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Lyme borreliosis (LB) is an important tick-borne disease which can cause a broad range of symptoms mainly affecting the skin, the nervous system and the joints. This study aims to estimate the incidence of the different clinical manifestations of LB in Belgium. The incidence of erythema migrans (EM) was estimated through the network of sentinel general practices at 97.6/100,000 inhabitants (uncertainty interval [UI] 82.0–113.0) for the period 2015–2017. This result was used to estimate the incidence of other LB manifestations based on their proportional distribution (ratios) to EM reported in the neighboring countries of Belgium. To estimate these ratios, we performed a systematic review of studies published between February 1, 2008 and January 31, 2018 and pooled the results using a random effects meta-analysis. Six studies were retained in the systematic review, and the meta-analysis estimated the occurrence ratios for Lyme neuroborreliosis/EM, Lyme arthritis/EM and other manifestations/EM at 0.024 (95% confidence interval [CI] 0.016–0.037), 0.022 (95% CI 0.020–0.024) and 0.014 (95% CI 0.012–0.016) respectively. Applying these ratios to the EM incidence in Belgium resulted in an incidence estimation of 2.4/100,000 inhabitants (95% UI 1.5–3.7) for Lyme neuroborreliosis, 2.1/100,000 (95% UI 1.7–2.6) for Lyme arthritis and 1.4/100,000 (95% UI 1.1–1.7) for other less frequent manifestations. Some of these LB manifestations, other than EM, are more severe, hence these estimates are essential to assess the health burden and economic cost of LB which would be highly relevant for patients, healthcare providers and policymakers. As both over- and underestimation of different clinical LB manifestations remain possible due to characteristics of the primary surveillance systems and the disease itself, future studies to validate these estimates would be of great value.

Highlights\ud •Tuberculosis (TB)-related stigma is an important social determinant of health that can impact health-seeking practices and illness management.\ud •Much research on TB-related stigma has been conducted in high incidence countries.\ud •This study aimed to systematically map out the research in low incidence countries.\ud •Few studies included stigma as a substantive topic; only one study aimed to reduce stigma.\ud •Both TB control programmes and media reporting were implicated in the production of stigma.\ud •Few studies theorized how stigma intersects with the social and structural determinants of health.\ud •Future interventions to reduce stigma would benefit from a stronger theoretical underpinning in relation to stigma and the intersection with the social determinants.\ud \ud Summary\ud Tuberculosis (TB)-related stigma is an important social determinant of health. Research generally highlights how stigma can have a considerable impact on individuals and communities, including delays in seeking health care and adherence to treatment. There is scant research into the assessment of TB-related stigma in low incidence countries. This study aimed to systematically map out the research into stigma. A particular emphasis was placed on the methods employed to measure stigma, the conceptual frameworks used to understand stigma, and whether structural factors were theorized. Twenty-two studies were identified; the majority adopted a qualitative approach and aimed to assess knowledge, attitudes, and beliefs about TB. Few studies included stigma as a substantive topic. Only one study aimed to reduce stigma. A number of studies suggested that TB control measures and representations of migrants in the media reporting of TB were implicated in the production of stigma. The paucity of conceptual models and theories about how the social and structural determinants intersect with stigma was apparent. Future interventions to reduce stigma, and measurements of effectiveness, would benefit from a stronger theoretical underpinning in relation to TB stigma and the intersection between the social and structural determinants of health.

The 1984 Bhopal accident in India resulted in severe consequences with more than a thousand people dying in the immediate vicinity of the Union Carbide facility. After this tragedy, the implementation of landuse and zoning restrictions around hazardous installations got accepted worldwide as an important strategy reducing consequences from potential industrial accidents. Many European countries have already formulated specific landuse planning policies taking industrial risks into account. However, till date India is yet to effectively employ risk assessment techniques for landuse planning decisions around industrial clusters, as well as the relevant acceptability or tolerability criteria are yet to be formulated. In this paper, we have applied the classical quantitative risk assessment method to map cumulative risk levels arising from a number of hazardous installations located in Haldia, a densely populated area where several industrial plants storing and processing dangerous substances are located. The risk maps were prepared using common GIS tools and functions, and their sensitivity to various factors ascertained using uncertainty analysis techniques. Through the analysis of some reference plants, the aim of the paper is to underline the current difficulties an analyst has to face to determine confident risk maps as a basis for planning the uses of land due to deficiencies in the Indian legislation and the lack of guidelines. (C) 2015 Elsevier Ltd. All rights reserved.

We studied short-term changes in macrozoobenthos in a 20. m deep borrow pit. A boxcorer was used to sample macrobenthic infauna and a bottom sledge was used to sample macrobenthic epifauna. Sediment characteristics were determined from the boxcore samples, bed shear stress and near-bed salinity were estimated with a hydrodynamic model. Two years after the cessation of sand extraction, macrozoobenthic biomass increased fivefold in the deepest areas. Species composition changed significantly and white furrow shell (Abra alba) became abundant. Several sediment characteristics also changed significantly in the deepest parts. Macrozoobenthic species composition and biomass significantly correlated with time after cessation of sand extraction, sediment and hydrographical characteristics. Ecosystem-based landscaped sand bars were found to be effective in influencing sediment characteristics and macrozoobenthic assemblage. Significant changes in epifauna occurred in deepest parts in 2012 which coincided with the highest sedimentation rate. We recommend continuing monitoring to investigate medium and long-term impacts.

Despite substantial advances in the management of cardiovascular disease, it remains a major cause of morbidity and mortality worldwide. Globally, cardiovascular disease is expected to account for over 23 million deaths by the year 2030, mostly attributable to an increasing incidence in low and middle income countries. Within the World Health Organisation European Region, cardiovascular disease accounts for over 4 million deaths per year. However, this rate varies considerably between European countries with evidence from observational databases to suggest that mortality rates from cardiovascular disease are higher in countries of Central and Eastern Europe, Central Asia, Finland and Malta.

