bluuebunny/crossref_metadata_2025 huggingface dataset:
Major health system reforms in 27 European countries in 2018 and 2019
Authors: Quentin W , Polin K , Hjortland M , van Ginnekin E , Maresso A
Published: October 2020

Background

Countries in Europe are continuously reforming their health care systems. Often similar reforms are happening simultaneously in different countries, and policymakers would benefit from considering reform experiences made abroad. However, no systematic information is available about reforms happening simultaneously across countries. This presentation provides an overview of major health reform trends in Europe in 2018 and 2019.

Methods

For the HSPM network's annual meetings in 2018 and 2019, information was collected from national experts on the three most important health reforms in each country happening in that year. In the 2019 survey round, experts were also asked to provide an update on the status of the three reforms they had reported in 2018. Subsequently, all reforms were clustered independently, assigning each reform to one (or several) of 11 categories.

Results

In 2018, national experts reported on 78 reforms from 26 European countries. Together, more than one-third of the reforms fell under three clusters: 'coverage & resource generation', 'purchasing & payment' and 'hospital care'. Each of these clusters included reforms from at least nine countries. In 2019, national experts reported 79 reforms from 27 countries. The top clusters were 'primary & ambulatory care' and 'governance', with fourteen and twelve reporting countries respectively. Most 2018 reforms (47/78) were still reported as ongoing in 2019, indicating the complexity of many reforms. More than 20 reforms were reported as implemented, while six reforms were abandoned.

Conclusions

Health reforms in different countries often focus on similar topics. Some countries are experimenting with reforms that have already been implemented or abandoned in other countries. There is huge potential for cross-country learning as information on reform experiences may provide inspiration for reforms or help avoid the making the same mistakes in another country.
'Orange is the new Blue': the start of organised colorectal cancer screening in a Milan penitentiary
Authors: Gandolfi C E , Iemmi D , Lari C , Danese R , Silvestri A R
Published: October 2020

Issue

According to the United Nations basic principles for the treatment of prisoners, they “shall have access to the health services available in the country without discrimination on the grounds of their legal situation”. In Italy this principle is executed by national legislation allocating responsibility for inmates' health directly to the National Health Service. In the Metropolitan City of Milan this duty is fulfilled by the Agency for Health Protection (ATS) that guarantees medical assistance in its penitentiaries.

Description of the problem

In Italy, cancer screening activities are considered essential levels of assistance i.e. guaranteed to all citizens. In fact, organised colorectal cancer (CRC) screening is offered by ATS, free of charge, to males and females, aged 50 to 74, in the form of a fecal immunochemical test every 2 years. Unfortunately, CRC screening uptake remains low among fragile patients, such as jail inmates, who are hard-to-reach by standard organised screening efforts. In 2019 the ATS Preventive Medicine Screening Unit began a small pilot organised CRC screening program, specific for inmates, starting in one of the city's main penitentiaries: Casa di Reclusione Milano Bollate, comprising 1200 inmates, and recently appointed nationwide referral center for elderly inmates.

Results

Inmates represent a large scarcely screened population that, following implementation of an organised tailored CRC screening program, showed high willingness to participate. Organised cancer screening programs may thus be necessary to guarantee maximum uptake among prisoners.

Lessons

Tailoring the organised CRC screening program to the prison-setting may increase adherence and ensure standardised coverage of the target population, eliminating disparity in the CRC screening service, and hopefully others in the future.

Key messages

Tailoring an organised CRC screening program to the prison-setting may increase adherence and ensure standardised coverage of the target population, eliminating disparity in the CRC screening service Organised screening programs could achieve extensive coverage and enhance equity of access in this hard-to-reach fragile population.
A shadow cast on a successful CRC screening programme, features of Interval Cancer FIT
Authors: Idigoras Rubio I , Bilbao Iturribarria I , Solís Ibinagagoitia M , Diaz Seoane M , Fernandez Landa M J , Portillo Villares I
Published: October 2020

Background

Colorectal Cancer (CRC) Screening started in 2009 inviting biennially to carry out an immunochemical quantitative occult blood test (FIT). Overall coverage was reached in 2014 The aims of this study were to determine the main features of Interval Colorectal Cancer (CRC), related to FIT (IC_FIT= false negatives of the FIT) on the population-based screening Programme (BCSP)

