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Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya

Infectious Diseases of Poverty 2021年第4期10卷 18-32页

作者： Beatrice Kirubi Jane Ong'angto Peter Nguhiu knut lonnroth Aiban Rono Kristi Sidney-Annerstedt Department of Global Public Health Karolinska InstitutetStockholmSweden WHO Collaborating Centre for Tuberculosis and Social Medicine StockholmSweden The Health and Social Protection Action Research&Knowledge Sharing Network(SPARKS) StockholmSweden Centre for Respiratory Disease Research Kenya Medical Research InstituteNairobiKenya Health Economics Research Unit KEMRI-WellcomeTrust Research ProgramNairobiKenya Monitoring Evaluation&ResearchNational TuberculosisLeprosy and Lung Disease ProgramMinistry of HealthNairobiKenya

Background::Despite free diagnosis and treatment for tuberculosis(TB),the costs during treatment impose a significant financial burden on patients and their *** study sought to identify the determinants for cata-strophic costs among patients with drug-sensitive TB(DSTB)and their households in ***::The data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample(n=1071).Treatment related costs and productivity losses were *** costs exceeding 20%of household income were defined as catastrophic and used as the *** Poisson regression analysis was performed to measure the association between selected individual,household and disease characteristics and occurrence of catastrophic costs.A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were ***::The proportion of catastrophic costs among DSTB patients was 27%(n=294).Patients with catastrophic costs had higher median productivity losses,39 h[interquartile range(IQR):20-104],and total median costs of USD 567(IQR:299-1144).The incidence of catastrophic costs had a dose response with household *** poorest quintile was 6.2 times[95%confidence intervals(CI):4.0-9.7]more likely to incur catastrophic costs compared to the *** prevalence of catastrophic costs decreased with increasing household expenditure quintiles(proportion of catastrophic costs:59.7%,32.9%,23.6%,15.9%,and 9.5%)from the lowest quintile(Q1)to the highest quintile(Q5).Other determinants included hospitalization:prevalence ratio(PR)=2.8(95%CI:1.8-4.5)and delayed treatment:PR=1.5(95%CI:1.3-1.7).Protective factors included receiving care at a public health facility:PR=0.8(95%CI:0.6-1.0),and a higher body mass index(BMI):PR=0.97(95%CI:0.96-0.98).Pre TB expenditure,hospitalization and BMI were significant predictors in all sensitivity analysis ***::There are signif

关键词： Tuberculosis Health expenditure Income loss Social protection Kenya

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Evaluating the yield of systematic screening for tuberculosis among three priority groups in Ho Chi Minh City,Viet Nam

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Infectious Diseases of Poverty 2020年第6期9卷 16-28页

作者： Luan Nguyen Quang Vo Andrew James Codlin Rachel Jeanette Forse NgaThuy Nguyen Thanh Nguyen Vu Giang Truong Le Vinh Van Truong Giang Chau Do Ha Minh Dang Lan Huu Nguyen Hoa Binh Nguyen Nhung Viet Nguyen Jens Levy knut lonnroth SBertel Squire Maxine Caws Friends for International TB Relief 68B Nguyen Van Troi8Phu NhuanHo Chi Minh CityViet Nam Interactive Research and Development Ho Chi Minh CityViet Nam Ho Chi Minh City Public Health Association Ho Chi Minh CityViet Nam Pham Ngoc Thach Hospital Ho Chi Minh CityViet Nam National Lung Hospital Ha NoiViet Nam KNCV Tuberculosefonds The HagueThe Netherlands Department of Global Public Health Karolinska InstitutetStockholmSweden Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK Birat Nepal Medical Trust LazimpatKathmanduNepal

Background: In order to end tuberculosis(TB),it is necessary to expand coverage of TB care services,including systematic screening ***,more evidence is needed for groups among whom systematic screening is only conditionally recommended by the World Health *** study evaluated concurrent screening in multiple target groups using community health workers(CHW).Methods:: In our two-year intervention study lasting from October 2017 to September 2019,CHWs in six districts of Ho Chi Minh City,Viet Nam verbally screened three urban priority groups:(1)household TB contacts;(2)close TB contacts;and(3)residents of urban priority areas without clear documented exposure to TB including hotspots,boarding homes and urban *** persons were referred for further screening with chest radiography and follow-on testing with the Xpert MTB/RIF *** individuals with normal or without radiography results were tested on smear *** described the TB care cascade and characteristics for each priority group,and calculated yield and number needed to ***,we fitted a mixed-effect logistic regression to identify the association of these target groups and secondary patient covariates with TB treatment ***: We verbally screened 321020 people including 24232 household contacts,3182 social and close contacts and 293606 residents of urban priority *** resulted in 1138 persons treated for TB,of whom 85 were household contacts,39 were close contacts and 1014 belonged to urban priority area *** yield of active TB in these groups was 351,1226 and 345 per 100000,respectively,corresponding to numbers needed to screen of 285,82 and *** fitted model showed that close contacts[adjusted odds ratio(aOR)=2.07;95%CI:1.38–3.11;P<0.001]and urban priority area residents(aOR=2.18;95%CI:1.69–2.79;P<0.001)had a greater risk of active TB than household ***: The study detected a large number of un

