bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal evaluation of existing agreements on avoidance of double taxation
Authors: Pyroha S. S.
Published: June 2024

The article analyzes double taxation agreements and reveals a number of shortcomings that actually contribute to income shifting. The main shortcomings of the agreements are the application of the principle of residency and the definition of a special mechanism for the payment of passive income. The term “resident” does not have a precise and specific definition. Individuals and legal entities can be residents of many countries at the same time, and identifying a resident’s affiliation to a specific country has a high corruption potential. And the determination of the jurisdiction of the enterprise is also carried out according to the concept of “being managed by a resident”. In the age of digital technology and the Internet, almost any place on planet Earth can be considered a place of control. Therefore, these concepts should be first and foremost specified in the legislation of Ukraine and applied in all concluded agreements on the avoidance of double taxation. In particular, it is necessary to determine whether the enterprise belongs to the jurisdiction of the state in whose territory it is located (it also applies to subsidiaries with the status of a legal entity). And income taxation is carried out according to the principle of source – income is taxed where the enterprise is actually located, the added value is produced, the salary is paid and the profit is received. The concept of “resident” of the country should be replaced by the more specific concept of citizen. When taxing royalties, a distinction should be made between industrial property and copyright. Industrial property is taxed at the place of its use for obtaining income and is paid from the profit that remains after the payment of taxes, contributions and fees provided for by the legislation of the country of the source of income. The fee for the use of the copyright is paid as a reward. The proposed definitions should be used in all double taxation treaties, although the author sees no need to retain these treaties. Therefore, it is possible to propose to denounce all current agreements of Ukraine on the avoidance of double taxation.
Theoretical principles of researching public-private partnership as an instrument of post-war economic reconstruction in Ukraine
Authors: Shevchenko A. E.
Published: June 2024

The article is dedicated to exploring the theoretical foundations of public-private partnership (PPP) as one of the key instruments for post-war economic reconstruction in Ukraine. A deep analysis of the genesis and evolution of PPP both globally and domestically is conducted. The position of PPP in the system of administrative and legal regulation is determined, along with its significant potential for stimulating economic development and the restoration of war-damaged infrastructure.
The war in Ukraine inflicted dreadful damage to the country’s economy, requiring substantial investments for its recovery and further development. In this context, PPP is considered as one of the promising sources of investment capable of stimulating economic growth and infrastructure modernization.
A retrospective analysis of the evolution of PPP from ancient times to its active implementation in the 20th century is carried out. Emphasis is placed on the experience of foreign countries where PPP is successfully utilized for project implementation in various spheres such as infrastructure, healthcare, education, energy, etc.
The formation and development of PPP in Ukraine are thoroughly analyzed. Key stages, legislative steps taken for its regulation, and factors hindering its dynamic growth are identified. The system of regulatory acts defining the legal framework for the functioning of PPP in Ukraine, the main principles and mechanisms for implementing PPP projects, as well as the powers of state bodies and the private sector in this sphere are disclosed.
Estimación económica de los años perdidos de vida productiva potencial por muertes violentas en México, 2000-2018
Authors: Vélez Echagaray Carlos Alejandro , Gómez Téllez David , De la Luz Tovar Christian
Published: June 2024

La cantidad de muertes violentas en México ha venido creciendo durante los últimos años, lo que ha ocasionado enormes retos en las políticas públicas, específicamente en las relacionadas con la seguridad pública, los servicios de salud y las aseguradoras. En general, una muerte violenta es una tragedia que, con frecuencia, puede ser evitada. Además, dicha pérdida no sólo afecta a la víctima y a sus familiares, ya que repercute en toda la sociedad. En efecto, al considerar esta problemática, y utilizando las ecuaciones de ingreso de Mincer, observamos que se han perdido cuantiosas vidas de trabajadores (potenciales o en activo), por lo que la sociedad ha perdido el ingreso y el consumo potenciales de las personas fallecidas. Por tal razón, en este artículo estimamos las pérdidas económicas causadas por las muertes violentas, esperando coadyuvar a aumentar la conciencia sobre la urgencia de delinear e instrumentar políticas públicas que disminuyan este tipo de fallecimientos que, insistimos, son evitables.
Centralidades periféricas y periferias centrales en la localización residencial inmigrante en el Distrito Metropolitano de Quito, Ecuador
Authors: Garrido Mantilla Adriana Lorena , Córdova Montúfar Marco , Durán Saavedra Gustavo
Published: June 2024

El artículo reflexiona sobre la problemática de la inserción residencial inmigrante en el mercado de alquiler del Distrito Metropolitano de Quito, Ecuador, mediante el análisis de las condiciones de habitabilidad y localización geográfica de 1 797 personas. Se busca comprender los patrones determinantes de su localización residencial en espacios de la centralidad periférica y la periferia central urbana, y se propone que sus elecciones residenciales están determinadas por factores estructurales relacionados con la lógica del mercado del suelo y la vivienda, las dinámicas urbanas, y sus condiciones socioeconómicas y migratorias. El trabajo utiliza métodos mixtos: cuantitativo, cualitativo y análisis socio espacial.
VALIDITAS MEDIA SMART GEOMETRY POP-UP BOOKS SEBAGAI UPAYA MENINGKATKAN HASIL BELAJAR PENGENALAN BANGUN GEOMETRI SISWA TUNARUNGU
Authors: Nurviyani Erly , Silfia Icha , Samodra Teguh , Fathur Rahman Ilham , Putri Purwaningrum Jayanti
Published: June 2024

