scholarly journals 79. Detroit’s Response to COVID-19 in Homeless Shelters

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S171-S171
Author(s):  
Gina Maki ◽  
David Bowser ◽  
Anita Shallal ◽  
Tyler Prentiss ◽  
Marcus Zervos ◽  
...  
Keyword(s):  
At Risk ◽  
Healthcare Access ◽  
Health Department ◽  
Poverty Rate ◽  
Homeless Shelters ◽  
Homeless Shelter ◽  
Surveillance Strategy ◽  
Hospital System ◽  
Transient Nature ◽  
Universal Testing

Abstract Background Detroit, Michigan has a poverty rate nearly three times the national average. Homeless shelters are at risk for infectious outbreaks due to reduced healthcare access for residents, compounded by overcrowding, hygienic challenges, lack of resources, and transient nature of residents. Prior to the first reported COVID-19 case in Michigan, the Detroit Health Department prioritized screening of both asymptomatic and symptomatic homeless residents residing in the city’s shelters. Early identification of COVID-19 positive cases allowed for implementation of strategies to halt further spread. Methods A surveillance strategy was implemented prior to the first confirmed COVID-19 case in Michigan. Surveillance involved temperature and symptom checks at each homeless shelter, three times weekly. 24 shelters were screened for symptoms, 13 shelters had universal testing performed. Two city-operated quarantine sites for COVID-positive and –suspected homeless individuals were organized. If a shelter resident tested positive, that shelter was placed in quarantine, and new referrals stopped for 14 days. Temperature and symptom check frequency increased to daily for 14 days. If a patient was positive for fever or symptoms, they were transferred to the quarantine center for testing and isolation. Results Over 23,000 temperature and symptom checks occurred in 24 shelters across Detroit since February 22. This identified 15 patients who were referred to the quarantine site. From April 11 to May 31, 721 residents from 13 homeless shelters were screened with universal testing for COVID-19, and 93 (12.9%) tested positive (Figure 1). Of 95 homeless residents who were referred through shelter surveillance, from the local hospital system and via unsheltered street outreach, and tested on-site at the quarantine and isolation shelter, 29 (31%) tested positive for COVID-19, and 66 (69%) tested negative. Figure 1. System-wide homeless shelter testing of COVID-19 Conclusion Homeless populations across the US are especially vulnerable to COVID-19, with high risk for rapid spread due to crowding and difficulty with physical distancing. The need for increased testing- and prevention-based strategies in this population is crucial. The process performed in Detroit’s homeless shelters can be a model for other communities at risk for COVID-19 outbreaks. Disclosures Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

scholarly journals Monitoring for COVID-19 by universal testing in a homeless shelter in Germany: a prospective feasibility cohort study

2020 ◽  
Author(s):  
Andreas K. Lindner ◽  
Navina Sarma ◽  
Luise Marie Rust ◽  
Theresa Hellmund ◽  
Svetlana Krasovski-Nikiforovs ◽  
...  
Keyword(s):  
Cohort Study ◽  
Program Planning ◽  
Retention Rates ◽  
Homeless Shelters ◽  
Homeless Shelter ◽  
Major Barrier ◽  
Oral Swab ◽  
Universal Testing ◽  
Increased Risk ◽  
Community Transmission

