Systematic review of individual-level, community-level, and healthcare system-level factors contributing to socioeconomic differences in healthcare utilisation in OECD countries with universal health coverage

Objectives Countries with universal health coverage (UHC) strive for equal access for equal needs without users getting into financial distress. However, differences in healthcare utilisation (HCU) between socioeconomic groups have been reported in countries with UHC. This systematic review provides an overview individual-level, community-level, and system-level factors contributing to socioeconomic status-related differences in HCU (SES differences in HCU).Design Systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The review protocol was published in advance.Data sources Embase, PubMed, Web of Science, Scopus, Econlit, and PsycInfo were searched on 9 March 2021 and 9 November 2022.Eligibility criteria Studies that quantified the contribution of one or more factors to SES difference in HCU in OECD countries with UHC.Data extraction and synthesis Studies were screened for eligibility by two independent reviewers. Data were extracted using a predeveloped data-extraction form. Risk of bias (ROB) was assessed using a tailored version of Hoy’s ROB-tool. Findings were categorised according to level and a framework describing the pathway of HCU.Results Of the 7172 articles screened, 314 were included in the review. 64% of the studies adjusted for differences in health needs between socioeconomic groups. The contribution of sex (53%), age (48%), financial situation (25%), and education (22%) to SES differences in HCU were studied most frequently. For most factors, mixed results were found regarding the direction of the contribution to SES differences in HCU.Conclusions SES differences in HCU extensively correlated to factors besides health needs, suggesting that equal access for equal needs is not consistently accomplished. The contribution of factors seemed highly context dependent as no unequivocal patterns were found of how they contributed to SES differences in HCU. Most studies examined the contribution of individual-level factors to SES differences in HCU, leaving the influence of healthcare system-level characteristics relatively unexplored

From test to rest:Evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands

IntroductionThe COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands.MethodologyThis retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results.ResultsAmong the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result.DiscussionOur findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans

Broadband Meter-Wavelength Observations of Ionospheric Scintillation

Intensity scintillations of cosmic radio sources are used to study astrophysical plasmas like the ionosphere, the solar wind, and the interstellar medium. Normally these observations are relatively narrow band. With Low Frequency Array (LOFAR) technology at the Kilpisj\"arvi Atmospheric Imaging Receiver Array (KAIRA) station in northern Finland we have observed scintillations over a 3 octave bandwidth. ``Parabolic arcs'', which were discovered in interstellar scintillations of pulsars, can provide precise estimates of the distance and velocity of the scattering plasma. Here we report the first observations of such arcs in the ionosphere and the first broad-band observations of arcs anywhere, raising hopes that study of the phenomenon may similarly improve the analysis of ionospheric scintillations. These observations were made of the strong natural radio source Cygnus-A and covered the entire 30-250\,MHz band of KAIRA. Well-defined parabolic arcs were seen early in the observations, before transit, and disappeared after transit although scintillations continued to be obvious during the entire observation. We show that this can be attributed to the structure of Cygnus-A. Initial results from modeling these scintillation arcs are consistent with simultaneous ionospheric soundings taken with other instruments, and indicate that scattering is most likely to be associated more with the topside ionosphere than the F-region peak altitude. Further modeling and possible extension to interferometric observations, using international LOFAR stations, are discussed.Comment: 11 pages, 17 figure

Intersubject and intrasubject variability of potential plasma and urine metabolite and protein biomarkers in healthy human volunteers

A limited understanding of intersubject and intrasubject variability hampers effective biomarker translation from in vitro/in vivo studies to clinical trials and clinical decision support. Specifically, variability of biomolecule concentration can play an important role in interpretation, power analysis, and sampling time designation. In the present study, a wide range of 749 plasma metabolites, 62 urine biogenic amines, and 1,263 plasma proteins were analyzed in 10 healthy male volunteers measured repeatedly during 12 hours under tightly controlled conditions. Three variability components in relative concentration data are determined using linear mixed models: between (intersubject), time (intrasubject), and noise (intrasubject). Biomolecules such as 3-carboxy-4-methyl-5-propyl-2-furanpropanoate, platelet-derived growth factor C, and cathepsin D with low noise potentially detect changing conditions within a person. If also the between component is low, biomolecules can easier differentiate conditions between persons, for example cathepsin D, CD27 antigen, and prolylglycine. Variability over time does not necessarily inhibit translatability, but requires choosing sampling times carefully.Analytical BioScience

Optimized Trigger for Ultra-High-Energy Cosmic-Ray and Neutrino Observations with the Low Frequency Radio Array

When an ultra-high energy neutrino or cosmic ray strikes the Lunar surface a radio-frequency pulse is emitted. We plan to use the LOFAR radio telescope to detect these pulses. In this work we propose an efficient trigger implementation for LOFAR optimized for the observation of short radio pulses.Comment: Submitted to Nuclear Instruments and Methods in Physics Research Section

Clinical Heterogeneity of Duchenne Muscular Dystrophy (DMD): Definition of Sub-Phenotypes and Predictive Criteria by Long-Term Follow-Up

