Mandatory Coverage Research Articles

Physicians’ perspectives on cancer-related fatigue management and their suggestions for improvements in medical training: a cross-sectional survey study in Germany

PurposeContrary to guidelines, many cancer patients are not screened for cancer-related fatigue (CRF) and do not receive information or adequate treatment. As physicians play a key role in cancer therapy, their knowledge of this common sequela and perspectives on its management are of major interest.MethodsFor an online survey, physicians working in oncology in Germany were systematically drawn from registers and invited by using institutional newsletters or colleagues. Descriptive analyses, logistic regression analysis of physicians’ knowledge, and Mann‒Whitney U tests were performed.ResultsTwo-thirds of the 148 surveyed physicians felt (rather) well informed about CRF and capable of counseling patients. Only 32% of the sample were aware of CRF-specific guidelines. Despite of this, participants rated the scientific evidence for recommending physical activity, exercise programs, and psychotherapeutic interventions in accordance with guidelines as being mostly (very) strong. However, despite 82.4% of the physicians being (rather) aware of its evidence, only 56.1% often to almost always recommended psychotherapeutic interventions. CRF was rarely covered in medical studies and medical specialist training. The completion of advanced training for palliative care increased the likelihood of knowing guidelines (OR = 2.6, 95% CI [1.1–6.0], p < 0.05). Suggestions for improving training included the mandatory coverage of CRF in medical training or its consideration in interprofessional supportive care workshops.ConclusionAlthough awareness and recommendation rates were adequate for some interventions in CRF treatment (such as physical activity), there were lower recommendation rates for others, including psychotherapy. Studies are required assessing for the reasons of this knowledge-to-practice gap. Moreover, training is needed among physicians in order to enhance knowledge of CRF guidelines.Trial registrationClinicaltrials.gov, identifier: NCT04921644. Registered in June 2021.

Affordable Care Act's Preventive Services Coverage Mandate and Receipt of Fluoride Varnish.

The Affordable Care Act required private insurers to cover a set of recommended preventive services without cost-sharing. This included coverage of fluoride varnish (FV) applications without cost-sharing for children aged 1 through 5 during medical visits, an evidence-based treatment that prevents tooth decay. We examined if this coverage mandate was associated with more young children receiving FV. Using the Massachusetts All-Payer Claims Database (2014-2018), we examined the likelihood that a privately insured child received FV during a medical visit in a month. We used a difference-in-differences approach, comparing those included in the coverage mandate (aged 1-5) to those excluded from the mandate (aged 6-9), before and after the mandate was enacted (January 2015). We repeated analyses in children with Medicaid because this mandate may have had spillover effects for this population. Among children aged 1 through 5 years with private insurance, 1-year postmandate the probability of FV receipt in a month increased 0.16 percentage points more relative to December 2014 (premandate) compared with the change among children aged 6 to 9 years (P < .001; 95% confidence interval = 0.1-0.22). When examining spillover to children with Medicaid, the mandate was not associated with a significant increase in the probability of monthly FV receipt 1-year postmandate. This Affordable Care Act mandate requiring coverage of FV without cost-sharing was associated with higher rates of young children receiving FV in medical settings, with the largest result observed among children with private insurance.

Baby-Making as Federal Policy: Mandating Insurance Coverage for Infertility Treatments Under the Patient Protection and Affordable Care Act

Baby-Making as Federal Policy: Mandating Insurance Coverage for Infertility Treatments Under the Patient Protection and Affordable Care Act

Barriers in Accessing Orthodontic Care for Patients with Orofacial Clefts: Insights from a Florida-Based Survey and National Database Analysis.

To assess the barriers to obtaining care for patients with orofacial clefts through a survey of Florida-based orthodontists and families and an analysis of the Pediatric Health Information System (PHIS) database. A cross-sectional study utilizing multiple-choice questionnaires completed by Florida orthodontists and caregivers of patients who attended a Florida-based cleft and craniofacial clinic. Additionally, data from the PHIS database were analyzed to investigate national factors affecting the age of alveolar bone grafting (ABG). Craniofacial team in Florida. The survey included 39 orthodontists (7.1% response rate) and 48 caregivers (41% response rate) The PHIS study included 1182 patients. Barrier to orthodontic care and age of ABG. Orthodontic Survey: Among the surveyed orthodontists, 71% treated cleft/craniofacial patients, 37% accepted Medicaid, and 55% provided pro-bono care. Poor reimbursement was identified as the most common barrier (58%). Caregiver Survey: Most patients were insured by Medicaid (67%), with 55% incurring out-of-pocket expenses. PHIS Database: The average age of ABG was 10.3 years (SD = 3.2). Government funding was associated with a 6.0-month delay in ABG (p = 0.047) and residing in non-Medicaid expanded states was linked to a 6.0-month delay (p = 0.023). Post-Medicaid expansion status was also associated with a delay (p = 0.004). Access to oral care is difficult for patients with OFC. Despite both federal and state mandates, many financial and non-financial barriers still exist in accessing orthodontic care and a majority of patients experience significant out-of-pocket expenses despite statutorily mandated insurance coverage.