关键词： Case detection Tuberculosis Active case finding Urban Viet nam

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Dose-response associations,physical activity intensity and mortality risk:A narrative review

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Journal of Sport and Health Science 2024年第1期13卷 24-29页

作者： Ulf Ekelund Miguel Adriano Sanchez-Lastra knut Eirik Dalene Jakob Tarp Department of Sport Medicine Norwegian School of Sport SciencesOslo 0806Norway Department of Chronic Diseases Norwegian Institute of Public HealthOslo 0213Norway Department of Special Didactics Faculty of Education and Sports SciencesUniversity of VigoPontevedra 36005Spain Well-Move Research Group Galicia-Sur Health Research Institute(SERGAS-UVIGO)Vigo 36213Spain

Physical activity is consistently associated with reduced mortality,decreased risk for non-communicable diseases,and improved mental health in observational *** controlled trials and observational Mendelian randomization studies support causal links between physical activity and health ***,the scarcity of evidence from randomized controlled trials,along with their inherent challenges like exposure contrasts,healthy volunteer biases,loss to follow-up,and limited real-world dose-response data,warrants a comprehensive *** review advocates synthesizing insights from diverse study designs to better understand the causal relationship between physical activity,mortality risk,and other health ***,it summarizes recent research since the publication of current physical activity *** observational studies utilizing device-measured physical activity underscore the importance of every minute of activity and suggest that all intensity levels confer health benefits,with vigorous-intensity potentially requiring lower volumes for substantial *** guidelines,informed by device-measured physical activity studies,may offer refined age-specific recommendations,emphasize vigorous-intensity physical activity,and include daily step counts as a simple,easily assessable metric using commercial wearables.

关键词： Accelerometers Non-communicable diseases Public health Sedentary behavior

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The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

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Infectious Diseases of Poverty 2019年第6期8卷 61-75页

作者： Suman Chandra Gurung Kritika Dixit Bhola Rai Maxine Caws Puskar Raj Paudel Raghu Dhital Shraddha Acharya Gangaram Budhathoki Deepak Malla Jens W.Levy Job van Rest knut lonnroth Kerri Viney Andrew Ramsay Tom Wingfield Buddha Basnyat Anil Thapa Bertie Squire Duolao Wang Gokul Mishra Kashim Shah Anil Shrestha Noemia Teixeira de Siqueira-Filha Birat Nepal Medical Trust KathmanduNepal Department of Clinical Sciences Liverpool School of Tropical MedicineLiverpoolUK KNCV Tuberculosis Foundation The HagueNetherlands Department of Public Health Sciences Karolinska InstitutetStockholmSweden Research School of Population Health Australian National UniversityCanberraAustralia University of St Andrews St AndrewsUK University of Liverpool LiverpoolUK Oxford University Clinical Research Unit KathmanduNepal National Tuberculosis Centre BhaktapurNepal Nick Simons Institute LalitpurNepal Institute for Health Technology Assessment Porto AlegreBrazil

Background:The World Health Organization(WHO)End TB Strategy has established a milestone to reduce the number of tuberculosis(TB)-affected households facing catastrophic costs to zero by *** role of active case finding(ACF)in reducing patient costs has not been determined *** study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding(PCF),and to determine the prevalence and intensity of patient-incurred catastrophic costs in ***:The study was conducted in two districts of Nepal:Bardiya and Pyuthan(Province No.5)between June and August *** hundred patients were included in this study in a 1:1 ratio(PCF:ACF,25 consecutive ACF and 25 consecutive PCF patients in each district).The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical *** costs were calculated based on the proportion of patients with total costs exceeding 20%of their annual household *** intensity of catastrophic costs was calculated using the positive overshoot *** chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and ***,the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of ***:Ninety-nine patients were interviewed(50 ACF and 49 PCF).Patients diagnosed through ACF incurred lower costs during the pre-treatment period(direct medical:USD 14 vs USD 32,P=0.001;direct non-medical:USD 3 vs USD 10,P=0.004;indirect,time loss:USD 4 vs USD 13,P<0.001).The cost of the pre-treatment and intensive phases combined was also lower for direct medical(USD 15 vs USD 34,P=0.002)and non-medical(USD 30 vs USD 54,P=0.022)costs among ACF *** prevalence of catastrophic direct costs was lower for ACF patients for all thresholds.A lower intensity of catastrophic costs was also documented for ACF patients,altho