Methods

All invitees from 2009-2016 were included in the study and with a follow-up by the Screening Coordination Centre according to the European Guidelines. Specific software was developed for the BCSP and able to be linked to medical records and cancer registries. Variables included: age at invitation, sex, type of participant (initial, regular, and irregular), TNM stage, and location (C-18.0-C-20.0), FIT threshold. Sensitivity Specificity and LR ratios were performed throughout all the period for FIT test. SPSS 23.0

Results

1,386,538 valid invitations were registered between 2009 and 2016. With a high participation rate (69.3%) and a total of 926,379 FIT negatives (94.1%). 444 CI_FIT were found before the next invitation to FIT. Most in men 60.7% (n = 278), higher on the oldest age group (60-69 years of age). 33.4% where found on regular participants on the screening. 82.1% of IC_FIT in previous rounds the FIT threshold was <10µHb/ g. Most of the IC_FIT 54.1% found on advanced Stage of the tumor, and located on the right colon (44.4%), but ringing a bell the 30.4% located on Rectum. The cumulative incidence for IC-FIT was 3.52 (IC95% 3.21-3.87) x 10,000 negative cases. Sensitivity for FIT was lower in women than men (87.7; CI 95% 85.8-89.4 vs 88.9%; CI95% 87.6-90.1) but not significant. Cumulative incidence for IC-FIT is significantly higher in men than women

Conclusions

The BSCP in the Basque Country shows a low incidence of Interval Cancer due to FIT. However, right colon and rectum location must be taken into account in further studies, in order to decrease the IC_FIT

Key messages

Participation on a BSCP is essential to decrease Incidence and mortality despite the IC_FIT (false negatives of the test). Most of the persons (82.1%) of IC_FIT group in the previous round of participation, the FIT threshold was very low.
Analysis of population-based and worksite cancer screening in Japan
Authors: Takahashi H , Machii R , Nakayama T
Published: October 2020

Background

In some European countries, cancer screening is conducted and evaluated by the nation. In Japan, about half of cancer screenings are conducted by the government or local governments, while the other half is in a worksite, conducted by business owners and insurers as part of a welfare program. The Ministry of Health, Labor and Welfare (MHLW) have prepared guidelines for cancer screening in worksite and provided specific recommendation methods to practitioners. For an understanding of its use does not progress, it is necessary to identify problems.

Methods

A research group, organized by the MHLW grant, surveyed 20 major insurers in Japan about the guidelines for cancer screening in worksite. The contents of the questionnaire are related to the establishment of a system with a view to organizing screening, and consist of a total of 45 items. Answers to these questions were obtained in the following format. (1. Yes, 2. No, 3. Can't answer, 4. Can't understand the meaning of the question)

Results

Around 30% of insurers were able to answer all items, but 70% were not able to answer any items. Approximately 10% of the respondents answered that they had implemented the items in the guidelines, while 70% did not, and 20% can't answer or can't understand the meaning of the question. The reasons for not being able to answer were that the terms were difficult to understand, there was no need to grasp the data of cancer screening, and there was a legal problem and personal information could not be obtained.

Conclusions

This suggests that employers and insurers differ in their understanding of cancer screening, resulting in various implementations and evaluations. In order to establish organized screening in the whole country, it is necessary to develop a system that can also evaluate data, such as cancer screenings and health check conducted in worksite. It is also important to improve the literacy of cancer screening practitioners.

Key messages

Integrating cancer screening across the country. Improving the literacy of cancer screening practitioners.
Smoking while using contraceptives: Risk perception and behavioral intention to quit
Authors: Van Der Heijde C M , Hilverda F , Vonk P
Published: October 2020

Background

Combining smoking with contraceptives containing ethinylestradiol increases the risk at several health issues, such as thrombosis, cardiovascular diseases and pulmonary embolism, especially when women are 35 years or older. It is important to inform women at an early stage and encourage them to quit smoking or change their contraceptive. The aim of this study is twofold. 1) using the Protection Motivation theory, we examine the predictors of the intention to quit smoking or change the currently used contraceptive method. 2) we provide insight into women's preferred ways to be informed and possible facilitators to change their behavior.

Methods

68 Women, between 25 and 60 (mean age 30.6, sd 6.6; academic degree 78%), using the combination of smoking and ethinylestradiol containing contraceptives of a General Practice in Amsterdam, The Netherlands, filled in a questionnaire. Predictors were cigarette dependence (cds-5), perceived severity, vulnerability, response efficacy and self-efficacy. Outcome variables: intention to quit smoking or the current contraceptive.

