Education as Risk Factor of Mild Cognitive Impairment: The Link to the Gut Microbiome.

BACKGROUND: With differences apparent in the gut microbiome in mild cognitive impairment (MCI) and dementia, and risk factors of dementia linked to alterations of the gut microbiome, the question remains if gut microbiome characteristics may mediate associations of education with MCI. OBJECTIVES: We sought to examine potential mediation of the association of education and MCI by gut microbiome diversity or composition. DESIGN: Cross-sectional study. SETTING: Luxembourg, the Greater Region (surrounding areas in Belgium, France, Germany). PARTICIPANTS: Control participants of the Luxembourg Parkinson's Study. MEASUREMENTS: Gut microbiome composition, ascertained with 16S rRNA gene amplicon sequencing. Differential abundance, assessed across education groups (0-10, 11-16, 16+ years of education). Alpha diversity (Chao1, Shannon and inverse Simpson indices). Mediation analysis with effect decomposition was conducted with education as exposure, MCI as outcome and gut microbiome metrics as mediators. RESULTS: After exclusion of participants below 50, or with missing data, n=258 participants (n=58 MCI) were included (M [SD] Age=64.6 [8.3] years). Higher education (16+ years) was associated with MCI (Odds ratio natural direct effect=0.35 [95% CI 0.15-0.81]. Streptococcus and Lachnospiraceae-UCG-001 genera were more abundant in higher education. CONCLUSIONS: Education is associated with gut microbiome composition and MCI risk without clear evidence for mediation. However, our results suggest signatures of the gut microbiome that have been identified previously in AD and MCI to be reflected in lower education and suggest education as important covariate in microbiome studies.

Creation of a pandemic memory by tracing COVID-19 infections and immunity in Luxembourg (CON-VINCE).

BACKGROUND: During the COVID-19 pandemic swift implementation of research cohorts was key. While many studies focused exclusively on infected individuals, population based cohorts are essential for the follow-up of SARS-CoV-2 impact on public health. Here we present the CON-VINCE cohort, estimate the point and period prevalence of the SARS-CoV-2 infection, reflect on the spread within the Luxembourgish population, examine immune responses to SARS-CoV-2 infection and vaccination, and ascertain the impact of the pandemic on population psychological wellbeing at a nationwide level. METHODS: A representative sample of the adult Luxembourgish population was enrolled. The cohort was followed-up for twelve months. SARS-CoV-2 RT-qPCR and serology were conducted at each sampling visit. The surveys included detailed epidemiological, clinical, socio-economic, and psychological data. RESULTS: One thousand eight hundred sixty-five individuals were followed over seven visits (April 2020-June 2021) with the final weighted period prevalence of SARS-CoV-2 infection of 15%. The participants had similar risks of being infected regardless of their gender, age, employment status and education level. Vaccination increased the chances of IgG-S positivity in infected individuals. Depression, anxiety, loneliness and stress levels increased at a point of study when there were strict containment measures, returning to baseline afterwards. CONCLUSION: The data collected in CON-VINCE study allowed obtaining insights into the infection spread in Luxembourg, immunity build-up and the impact of the pandemic on psychological wellbeing of the population. Moreover, the study holds great translational potential, as samples stored at the biobank, together with self-reported questionnaire information, can be exploited in further research. TRIAL REGISTRATION: Trial registration number: NCT04379297, 10 April 2020.

Impact of nirsevimab prophylaxis on paediatric respiratory syncytial virus (RSV)-related hospitalisations during the initial 2023/24 season in Luxembourg.

After Luxembourg introduced nirsevimab immunisation against respiratory syncytial virus (RSV), estimated neonatal coverage was 84% (1,277 doses/1,524 births) in 2023. That year, paediatric RSV-related hospitalisations, especially concerning infants < 6 months old (n = 72) seemed to decrease compared to the same period in 2022 (n = 232). In 2023, hospitalised children's mean age increased (14.4 months vs 7.8 months in 2022; p < 0.001) and hospital-stay length decreased (3.2 days vs 5.1 days; p < 0.001). In infants < 6 months old, intensive-care unit admissions appeared to drop (n = 28 vs 9). This suggests that nirsevimab prophylaxis reduced severe RSV infections, particularly in infants < 6 months old, thereby alleviating healthcare strain.