Vaccinations at home: a new strategy to contain vaccine hesitancy? The experience of ASL Napoli 1 Centro, Italy.

Vaccination coverage are generally geographically variable, even within large cities; furthermore, across target population are embedded difficult-to-reach clusters. To address this issue and improve coverage of mandatory vaccinations, a study group explored bringing vaccination at home as an interventional strategy. In a pilot experience, parents of unvaccinated and under vaccinated children of the 2020 birth cohort living in Naples, Italy were contacted by telephone to offer home administration of vaccinations. A specifically trained team arranged vaccinations visits at home. Coverage rates were evaluated at baseline and one month after the intervention strategy. A significant positive increase in hexavalent vaccine (+1.43%) and measles-mumps-rubella (+1.85%) coverage was registered despite the short duration of the pilot program. Home vaccination turned out to be a medical resource consuming but feasible and successful strategy to increase mandatory vaccinations coverage among the most difficult-to-reach and fragile segments of the pediatric population.

Preferences for a Clostridioides difficile vaccine among adults in the United States

IntroductionClostridioides difficile (C.diff) infection (CDI) causes significant morbidity and mortality among older adults. Vaccines to prevent CDI are in development; however, data on the target population's preferences are needed to inform vaccination recommendations in the United States (US). This study assessed US adults' willingness to receive a C.diff vaccine and examined how vaccine attributes influence their choices. MethodsA cross-sectional online survey with a discrete choice experiment (DCE) was conducted among US adults aged ≥50 years. DCE attributes included effectiveness, duration of protection, reduction in symptom severity, out-of-pocket (OOP) costs, number of doses, and side effects. The DCE included 11 choice tasks, each with two hypothetical vaccine profiles and an opt-out (i.e., no vaccine). Attribute-level preference weights were estimated using hierarchical Bayesian modeling. Attribute relative importance (RI) was compared between select subgroups. ResultsOf 1216 adults in the analyses, 29.9% reported they knew either ‘a little’ (20.7%) or ‘a lot’ (9.2%) about C.diff before the study. A C.diff vaccine was chosen 58.0% of the time (vs. opt-out) across choice tasks. It was estimated that up to 75.0% would choose a vaccine when OOP was $0. Those who were immunocompromised/high-risk for CDI (vs. not) more frequently chose a C.diff vaccine. Decreases in OOP costs (RI = 56.1), improvements in vaccine effectiveness (RI = 17.7), and reduction in symptom severity (RI = 10.3) were most important to vaccine choice. The rank ordering of attributes by importance was consistent across subgroups. ConclusionOOP cost, improvements in vaccine effectiveness, and reduction in CDI severity were highly influential to vaccine selection. Most adults aged ≥50 years were receptive to a C.diff vaccine, especially with little-to-no OOP cost, suggesting that mandating insurance coverage of vaccination with no copayment may increase uptake. The limited awareness about C.diff among adults presents an opportunity for healthcare providers to educate their patients about CDI prevention.

Gender-differences in retirement from entrepreneurship: the influence of pension policies across Europe

PurposeThe interest in older entrepreneurs increases due to population aging. Previous research showed clear gender-differences among older entrepreneurs. This study investigates whether such gender-differences also exist in the retirement transition from entrepreneurship. It explores the influence of pension regulations for entrepreneurs on these gender-differences.Design/methodology/approachLongitudinal micro-level data from the Survey of Health, Aging and Retirement in Europe is analyzed in multichannel sequence analyses and cluster analyses. Developments from age 50 to 69 are compared in the dimensions of entrepreneurship, employment and old-age pensions.FindingsEntrepreneurs retire in three different transition patterns: (1) entrepreneurs becoming pensioners at 60, (2) entrepreneurs becoming pensioners at 65 and (3) individuals combining entrepreneurship with employment until they become pensioners at 65. Female entrepreneurs follow the same transition patterns as their male counterparts but retire earlier. Pension regulations for entrepreneurs modify the extent of the gender-differences within a country. Mandatory pension schemes with identical state pension ages for men and women reduce gender-differences, whereas mandatory schemes with gender-differences in the state pension age increase them. Schemes without mandatory coverage range in between the other two.Originality/valueThis article expands our knowledge on gender-differences among older entrepreneurs. These gender-differences also extent to how entrepreneurs transition into retirement. Pension regulations for entrepreneurs influence the extent of the gender-differences. Therefore, pension regulations for entrepreneurs constitute tools for promoting or hindering gender equality.