Results

The average intention to quit smoking was higher (3,26 on a 5-point scale) than the average intention to quit the contraceptive method (2,47 on a 5-point scale). The predictors vulnerability, education level and reason for contraceptive use significantly predicted the intention to quit smoking (F(3, 65) = 40.22, p = .03), while self-efficacy and education level significantly predicted the intention to quit the contraceptive method. (F(2, 66) = 32.36, p =.02)

Conclusions

Risk perception stimulates women to quit smoking, while perceiving oneself capable of quitting or having alternatives is related to contraceptive change. A second wave of data is collected to enlarge the sample size. We add a qualitative study to get insight into strategies to alter women's behavior. This study will inform risk communicators and health care professionals, ultimately resulting in less women with this combination.

Key messages

Quitting smoking is potentially popular in a group of women with the risky combination of smoking with contraceptives containing ethinylestradiol. Risk perception stimulates women to quit smoking, while perceiving oneself capable of quitting or having alternatives is related to contraceptive change.
Smoking-attributable mortality at an infra-national level: regional estimates in France in 2015
Authors: Bonaldi C , Jezewski-Serra D , Nguyen-Thanh V
Published: October 2020

Background

Tobacco smoking is a major leading preventable cause of mortality. The Peto-Lopez method and its variants are commonly used for estimating smoking-attributable mortality in population in high-income countries. The method assumes the average cumulative exposure of tobacco smoking in the population can be approximated using lung cancer death rates. However, providing estimates at an infra-national level is often much more challenging because the observed number of deaths for lung cancer are generally too low to use directly the method. The aim of this study was to estimate the number of deaths attributable to smoking at the regional level in France in 2015.

Methods

Population attributable fractions were computed using the Peto-Lopez method modified by Parkin which combines mortality statistics, lung cancer death rates and adjusted relative risks of deaths associated with smoking. To estimate the proxy for smoking prevalence in regional level by sex and age group, we pooled lung cancer mortality on several years according to the size of the regional populations and we smoothed the non-linear relationship of age with the estimates of the proxy. The attributable fractions were estimated for the 13 metropolitan regions and 4 French overseas regions.

Results

In whole France, we estimated that 19% of deaths among men and 7% among women were attributable to smoking in 2015. Deaths attributable to smoking ranged across metropolitan regions from 17% to 23% among men and from 5.5% to 8.7% among women. In overseas territories, estimates presented much more variability with a range from 6% to 18% for men and from 1.2% to 4.3% for women.

Conclusions

We highlighted disparities in regional mortality attributable to smoking. Producing estimates of the burden of smoking at an infra-national level is a tool offering many perspectives for better analyzing territorial inequalities and ultimately to further guide more effective localized interventions to reduce tobacco consumptions.

Key messages

We provide a straightforward solution to estimate the infra-national burden attributable to tobacco from a usual method. Our results highlight the disparities in mortality attributable to smoking across regions in France in 2015.
30.G. Round table: Health planning In Europe: preparing for the expected and the unexpected
Authors:   Organised by: Karolinska Institutet (Sweden),   Chair persons: Birger Forsberg - Sweden, Bernd Rechel - European Observatory
Published: October 2020

The objective of this round table discussion is to highlight the need for careful and systematic health planning of health systems in Europe, illustrate how health planning can be used for policy and management and provide some useful tools for participants to bring home and apply in their own contexts. Participants will acquire knowledge on current health care planning in some leading international organisations, with examples from some countries and region

Health in Europe is facing challenges and threats of both immediate and longer term character. In recent years, discussions on health care in the future has focussed on pressures coming from the increase in chronic diseases and demographic changes, such as the growing number of older people. Recently, the covid-19 outbreak has shown that newly emerging diseases can cause massive challenges to public health and health services. Both developments illustrate the need of health systems to be prepared for both expected and unexpected developments and to engage in careful planning of resource needs to ensure good health services to all. This session seeks to present approaches to health planning and discuss with the audience different methods for simulation and analysis of future health care needs and the resulting requirements for financial and human resources. The session will contribute to the development of health services and public health in Europe by highlighting the necessity to establish structures for comprehensive health planning and to seek ways to meet future challenges well in time. The round-table will have four participants, each of them giving an initial brief on some essential elements of health planning: projections of disease burden and health care needs,forecasting of health care costs and funding sources,health workforce needs in relation to disease burden projections, andplanning for unexpected events such as pandemics and climate threats

Each brief will be given a short comment by one of the other participants. After all four briefs, panel members will give general or specific comments on the topic and subsequently, the audience will be invited to provide input and pose questions to the panel members. Based on the presentations given and the information provided in the discussions, a report on the session will be compiled and made available to participants and the wider public electronically.