The transmissible nature of communicable diseases is what sets them apart from other diseases modeled by health economists. The probability of a susceptible individual becoming infected at any one point in time (the force of infection) is related to the number of infectious individuals in the population, will change over time, and will feed back into the future force of infection. These nonlinear interactions produce transmission dynamics that require specific consideration when modeling an intervention that has an impact on the transmission of a pathogen. Best practices for designing and building these models are set out in this article.

Hepatitis E is a viral disease that causes serious concerns for public health. Hepatitis E virus (HEV) genotype 3 is endemic in commercial pig farms worldwide that act as a reservoir. Pig-to-human transmission may occur when infectious animals enter the food chain at slaughter, through consumption of contaminated meat, direct exposure or use of by-products. To reduce the fraction of infectious animals at slaughter age and thus the risk for public health, it is important to understand the transmission dynamics of HEV in pig populations. In this study, we estimate the transmission rate parameter and mean infectious period of HEV in pigs from field data, using a Bayesian analysis. The data were collected in ten commercial pig herds that are each divided into three different age groups. Two transmission models were compared, assuming that animals are infected either locally by their group mates or globally by any infectious animal regardless of its group. For local and global transmission, the transmission rate parameters were 0.11 (posterior median with 95% credible interval: 0.092-0.14 day(-1)) and 0.16 (0.082-0.29 day(-1)), the mean infectious periods were 24 (18-33) days and 27 (20-39) days and the reproduction numbers were 2.7 (2.2-3.6) and 4.3 (2.8-6.9). Based on these results, global transmission is considered to be the more conservative model. Three effects of vaccination were explored separately. When vaccination is not sufficient to eliminate the virus, a shorter mean infectious period decreases the fraction of infectious animals at slaughter age, whereas a reduced transmission rate parameter adversely increases it. With a reduced susceptibility, vaccination of animals at a later age can be a better strategy than early vaccination. These effects should be taken into account in vaccine development.

Policy makers must base their decisions on preliminary and partially revised data of varying reliability. Realistic modeling of data revisions is required to guide decision makers in their assessment of current and future conditions. This paper provides a new framework with which to model data revisions.Recent empirical work suggests that measurement errors typically have much more complex dynamics than existing models of data revisions allow. This paper describes a state-space model that allows for richer dynamics in these measurement errors, including the noise, news and spillover effects documented in this literature. We also show how to relax the common assumption that "true" values are observed after a few revisions.The result is a unified and flexible framework that allows for more realistic data revision properties, and allows the use of standard methods for optimal real-time estimation of trends and cycles. We illustrate the application of this framework with real-time data on US real output growth. (C) 2011 Elsevier B.V. All rights reserved.

Markets are dynamic by nature; and marketing-efforts can be directed to stimulate, reduce, or to utilize these dynamics. The field of marketing dynamics aims at modeling the effects of marketing actions and policies on short-term performance ("lift") and on long-term performance ("base"). One of the core questions within this field is: "How do marketing efforts affect outcome metrics such as revenues, profits, or shareholder value over time?" Developments in statistical modeling and new data sources allow marketing scientists to provide increasingly comprehensive answers to this question. We present an outlook on developments in modeling marketing dynamics and specify research directions. (c) 2009 Elsevier B.V. All rights reserved.

Purpose Low-molecular weight heparin (LMWH) followed by vitamin K antagonists (VKAs) are the current standard treatment of acute venous thromboembolism (VTE) and prevention of recurrent VTE. The direct oral anticoagulant apixaban was recently found noninferior in efficacy and superior in preventing major bleeding compared with LMWH/VKAs in the AMPLIFY (Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-Line Therapy) trial. The objective of this study was to calculate the cost-effectiveness of apixaban compared with LMWH/VKA in the treatment of acute VTE and prevention of recurrent VTE in the Netherlands. Methods A Markov model was designed to simulate a cohort of 1,000 VTE patients receiving either apixaban or LMWH/VKA. Transition probabilities, costs, and utilities were obtained from the AMPLIFY trial and other literature. The incremental cost-effectiveness ratio (ICER) was calculated from the societal perspective; therefore, the model included both direct (inside and outside the health care sector) and indirect costs. In the univariate and probabilistic sensitivity analyses (PSAs) the robustness of the results was tested, and various additional scenario analyses were conducted. Findings In the base-case analysis, apixaban saved €236 and 0.044 quality-adjusted life years (QALYs) and 0.039 LYs were gained compared with LMWH/VKA. In the univariate sensitivity analysis the model appeared to be robust. The results of 2,000 iterations in the PSA found that the probability of apixaban being cost-effective at a willingness-to-pay threshold of €20,000/QALY was 100% and cost-saving was 94%. The scenario of 18-month treatment duration was the only scenario not indicating cost-savings with an ICER of €425/QALY. Implications In acute anticoagulation use apixaban was found to be cost-saving. A longer anticoagulation period (18 months) resulted in a higher difference in drug costs, indicating a higher ICER. The cost-effectiveness of long-term or life-long use should be examined in future research.

Less than a decade ago, several German states introduced tuition fees for university education. Despite their comparatively low level, fees were perceived by the public to increase social injustice, and have been abolished. Whereas other studies have shown no effect on enrollment, we analyze the effects on students' budgets. To identify causal effects, we exploited the natural experiment established by the introduction of fees. They did not affect students' spending behavior independently of social background, but females experienced a small negative effect. Effects on other outcomes indicate that students increased their budgets only marginally; fees did not increase social inequality.