International audienceBACKGROUND: To explore clinical heterogeneity of Duchenne muscular dystrophy (DMD), viewed as a major obstacle to the interpretation of therapeutic trials METHODOLOGY/PRINCIPAL FINDINGS: A retrospective single institution long-term follow-up study was carried out in DMD patients with both complete lack of muscle dystrophin and genotyping. An exploratory series (series 1) was used to assess phenotypic heterogeneity and to identify early criteria predicting future outcome; it included 75 consecutive steroid-free patients, longitudinally evaluated for motor, respiratory, cardiac and cognitive functions (median follow-up: 10.5 yrs). A validation series (series 2) was used to test robustness of the selected predictive criteria; it included 34 more routinely evaluated patients (age>12 yrs). Multivariate analysis of series 1 classified 70/75 patients into 4 clusters with distinctive intellectual and motor outcomes: A (early infantile DMD, 20%): severe intellectual and motor outcomes; B (classical DMD, 28%): intermediate intellectual and poor motor outcome; C (moderate pure motor DMD, 22%): normal intelligence and delayed motor impairment; and D (severe pure motor DMD, 30%): normal intelligence and poor motor outcome. Group A patients had the most severe respiratory and cardiac involvement. Frequency of mutations upstream to exon 30 increased from group A to D, but genotype/phenotype correlations were restricted to cognition (IQ>71: OR 7.7, 95%CI 1.6-20.4, p6 at 8 yrs" with "normal or borderline mental status" reliably assigned patients to group C (sensitivity: 1, specificity: 0.94). These criteria were also predictive of "early infantile DMD" and "moderate pure motor DMD" in series 2. CONCLUSIONS/SIGNIFICANCE: DMD can be divided into 4 sub-phenotypes differing by severity of muscle and brain dysfunction. Simple early criteria can be used to include patients with similar outcomes in future therapeutic trials

The peculiar radio galaxy 4C 35.06: a case for recurrent AGN activity?

Using observations obtained with the LOw Fequency ARray (LOFAR), the Westerbork Synthesis Radio Telescope (WSRT) and archival Very Large Array (VLA) data, we have traced the radio emission to large scales in the complex source 4C 35.06 located in the core of the galaxy cluster Abell 407. At higher spatial resolution (~ 4″), the source was known to have two inner radio lobes spanning 31 kpc and a diffuse, low-brightness extension running parallel to them, offset by about 11 kpc (in projection). At 62 MHz, we detect the radio emission of this structure extending out to 210 kpc. At 1.4 GHz and intermediate spatial resolution (~ 30″), the structure appears to have a helical morphology. We have derived the characteristics of the radio spectral index across the source. We show that the source morphology is most likely the result of at least two episodes of AGN activity separated by a dormant period of around 35 Myr. The outermost regions of radio emission have a steep spectral index (α-1), similar to what is found in other clusters. The derived column density is NHI ~ 4 × 1020 cm-2 for a Tspin = 100 K. This detection supports the connection – already suggested for other restarted radio sources – between the presence of cold gas and restarting activity. The cold gas appears to be dominated by a blue-shifted component although the broad H I profile could also include gas with different kinematics. Understanding the duty cycle of the radio emission as well as the triggering mechanism for starting (or restarting) the radio-loud activity can provide important constraints to quantify the impact of AGN feedback on galaxy evolution. The study of these mechanisms at low frequencies using morphological and spectral information promises to bring new important insights in this field

Object manipulation and tool use in Nicobar long-tailed macaques (Macaca fascicularis umbrosus)

This is an accepted manuscript of an article published by Springer in International Journal of Primatology on 08/09/2020, available online: https://link.springer.com/article/10.1007%2Fs10764-020-00141-y The accepted version of the publication may differ from the final published version.Object manipulation and tool use by non-human primates have received considerable attention from primatologists and anthropologists, because of their broad implications for understanding the evolution of tool use in humans. To date, however, most of the studies on this topic have focused on apes, given their close evolutionary relationship with humans. In contrast, fewer studies on tool use and object manipulation have been conducted on monkeys. Documenting and studying object manipulation and tool use in species that are more distantly related to humans can provide a broader perspective on the evolutionary origins of this behaviour. We present a detailed description of toolaided behaviours and object manipulation by Nicobar long-tailed macaques ( Macaca fascicularis umbrosus ) living along the coastlines of Great Nicobar Island. We made observations from December 2018 to March 2019, using ad libitum and focal sampling methods. We observed behaviours related to object manipulation and tool use in six different behavioural contexts (foraging, hygiene, communication, play, selfdirected and self-hygiene behaviour) involving eight different types of objects, namely resonance rod, play object, rolling platform, scraping tool, dental groom, pounding substrate, leaves as grip pads and wipers, and stimulation tool. We observed that males were involved in tool use and object manipulation more frequently than females. Our results add to existing records of object manipulation, tool-use behaviour and tool variants displayed by non-human primates, showing that Nicobar macaques perform multiple and diverse tool-aided behaviours