Key messages

Health care planning is important for emergency preparedness and long term sustainable delivery of health services. The best available estimates of population health developments and the resulting needs for prevention and health care should be the basis for health services planning.
Opportunities and strategies for HIA implementation – from a public health perspective
Authors: Mekel O , Martin-Olmedo P , Classen T
Published: October 2020

Health Impact Assessment (HIA) has various origins: environmental health, health promotion with the perspective of the wider determinants of health, and health equity. These three individual but related areas are linked by the overall aim of promoting healthier programmes, policies and projects, which are developed in non-health sectors mostly. As a consequence, this led to a significant use of HIA worldwide. The areas are complementary, but given their different original frameworks, applied methodologies may differ. Another typology of characterizing HIA can be done by the purpose for which HIA has been conducted in practice: mandated, decision support, advocacy and community-led HIA. These forms are important with regard to HIA implementation strategies. By now, the consideration of health in Environmental Impact Assessment (EIA) has become an established feature, not least due to the mandatory legal basis in many countries of the world. However, this situation is different for application in other policy areas so far. Some countries, in the absence of specific HIA legislation, have established HIA support units to conduct, commission, support HIA and deliver training. Advocacy and community-led HIA are mainly carried out by non-governmental organisations and universities. However, in general the potential of HIA has not yet been fully recognised: HIA is seen as a time-consuming and costly process and the effectiveness of HIA has not yet been communicated convincingly. The Health in All Policies approach is becoming increasingly important in the policy arena as a strategy to reduce non-communicable diseases by policies from non-health sectors. This requires different public health methods for implementation. HIA is particularly suitable for this. This development offers new opportunities for the implementation of HIA, which will be presented in detail.
Nutritional Supplements and Chronic Disease: Bridging the Gap between Myth and Reality
Authors: Stranges S
Published: October 2020

Several studies have appraised the role of vitamin and mineral supplements in primary or secondary prevention of chronic disease have consistently found null results or possible harms. Evidence involving tens of thousands of people randomly assigned in many clinical trials shows that β-carotene, vitamin E, and possibly high doses of vitamin A supplements increase mortality and that other antioxidants, folic acid, B and D vitamins, and multivitamin supplements have no clear benefit.

The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.

The evidence also has implications for research. Antioxidants, folic acid, and B vitamins are harmful or ineffective for chronic disease prevention, and further large prevention trials are no longer justified. Vitamin D supplementation, however, is an open area of investigation, particularly in deficient persons. However, clinical trials have been equivocal and sometimes contradictory. Finally, implications on the clinical management and public health recommendations concerning the use of nutritional supplements in chronic disease will be addressed. Likewise, issues around the marketing and advertising of these supplements in the general public will be also discussed.
Extended HSPA framework for UHC
Authors: Karanikolos M
Published: October 2020

Based on the work presented earlier, this presentation shows the entire extended HSPA framework for UHC. The framework consists of the functions and their subfunctions, linked to performance assessment areas and leading, ultimately, to the achievement of health system goals (population health, responsiveness, financial protection; as well as equity and efficiency as distribution of outcomes and ratio of inputs respectively).

This approach shows that it is possible to have a common denominator between the existing HSPA frameworks and tools, that can be allied in various income settings globally. The added value of this approach is that country reports generated through the use of the existing health system assessment tools can be used not just to describe health system structures and functioning, but also to assess performance of individual health system components down to sub-function level. While not intended to provide a deep-dive into smaller, specific parts within health systems, the HSPA framework for UHC can help in identifying potential areas of strengths and weaknesses, which can then be related to actions or responsibilities of specific actors within a health system, or linkages to other sectors.
Tackling challenges in cancer care and improving its governance in the European Union
Authors: Wesselmann S , Borras J-M
Published: October 2020

Background

The aim of a cancer care system should be to give all patients access to a high-quality care that covers all components of the cancer continuum from early diagnosis to treatment and palliative care. Fragmentation of health services providers among different levels of care and lack of coordination among them is the main obstacle to achieving the desired continuity of patient care.