Programme Dementia Prevention (pdp): A Nationwide Program for Personalized Prevention in Luxembourg.

BACKGROUND: With continuously aging societies, an increase in the number of people with cognitive decline is to be expected. Aside from the development of causative treatments, the successful implementation of prevention strategies is of utmost importance to reduce the high societal burden caused by neurodegenerative diseases leading to dementia among which the most common cause is Alzheimer's disease. OBJECTIVE: The aim of the Luxembourgish "programme dementia prevention (pdp)" is to prevent or at least delay dementia in an at-risk population through personalized multi-domain lifestyle interventions. The current work aims to provide a detailed overview of the methodology and presents initial results regarding the cohort characteristics and the implementation process. METHODS: In the frame of the pdp, an extensive neuropsychological evaluation and risk factor assessment are conducted for each participant. Based on the results, individualized multi-domain lifestyle interventions are suggested. RESULTS: A total number of 450 participants (Mean age = 69.5 years; SD = 10.8) have been screened at different recruitment sites throughout the country, among whom 425 participants (94.4%) met the selection criteria. CONCLUSIONS: We provide evidence supporting the feasibility of implementing a nationwide dementia prevention program and achieving successful recruitment of the target population by establishing a network of different healthcare providers.

Risk and protective factors of mental health in children in residential care: A nationwide study from Luxembourg.

BACKGROUND: Children who grow up in residential care are at high risk for mental health problems. Existing studies have focused on negative mental health indicators and risk factors. There has been less emphasis on identifying protective factors, particularly those associated with positive mental health outcomes. OBJECTIVE: This study explores positive and negative dimensions of mental health and their links to risk and protective factors in children who have experienced early adversity and trauma and have been placed in residential care. PARTICIPANTS AND SETTINGS: Children aged 11 to 18 (N = 264) were recruited from residential care homes in Luxembourg, a small, high-income European country. METHODS: The children completed self-report questionnaires on mental health, perceived stress, school pressure, and participation. Residential care workers provided information on demographic factors, developmental and care history, and pre-care experiences of early adversity and trauma. RESULTS: Confirmatory factor analysis indicated that subjective well-being, internalising problems, and externalising problems are separate yet interconnected components of mental health. Multiple Indicators Multiple Causes models showed that individual, contextual, and psychosocial predictors contribute differentially to positive and negative mental health outcomes. CONCLUSIONS: Using a national sample of children in residential care in Luxembourg, this research indicates that subjective well-being, internalising problems, and externalising problems are distinct but related aspects of mental health. 'Child participation' and 'school pressure' displayed strong links with positive mental health outcomes and may serve as a potential path for improving public health interventions for children in care.

Ten-Year Changes in the Physical Activity and Sedentary Behaviors of Adults: An Analysis of the 2 Cross-Sectional Observation of Cardiovascular Risk Factors in Luxembourg Studies.