Keterbalakangan daya pikir dalam mengenal bangun geometri pada siswa tunarungu dan media yang digunakan oleh sekolah masih kurang efektif, menjadikan siswa tunarungu kesulitan dalam mengenal bangun geometri. Penelitian ini bertujuan untuk (1) Mengetahui adanya peningkatan persentase kelayakan pada media smart geometry pop-up books(2) Mengetahui kelayakan media smart geometry pop-up books yang bermuatan matematika pada siswa kelas IV dan V SLBN Cendono Kudus. Penelitian ini, menggunakan metode Research and Development (RnD) dengan menggunakan jenis penelitian kuantitatif. Subjek penelitian adalah 5 siswa tunarungu terdiri dari kelas IV dan V SLBN Cendono Kudus. Penelitian yang dilakukan melalui beberapa tahapan yaitu potensi dan identifikasi masalah, pengumpulan data, desain produk, validasi media dan revisi media. Teknik pengumpulan data pada penelitian ini melalui wawancara, angket dan dokumentasi. Hasil dari penelitian ini yaitu media yang dikembangkan dinyatakan layak dengan validasi ahli media yaitu dengan rata-rata keseluruhan sebesar 27 dan presentase 81% dengan kategori layak, validasi ahli materi yaitu rata-rata keseluruhan sebesar 4,1 dan presentase 82% dengan kategori layak untuk diuji cobakan. Berdasarkan hasil penelitian yang diperoleh, maka kesimpulan dari pengembangan media smart geometry pop-up books ini dikatakan layak pada pembelajaran matematika dengan materi pengenalan bangun datar dan ruang pada siswa kelas IV dan V SLBN Cendono Kudus.
MANIFESTASI SOLIDARITAS DALAM PENDIDIKAN KARAKTER GURU SEKOLAH DASAR
Authors: Tazkiyah Era , Permatasari Almanik Dyan
Published: June 2024

Solidaritas merupakan salah satu nilai yang menjadi sorotan oleh Kementerian Pendidikan, Kebudayaan, Riset, dan Kebudayaan Republik Indonesia (Kemendikbudristek RI) dalam dunia pendidikan dan juga pada Kelompok Kerja Pendidikan G20 yang terselenggara di tahun 2022. Tujuan dari penulisan ini untuk menganalisis beragam wujud dari solidaritas yang telah terjadi dan bisa diterapkan di lingkungan sekolah dasar, juga sebagai bahan refleksi bagi para guru untuk dapat menerapkan nilai solidaritas. Jenis dari penulisan ini menggunakan kualitatif-deskriptif. Penulis menggumpulkan beragam data menggunakan teknik penelitian seperti observasi, wawancara dan dokumentasi untuk memeroleh beragam wujud dari manifestasi yang terjadi. Analisis data menggunakan model dari MilesHuberman yang berupa reduksi data, penyajian data, dan penarikan kesimpulan. Subjek penelitan ini merupakan guru-guru di SDN 3 Depok yang berjumlah 10 orang dengan beragam pengalaman yang sudah memenuhi kriteria dari peneliti yang dilakukan selama kurang lebih 3 bulan. Hasil penelitian menunjukkan bahwa solidaritas sudah diwujudkan oleh para guru dalam beragam program yang ada di sekolah seperti Jumat Bersih, Jumat Sehat dan Senin Berteman. Selain itu, nilai dari solidaritas penting untuk dijunjung, dan diimplementasikan oleh setiap guru yang sejalan dengan keinginan Kemendikbudristek RI yang dikemukakan pada G20 Education Working Group/EdWG. Manifestasi dari nilai solidaritas dapat diterapkan apabila guru memiliki karakter baik yang dibutuhkan di zaman modern ini.
Alcohol consumption and suicide: a country-level study
Authors: Inelmen Emine M. , Gazerro Marialuisa , Inelmen Erol , Sergi Giuseppe , Manzato Enzo
Published: June 2024

Background: The relationship between suicide and alcohol consumption is well established at the individuallevel. In this article we examine this relationship at a national level across 98 different countries.Methods: The suicide and alcohol consumption rates considered were those calculated by the WHO (2008and 2004 database respectively). A simple correlation analysis was conducted and cross-national variationswere shown in cartograms with the values of the standard deviation as class breaks.Results: A significant positive association (r = 0.42 in the case of men, r = 0.34 in the case of women) emergedbetween per capita alcohol consumption and gender-specific suicide rates when we considered all the 98countries around the world for which data were available. When considering the group of ex-communistcountries alone, the correlation coefficient between alcohol consumption and suicide rates was higher andstatistically significant for both men (0.51) and women (0.47).Conclusions: Bivariate analysis at the country level delineates a worldwide association between suicide ratesand alcohol consumption. There were no countries where a high or moderate-high alcohol consumption ratecoincided with a low or medium-low suicide rate. Where alcohol consumption is high, there is an impacton suicide rates. Where it is low, this seems to have a protective effect, unless other suicide determinantsacquire a major role.Suicide is multi-factorial and the determinants may be different in any given country, multivariate analysisand local studies are therefore required.
Healthy life styles and perceived health status in the general population of a Northern Italian health district: a cross-sectional study
Authors: Colzani Edoardo , Bonazzi Chiara , Del Corno Giuseppe
Published: June 2024