Results

These can be summarized in the following main outputs: Strategies to improve cancer outcomes in pancreatic cancer as case study. A consensus among relevant stakeholders was developed and analysis of outcomes in several countries will be presented to support the proposed measures.Impact of Information Technologies on Multidisciplinary care will have consequences on the way care is organized.Comprehensive cancer care networks (CCCNs) are based on tumor specific management groups. Patient pathways are to provide continuity of care along the whole chain of health care, while quality of care will be measured using tumor specific quality indicators and Patient Reported Outcome Measures and a process for continuous quality improvement must be in place. The CCCN concept will be implemented in two pilot sites and the implementation process will be evaluated.

Conclusions

Development of strategies on how to improve outcomes for pancreatic cancer Development of a list of quality indicators for different areas of cancer care Criteria and standards for CCCNs and their implementation in two sites Definition of patient pathways in cancer care and their practical implementation Amend the existing structure of National Cancer Control Programmes to include all the challenges mentioned above.

Key message

International expert collaboration across countries with the support of the EU provides an excellent framework for the development of important policy responses to the current challenges in the organization of cancer care.
32.L. Workshop: Deconstructing the DALY: step by step guide to calculating YLL and YLD
Authors:   Organised by: COST Action CA18218,   Chair persons: Ian Grant - UK, Elena von der Lippe - Germany
Published: October 2020

A Burden of Disease (BoD) approach can be used to summarise the debilitating effects of morbidity and premature mortality in a population in a consistent and comparable manner. Summary measures of population health such as the Disability-Adjusted Life Year (DALY) have become key metrics for quantifying burden of disease. DALYs quantify the health gap between a life lived in perfect health and current health status, as the number of healthy life years lost due to illness (Years Lived with Disability, YLDs) and premature death (Years of Life Lost, YLLs). DALYs combine the effects of morbidity and mortality in an equitable way, and can therefore be used to identify the leading causes of disease or injury that cause BoD and to quantify the relative importance of specific risk factors. BoD studies are becoming an increasingly popular way to assess national and local population health as a means to influence national and local policy decisions.

The increasing prominence of the burden of disease approach, however, comes at a cost. Calculations of DALYs involve multiple components and as such can be difficult for people to interpret. Burden of disease methodology is complex and highly data intensive, which has led to major disparities across researchers and nations in their capacity to perform studies, to interpret the soundness of available estimates, or to evidence and advocate for the use of particular methodological choices.

In this skills-building seminar, we will give an overview of the methodology of calculating the DALY. It will outline the single steps to be undertaken, and the necessary assumptions that have to be taken, on the way to the calculation of the DALYs. This workshop will be supported by technical presentations from burden of disease experts about different choices of estimation methods to calculate both the fatal burden (YLL) and the non-fatal burden (YLD). Throughout the presentations, cerebrovascular disease will be used as a case study, giving a complete, real-life example of how DALYs are calculated. Overall, the aim is to demonstrate the importance of the choices researchers make when designing and interpreting BoD studies as a means of supporting evidence-based decision making. The workshop will foresee ample time for interaction with the audience and discussion of the implications of the different methodological choices.

Key messages

Although burden of disease methodology is complex, with calculations of DALYs involving multiple components, simple roadmaps can be created to enhance methodological knowledge. The choices and assumptions researchers make are important when designing and interpreting burden of disease studies.
32.M. Workshop: Mig-HealthCare project: Reducing health inequalities of vulnerable migrants in Europe
Authors:   Organised by: Mig-HealthCare,   Chair persons: Pania Karnaki - Greece, Alejandro Gil-Salmerón - Spain
Published: October 2020

This MigHealthCare Workshop will be a forum to present and discuss the project's final results with a wide range of health and social care professionals working on the field of migrant/refugee health. The Mig-HealthCare project is a collaboration of 14 partners, among them universities, national authorities and NGOs from 10 countries across Europe (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). The major aim of the project is to reduce health inequalities and improve the integration of vulnerable migrants and refugees into local communities in Europe. The project is co-funded by the III Health Programme of the European Commission from 2017-2020.