AbstractBackgroundLiving conditions in homeless shelters may facilitate the transmission of COVID-19. Social determinants and pre-existing health conditions place homeless people at increased risk of severe disease. Described outbreaks in homeless shelters resulted in high proportions of infected residents and staff members. In addition to other infection prevention strategies, regular shelter-wide (universal) testing for COVID-19 may be valuable, depending on the level of community transmission and when resources permit.MethodsThis was a prospective feasibility cohort study to evaluate universal testing for COVID-19 at a homeless shelter with 106 beds in Berlin, Germany. Co-researchers were recruited from the shelter staff. A PCR analysis of saliva or self-collected nasal/oral swab was performed weekly over a period of 3 weeks in July 2020. Acceptability and implementation barriers were analyzed by process evaluation using mixed methods including evaluation sheets, focus group discussion and a structured questionnaire.ResultsNinety-three out of 124 (75%) residents were approached to participate in the study. Fifty-one out of the 93 residents (54.8%) gave written informed consent. High retention rates (88.9% – 93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive. Language barriers were the main reason for non-participation. Flexibility of sample collection schedules, the use of video and audio materials, and concise written information were the main recommendations of the co-researchers for future implementation.ConclusionVoluntary universal testing for COVID-19 is feasible in homeless shelters. Universal testing of high-risk facilities will require flexible approaches, considering the level of the community transmission, the available resources, and the local recommendations. Lack of human resources and laboratory capacity may be a major barrier for implementation of universal testing, requiring adapted approaches compared to standard individual testing. Assisted self-collection of specimens and barrier free communication may facilitate implementation in homeless shelters. Program planning must consider homeless people’s needs and life situation, and guarantee confidentiality and autonomy.

scholarly journals Monitoring for COVID-19 by universal testing in a homeless shelter in Germany: a prospective feasibility cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andreas K. Lindner ◽  
Navina Sarma ◽  
Luise Marie Rust ◽  
Theresa Hellmund ◽  
Svetlana Krasovski-Nikiforovs ◽  
...  
Keyword(s):  
Cohort Study ◽  
Program Planning ◽  
Homeless Shelters ◽  
Homeless Shelter ◽  
Sample Collection ◽  
Major Barrier ◽  
Oral Swab ◽  
Universal Testing ◽  
Increased Risk ◽  
Community Transmission

Abstract Background Living conditions in homeless shelters facilitate the transmission of COVID-19. Social determinants and pre-existing health conditions place homeless people at increased risk of severe disease. Described outbreaks in homeless shelters resulted in high proportions of infected residents and staff members. In addition to other infection prevention strategies, regular shelter-wide (universal) testing for COVID-19 may be valuable, depending on the level of community transmission and when resources permit. Methods This was a prospective feasibility cohort study to evaluate universal testing for COVID-19 at a homeless shelter with 106 beds in Berlin, Germany. Co-researchers were recruited from the shelter staff. A PCR analysis of saliva or self-collected nasal/oral swab was performed weekly over a period of 3 weeks in July 2020. Acceptability and implementation barriers were analyzed by process evaluation using mixed methods including evaluation sheets, focus group discussion and a structured questionnaire. Results Ninety-three out of 124 (75%) residents were approached to participate in the study. Fifty-one out of the 93 residents (54.8%) gave written informed consent; thus 41.1% (51 out of 124) of all residents were included in the study. Among these, high retention rates (88.9–93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. Around 48 person-hours were necessary for the sample collection including the preparation of materials. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive by RT-PCR. Language barriers were the main reason for non-participation. Flexibility of sample collection schedules, the use of video and audio materials, and concise written information were the main recommendations of the co-researchers for future implementation. Conclusions Voluntary universal testing for COVID-19 is feasible in homeless shelters. Universal testing of high-risk facilities will require flexible approaches, considering the level of the community transmission, the available resources, and the local recommendations. Lack of human resources and laboratory capacity may be a major barrier for implementation of universal testing, requiring adapted approaches compared to standard individual testing. Assisted self-collection of specimens and barrier free communication may facilitate implementation in homeless shelters. Program planning must consider homeless people’s needs and life situation, and guarantee confidentiality and autonomy.

Shelter Characteristics, Infection Prevention Practices, and Universal Testing for SARS-CoV-2 at Homeless Shelters in 7 US Urban Areas

2021 ◽  
pp. e1-e6
Author(s):  
Julie L. Self ◽  
Martha P. Montgomery ◽  
Karrie-Ann Toews ◽  
Elizabeth A. Samuels ◽  
Elizabeth Imbert ◽  
...  
Keyword(s):  
Urban Areas ◽  
Infection Prevention ◽  
The United States ◽  
Homeless Shelters ◽  
Infection Prevalence ◽  
Universal Testing ◽  
Modifiable Factors ◽  
High Infection ◽  
Sleeping Arrangements ◽  
Risk Ratios