BACKGROUND: Monitoring population physical activity (PA) and sedentary behavior over time is important to guide public health actions. The objective of this study was to investigate the changes in PA and sedentary behavior of adult residents in Luxembourg over 10 years. We also investigated variations in change over time across sociodemographic subgroups. METHODS: Two population-based cross-sectional studies of adults living in Luxembourg (Observation of Cardiovascular Risk Factors in Luxembourg [ORISCAV-LUX] [2007-2008] and ORISCAV-LUX 2 [2016-2018]) were considered. Multilevel mixed-effects models were used to investigate changes over time between the studies with regard to self-reported total PA (metabolic equivalent of task-min/week), PA levels (inactive/sufficiently active/highly active), total sitting time, recreational television viewing, and personal computer (PC) use outside of work (in minutes per day). RESULTS: The ORISCAV-LUX study included 1318 participants and the ORISCAV-LUX 2 study involved 1477 participants; 573 adults took part in both studies. The proportion of participants categorized as highly active increased over time by 6.9%. Total PA (761 metabolic equivalent of task-min/wk), television viewing (12 min/d), and PC use outside of work (13 min/d) also increased, whereas the total sitting time decreased by 25 minutes per day. Variations in change over time were observed by sex, country of birth, education, employment status, and perceived financial difficulty. CONCLUSIONS: Over a 10-year period, PA increased and total sitting time decreased in adults living in Luxembourg. With regard to specific sedentary behaviors, television viewing, and PC use outside of work increased. Specific population subgroups will benefit the most from targeted efforts to increase PA and minimize sedentary behavior.

Environmental dynamics of Campylobacter jejuni genotypes circulating in Luxembourg: what is the role of wild birds?

Campylobacter jejuni is the leading cause of bacterial gastroenteritis worldwide, but, unlike other foodborne pathogens, is not commonly reported as causing outbreaks. The population structure of the species is characterized by a high degree of genetic diversity, but the presence of stable clonally derived genotypes persisting in space and time, and potentially leading to diffuse outbreaks, has recently been identified. The spread of these recurring genotypes could be enhanced by wild birds, suspected to act as vectors for a wide range of microorganisms that can be transmissible to other animals or humans. This study assessed the genetic diversity of C. jejuni carriage in wild birds and surface waters to explore a potential link between these environments and the persistence over years of recurring lineages infecting humans in Luxembourg. These lineages corresponded to over 40 % of clinical isolates over a 4 year period from 2018 to 2021. While mainly exotic genotypes were recovered from environmental samples, 4 % of C. jejuni from wild birds corresponded to human recurring genotypes. Among them, a human clinical endemic lineage, occurring for over a decade in Luxembourg, was detected in one bird species, suggesting a possible contribution to the persistence of this clone and its multi-host feature. Whereas 27 % of wild birds were carriers of C. jejuni, confirming their role as spreader or reservoir, only three out of 59 genotypes overlapped with recurring human strains. While direct transmission of C. jejuni infection through wild birds remains questionable, they may play a key role in the environmental spreading of stable clones to livestock, and this issue merits further investigation.

Old age takes its toll: Long-run projections of health-related public expenditure in Luxembourg.

This paper simulates long-term trends in Luxembourg's public expenditure on healthcare and on long-term care. We combine population projections with micro-simulations of individuals' health status that account for their demographic, socio-economic characteristics and their childhood circumstances. Model equations estimated on data from the SHARE survey and from several branches of Social Security provide a rich framework to study policy-relevant applications. We simulate public expenditure on healthcare and long-term care under different scenarios to evaluate the separate contributions of population ageing, costs of producing health-related services, and the distribution of health status across age cohorts. Results suggest that rising per capita expenditure on healthcare will mostly result from production costs, while rising expenditure on long-term care will mostly reflect population ageing.

Quality of maternal and newborn care around the time of childbirth in Luxembourg during the COVID-19 pandemic: Results of the IMAgiNE EURO study.