The Mig-HealthCare project addresses the need for structural changes in the health systems to respond to the unmet needs of vulnerable migrants and refugees in Europe and promotes community-based care. Community-based health care has proven to be effective in reducing health inequalities in health, as well as improving accessibility to appropriate care. For this purpose, the consortium has produced an evidence-based Roadmap and Toolbox to reorient health care services to a community level which is a user-friendly online application focusing on the key steps for optimal health care delivery to migrants and refugees. In this regard and as part of these operative tools, within the Mig-HealthCare project, effective community-based care interventions focused on health promotion or prevention were designed and piloted in 8 different contexts and countries.

As main results of the MigHealthCare project, the Roadmap and Toolbox comprise both the necessary factors that health policy and practice need to deliver culturally competent care as well as the particular health issues especially faced by migrants and refugees in order to better prepare public health response.

Key messages

Community-based care for vulnerable migrants and refugees has proven to be effective in reducing health inequalities. Evidence on the drivers of the success or failure of health promotion strategies for migrants and refugees should be considered when planning interventions.
The challenge of combined exposure to multiple chemicals: scientific and regulatory approaches to protect human health
Authors: Bopp S , Kienzler A , Worth A
Published: October 2020

Every day we are exposed to low levels of hundreds of different manmade chemicals present for example in our food, consumer products and the air we breathe. Combined exposure to multiple chemicals can lead to adverse effects on human health or the ecosystem, even if single chemicals in the mixtures are below their individual safety thresholds. However, current safety assessment practice is primarily based on understanding the potential risk posed by single chemicals rather than their 'real life' combinations. In particular, while manufactured products such as pesticide formulations or cosmetic products are covered, unintentional mixtures which are coincidentally formed such as mixtures of contaminants in indoor air, are not consistently addressed. Their composition is often unknown and changes over time. The assessment of unintentional mixtures is therefore usually limited to specific legislative sectors only, such as pesticide residues in food.

Generally, methodologies to address chemical mixtures have been developed; however, there are still several data and methodological gaps to be addressed. New approach methodologies can support the filling of knowledge gaps on the toxicity and mode(s) of action of individual chemicals, to unravel links between chemical exposure and health effects. (Bio)Monitoring, modelling, and better data sharing will support the derivation of more realistic co-exposure scenarios. Considering the large number of possible combinations of chemicals in mixtures, prioritization is needed, so that actions first address mixtures of highest concern and chemicals that drive the mixture risk. As chemicals with different applications and regulated separately might lead to similar toxicological effects, it is important to consider chemical mixtures across legislative sectors.

This contribution to the workshop will summarise current challenges and ways forward in the risk assessment and risk management of mixtures for protecting public health.
The Swiss Learning Health System: a national initiative supporting evidence-informed decision-making
Authors: Mantwill S , Kasper Wicki T , Boes S
Published: October 2020

Issue

Over the last years, there has been an ever-increasing interest in how to promote and support uptake of evidence and evidence-informed decision-making in health-systems related policy and practice. However, only few efforts have been made that aim at fully leveraging the knowledge and expertise of bigger networks to address this issue more comprehensively.

Description of the problem

Also, in Switzerland, the need to address this matter has been increasingly emphasized by actors in the health system. In particular, the lack of comprehensive coordination efforts in the field of health services research, and subsequent knowledge translation activities, has been stressed.

Results

In response, the Swiss Learning Health System (SLHS) was established as a nationwide project in 2017, currently involving 10 academic partners. One of the overarching objectives of the SLHS is to bridge research, policy, and practice by providing an infrastructure that supports learning cycles. Learning cycles enable the continuous integration of evidence into policy and practice by: continuously identifying issues relevant to the health system, systemizing relevant evidence, presenting potential courses of action, and revising and reshaping responses. Key features of learning cycles in the SLHS include the development of policy/evidence briefs that serve as a basis for official stakeholder dialogues, which are structured dialogues during which the best course of action is discussed and evaluated. Issues that are identified to be further pursued are monitored for potential implementation and eventually evaluated to inform new learning cycles and to support continuous learning within the system.

Lessons

The SLHS is an important mechanism to institutionalize learning cycles within the Swiss health system by leveraging the expertise and knowledge of a comprehensive network, going beyond individual initiatives, and to respond effectively to newly occurring health system challenges.