Objectives. To examine shelter characteristics and infection prevention practices in relation to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection point prevalence during universal testing at homeless shelters in the United States. Methods. SARS-CoV-2 testing was offered to clients and staff at homeless shelters, irrespective of symptoms. Site assessments were conducted from March 30 to June 1, 2020, to collect information on shelter characteristics and infection prevention practices. We assessed the association between SARS-CoV-2 infection prevalence and shelter characteristics, including 20 infection prevention practices by using crude risk ratios (RRs) and exact unconditional 95% confidence intervals (CIs). Results. Site assessments and SARS-CoV-2 testing results were reported for 63 homeless shelters in 7 US urban areas. Median infection prevalence was 2.9% (range = 0%–71.4%). Shelters implementing head-to-toe sleeping and excluding symptomatic staff from working were less likely to have high infection prevalence (RR = 0.5; 95% CI = 0.3, 0.8; and RR = 0.5; 95% CI = 0.4, 0.6; respectively); shelters with medical services available were less likely to have very high infection prevalence (RR = 0.5; 95% CI = 0.2, 1.0). Conclusions. Sleeping arrangements and staffing policies are modifiable factors that might be associated with SARS-CoV-2 infection prevalence in homeless shelters. Shelters should follow recommended practices to reduce the risk of SARS-CoV-2 transmission. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e6. https://doi.org/10.2105/AJPH.2021.306198 )

scholarly journals Mobile Traveling Healthcare Teams: An Innovative Delivery System for Underserved Populations

2018 ◽  
Vol 23 (3) ◽  
Author(s):  
Glenda Walker ◽  
Viviana Martinez-Gómez ◽  
Roberto Gonzalez
Keyword(s):  
Delivery System ◽  
Underserved Populations ◽  
Healthcare Access ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Health Department ◽  
State Mental Health ◽  
Social Determinant ◽  
Healthcare Team ◽  
Health Project

Reaching disenfranchised clients who are either underinsured or who have no insurance presents unique challenges for healthcare providers and organizations. To reach clients experiencing disparities in healthcare access, a social determinant of health, innovative models of healthcare delivery must be developed. The Juntos for Better Health project directly focused on the social determinant of lack of access to care for prevention and treatment of diabetes, depression, and obesity. In the article, we discuss the background that provided the framework for this project, reviewing literature related to mobile vans and traveling nurses, and then describe the geographical traveling healthcare team setting. The article discusses the Juntos for Better Health project, including several phases of implementation, services of the traveling healthcare team delivery system, and partnerships that included four healthcare providers and a state university in a United States-Mexico border town located in Texas. Partnering agencies included a community-based federally qualified healthcare center, the local state mental health authority, the city health department, and the local drug treatment agency. The conclusion briefly describes plans for the future.

scholarly journals Point-of-care molecular testing and antiviral treatment of influenza in residents of homeless shelters in Seattle, WA: study protocol for a stepped-wedge cluster-randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kira L. Newman ◽  
◽  
Julia H. Rogers ◽  
Denise McCulloch ◽  
Naomi Wilcox ◽  
...  
Keyword(s):  
Point Of Care ◽  
Antiviral Treatment ◽  
Homeless Shelters ◽  
Molecular Testing ◽  
Symptom Duration ◽  
Homeless Shelter ◽  
Stepped Wedge ◽  
Site Testing ◽  
Cluster Randomized ◽  
The Impact

Abstract Introduction Influenza is an important public health problem, but data on the impact of influenza among homeless shelter residents are limited. The primary aim of this study is to evaluate whether on-site testing and antiviral treatment of influenza in residents of homeless shelters reduces influenza spread in these settings. Methods and analysis This study is a stepped-wedge cluster-randomized trial of on-site testing and antiviral treatment for influenza in nine homeless shelter sites within the Seattle metropolitan area. Participants with acute respiratory illness (ARI), defined as two or more respiratory symptoms or new or worsening cough with onset in the prior 7 days, are eligible to enroll. Approximately 3200 individuals are estimated to participate from October to May across two influenza seasons. All sites will start enrollment in the control arm at the beginning of each season, with routine surveillance for ARI. Sites will be randomized at different timepoints to enter the intervention arm, with implementation of a test-and-treat strategy for individuals with two or fewer days of symptoms. Eligible individuals will be tested on-site with a point-of-care influenza test. If the influenza test is positive and symptom onset is within 48 h, participants will be administered antiviral treatment with baloxavir or oseltamivir depending upon age and comorbidities. Participants will complete a questionnaire on demographics and symptom duration and severity. The primary endpoint is the incidence of influenza in the intervention period compared to the control period, after adjusting for time trends. Trial registration ClinicalTrials.gov NCT04141917. Registered 28 October 2019. Trial sponsor: University of Washington.