关键词： Tuberculosis Case finding Cost Catastrophic cost Patient-incurred cost Nepal

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Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes:Cross-country comparison of cohort studies

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Journal of Sport and Health Science 2024年第2期13卷 212-221页

作者： Jakob Tarp Mengyun Luo Miguel Adriano Sanchez-Lastra knut Eirik Dalene Borja del Pozo Cruz Mathias Ried-Larsen Reimar Wernich Thomsen Ulf Ekelund Ding Ding Department of Clinical Epidemiology Aarhus University&Aarhus University HospitalAarhus 8200Denmark Prevention Research Collaboration Sydney School of Public HealthThe University of SydneyCamperdownNSW 2006Australia Charles Perkins Centre the University of SydneyCamperdownNSW 2050Australia Department of Sports Medicine Norwegian School of Sports SciencesOslo 0806Norway Department of Special Didactics Faculty of Education and Sports SciencesUniversity of VigoPontevedra 36005Spain Well-Move Research Group Galicia Sur Health Research Institute(IIS Galicia Sur)SERGAS-UVIGOVigo 36213Spain Department of Chronic Diseases Norwegian Institute of Public HealthOslo 0473Norway Centre for Active and Healthy Ageing Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdense 5230Denmark Faculty of Education University of CadizCadiz 11519Spain Biomedical Research and Innovation Institute of Cadiz(INiBICA)Research Unit Puerta del Mar University HospitalUniversity of CadizCadiz 11009Spain The Centre of Inflammation and Metabolism&the Centre for Physical Activity Research RigshospitaletUniversity of CopenhagenCopenhagen 2100Denmark Department of Sports Science and Clinical Biomechanics University of Southern DenmarkOdense 5230Denmark

Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 ***:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and *** leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national ***:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response *** below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese *** with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 ***-time PA above current recom

关键词： Complications Epidemiology Exercise Prevention

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From EBIT to SEBIT(Sustainable EBIT):Sustainable Performance Accounting(SPA)Using the Example of CO_(2) Accounting

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Journal of Modern Accounting and Auditing 2024年第2期20卷 49-71页

作者： knut Henkel Jenny Lay-Kumar Christian Hiß University of Applied Sciences Emden/Leer EmdenGermany Regionalwert Research gGmbH LeipzigGermany Agriculture Food&Beverages sector writing teamLeipzigGermany Regionalwert Leistungen GmbH Freiburg Br.Germany

Corporate sustainability reporting has become increasingly important in recent ***,conventional approaches reach their limits when it comes to quantifying and measuring the actual sustainability performance of a *** article presents a new approach:Sustainable Performance Accounting(SPA),which is based on an extension of bookkeeping by including ESG *** enables companies to systematically measure and manage their sustainability *** article provides an overview of the basics of SPA methodology and uses a comprehensive example showing how SPA can be implemented in *** article is aimed at interested readers from science and practice as well as decision-makers who are interested in future-oriented sustainability reporting.

关键词： CO_(2)accounting CO_(2)emissions CSRD ESG(Environmental Social Governance) ESG bookkeeping ESG provision ESG asset ESRS integrated financial reporting internalisation of external effects connectivity monetisation of ESG issues sustainability sustainability indicators negative emissions sequestration performance Sustainable Performance Accounting(SPA)

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Between Early Literary Modernism and Contemporary Post-Postmodernism——Jan Kjrstad Rewrites knut Hamsun’s Novel Hunger 100 Years Later

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外国文学研究 2005年第3期27卷 54-60页

作者： knut Brynhildsvoll professoranddirectoroftheCentreforIbsenStudies UniversityofOslo.