OBJECTIVE: To investigate the quality of maternal and newborn care (QMNC) during childbirth in Luxembourg from women's perspectives. METHODS: Women giving birth in facilities in Luxembourg between March 1, 2020, and July 1, 2021, answered a validated online WHO standards-based questionnaire as part of the multicountry IMAgINE EURO study. Descriptive and multivariate quantile regression analyses were performed. RESULTS: A total of 493 women were included, representing 5.2% of women giving birth in the four maternity hospitals in Luxembourg during the study period. Most quality measures suggested high QMNC, although specific gaps were observed: 13.4% (n = 66) of women reported not being treated with dignity, 9.1% (n = 45) experienced abuse, 42.9% (n = 30) were not asked for consent prior to instrumental vaginal birth, 39.3% (n = 118) could not choose their birth position, 27% (n = 133) did not exclusively breastfeed at discharge (without significant differences over time), 20.5% (n = 101) reported an insufficient number of healthcare professionals, 20% (n = 25) did not receive information on the newborn after cesarean, and 41.2% (n = 203) reported lack of information on newborn danger signs before discharge. Multivariate analyses highlighted higher reported QMNC indexes among women born outside Luxembourg and delivering with a gynecologist, and significantly lower QMNC indexes in women with the highest education levels and those delivering in the hospital offering some private services. CONCLUSIONS: Despite maternal reports suggesting an overall high QMNC in Luxembourg, improvements are needed in specific aspects of care and communication, mostly related to maternal autonomy, respect, and support, but also number and competencies of the health workforce.

Low prevalence of relative age effects in Luxembourg's male and female youth football.

The relative age effect (RAE) is a well-established phenomenon in football. However, while the majority of previous studies focussed on established football nations, it remains unclear if the constraint of a limited population of soccer players in smaller countries associated with less strict selection procedures may reduce the risk of RAE. This study aims to investigate the RAE in Luxembourg that follows an 'open-door' selection policy in youth football due to the limited pool of players. Birthdates from all licensed and actively playing Luxembourgish youth footballers including all players of the youth national teams (396 girls and 10981 boys) competing in the season 2018/2019 were analysed and categorised into birth quarters and semesters. To further investigate a performance dependence of the RAE in amateur leagues, success was determined based on the teams' rankings at the end of the season. Differences between observed and expected birthdate distributions were calculated across all licensed players and age groups, within the national teams, and for the top- and bottom-tier football teams using chi-square statistics. While a RAE was absent across all age groups (except U7), significant RAEs with high effect sizes were observed in the top-level and national teams. These findings contrast the substantial RAE effects in large football nations and suggest that open selection systems might reflect an environmental constraint that limit the prevalence of RAE in football. Further, this study indicates that a performance dependence of the RAE is not limited to high level football but already occurs on an amateur level.

Sexual satisfaction and sexual behaviors during the COVID-19 pandemic: results from the International Sexual Health And REproductive (I-SHARE) health survey in Luxembourg.

AIM: To identify the impact of COVID-19 measures on sexual behaviors and sexual satisfaction in Luxembourg residents. METHODS: We conducted a cross-sectional online survey of adults (> 18 years of age) residing in Luxembourg, while COVID-19 restrictions were in place. The survey was available from January 15 to February 12, 2021 in four languages (French, German, English and Portuguese). Survey questions focused on masturbation, cuddling, condom use, sex frequency, sexting, cybersex, watching porn, and sexual satisfaction. RESULTS: 557 volunteers completed the survey (35.5% men, 64.3% women). Sexual satisfaction and sexual problems variables were assessed on 4-point Likert scales (0 = not at all/never to 3 = very/often). Sexual problems increased during the COVID-19 measures while sexual satisfaction decreased compared to before the introduction of COVID-19 restrictions (assessed retrospectively). Factors associated with increased odds of sexual satisfaction included having a steady relationship before COVID-19 restrictions, engaging in sexting, reporting good mental health and not altering alcohol intake. CONCLUSIONS: The context of the COVID-19 pandemic and the measures implemented in Luxembourg affected sexual behaviors and sexual satisfaction. Sexual and reproductive health care centers and health professionals in general should take these results into consideration when providing care. Recommendations on the importance of sexual health for general wellbeing and behaviors associated with sexual satisfaction should be offered and possibilities to experience sexuality while reducing contamination risks be discussed.

Surveillance of Indoor Air Concentration of Volatile Organic Compounds in Luxembourgish Households.