scholarly journals Health Department Collaboration with Emergency Departments as a Model for Public Health Programs among at-Risk Populations

2005 ◽  
Vol 120 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Michael S. Lyons ◽  
Christopher J. Lindsell ◽  
Holly K. Ledyard ◽  
Peter T. Frame ◽  
Alexander T. Trott
Keyword(s):  
Public Health ◽  
At Risk ◽  
Emergency Departments ◽  
Health Department ◽  
Health Programs ◽  
Publicly Funded ◽  
Hiv Counseling And Testing ◽  
Hiv Counseling ◽  
Public Health Programs ◽  
Counseling And Testing

Objectives. Accessing at-risk and underserved populations for intervention remains a major obstacle for public health programs. Emergency departments (EDs) care for patients not otherwise interacting with the health care system, and represent a venue for such programs. A variety of perceived and actual barriers inhibit widespread implementation of ED-based public health programs. Collaboration between local health departments and EDs may overcome such barriers. The goal of this study was to assess the effectiveness of a health department-funded, ED-based public health program in comparison with other similar community-based programs through analysis of data reported by health department-funded HIV counseling and testing centers in one Ohio county. Method. Data for HIV counseling and testing at publicly funded sites in southwestern Ohio from January 1999 through December 2002 were obtained from the Ohio Department of Health. Demographic and risk-factor profiles were compared between the counseling and testing program located in the ED of a large, urban teaching hospital and the other publicly funded centers in the same county. Results. A total of 26,382 patients were counseled and tested; 5,232 were ED patients, and 21,150 were from community sites. HIV positivity was 0.86% (95% confidence interval [CI] 0.64%, 1.15%) in the ED and 0.65% (95% CI 0.55%, 0.77%) elsewhere. The ED program accounted for 19.8% of all tests and 24.7% of all positive results. The ED notified 77.3% of individuals testing positive and 84.4% of individuals testing negative. At community program centers, 88.3% of patients testing positive and 63.8% of patients testing negative were notified of results. All ED patients notified of positive status were successfully referred to infectious disease specialists. Conclusions. Public health programs can operate effectively in the ED. EDs should have a rapidly expanding role in the national public health system.

scholarly journals OLDER ADULT FALLS PREVENTION: THREE ADOPTED CLINICAL STRATEGIES FROM EVALUATION OF THE CDC STEADI INITIATIVE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S567-S567 ◽  
Author(s):  
Jennifer Edwards ◽  
Brittany Bickford ◽  
Yvonne Johnston ◽  
Aaron Alford
Keyword(s):  
At Risk ◽  
New York ◽  
Tai Chi ◽  
Systems Approach ◽  
Health Department ◽  
Falls Prevention ◽  
Public Service Announcement ◽  
Home Setting ◽  
National Network ◽  
Patients At Risk

Abstract This evaluation examines patients’ barriers and facilitators to adopting an evidence-based fall prevention strategy. Twenty-one patients were telephone interviewed. The purposive sample includes patients over age 65, screened as at risk for falls, and who received a referral for falls risk intervention. Seven themes emerged from the qualitative analysis of interview transcripts: 1. Behavioral Facilitators, 2. Personal Fall Experiences, 3. Informed Decision-making, 4. Providers, 5. Friends and Family, 6. Home Setting Facilitators, and 7. Risk Perception. Three opportunities were identified: 1. Develop an outpatient follow-up protocol, 2. Develop a falls screening public service announcement, and 3. Partner with the local Office for Aging to connect patients at risk with community programs such as Tai Chi. A systems approach involving the CDC, National Network of Public Health Institutes (NNPHI), Broome County Health Department, and an Upstate New York hospital system’s outpatient practices was vital for the success of this evaluation.