A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts.

Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race-based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. Four hospitals offering PCa treatment in Massachusetts were selected using a case-mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment. Nevertheless, most interviewed stakeholders lacked clear implementation plans.

The State of State Biomarker Testing Insurance Coverage Laws

This Viewpoint discusses laws mandating insurance coverage of biomarker testing to broaden access to care for patients with cancer.

P56. Effect of Legislation Mandating Insurance Coverage on Access to Surgical Care for Minority Transgender Patients

P56. Effect of Legislation Mandating Insurance Coverage on Access to Surgical Care for Minority Transgender Patients

Discordance Between Insurance Coverage of Antiviral Medications and Nicotine Replacement Therapy Among Individuals With Human Immunodeficiency Virus Who Smoke.

Tobacco contributes to the leading causes of morbidity and mortality among persons with human immunodeficiency virus (PWHs). Nonetheless, medications for tobacco use disorder are widely underused, particularly among PWHs. We sought to characterize the extent to which insurance barriers impacted access to medications for tobacco use disorder and, in comparison, to access to antiretroviral therapy (ART). This is a secondary analysis of data on individuals enrolled in a randomized clinical trial to address tobacco use involving nicotine replacement therapy and, for some, additionally, varenicline or bupropion. Medication prescriptions are transmitted electronically from the clinic to neighborhood pharmacies. Data sources included participant assessments and intervention visit tracking forms. Of 93 participants enrolled from September 2020 to July 2021, 20 (22%) were unable to fill or had difficulty filling their nicotine replacement therapy (NRT) prescriptions because of insurance barriers. These fell into 2 broad categories: enrollment in a publicly insured managed care plan in which the pharmacy benefit manager excluded nonprescription NRT and lack of understanding by the pharmacy of the scope of coverage. Of these 20 participants, 5 (25%) were unable to obtain medications at all, and 3 of these participants dropped out of the study. One additional participant paid out-of-pocket to obtain NRT. No participant was denied coverage of ART, bupropion, or varenicline. Gaps in insurance coverage may result in PWHs receiving ART without simultaneous medical management of their tobacco use. This may undermine the efficacy of antivirals. Mandated insurance coverage of nonprescription NRT may improve the health of PWHs who smoke.

Health Insurance Mandates for Nonpharmacological Pain Treatments in 7 US States

This cross-sectional study examines the extent to which states have introduced or enacted mandates for coverage of nonpharmacological pain treatments and characterizes the variation in such mandates.

Impact of Mandated Insurance Coverage of Assisted Reproductive Technology on Clinic Website Transparency.

Objective: The purpose of this study was to determine whether website transparency of service costs, accepted insurance plans, and financing options differs between reproductive endocrinology and infertility clinics located in states that do and do not mandate insurance coverage of assisted reproductive technology (ART). Methods: Six hundred forty-six clinics were identified using the Society for Assisted Reproductive Technology online locator. Clinics were excluded for missing website links, duplicate entries, broken websites, or permanent closure. Mandated coverage by state was gathered on resolve.org Chi-squared testing and logistic regression were performed. Results: Of the 311 clinic websites analyzed, 28.6% were in states that mandate ART coverage and 71.4% were not. Clinics in states that have mandated coverage were more likely to list specific prices on their websites. These clinics were 2.13 times more likely to list specific costs (odds ratio [OR]; 95% confidence interval [CI]: 1.19-3.81, p = 0.01). There was also a significant difference between the percent of clinics in mandated coverage states and nonmandated states that listed accepted insurance plans. These clinics were 2.44 times more likely to report accepted insurance plans (OR; 95% CI: [1.47-4.05], p = 0.005). There was no significant difference in the mention of financial assistance between the groups. Clinics in states with mandated coverage were more likely to mention discount programs, but there was no significant difference for other types of financial assistance. Conclusion: Clinics located in states that mandate insurance coverage of ART are more likely to list specific costs, accepted insurance plans, and the availability of discount programs on their website. Patients living in states without mandated coverage are more likely to need to finance their own treatment, yet these patients are less likely to have nearby clinics that provide financial transparency on their websites.