Background: Evidence should drive public health initiatives to better address the most important healthissues. Chronic diseases represent the main burden of healthcare expenditure in Western countries andare determined by risk factors related to behaviour. Population-based surveys should lead to well informeddecision making in this field.Methods: A cross-sectional survey was carried out among the general population aged between 18 and69 in the district of Monza-Brianza in Northern Italy through phone interviews. A validated questionnaireinvestigating health-related lifestyles and behaviours was used. The questionnaire was divided into thefollowing parts: general health status, physical activity, smoking habit, nutrition, alcohol consumption,driving safety, cardiovascular risk, cancer screening, mental health, domestic safety and socio-economicstatus.Results: In total, 308 interviews were carried out (response rate=76%). Almost 40% reported a body massindex >25, 64.9% had high school or university degrees, 60.4% worked full-time, 26.2% were assessedas physically inactive, and 13.3% were on a weight –loss diet. In addition, 19.7% had an “at risk” alcoholconsumption , especially among younger age groups. Symptoms of depression were identified in 4.9% of thestudy subjects, particularly in women.Conclusions: Age, body mass index, education, and occupation were significantly associated with thelikelihood of reporting poor health status. Young subjects were more likely to be smokers and drinkers atrisk. Psychological health and appropriate prescription of anti-cholesterol and anti-hypertensive drugs areareas deserving further investigations. Nutrition, physical activity, driving safety and youth health, especiallyconcerning drinking habits, are areas where initiatives should be undertaken
Facoltà d’Amarsi”: when young people try to change the situation. Youth project as a tool for health communication and STD prevention
Authors: Massini Sara , Marona Rubina , Di Pinto Georgia Helen , Saulle Rosella
Published: June 2024

Background: Since its discovery, AIDS has been a major pandemic infection. Nowadays, despite high levels ofawareness, HIV infection is still one of the most complex phenomenon in our society and people, especiallyyoung people, don’t apply changes to reduce sexual risk behaviour to bring about prevention of HIV andAIDS. Condom use, particularly consistent use, is suboptimal in our communities. In our country, for FamilyPlanning Worldwide 2008, just 38,3% of young people reported to use condoms. Monogamy and harmoniousrelationships play a positive role in young people and reduce their risk of HIV infection and such aspects ofrelationship contexts could form a significant part of the progressive strategies required for HIV-preventioninterventions to be successful. Many prevention campaigns have been realized and in particular they try toexplain the risk connected to HIV and give information about how to prevent infection and the infection’scourse. The next generation of HIV prevention and risk reduction interventions should move beyond basicsex education and condom use / availability. Successful interventions must optimize strategies that supportHIV risk reduction behaviours. Despite extensive behavioural research, current strategies have not resulted.Methods: In this article we explain why the old campaign didn’t work and why youth initiatives could bea possible answer to a prevention needs. We choose the method of peer education and scientific contentsusing transverse knowledge from expert of medicine, psychology and media science to face off at the needsof efficacy and reliability.Results: The final sample is made by 271 students, 102 males, 164 females. 91,5% declare that had alreadysexual relations, instead 5,19% never had one. 38,% of sample affirm to use habitually condoms, 20,3%sometimes, 18,8% never used condoms.Conclusions: This study shows how new approach to the problem could help people changing their behaviors
The European Union action in the field of rare diseases
Authors: Montserrat Moliner Antoni
Published: June 2024

Background: Rare diseases, including those of genetic origin, are defined by the European Union as life-threatening or chronically debilitating diseases which are of such low prevalence (less than 5 per 10 000). Thespecificities of rare diseases - limited number of patients and scarcity of relevant knowledge and expertise -single them out as a unique domain of very high European added-value.Methods: The legal instruments at the disposal of the European Union, in terms of the Article 152 of theTreaties, are very limited. However a combination of instruments using the research and the pharmaceuticallegal basis and an intensive and creative use of funding from the Second Health Programme has permitted tocreate a solid basis that Member States have considered enough to put rare diseases in a privileged positionin the health agenda.Results: The adoption of the Commission Communication, in November 2008, and of the CouncilRecommendation, in June 2009, and the future adoption of the Directive on Cross-border healthcare, end2009 or mid 2010, have created an operational framework to act in the field of rare disease with Europeancoordination in several areas (classification and codification, European Reference Networks, orphan drugs,European Committee of Experts, etc.).Conclusions: Rare diseases is an area with enormous and practical potentialities for European cooperation.
Can savings induced by off-patent drugs balance the increase of pharmaceutical expense associated with the high ageing rate of the Italian population?
Authors: Russo Pierluigi , Capone Alessandro , Pieri Vasco , Favato Giampiero
Published: June 2024