The article is a comparative study of knut Hamsun’s novel Hunger (1890) and Jan Kjrstad’s novel The Brink (1990), focusing on similar motives, topics and references from the point of view of early modernism and post-postmodernism. It sheds light on aesthetic problems concerning how to deal with existential and metaphysical questions viewed against the background of changing historical and philosophical experiences and new ways of poetic expression. The article points out the resemblances and differences between the novels and shows how two of the front figures of modern Scandinavian literature meet the challenges of renewing the traditional forms of writing.

关键词： Between and

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Is convenience really king? Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam: a longitudinal patient cost study

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贫困所致传染病(英文) 2024年第2期13卷 17-28页

作者： Nguyen Hoa Binh Quang Vo Luan Nguyen Forse Rachel Jeanette Wiemers Anja Maria Christine Huynh Huy Ba Dong Thuy Thi Thu Phan Yen Thi Hoang Creswell Jacob Dang Thi Minh Ha Nguyen Lan Huu Shedrawy Jad L?nnroth knut Nguyen Tuan Dinh Van Dinh Luong Annerstedt Kristi Sidney Codlin Andrew James National Lung Hospital Ha Noi Viet Nam Friends for International TB Relief Ha Noi Viet Nam Department of Global Public Health WHO Collaboration Centre On Tuberculosis and Social Medicine Karolinska Institute Stockholm Sweden Stop TB Partnership Geneva Switzerland Pham Ngoc Thach Hospital Ho Chi Minh City Viet Nam

Background In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private *** Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate *** The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578;P=0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313;P=0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164;P<0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%;P=0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio [(aOR=13.71; 95% confidence interval (CI): 1.36–138.14;P=0.026], unemployment during treatment (aOR=10.86; 95%CI: 2.64–44.60;P<0.001) and experiencing TB-related stigma (aOR=37.90; 95%CI: 1.72–831.73;P=0.021).Conclusions Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the

关键词： Tuberculosis Patient cost Catastrophic cost Private sector Comparative analysis Viet Nam

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The Claim of the Ideal: Ethics in Ibsen′s Dramas

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外国文学研究 2005年第1期27卷 12-17页

作者： knut Brynhildsvoll the Centre for Ibsen Studies University Oslo

这是一组专题论文 ,由六篇论文组成 ,分别从不同的视角讨论了文学伦理学批评。聂珍钊教授从总体上对文学伦理学批评的起源、方法、内涵、思想基础、适用范围、实用价值和现实意义进行了论述。克努特教授以易卜生的戏剧为例 ,不仅讨论了... 详细信息

这是一组专题论文 ,由六篇论文组成 ,分别从不同的视角讨论了文学伦理学批评。聂珍钊教授从总体上对文学伦理学批评的起源、方法、内涵、思想基础、适用范围、实用价值和现实意义进行了论述。克努特教授以易卜生的戏剧为例 ,不仅讨论了易卜生戏剧中的伦理道德问题 ,而且还就文学伦理学发表了自己的重要意见。王宁教授把生态批评同文学伦理学批评结合在一起 ,为我们提供了这种批评同其它批评相结合的范例。刘建军教授以人对自身认识的发展所经历的三个时期为基础 ,用比较的和多学科的观点对文学伦理学批评作了进一步阐释。乔国强教授的论文在一个广阔的思想空间里 ,对文学伦理学批评的定义、思想与理论基础 ,对作家、作品以及读者的价值取向等方面深入阐释了自己的学术见解。邹建军教授从文学伦理学批评的三维指向讨论了它的历史价值、现实意义和方法论启示。这些论文企图说明 ,在目前中国的文学批评出现伦理道德价值缺位的时候 ,我们的文学批评应该肩负起道德责任 ,以实现文学伦理道德价值的回归 ,而文学伦理学批评就是达到这一目标的重要途径。

关键词：易卜生戏剧评论道德观道德规范

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Limitations of Freedom in Henrik Ibsen’s Dramas

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外国文学研究 2005年第5期27卷 16-21页

作者： knut Brynhildsvoll Central areas of research are Nordic and Germanic literature from the Romantic Period to Modernism and Post Modernism with an emphasison research ofnovels drama and moderntheories of literature

The article deals with some problems concerning the delimination of individual freedom in Ibsen’s dramas with a special focus on the period after his two philosophical youth dramas Brand and Peer Gynt, hereby emphasising the well known conflicts between will and determination, wish and abilities, rebellion and submission etc. Ibsen deals with this basic conflicts in the realms of marriage, profession and public life. The article intend to reconstruct important parts of the philosophical and socio-cultural context in which the problems of confined freedom are dealt with.

关键词：易卜生国际学术研讨会挪威 2005年文学研究

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