 6.5% in the Netherlands and 15.4% in Italy. Loneliness increased with time for all observed countries. The increase between 2004 and 2013 was highest in France − 30.2%, Italy – 33. 4% and Belgium – 25.0%. The level of loneliness among older adults in the Netherlands increased after 2011. However, it is still lower than in other countries. There was no statistical significant difference in age between waves (67.36 ± 13.7 before 2011 to 68.55 ± 9.24 after 2011, p = 0.01). Based on the DiD estimator, there is no statistically significant difference in the incidence of loneliness between older adults in the Netherlands and those in the control countries. Conclusion Our results do not suggest that the policy change and budget cut in 2007 on household help has had an effect on loneliness. In absolute numbers, the prevalence of loneliness has increased since 2011, however we find no evidence that this can be attributed to the policy change

Galectin-3 in inflammasome activation and primary biliary cholangitis development

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Primary biliary cholangitis (PBC) is a chronic inflammatory autoimmune liver disease characterized by inflammation and damage of small bile ducts. The NLRP3 inflammasome is a multimeric complex of proteins that after activation with various stimuli initiates an inflammatory process. Increasing data obtained from animal studies implicate the role of NLRP3 inflammasome in the pathogenesis of various diseases. Galectin-3 is a β-galactoside-binding lectin that plays important roles in various biological processes including cell proliferation, differentiation, transformation and apoptosis, pre-mRNA splicing, inflammation, fibrosis and host defense. The multilineage immune response at various stages of PBC development includes the involvement of Gal-3 in the pathogenesis of this disease. The role of Galectin-3 in the specific binding to NLRP3, and inflammasome activation in models of primary biliary cholangitis has been recently described. This review provides a brief pathogenesis of PBC and discusses the current knowledge about the role of Gal-3 in NLRP3 activation and PBC development