Background: The predicted ageing rate of the Italian population is one of the highest worldwide and thiscondition is expected to produce a growing increase in pharmaceutical expenditure. The objective of thisstudy was to assess whether or not off-patent drugs could counterbalance the economic effects generated bythe aging of the Italian population in the next ten years.Methods: On the basis of the predicted ageing rate of the Italian population for the period 2008-2018, theaverage annual cumulative increase of pharmaceutical expenditure and potential savings generated by thefuture loss of patent coverage have been considered in order to identify the year of the Breakeven Point.Results: The economic effect induced by the progressive ageing of population produces an average of 0.94%cumulative increase in local pharmaceutical expenditure per year, corresponding to an incrementalpharmaceutical expenditure of about € 116 millions per year.A number of 509 brands (103 active substances) will lose their patent coverage in the next 10 years.Considering both the present legislation and a level of price reduction, after patent expiration, correspondingto 40%, it is predicted that the Breakeven Point will be achieved at the end of 2011.Conclusions: In this study, a long term balance between the predictable increase of pharmaceuticalexpenditure induced by the ageing of Italian population and savings produced by future off-patent drugs wasnot established. In order to assure the future sustainability of pharmaceutical expenditure, this studysupports the need for the development of new health policy strategies.
Network EuroLifestyle - an independent scientific network
Authors: Neumann Grit , Kirch W.
Published: June 2024

The Network EuroLifestyle aims to contribute to the improvement of the population health status in the European Union. The network will do so by adequately informing stakeholders and the inhabitants of the European Union about health effects and consequences of different lifestyles. For that purpose the network will identify and help to reduce lifestyle-related health inequalities. EuroLifestyle will prepare high impact communication to provide sound information of lifestyle issues so that stakeholders and the European population can make informed lifestyle choices.
Strategic challenges in upgrading the population’s health in the transition countries of South Eastern Europe
Authors: Bjegovic-Mikanovic Vesna , Laaser Ulrich
Published: June 2024

Since the devastating nineties of the last century a slow but steady improvement of the living conditions in the region of South Eastern Europe (SEE) has be observed. However, so far only three countries, i.e. Bulgaria, Romania and Slovenia, have managed to ascent to the European Union and only Slovenia has joined the European currency. All others are still struggling with a difficult heritage of inappropriate vertical management structures, overstaffing and outmigration of the well educated young. This résumé applies also to the field of public health where, for example, the old hygienic tradition remained dominant, often maintaining huge laboratory facilities in the institutes of public health and very small numbers of staff being allocated to health promotion and modern participative management. This situation cannot be overcome easily nor in short term. Supported by funds from the German contribution to the European Stability Pact, the Forum for Public Health in South Eastern Europe (FPH-SEE: www.snz.hr/fphsee) has established a permanent collaboration between the public health institutions in the region, including foremost the Schools of Public Health (SPH), the National Public Health Associations (PHA) and some national Institutes of Public Health (IPH).
Health insurance system and provider payment reform in the Republic of Macedonia
Authors: Donev Doncho M.
Published: June 2024

This article gives an insight to the current health insurance system in the Republic of Macedonia. Specialemphasis is given to the specificities and practice of both obligatory and voluntary health insurance, to thescope of the insured persons and their benefits and obligations, the way of calculating and payment of thecontributions and the other sources of revenues for health insurance, user participation in health careexpenses, payment to the health care providers and some other aspects of realization of health insurance inpractice. According to the Health Insurance Law, which was adopted in March 2000, a person can become aninsured to the Health Insurance Fund on various modalities. More than 90% of the citizens are eligible to theobligatory health insurance, which provides a broad scope of basic health care benefits. Till end of 2008payroll contributions were equal to 9.2%, and from January 1st, 2009 are equal to 7.5% of gross earned wagesand almost 60% of health sector revenues are derived from them. Within the autonomy and scope of activitiesof the Health Insurance Fund the structures of the revenues and expenditures are presented. Health financingand reform of the payment to health care providers are of high importance within the ongoing health carereform in Macedonia. It is expected that the newly introduced methods of payments at the primary health carelevel (capitation) and at the hospital sector (global budgeting, DRGs) will lead to increased equity, efficiencyand quality of health care in hospitals and overall system.
Vector-associated diseases in the context of climate change: Analysis and evaluation of the differences in the potential spread of tertian malaria in the ecoregions of Lower Saxony
Authors: Schmidt Gunther , Holy Marcel , Schröder Winfried
Published: June 2024