Exposure to air pollution is a well-known health risk. For instance, volatile and very volatile organic compounds (VOCs and VVOCs) are known to cause respiratory, haematologic or immune diseases, and even cancer. Based on the Luxembourgish indoor pollution surveillance program, we performed an exploratory analysis for the period 2014-2019, in order (1) to evaluate the prevalence of VOCs and VVOCs in households, and (2) to estimate the risks of lifelong exposure to selected VOCs on the health of the adult population. The database included 715 indoor air samples from 159 different households. Observed VOC and VVOC levels were similar to those in neighbouring countries. Our health impact assessment identified some health risks associated with the observed concentrations in Luxembourg. Furthermore, this study shows the major public health importance of having a national indoor pollution surveillance system in place. Highlights: (1) This study provides an overview of the domestic indoor pollution in Luxembourg. (2) (V)VOCs levels in Luxembourg were similar to those in neighbouring countries. (3) The results clearly show the importance of having a surveillance system in place.

Usutu Virus Africa 3 Lineage, Luxembourg, 2020.

We detected Usutu virus in a dead Eurasian blackbird (Turdus merula) in Luxembourg in September 2020. The strain clustered within the Africa 3.1 lineage identified in Western Europe since 2016. Our results suggest maintenance of the virus in Europe despite little reporting during 2019-2020, rather than a new introduction.

Associations between physical activity prior to infection and COVID-19 disease severity and symptoms: results from the prospective Predi-COVID cohort study.

OBJECTIVE: To investigate if the physical activity (PA) prior to infection is associated with the severity of the disease in patients positively tested for COVID-19, as well as with the most common symptoms. DESIGN: A cross-sectional study using baseline data from a prospective, hybrid cohort study (Predi-COVID) in Luxembourg. Data were collected from May 2020 to June 2021. SETTING: Real-life setting (at home) and hospitalised patients. PARTICIPANTS: All volunteers aged >18 years with confirmed SARS-CoV-2 infection, as determined by reverse transcription-PCR, and having completed the PA questionnaire (n=452). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was disease severity (asymptomatic, mild illness and moderate illness). The secondary outcomes were self-reported symptoms. RESULTS: From the 452 patients included, 216 (48%) were female, the median (IQR) age was 42 (31-51) years, 59 (13%) were classified as asymptomatic, 287 (63%) as mild illness and 106 (24%) as moderate illness. The most prevalent symptoms were fatigue (n=294; 65%), headache (n=281; 62%) and dry cough (n=241; 53%). After adjustment, the highest PA level was associated with a lower risk of moderate illness (OR 0.37; 95% CI 0.14 to 0.98, p=0.045), fatigue (OR 0.54; 95% CI 0.30 to 0.97, p=0.040), dry cough (OR 0.55; 95% CI 0.32 to 0.96, p=0.034) and chest pain (OR 0.32; 95% CI 0.14 to 0.77, p=0.010). CONCLUSIONS: PA before COVID-19 infection was associated with a reduced risk of moderate illness severity and a reduced risk of experiencing fatigue, dry cough and chest pain, suggesting that engaging in PA may be an effective approach to minimise the severity of COVID-19. TRIAL REGISTRATION NUMBER: NCT04380987.

Screening for familial hypercholesterolaemia in primary school children: protocol for a cross-sectional, feasibility study in Luxembourg city (EARLIE).