Eficiencia técnica en la ganadería de carne bovina en Uruguay

Livestock farming is the agricultural activity with the greatest individual land-use, but it faces competition from other sectors for land, and is criticized for its environmental footprint. In this global context, Uruguay emerges as an important case study, boasting a long tradition and significance in the beef export sector. Enhancing livestock productivity is imperative to mitigate environmental impacts, and bolster farm competitiveness and food production. This study delves into the technical efficiency of cattle ranches focused on cow-calf production in Uruguay during the 2011 agricultural year, with nationwide and mandatory data coverage. Using data from the 2011 General Agriculture Census we estimate a translog stochastic production frontier model encompassing key inputs (livestock units, grazing area, and labor), along with control variables such as soil suitability and infrastructure improvements. Our findings underscore the potential to augment Uruguay's beef production by an average of 26.4%, harnessing existing resources and technology while improving ranch management. Moreover, variables like the extent of reliance on livestock farming as the primary source of income of the ranch, the use of outsourced services, foreign cattle ownership ratios, and agronomic and veterinary consultation exert noteworthy significant impacts on TE.

Mandatory childhood vaccination coverage and notifications of vaccine-preventable diseases in a municipality in the Eastern Amazon

The mandatory vaccination coverage rate for children has been declining over time in Brazil, leading to the reappearance of diseases considered eradicated or under control. This study aims to analyze the trend of the historical series (2016 to 2022) of vaccination coverage (VC) in children under nine years of age and the records of vaccine-preventable diseases in this age group in the municipality of Belém, Pará. This is a cross-sectional, descriptive, quantitative study based on collecting secondary data from the National Immunization Program Information System. Descriptive statistics were used to calculate the arithmetic mean, median, standard deviation, and simple linear regression. The data obtained on VC for seven vaccines contained in the Brazilian calendar, associated with cases of reported diseases, were placed in combinatorial graphs to better interpret and demonstrate the data. Analysis of this data indicated a downward trend in VC, with only the BCG vaccine reaching its targets in the period analyzed in two alternate years: 2016 and 2018. The targets (95%) for coverage recommended by the National Immunization Program were not reached for the other six. As for records of illnesses, the occurrences of meningitis (29.14 ± 12.37) and measles (27.85 ± 55.05) were the highest among cases of reported diseases. Tuberculosis was also high in the municipality of Belém between 2016 (1,315) and 2017 (1,435), in other words, an increase of 120 cases. However, the number of cases notified to the Ministry of Health in this period was 7 (5.8%). Therefore, it should be noted that more attention should be paid to the cases notified and those occurring and registered in the municipality to better plan and achieve the vaccination targets and, in this way, diminish or keep these diseases under control.

Characteristics of migrant workers admitted from the emergency department.

Emergency department (ED) admissions for non-work-related injuries and illnesses in the migrant worker (MW) population in Singapore are not well studied. We aimed to examine ED triage acuity and bills associated with admissions among MW for non-trauma, workplace injury (WI) trauma, and non-workplace injury (NWI) trauma. In this retrospective observational study, we included all work permit holders admitted to hospital via the ED of three public hospitals from 1 May 2016 to 31 October 2016. Data obtained from medical records included demographics, triage acuity and bill information. There were 1,750 unique patients accounting for 1,788 admissions. The median age was 33 (interquartile range 27-40) years, with a male predominance of 67%. Trauma accounted for 33% (n = 595) of admissions, and of these, 73% (n = 433) were due to WI. Admissions for NWI, as compared to WI, were more likely to present as high acuity P1 cases (43% vs 24%, P < 0.001), be conveyed by ambulance (49% vs 24%, P < 0.001) and result in trauma team activations (29% vs 7%, P < 0.001). More NWI admissions (22%, 36/162) exceeded the insurance claim limit under prevailing healthcare policies, as compared to WI admissions (3%, 13/433). Migrant workers are admitted to hospital for non-trauma conditions more frequently than for trauma. Non-workplace injury trauma may be severe. Non-trauma and NWI admissions can result in large bills that exceed mandatory insurance coverage. Recent changes to healthcare policy governing MW to allow copayment of large bills and better access to primary care are timely.