Background: The outbreak of vector-associated diseases is determined by different factors. One of them is the existence of appropriate climatic conditions which influence the development of vectors as well as pathogens. Nowadays, accurate data on the occurrence of both vectors and pathogens are often not available in Germany, espite the coastal zones of Lower Saxony (Germany) being former malaria regions. Thus, the question arises, whether a new autochthonous transmission could take place due to the monthly mean temperatures of recent ears taking into consideration the predicted increase in air temperatures according to the IPCC scenarios.
Methods: To model areas at risk, the transmission potential for new tertian malaria spreads in respect to emperature was computed in a GIS environment using the Basic Reproduction Rate (R0) formula.
Results:We were able to corroborate that the risk of tertian malaria transmission is increasing as temperature s the determining variable of the mathematical model.
Conclusions: Lower Saxony is at risk of a new outbreak of tertian malaria assuming no other risk factors than emperature being of relevance.
Methodology for measuring environmental health within Europe. Health Risk from Environmental Pollution Levels in Urban Systems (HEREPLUS)
Authors: Zscheppang Anja , Manes Fausto , La Torre Giuseppe , Boccia Antonio , Trueman Stephen , Sarigiannis Dimosthenis , Pavlos Kalabokas , Artíñano Begoña , Perrino Cinzia , Fernández Patier Rosalía , Rigby Michael , Jankovic Slavenka , Kirch Wilhelm
Published: June 2024

Background: The European Commission funds a European research project titled “Health Risk fromEnvironmental Pollution Levels in Urban Systems” (HEREPLUS) that focuses on environmental health withinEurope. The HEREPLUS project was presented at the 16th EUPHA conference in Lisbon in November 2008within a workshop named “The assessment of the effect of air pollution on population and environmentalhealth: the integration of epidemiology and geographical information system (GIS)”.Methods: The HEREPLUS project aims to measure the correlation between air pollution (especially ozone andparticulate matter), meteorology, vegetation and human health in four European cities (Rome, Madrid, Athensand Dresden) by using a Geoinformation System to develop risk maps and subsequently guidelines to reduceair pollution and number of diseases.Results: The project started in September 2008 and a large, structured, relational database has beendeveloped and completed. A literature review including national as well as international scientific literaturegoes on and will be completed in April 2009. Final results will be presented and published in 2011.Conclusions: Detailed scientific knowledge is important and needed to implement environmentalprogrammes with the overall aim to protect human population against environmental related diseases.
Income distribution and mortality in Sweden
Authors: Lindholm Christina , Fredlund Peeter , Wamala Sarah
Published: June 2024

Background: The hypothesis that a high income inequality on a societal level is associated with poor healthoutcomes has been both rejected and accepted in empirical studies. Whether the influence of economiccircumstances on health operates at the individual level or societal level has important implications on policyand intervention alternatives. The objective of this study was to analyse the relationship between incomeinequality and mortality in Swedish municipalities and if the relationship varies depending on the meanincome or on the time-lag between income inequality and mortality.Methods: The study was based on register data on mean income and income inequality (Gini coefficients)from Statistics Sweden 1982 and 1998, aggregated on the municipality level. Data on age-standardised deathrates per 100,000 persons were obtained for 1983, 1988, 1993, 1998 and 2002. The analysis on 1998 was atest of the robustness of the results.Results: The relationship between high income inequality in 1982 and mortality in 1983 was negative with asimilar relationship in 1998. Using latency periods, the results show a decreasing trend of mortality in relationto higher Gini coefficients. A positive relationship between Gini and mean income implies that municipalitieswith larger income distribution also had a higher mean income and vice versa.Conclusions: High income inequality does not have a negative effect on mortality in Swedish municipalities.The municipalities with high income inequality have also high mean income as opposed to many othercountries. The income level seems to be more substantial for mortality than the income inequality.
Disability: concepts and statistical information
Authors: Baldassarre Giordana , Battisti Alessandra , Rosano Aldo , Solipaca Alessandro
Published: June 2024

Background: The measurement and definition of disability is difficult due to its objective and subjectivecharacteristics. In Italy, three different perspectives have been developed during the last 40 years. Thesevarious perspectives have had an effect, not only on how to measure disability, but also on policies to improvethe social integration of people with disabilities.Methods: This paper examines the various conceptual models behind the definition of disability and thedifferences in the estimated number of persons with disabilities. In addition, it analyses in accordance withthe International Classification of Functioning, disability and health, the European and international initiativesundertaken to harmonize the definitions of disability.Discussion: There are various bodies and central government agencies that either have management data orcarry out statistical systematic surveys and disability surveys. Statistically speaking, the worst aspect of thisscenario is that it creates confusion and uncertainty among the end users of this data, namely the policy makers.At international level the statistical data on disability is scarcely comparable among countries, despite hugeefforts on behalf of international organisations to harmonize classifications and definitions of disability.Conclusions: Statistical and administrative surveys provide information flows using a different definition andlabel based on a conceptual model that reflects the time period in which they were implemented. The use ofdifferent prescriptive definitions of disability produces different counts of persons with disabilities in Italy. Forthis reason it is important to interpret the data correctly and choose the appropriate cross section that bestrepresents the population on which to focus attention.
Health for All - Italia, an informative health system
Authors: Loghi Marzia , D’Errico Alessia
Published: June 2024