scholarly journals Outbreak of autochthonous cases of malaria in coastal regions of Northeast Brazil: the diversity and spatial distribution of species of Anopheles

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Elainne Christine de Souza Gomes ◽  
Derciliano Lopes da Cruz ◽  
Maria Alice Varjal Melo Santos ◽  
Renata Maria Costa Souza ◽  
Cláudia Maria Fontes de Oliveira ◽  
...  
Keyword(s):  
At Risk ◽  
Spatial Distribution ◽  
Spatial Analysis ◽  
Mosquito Species ◽  
Health Department ◽  
Transmission Cycle ◽  
Imported Case ◽  
Bg Sentinel ◽  
Epidemiology Investigation ◽  
Amazonian Region

Abstract Background Brazil has the fourth highest prevalence of malaria of all countries in the Americas, with an estimated 42 million people at risk of contracting this disease. Although most cases occur in the Amazon region, cases of an autochthonous nature have also been registered in the extra-Amazonian region where Anopheles aquasalis and An. albitarsis are the mosquito species of greatest epidemiological interest. In 2019, the municipality of Conde (state of Paraíba) experienced an epidemic of autochthonous cases of malaria. Here we present preliminary results of an entomological and case epidemiology investigation, in an attempt to correlate the diversity and spatial distribution of species of Anopheles with the autochthonous cases of this outbreak of malaria. Methods Case data were collected using case report forms made available by the Conde Municipal Health Department. The entomological survey was carried out from July to November 2019. The various methods of capture included the use of battery-powered aspirators, mouth aspirators, Shannon traps, BG-Sentinel traps (with and without dry ice) and CDC light traps. Captured mosquitoes were separated, packaged and sent to the laboratory for sexing and molecular identification of the various species of anophelines. The data were tabulated and analyzed using Microsoft Excel. Spatial analysis of the data was performed using ArcGis 10 software. Results In 2019, 20 autochthonous cases and one imported case of malaria caused by Plasmodium vivax were diagnosed, with three cases of relapses. A total of 3713 mosquitoes were collected, of which 3390 were culicines and 323 were anophelines. Nine species of genus Anopheles were identified, with the most abundant being An. aquasalis (38.9%), followed by An. minor (18.2%) and An. albitarsis (9.0%). Spatial analysis of the data showed that the area could be considered to be at risk of malaria cases and that there was a high prevalence of Anopheles. Conclusions The results presented indicate that this extra-Amazonian region has an environment conducive to maintenance of the malaria transmission cycle owing to the wide diversity of Anopheles species. This environment in combination with the high influx of people from endemic areas to the study area provides a perfect setting for the occurrence and maintenance of malaria.

scholarly journals Comparison of four COVID-19 screening strategies to facilitate early case identification within the homeless shelter population: A structured summary of a study protocol for a randomised controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Timothy O’Shea ◽  
Lawrence Mbuagbaw ◽  
Vaibhav Mokashi ◽  
David Bulir ◽  
Jodi Gilchrist ◽  
...  
Keyword(s):  
Sample Size ◽  
Detection Rate ◽  
The Other ◽  
Homeless Shelters ◽  
Homeless Shelter ◽  
Comparator Group ◽  
Full Protocol ◽  
Randomization Scheme ◽  
The City ◽  
Visual Instructions