Early Intervention for Children with Autism Spectrum Disorder in Dubai: A Rapid Review and Policy Option Analysis

Background:: Autism Spectrum Disorder (ASD) is a complex and heterogeneous neurodevelopmental disorder that is associated with functional impairments across an individual’s lifespan. The complexity and increasing global prevalence of ASD pose significant strains on healthcare systems. Early Intensive Behavioral Interventions (EIBI) are cost-effective evidence-based interventions that improve outcomes for individuals with ASD, especially when implemented in early childhood. Objectives:: This study reviews the disease burden of ASD and analyzes four potential financing models for EIBI in Dubai. Methods:: A rapid literature review was conducted to synthesize the disease burden of ASD and EIBI services in Dubai. Bardach’s eightfold model for policy analysis was used to analyze four policy options for EIBI in Dubai: (1) Government financing and provision of EIBI through specialized centers, (2) Government financing of EIBI through contracting private providers, (3) Mandating insurance coverage of EIBI for children with ASD, and, lastly, (4) A mixed model that includes both mandating insurance coverage for EIBI and government provision through non-profit organizations. Results:: EIBI services were available in Dubai but were associated with a substantial out-of-pocket (OOP) burden on families. Many young children with ASD were unable to access EIBI. Option (4) of using the mixed financing model of EIBI was optimal in the context of Dubai, based on evaluation criteria, including accessibility, cost-effectiveness, quality, and implementability, with minimal OOP burden on families. Conclusion:: To ease the burden on families with children suffering from ASD, the stakeholders, including the government of Dubai, should consider a mixed financial model to provide EIBI.

Abstract C118: Racial disparities in insurance coverage for supplemental breast cancer screening

Abstract Introduction and Purpose: Women with dense breasts have increased risk both for developing breast cancer and false-negative mammograms. Supplemental screening with breast MRI has been shown to shown to significantly increase cancer detection among women with dense breasts. In May 2023, Pennsylvania (PA) mandated insurance coverage of one supplemental screening study (breast MRI or ultrasound ) annually for women with dense breasts. Prior research suggests that Black women have lower breast density on average than white women based on subjective grading from the American College of Radiology Breast Imaging and Reporting Data System (BI-RADS), partially due to larger average breast size and higher body mass index (BMI) than white women. The purpose of this study was to estimate the potential impact of this supplemental screening law on different patient populations in a large health system. Methods: Women without prior breast cancer or known BRCA1/2 mutations who underwent mammographic screening at a large PA health system from April 2015-December 2017and completed a risk factor questionnaire were included (N=83,579). Under PA law, women must have either heterogeneously dense breasts plus &amp;gt;20% lifetime risk of breast cancer or extremely dense breasts to be eligible for insurance coverage for supplemental screening, both of which involve subjectively graded breast measurements. Breast cancer risk for each patient was estimated using the Gail model. The cancer detection rate (CDR) for mammographic screening was calculated as the number of cancers diagnosed within one year of a positive mammographic screen; the interval cancer rate was calculated as the number of cancers diagnosed within one year of a non-actionable screening mammogram per 1000 women. Logistic regression was used to calculate the odds of eligibility adjusted for age and BMI. Results: Black women were less likely to have extremely or heterogeneously dense breasts than white women (23.7% vs. 45.0%, p&amp;lt;0.001). Under PA law, 2.5% of Black women and 9.9% of white women would qualify for insurance coverage for supplemental screening (p&amp;lt;0.001). Only 0.2% of Black women and 2.3% of white women had heterogeneously dense breasts and &amp;gt;20% lifetime risk. Black women were more likely to have triple-negative breast cancer (TNBC) than white women (p&amp;lt;0.001). After adjusting for age and BMI, Black women remained 54% less likely to be eligible for supplemental screening than white women (OR=0.46, 95% 0.42-0.51, p&amp;lt;0.001).Conclusions: Black women are less likely to qualify for insurance coverage for supplemental breast cancer screening than white women under PA law. Given that Black women have lower prevalence of subjectively graded dense breasts and higher prevalence of TNBC, the new supplemental screening law is unlikely to meaningfully reduce racial disparities in breast cancer mortality. Methods to better assess breast cancer risk among Black women, particularly the risk of TNBC, are urgently needed to identify Black women that may benefit from supplemental screening. Citation Format: Mattia A. Mahmoud, Sarah Ehsan, Oluwadamilola M. Fayanju, Susan M. Domchek, Katherine L. Nathanson, Despina Kontos, Emily F. Conant, Anne Marie McCarthy. Racial disparities in insurance coverage for supplemental breast cancer screening [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C118.