Background: On ISTAT website the informative system Health for All – Italia is available. It collects indicatorson health coming from various sources to make up a basis for constructing an organic and joint framework onthe country’s health reality. The system includes more than 4000 indicators about: demographic and socio-economic context; causes of death; life styles; disease prevention; chronic and infectious diseases; disability;health status and life expectancy; health facilities; hospital discharges by diagnosis; health care resources.The database-related software was developed by the World Health Organization to make it easier for any userto access the information available either as tables, graphs and territorial maps.Methods: The system has been built considering data coming from different sources and using, if possible,the same definitions, classifications and desegregations. Time series goes from 1980 to the last year available(which can differ among the different sources). Indicators are calculated by provinces (if possible), regions,big areas and Italy. In order to compare indicators over time and space, standardised rates are calculated,using the same population reference.For each indicator metadata are available to give users additional notes necessary to correctly read and usethe data, and publications or internet websites to examine more in-depth the argument.Results: Different kind of users find Health for All – Italia very useful for their aims: students, researchers,doctors, socio-sanitary operators, policy makers. Some examples of official reports from public institutionsare briefly described in the paper.Conclusions: The increasing number of users of Health for All – Italia make necessary the online version andan English version for international comparisons.
Spider: managing clinical data of cancer patients treated through a multidisciplinary approach by a palm based system
Authors: Valentini Vincenzo , Maurizi Francesca , Tagliaferri Luca , Balducci Mario , Cellini Francesco , Gambacorta Maria Antonietta , Lanzotti Vito , Manfrida Stefania , Mantini Giovanna , Mattiucci Gian Carlo , Meduri Bruno , Miccichè Francesco , Nardone Luigia , D’Agostino Giuseppe Roberto
Published: June 2024

Background: The complexity of modern oncology, based on multi-disciplinary management of cancer patients, results in critical amounts of data, leading to problems in managing and sharing information.
Methods: Spider is a multi-user system, based on integrated palm technology, created to facilitate data recording, managing and sharing, through Intra-Internet connection. By palms or PCs, data are collected directly at the place where information is generated. Every health professional can edit, modify and display all of the patient's data according to his/her operational level. A powerful engine enables Spider’s users to create series of cancer patients’ appointments linked to one another by specified time intervals and save them as “Protocols”. Applying a protocol to the patient, the system schedules a wave of appointments and alerts keeping the correlation with time intervals previously specified by specialists. XML technology is integrated with traditional RDBMS technology to build the Electronic Patient File (EPF) updated during each patient’s admission or consultation, including any new diagnostic/therapeutic events and collective decisions. The system automatically produces all clinical documents routinely in use (discharge letters, exams’ requests, etc.).
Results: Spider’s different archives include 4387 patients (Prostate, n=849; Lung, n=1596; Rectum, n=1541; Head & Neck, n=291; Cervix, n=110). The EPF includes specific modules: staging, surgery, chemotherapy, hormonotherapy, radiotherapy, toxicity, pathology, follow-up and clinical summary. Spider Hospitalization displays the ward map and important details of patients occupying each single bed.
Conclusions: Spider makes data capture easier and accurate. The availability of large amounts of information accelerates outcome analysis and improves cancer research.
Public health genomics: origins and basic concepts
Authors: Zimmern Ron , Stewart Alison
Published: June 2024

Knowledge and technologies arising from the Human Genome Project promise in time to offer newopportunities for the treatment and prevention of disease. The enterprise of public health genomics aims tobridge the gap between advances in basic research and their responsible and effective implementation inclinical services and public health programmes. Public health genomics stresses the importance ofunderstanding how genes and environment act together to influence health; avoiding geneticexceptionalism; appreciating the social and political context of genomic advances; and encouraging criticalevaluation of proposed new tests and interventions. New international networks and collaborations arebeing established to develop public health genomics and further its aims.
Quality assurance in genetic testing: a European perspective
Authors: Ibarreta Dolores , Matthiessen-Guyader Line
Published: June 2024

Genetic testing has moved rapidly from research to clinical use and the issues of quality have not alwaysreceived sufficient attention. In response to these needs to improve the overall quality assurance system forgenetic testing and services there have been several international initiatives that are reviewed here. Themain activities at European level towards improving the quality assurance of genetic testing are described.
Cancer care commissioning, information and choice in England: a commentary
Authors: McCarthy Mark
Published: June 2024

The National Health Service in England has focused on improving cancer services over the last decade,following indications from the international EUROCARE study that cancer services, and survival, were behindother comparable countries. New managerial structures and processes have been created to encourageservice specialization by cancer type, develop coordination between hospitals and improve access times forpatients. However, within the NHS in England as a whole, the government has been encouraging marketideas that contrast with this centralist direction. To improve patient ‘choice’, an improved informationsystem, drawing on timely clinical and administrative data, is needed for cancer care commissioning.
Systematic reviews of effectiveness of Public Health practice
Authors: Faggiano Fabrizio , Vigna-Taglianti Federica
Published: June 2024