INTRODUCTION: Familial hypercholesterolaemia (FH) is a frequent (1:300) autosomal dominantly inherited condition which causes premature (women <60 years, men <55 years) cardio-cerebrovascular disease (CVD). Early detection and initiation of treatment can prevent the development of CVD and premature death. Our pilot study aims to investigate the prevalence of FH, the feasibility and efficacy of a screening based on a capillary blood test performed during a school medicine visit in primary school children. METHODS AND ANALYSIS: In this cross-sectional study, all children (n=3200) between 7 and 12 years, attending primary school in the city of Luxembourg and invited for their mandatory medical school examinations between 2021 and 2023 are invited to participate. A study nurse performs a capillary blood test to analyse the lipid profile. Families receive the result including an interpretation and invitation to seek medical advice if indicated. If FH is confirmed, a reverse cascade screening in that family will be proposed. The child will receive standard care. Primary outcome is the occurrence of confirmed FH in the study population. Secondary outcomes include the percentage of children screened, percentage of children with abnormal lipid values, percentage of families screened and percentage of families with additionally identified members suffering from hypercholesterolaemia. A health economic analysis will be performed. ETHICS AND DISSEMINATION: Ethics approval (reference number 202108/01) has been obtained from the National Research Ethics Committee (CNER (Luxembourg)) and was authorised by the ministry of health in Luxembourg. Families receive written information with an informed consent form. Participation requires an informed consent form signed by the parents. The results will be disseminated in peer-reviewed publications, conference presentations and by public media to the general public. TRIAL REGISTRATION NUMBER: NCT05271305.

Estimating the impact of interventions against COVID-19: From lockdown to vaccination.

Coronavirus disease 2019 (COVID-19) is an infectious disease of humans caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the first case was identified in China in December 2019 the disease has spread worldwide, leading to an ongoing pandemic. In this article, we present an agent-based model of COVID-19 in Luxembourg, and use it to estimate the impact, on cases and deaths, of interventions including testing, contact tracing, lockdown, curfew and vaccination. Our model is based on collation, with agents performing activities and moving between locations accordingly. The model is highly heterogeneous, featuring spatial clustering, over 2000 behavioural types and a 10 minute time resolution. The model is validated against COVID-19 clinical monitoring data collected in Luxembourg in 2020. Our model predicts far fewer cases and deaths than the equivalent equation-based SEIR model. In particular, with R0 = 2.45, the SEIR model infects 87% of the resident population while our agent-based model infects only around 23% of the resident population. Our simulations suggest that testing and contract tracing reduce cases substantially, but are less effective at reducing deaths. Lockdowns are very effective although costly, while the impact of an 11pm-6am curfew is relatively small. When vaccinating against a future outbreak, our results suggest that herd immunity can be achieved at relatively low coverage, with substantial levels of protection achieved with only 30% of the population fully immune. When vaccinating in the midst of an outbreak, the challenge is more difficult. In this context, we investigate the impact of vaccine efficacy, capacity, hesitancy and strategy. We conclude that, short of a permanent lockdown, vaccination is by far the most effective way to suppress and ultimately control the spread of COVID-19.

Predictors of Problematic Social Media Use in a Nationally Representative Sample of Adolescents in Luxembourg.

Social media use has increased substantially over the past decades, especially among adolescents. A proportion of adolescents develop a pattern of problematic social media use (PSMU). Predictors of PSMU are insufficiently understood and researched. This study aims to investigate predictors of PSMU in a nationally representative sample of adolescents in Luxembourg. Data from the Health Behavior in School-aged Children (HBSC) study in Luxembourg were used, in which 8687 students aged 11-18 years old participated. The data were analyzed using hierarchical multiple regression. A range of sociodemographic, social support, well-being and media use predictors were added to the model in four blocks. The predictors in the final model explained 22.3% of the variance in PSMU. The block of sociodemographic predictors explained the lowest proportion of variance in PSMU compared with the other blocks. Age negatively predicted PSMU. Of the predictors related to social support, cyberbullying perpetration was the strongest predictor of PSMU. Perceived stress and psychosomatic complaints positively predicted PSMU. The intensity of electronic media communication and preference for online social interaction were stronger predictors of PSMU than the other predictors in the model. The results indicate that prevention efforts need to consider the diverse range of predictors related to PSMU.

Towards precision cardiometabolic prevention: results from a machine learning, semi-supervised clustering approach in the nationwide population-based ORISCAV-LUX 2 study.

