An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been ...accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention.
In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics.
An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health-implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified.
The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions.
Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.
In Europe, health insurance arrangements are under reform. These arrangements redistribute collectively financed resources to ensure access to health care for all. Allocation of health services is ...historically based on medical needs, but use of other criteria, such as lifestyle, is debated upon. Does the general public also have preferences for conditional allocation? This depends on their opinions regarding deservingness. The aim of this study was to gain insight in those opinions, specifically by examining the perceived weight of different criteria in allocation decisions. Based on literature and expert interviews, we included 5 criteria in a discrete choice experiment: need, financial capacity, lifestyle, cooperation with treatment, and package/ premium choice. A representative sample of the Dutch population was invited to participate (n = 10 760). A total of 774 people accessed the questionnaire (7.2%), of whom 375 completed it (48.4%). Medical need was overall the most important criterion in determining deservingness (range β = 1.60). Perceived deservingness decreased if claimants had higher financial capacity (1.26) and unhealthier lifestyle (1.04), if their cooperation was less optimal (1.05), or if they had opted for less insurance coverage (0.56). However, preferences vary among respondents, in relation to demographic and ideological factors.
Reablement encourages older adults to do things themselves rather than having things done for them. To implement reablement in practice homecare staff needs the right knowledge, attitude, skills and ...support. This study evaluated the effectiveness of the “Stay Active at Home” reablement training program. A 12-month cluster-RCT was conducted, involving staff (n=313) and clients (n=264) from 10 homecare teams, five of which were trained. Effects were evaluated using data from accelerometers, physical performance tests, questionnaires and electronic patient records. No beneficial effects were observed in older adults for sedentary behavior; daily, physical, and psychological functioning; and falls. In homecare staff there were no statistically significant differences between study groups for self-efficacy and outcome expectations scores except for higher self-efficacy scores in more compliant staff (adjusted mean difference: 1.9 95% CI 0.1, 3.7). No differences were observed for any cost category except for domestic help costs in the intervention group (adjusted mean difference: €-173 95% CI -299, -50). The probability that “Stay Active at Home” is cost-effective compared to usual care at a willingness-to-pay of €20,000 was 19.7%/ daily minute of sedentary time averted, 19.2%/ percent of sedentary time averted as proportion of wake/wear time, and 5.9%/QALY gained, respectively. The reablement training program needs further development based on the lessons learned before wider implementation.
Abstract
Reablement encourages older adults to do things themselves rather than having things done for them. To implement reablement in practice homecare staff needs the right knowledge, attitude, ...skills and support. This study evaluated the effectiveness of the “Stay Active at Home” reablement training program. A 12-month cluster-RCT was conducted, involving staff (n=313) and clients (n=264) from 10 homecare teams, five of which were trained. Effects were evaluated using data from accelerometers, physical performance tests, questionnaires and electronic patient records. No beneficial effects were observed in older adults for sedentary behavior; daily, physical, and psychological functioning; and falls. In homecare staff there were no statistically significant differences between study groups for self-efficacy and outcome expectations scores except for higher self-efficacy scores in more compliant staff (adjusted mean difference: 1.9 95% CI 0.1, 3.7). No differences were observed for any cost category except for domestic help costs in the intervention group (adjusted mean difference: €-173 95% CI -299, -50). The probability that “Stay Active at Home” is cost-effective compared to usual care at a willingness-to-pay of €20,000 was 19.7%/ daily minute of sedentary time averted, 19.2%/ percent of sedentary time averted as proportion of wake/wear time, and 5.9%/QALY gained, respectively. The reablement training program needs further development based on the lessons learned before wider implementation.
Economic evaluations of the various interventions available for low back pain will help clinicians and policymakers to identify the most beneficial treatment. This chapter aims to evaluate the most ...cost-effective treatments for patients with non-specific low back pain. Pubmed, Embase and the Cochrane library were used to search for articles published from 1966 to July 2004 using a variety of keywords. References were checked to identify additional studies. The consensus health economic criteria (CHEC) list was used to assess the methodological quality of the studies. We found 17 studies; six of these concluded that the intervention of interest was superior to the control intervention. However, definite conclusions about the most cost-effective intervention could not be drawn because of the heterogeneity of interventions, controls and study populations. More high-quality economic evaluations are needed before such a conclusion can be made.