Background: Public Health is the main discipline involved in the prevention of avoidable deaths. Toimplement interventions aimed at eliminating causes of death, and to take decisions based on evidence ofeffectiveness, research summaries are needed.Methods: To discuss the critical points for synthesizing the evidence on the effectiveness of public healthinterventions, the inconsistencies between the results produced by different epidemiological study designsand the methodological issues related to the quality of the summaries are underlined.Results: The Randomized Controlled Trial is recognized as the best study design for the assessment of theeffectiveness of clinical practices; however, the integration of the results from non-randomized andrandomized interventions has been suggested recently. In particular this involves Public Health, where therandomization of individuals is often impossible, and interventions are administered at different levels(individual, group, population).Conclusions: Systematic reviews are not common in Public Health. Methodological tools to write rigoroussummaries of the evidence from public health interventions, taking into account all possible biases, appearto be a priority.
Educating patients suffering from re-acutisation of chronic bronchitis. A pilot support project within Intermediate Care
Authors: Cocco Giulio , Langiano Elisa , Mattiello Vincenza , Federico Bruno , Gentile Adele , De Vito Elisabetta
Published: June 2024

Background: Chronic Obstructive Pulmonary Disease (COPD) represents one of the main causes ofhospitalization, disability and mortality worldwide; it is predicted that by the year 2020 it will become thethird leading cause of death and the fifth leading cause of disability in industrialized countries.An educational programme has been proposed to allow the COPD patient to prevent or to deal with a re-acutisation.Methods: The project involved 50 patients with a diagnosis of moderate or severe COPD. The educationprogram included information relating to disease process, proper use of medication, energy conservationmethods, and the filling in of the Saint George’s Respiratory Questionnaire (SGRQ), the Zung Self-RatingDepression Scale (ZSDS) and the State Trait Anxiety Inventory (STAI). Sociodemographic factors,assessment of living arrangements, social and family conditions were also collected. One year later the samequestionnaires and learning assessment tests were re-administered.Results: The mean age of the participants was 69.7±10.4 years with a mean low income and a limited degreeof education. Following the educational program, an improvement of quality of life emerged consequent tothe awareness of all of the forms of support provided for the pathology and socio-economic conditions. Theability to manage their therapy and their activities of daily living have improved. The mean total score onSGRQ was 78.07±7.2 pre-program and 73.12±7.2 post-program; 52% of the patients are now within normalparameters compared to the initial 30% suffering from depression syndrome, furthermore the mean anxietyvalue decreased from 59.54 ± 8.6 to 54.54±7.8. The number of hospital admissions and the number ofsmokers were also halved.Conclusion: The improvements obtained after conducting all of the educational sessions are significant. Thehigh value of the mean total score on SGRQ suggests overall poor health among patients affected bymoderate/ severe COPD and according to other studies this population is inclined to anxiety and depression.The role of the social worker was very important because the explanation of the appropriate laws has leadto the recognition of their disability status and therefore access to established benefits. The decrease inhospitalization has brought about an economic benefit for the educational program but further studiesshould be carried out on more patients over longer periods of time
Health Technology Assessment (HTA) in a changing social and health care context
Authors: Granados Alícia
Published: June 2024

Health Technology Assessment (HTA) has been defined in different ways, nevertheless it can be described briefly as a multidisciplinary process of analysis dealing with evidence and context to inform decision making in health care.
For decades HTA and related fields, aimed to produce and encourage the use of scientific evidence to inform decision making, at all levels of the health care system, from policy making and management to clinical decision making [1,2]. Scientific evidence involved in the HTA process may refer to efficacy, effectiveness, safety, needs, appropriateness, efficiency, equity, acceptability and some other issues related to the effect of the introduction, use and diffusion of medical technologies on health and health care. The evaluation, with formal rules, of the quality of available scientific information is an important step of the HTA process as are the skills required for literature searching.The source of scientific information should not be limited to clinical literature, but also exploit other areas of knowledge such as epidemiology, social sciences,economics,health services research among others [1].
The best method to be used in the HTA analysis process obviously depends on the uncertainties to be assessed. It could range from the synthesis and/or integration of scientific information to production of primary data.
The latter is the option of choice when there is insufficient existing evidence or its quality is poor. The assessments often require a multidisciplinary and multi-method approach, the former, of course, must be chosen after translating the uncertainty into sound research questions.
Health Technology Assessment: a flexible approach? Experiences in Lombardy
Authors: Amigoni Maurizio , Francesconi Alberto , Lago Paolo , Maccarini Maurizio E. , Pellegrini Luca
Published: June 2024

Italy is dealing with an early stage of Health Technology Assessment diffusion. In our opinion, there are atleast three important dimensions related to Health Technology Assessment (strategy, inter-organisationalrelationships and governance) that are able to affect it, at each level, systemic and operating-unit related.Although Health Technology Assessment may have originated as a centralised function conducted byfederal government agencies or other national/regional organisations, it is an increasingly decentralisedactivity. In Italy this decentralisation process is now reaching a peak because of the almost totalassignment of health responsibilities to regional authorities. Moreover, Health Technology Assessment isinterdisciplinary and it is interdependent with innovation processes. The context seems to be very complex:in our opinion a flexible approach is advisable. The following describes this new approach and theexperiences in Lombardy where various solutions have been adopted to support and improve HealthTechnology Assessment processes.
Understanding inappropriate hospital admissions of patients presenting to the Emergency Department
Authors: Siliquini Roberta , Rocca Nadia , Rocca Giuseppe , Minniti Davide , Gianino Maria Michela , Renga Giovanni
Published: June 2024