Given the rapid increase in the incidence of cardiometabolic conditions, there is an urgent need for better approaches to prevent as many cases as possible and move from a one-size-fits-all approach to a precision cardiometabolic prevention strategy in the general population. We used data from ORISCAV-LUX 2, a nationwide, cross-sectional, population-based study. On the 1356 participants, we used a machine learning semi-supervised cluster method guided by body mass index (BMI) and glycated hemoglobin (HbA1c), and a set of 29 cardiometabolic variables, to identify subgroups of interest for cardiometabolic health. Cluster stability was assessed with the Jaccard similarity index. We have observed 4 clusters with a very high stability (ranging between 92 and 100%). Based on distinctive features that deviate from the overall population distribution, we have labeled Cluster 1 (N = 729, 53.76%) as "Healthy", Cluster 2 (N = 508, 37.46%) as "Family history-Overweight-High Cholesterol ", Cluster 3 (N = 91, 6.71%) as "Severe Obesity-Prediabetes-Inflammation" and Cluster 4 (N = 28, 2.06%) as "Diabetes-Hypertension-Poor CV Health". Our work provides an in-depth characterization and thus, a better understanding of cardiometabolic health in the general population. Our data suggest that such a clustering approach could now be used to define more targeted and tailored strategies for the prevention of cardiometabolic diseases at a population level. This study provides a first step towards precision cardiometabolic prevention and should be externally validated in other contexts.

Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg.

OBJECTIVES: We investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability of reporting unmet need. DESIGN: Cross-sectional survey conducted between February and December 2014. SETTING AND PARTICIPANTS: 4004 members of the resident population in private households registered with the health insurance fund in Luxembourg aged 15 years and over. OUTCOME MEASURES: Six binary variables that measured unmet need arising from wait time, distance/transportation and affordability of medical, dental and mental healthcare and prescribed medicines among those who reported a need for care. RESULTS: The most common barrier to access arose from wait times (32%) and the least common from distance/transportation (4%). Dental care (12%) was most often reported as unaffordable, followed by prescribed medicines (6%), medical (5%) and mental health (5%) care. Respondents who reported bad/very bad health were associated with a higher risk of unmet need compared with those with good/very good health (wait: OR 2.41, 95% CI 1.53 to 3.80, distance/transportation: OR 7.12, 95% CI 2.91 to 17.44, afford medical care: OR 5.35, 95% CI 2.39 to 11.95, afford dental care: OR 3.26, 95% CI 1.86 to 5.71, afford prescribed medicines: OR 2.22, 95% CI 1.04 to 4.71, afford mental healthcare: OR 3.58, 95% CI 1.25 to 10.30). Income between the fourth and fifth quintiles was associated with a lower risk of unmet need for dental care (OR 0.29, 95% CI 0.16 to 0.53), prescribed medicines (OR 0.38, 95% CI 0.17 to 0.82) and mental healthcare (OR 0.17, 95% CI 0.05 to 0.61) compared with income between the first and second quintiles. CONCLUSIONS: Recent and planned reforms to address waiting times and financial barriers to accessing healthcare may help to address unmet need. In addition, policy-makers should consider additional policies targeted at high-risk groups with poor health and low incomes.

COVID-19 crisis management in Luxembourg: Insights from an epidemionomic approach.

We develop an epidemionomic model that jointly analyzes the health and economic responses to the COVID-19 crisis and to the related containment and public health policy measures implemented in Luxembourg. The model has been used to produce nowcasts and forecasts at various stages of the crisis. We focus here on two key moments in time, namely the deconfinement period following the first lockdown, and the onset of the second wave. In May 2020, we predicted a high risk of a second wave that was mainly explained by the resumption of social life, low participation in large-scale testing, and reduction in teleworking practices. Simulations conducted 5 months later reveal that managing the second wave with moderately coercive measures has been epidemiologically and economically effective. Assuming a massive third (or fourth) wave will not materialize in 2021, the real GDP loss due to the second wave will be smaller than 0.4 percentage points in 2020 and 2021.