Services, Quality of Life And Satisfaction of Senior Citizens in Bacolod City

The main purpose of this study was to come up with a general description and relationship among the extent of services, quality of life and satisfaction of senior citizens in Bacolod city. The areas of services include; health social access to public transport, utility discount and mandatory Philhealth coverage. Areas in the quality of life includes; health status, financial security, organizational affiliation, household relations and access to senior citizens’ benefits. Areas on satisfaction includes; appreciation of good health, social support, emotional security, contentment and leisure and activity. The study employed the descriptive, comparative and relational analytical schemes in coming up with a general description, comparison and relationship among the selected variables. The mean, t-test and Pearson Product Moment of Correlation formula was used. Findings of the duty revealed that senior citizens were adequately provided with all these services particularly on health, social public transport, utility discount and mandatory Philhealth services. They are experiencing quality living with regards ti their relationship in their household and access to Philhealth benefits. However, findings showed that they are not adequately contented with regards to health condition and financial security. They were having high level of satisfaction on the aspect of social support, emotional security, and leisure activities. Moreover, study showed that there was significant relationship between services and quality of life of senior citizens. Likewise, a significant relationship between the services and satisfaction of senior citizens and a significant relationship between the satisfaction and quality of life of senior citizens has existed. The study concluded that on services, although the extent was not at its highest degree of contentment to the services but senior citizens were contented of all the services provided to them. On quality of life, senior citizens were not fully contented and happy about the quality of life they were experiencing to note that a moderate extent on contentment was perceived by the senior citizens. On satisfaction, senior citizens degree of satisfaction was high considering that majority of life satisfaction was perceived by them to be high particularly in social, emotional, leisure and contentment. It was concluded further that senior citizens were not fully satisfied or contented about their health condition. The study highly recommends that medical programs/project shall provide greater emphasis on the following; married, low income, rural areas, male, without college degree senior citizens. Social services programs/project shall provide greater emphasis on the following; married, low income, rural areas, without college degree. Access to public transport programs/project shall provide greater emphasis on the following; married, low income. Utility discount programs/project shall provide greater emphasis on the following; married, without college degree, low income and leisure activity with greater emphasis on married, without college degree and low income senior citizens

Trend in mandatory vaccination coverage in Italy from 2000 to 2021. A joinpoint Regression Analysis

Abstract Introduction Vaccination is one of the most effective public health interventions, preventing more than 4 million deaths each year. However, the complex and multifactorial phenomenon of vaccine hesitancy has increased over the years, causing a reduction in vaccination coverage (VC) and the resurgence of epidemics from vaccine-preventable diseases (VPD). Moreover, the COVID-19 pandemic had a major impact on the capacity of health systems to continue the delivery of essential health services, including vaccination. In this context, the objective of this study is to analyse the trend of 10 vaccinations in Italy (measles, mumps, rubella, tetanus, diphtheria, pertussis, chickenpox, hemophilus, hepatitis B, and polio), from 2000 to 2021, evaluating the impact of the introduction of the mandatory law in 2017 and the pandemic. Methods Data were obtained from the Italian Ministry of Health. The joinpoint regression model was used to estimate changes in vaccination coverage trends for each indicator. It allows estimation of an annual percentage change (APC) in vaccination coverage, reflecting an increase or decrease over time. For each indicator, the presence of a joinpoint expressed significant changes in APC trends. APC was considered significant when p &amp;lt; 0.05. Results Until 2017, a gradual decline in VC is observed, with values below 95% for all indicators considered. For all indicators analysed, an increase (p &amp;lt; 0.005 for measles and chickenpox) in VC is observed following the mandatory law of 2017. Similarly, a reduction in all values is observed from 2020 (p &amp;lt; 0.005 for Tetanus). Conclusions The mandatory law represented an effective intervention, leading to an increase in all VC, which for 6 vaccinations reached a value &amp;gt;95%. On the other hand, the pandemic had a significant impact on the reduction of VC in Italy. It is necessary to plan recovery interventions for children in pandemic-affected cohorts to ensure adequate VC values and avoid epidemics from VPD. Key messages • The mandatory law represented an effective intervention increasing vaccination coverage. • It is necessary to plan recovery interventions for children in pandemic-affected cohorts to ensure adequate vaccination coverage.