Context: Throughout Europe, the financial risks of health and long-term care are covered to varying degrees through models of national (health) insurance. Such insurance draws upon the principle of ...solidarity. Much is unknown on the solidarity-effects of reforms in national insurance schemes.Objective: To present an empirical analysis of the effects of recent reforms in national health insurance on solidarity in one country.Methods: We conducted a comparative analysis of the 2006 health care insurance reform and the 2015 long-term care insurance reform in the Netherlands. A multidimensional analytical framework of solidarity was developed to study the solidarity-effects of both reforms.Findings: Reforms of health care and long-term care insurance in the Netherlands had some solidarity effects, but they should not be overstated. We found evidence for increased and decreased solidarity. Health care insurance seems more ‘immune’ to reductions in solidarity than long-term care insurance.Limitations: The present case study involves reforms in the Netherlands. The solidarity framework is specifically designed for the study of solidarity-effects of reforms on national health and long-term care insurance. Effects on informal arrangements for care are beyond the scope of this study. More detailed and quantitative research is required to investigate how the reforms played out for specific groups, for instance the frail elderly, people with a disability and people with rare conditions. Similarly, long-term effects require further investigation.Implications: Given the limited scope of our analysis, more comparative research (including on an international scale) is required to develop systematic insight into the solidarity-effects of reforms in national health and long-term care insurance.
Decisions about clinical practice change, that is, which guidelines to adopt and how to implement them, can be made sequentially or simultaneously. Decision makers adopting a sequential approach ...first compare the costs and effects of alternative guidelines to select the best set of guideline recommendations for patient management and subsequently examine the implementation costs and effects to choose the best strategy to implement the selected guideline. In an integral approach, decision makers simultaneously decide about the guideline and the implementation strategy on the basis of the overall value for money in changing clinical practice. This article demonstrates that the decision to use a sequential v. an integral approach affects the need for detailed information and the complexity of the decision analytic process. More importantly, it may lead to different choices of guidelines and implementation strategies for clinical practice change. The differences in decision making and decision analysis between the alternative approaches are comprehensively illustrated using 2 hypothetical examples. We argue that, in most cases, an integral approach to deciding about change in clinical practice is preferred, as this provides more efficient use of scarce health-care resources.
Sexual health problems are not uncommon among young people in the Netherlands and finding the proper treatment for such problems is often challenging. More insight regarding young people's ...perceptions of sexuality and its associated problems is needed to improve both treatment and education. This qualitative study of 22 young people (aged 13 to 25 years) explored perceptions of sexuality and sexual health. The results show that sexuality is narrowly defined by young people, with focus clearly being placed on physical aspects of sexuality, and sexual intercourse in particular. Sexual problems are usually defined as physical or medical problems. The data show that participants had limited knowledge regarding sexual problems associated with sexual functioning. Schools, parents and culture all appear to play a role in perceptions of sexuality and sexual health. In their totality, the findings suggest that knowledge about the complexity of sexuality and sexual health is lacking among young people in the Netherlands. We recommend broader sexual health education programs in schools that include the discussion of multiple aspects of sexuality, including pleasure. We also suggest that parents take a more prominent role in educating their children about sexuality.
Purpose: To compare systematically the national and per capita estimates of the cost of epilepsy in different countries.
Methods: Studies for this literature review were selected by conducting a ...Medline literature search from January 1966 to March 2000. Key methodologic, country‐related, and monetary issues of the selected epilepsy cost studies were evaluated to compare their direct cost estimates and to explore their distribution. The results of the selected studies were made comparable by converting them with different types of conversion factors and expressing them as a proportion of the national expenditure on health care.
Results: Ten epilepsy cost studies were reviewed. The proportion of national health care expenditure on epilepsy shows a range of 0.12–1.12% or 0.12–1.05% depending on the type of conversion factor. The list of cost components included in the estimation of the direct costs of epilepsy differs from study to study. A comprehensive list is associated with a decrease in the contribution of drug and hospital costs to the total direct costs of epilepsy.
Conclusions: This study highlights the importance of studying the economic consequences of epilepsy and of interpreting the results on the international level. The results of epilepsy cost studies can provide insight into the distribution of the costs of epilepsy and the impact of epilepsy on the national expenditure on health care.
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