Abstract Objectives 1. To compare the effectiveness of four different surveillance strategies in detecting COVID-19 within the homeless shelter population. 2. To assess the participant adherence over time for each surveillance method. Trial Design This is a prospective cluster-randomized study to compare the effectiveness of four different surveillance regimens across eight homeless shelters in the city of Hamilton. Participants Participants will include both residents of, and the staff working within, the homeless shelters. All participants aged 18 or older who consent to the study and are able to collect a swab sample (where relevant) are eligible for the study. The study will take place across eight homeless shelters (four men-only and four women-only) in the City of Hamilton in Ontario, Canada. Intervention and Comparator Groups The comparator group will receive active daily surveillance of symptoms and testing will only be completed in symptomatic participants (i.e. those who fail screening or who seek care for potential COVID-19 related symptoms). The three intervention arms will all receive active daily surveillance of symptoms and testing of symptomatic participants (as in the comparator group) in addition to one of the following: 1. Once weekly self-collected oral swabs (OS) regardless of symptoms using written and visual instructions. 2. Once weekly self-collected oral-nares swab (O-NS) regardless of symptoms using written and visual instructions. 3. Once weekly nurse collected nasopharyngeal swab (NPS) regardless of symptoms. Participants will follow verbal and written instructions for the collection of OS and O-NS specimens. For OS collection, participants are instructed to first moisten the swab on their tongue, insert the swab between the cheek and the lower gums and rotate the swab three times. This is repeated on the other side. For O-NS collection, after oral collection, the swab is inserted comfortably (about 2-3 cm) into one nostril, parallel to the floor and turned three times, then repeated in the other nostril. NPS specimens were collected by the nurse following standard of care procedure. All swabs were placed into a viral inactivation medium and transported to the laboratory for COVID-19 testing. Briefly, total nucleic acid was extracted from specimens and then amplified by RT-PCR for the UTR and Envelope genes of SARS-CoV-2 and the human RNase P gene, which is used as a sample adequacy marker. Main Outcomes 1. Primary outcome: COVID-19 detection rate, i.e. the number of new positive cases over the study period of 8 weeks in each arm of the study. 2. Secondary outcomes: Qualitative assessment of study enrollment over 8 weeks. Percentage of participants who performed 50% or more of the weekly swabs in the intervention arms in the 8 week study period. Randomization We will use a computer-generated random assignment list to randomize the shelters to one of four interventions. Shelters were stratified by gender, and the simple randomization scheme was applied within each stratum. The randomization scheme was created using WinPEPI. Blinding This is an open-label study in which neither participants nor assessors are blinded. Numbers to be randomized (sample size) Since we are including our total sample frame, a sample size estimation at the cluster level is not required. However, if we succeed to enroll 50 participants per shelter from 8 shelters (n=400), and the detection rate is 3 times higher in the intervention groups (0.15) than in the comparator groups (0.05), we will have 90% power to detect a statistically significant and clinically important difference at a type I error rate of alpha=0.05 (one tailed), assuming an intraclass correlation of ~0.008. These computations were done using WinPEPI, and informed by conservative estimates from other studies on respiratory illness in the homeless (see Full protocol). Trial Status The protocol version number is 3.0. Recruitment began on April 17, 2020 and is ongoing. Due to low numbers of COVID cases in the community and shelter system during the initial study period, the trial was extended. The estimated date for the end of the extended recruitment period is Feb 1, 2021. Trial Registration The trial was registered with ClinicalTrials.gov on June 18, 2020 with the identifier NCT04438070. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

The use of beta regression in the modelling of severe material deprivation indicator in the European Union countries

2018 ◽  
Vol 63 (3) ◽  
pp. 24-39
Author(s):  
Hanna Dudek
Keyword(s):  
At Risk ◽  
European Union ◽  
Social Protection ◽  
Variable Interval ◽  
Poverty Rate ◽  
Material Deprivation ◽  
The European Union ◽  
European Union Countries ◽  
Per Capita

The severe material deprivation rate indicates the proportion of the population that cannot fulfil at least four of the nine needs identified as basic ones in the European conditions. The study attempts to identify factors differentiating this indicator in the European Union countries. The parameters for regression beta models were estimated on the basis of data from the European Survey of Income and Living Conditions (EU-SILC) for 2014. Such models are useful when the value of the dependent variable interval is included between 0 and 1. It was found that severe material deprivation rate is affected by such factors as: type of household, median equalized disposable income, at-risk-of-poverty rate, relative median at-risk-of-poverty gap, inequality of income distribution, long-term unemployment rate, GDP per capita, and share of social protection expenditure in GDP.

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