Objectives. To identify 1) the characteristics of patients receiving non acute (inappropriate) care and 2) thevariables associated to inappropriate hospital use, in order to 3) estimate the relevance of the problem andto 4) focus future concurrent reviews and efforts to allocate patients to alternative health care settings.Design. A prospective review of a random sample of adult patients who presented to the EmergencyDepartment of the Molinette Hospital. Patients were assessed at admission and on day 3, 5 and 8 using theAppropriateness Evaluation Protocol (Italian validated version). Patients: 490 overall; 312 (64 %) medicaland 178 (36 %) surgical.Outcome measures. Acute (appropriate) and non acute (inappropriate) admissions, Major Disease Category,costs, mean weights of Diagnosis Related Groups, and length of stay (days).Results. The proportion of patients requiring acute care declined rapidly from presentation (84.5%) to thefifth day of admission (60.9%). Patients admitted during weekends showed a higher rate of inappropriatestay on day 5 (P=0.04). The proportion of inappropriate admissions was higher for medical rather thansurgical patients (P=0.07) at presentation and at day 5 (P < 0.01). Traditional social-demographic variableswere not significant risk indicators for inappropriate admissions. The likelihood ratio for inappropriateadmission at presentation was significantly higher for minor illnesses and disturbances (P=0.03).Inappropriate stay on day 5 was significantly associated with lower cost (P < 0.01), lower mean DRG weight(P < 0.01) and shorter length of stay (P=0.05) for medical but not for surgical admissions.Conclusions. Traditional epidemiological indicators are inadequate to target prospective concurrent reviews.Qualitative studies focusing on patient physician dialogue in different situations and contexts could widenour understanding of the problem and suggest new theoretical frameworks and theories to provide us withmore detailed explanations.
Development of a sensitive real-time PCR for simultaneous detection and subtyping of influenza A and B viruses
Authors: Amicizia Daniela , Bacilieri Sabrina , Banfi Federica , Righello Ornella , Valle Laura , Sticchi Laura , Lai Piero , Ansaldi Filippo
Published: June 2024

A new real-time PCR assay, using melting curve analysis, was developed for the rapid and reliable detectionand sub-typing of influenza A and B. In order to evaluate it’s specificity, cell culture surnatants positive forRespiratory Syncytial Virus, Parainfluenza Viruses 1, 2 and 3, Measles Virus, Influenza A (to evaluateInfluenza B primer) and B (to evaluate Influenza A primer) were tested and all of the results were negative.A series of Influenza A and B cell culture-grown viruses were diluted in virus transport medium, titrated andtested to determine the analytical sensibility which equated to 0.64, 0.026, 0.64, 0.62 PFU for A/H1N1,A/H3N2, Victoria-like and Yamagata-like B viruses, respectively. Twenty-five specimens, collected during the2001/02 and 2002/03 seasons, which were positive for A/H1N1 (n = 7), A/H3N2 (n = 10), B Victoria-lineage(n = 5) and B Yamagata-lineage (n = 3), were tested in order to evaluate the assay’s clinical sensitivity, all ofthe results were positive. The new real-time PCR appears to be a suitable tool for virological surveillance andthe diagnosis of respiratory infections
Molecular methods in Public Health - Metodi Molecolari in Sanità Pubblica
Authors: Boccia Stefania
Published: June 2024

Public Health (PH) practitioners are becoming increasingly interested in biomolecular techniques, this stands as testimony to the number of courses and dedicated sessions in national conferences that have occurred since 1990 which have involved several colleagues.
On behalf of the past-president of Italian Society of PH (SItI), Prof.G. Renga, the volume Molecular methods in Public Health - Metodi Molecolari in Sanità Pubblica represents the first attempt to rigorously collect different contributions from Italian researchers working in the field of molecular biology as applied to PH. The volume, edited by Prof. G. Giammanco and Prof. S. De Flora and published by Centro Scientifico Editore 2004, addresses all of the traditional aspects of molecular biology in PH. It is divided into six sections, focusing on the areas of epidemiology and prevention of infectious diseases in community and nosocomial settings, the epidemiology of chronic-degenerative diseases, hygiene in the working and living environment, food and water hygiene, and genetically modified organisms (GMOs). As far as the prevention of infectious diseases is concerned, the molecular approach has shown that genotyping aetiological agents permits the comparison of different isolates collected during epidemic events, thus providing the timely reconstruction of the chain of transmission of the disease. In this context all of the recent molecular techniques used for bacteria and viral genotyping are discussed, for example, Restriction Fragment Length Polymorphisms (RFLP) of genomic DNA, Southern blotting analysis, Pulsed Field Gel Electrophoresis (PFGE), Amplified Fragment Length Polymorphisms (AFLP),ribotyping,and others based on Polymerase Chain Reaction (RAPD, ERIC-PCR, REP-PCR) and genome sequencing