Key messages

The Swiss Learning Health System is the first nationwide project that aims to establish learning cycles that support evidence-informed decision-making in health-system-related policy and practice. The Swiss Learning Health System is an infrastructure that supports the continuous flow of evidence into policy and practice, providing a mechanism to respond to occurring health system challenges.
The Ipaac Evaluation Tool: how to select Quality Indicators for Comprehensive Cancer Care Networks
Authors: Cocchiara R A , Lia L , Dorelli B , Mannocci A , Follmann M , Griesshammer E , Wesselmann S , De Angelis R , Federici A , La Torre G
Published: October 2020

Background

The Comprehensive Cancer Care Networks (CCCNs) represent innovative approaches for the management of cancer patients consisting of multiple cooperating health units with specific expertise in the different steps of care. Quality Indicators (QIs) constitute valid and reliable tools that allow to measure the quality of care among similar structures belonging to different health systems. Objective of this project was to develop a standardized tool in order to define a multi-step process for the selection of QIs for the evaluation of CCCNs.

Methods

Under the coordination of the Innovative Partnership for Action Against Cancer (IPAAC) joint action, our research team performed a systematic review of the scientific literature to identify the reported methodology for the selection of QIs applicable for the CCCNs' setting. An additional search of national and international Quality Assurance organizations was performed to detect any missing information.

Results

The IET (Ipaac Evaluation Tool) for QIs was developed: a methodological tool describing an 8-step process that leads to the selection of QIs feasible for the CCCN setting. The tool was implemented accordingly with the reporting standards for guideline-based performance measures of the Guideline International Network (GIN). A pilot testing of the tool was performed in order to identify its strengths and weaknesses.

Conclusions

The IET for QIs represents an innovative methodological instrument to select valid and reliable indicators for the assessment of the quality of care within the CCCN settings.

Key messages

The Quality Indicators represent valid and reliable tools to measure and compare the quality of care delivered to cancer patients in Comprehensive Cancer Care Networks. The development of the Ipaac Evaluation Tool leads to a standardized assessment of the quality of care provided for cancer patients within the CCCN setting.
Profiling biopsychosocial health of cancer-diagnosed elderly in Italy by Passi d’Argento, 2016-2017
Authors: Contoli B , Minardi V , Possenti V , Carrozzi G , Cristofori M , D'Argenzio A , De Luca A M C , Ramigni M , Trinito M O , Masocco M
Published: October 2020

Background

PASSI d'Argento (PdA) is an Italian population-based surveillance system, coordinated by the Istituto Superiore di Sanità (ISS) and carried out by the Local Health Units (LHUs). PdA monitors wide-ranged health related-behaviours in the elderly (65+) living in Italy as per the three pillars of the “Active Healthy Ageing” framework: Health, Participation, Security.

Methods

The PdA sample is randomly selected from the LHU lists, stratified by sex and age. 22,811 records have been collected in 2016-2017 on a representative sample of residents aged over65, not being hospitalised, in long-term care, in a nursing home or prison.

Results

3,019 respondents resulted cancer-diagnosed elderly (CDE) reporting cancer diagnosis or confirmation, leukaemia and lymphomas included (annual average prevalence of 12.8%, Confidence Intervals 95%: 12.1-13.4%; one million and 729 thousand people). CDE refer: poorer health conditions (22%) than Chronic Elderly Patients (CEP; 18%) and Healthy Elderly (HE; 5%), sight impairment (12%), hearing loss (15%) and chewing problems (14%). CDE (10%) and CEP (11%) are more prone to fall than HE do (6%). Disability accounts for 21% in CDE and CEP vs. 12% in HE. A multivariate analysis confirms a compromised psychophysical health profile in CDE vs. HE, and vs. CEP. CDE behave still unhealthily, are insufficiently advised by health professionals, do not comply with the seasonal flu vaccination [Health]. CDE face increased risk for isolation or cognitive decline: they experience lower social connectedness (17%) than CEP (20%) and HE (28%) [Participation], and perceive higher neighbourhood insecurity (19%) than how CEP (17%) and HE (13%) do [Security].

Conclusions

PdA data on the poor biopsychosocial health profile of CDE highlight to what extent healthy behaviours and prevention can ameliorate their quality of life PdA calls for global action strategies in Italy, which aim at taking complete charge of CDE and also CEP.

Key messages

In Italy, elderly cancer survivors show poor biopsychosocial health profile and overall quality of life. By modifying behaviours, elderly suffering from any cancer or chronic disease can age healthily.
Palliative care delivery according to age among metastatic breast cancer patients. ESME-MBC cohort
Authors: Frasca M , Courtinard C , Bouleuc C , Levy C , Mouret-Reynier M A , Bachelot T , Goncalves A , Perotin V , Eymard J C , Mathoulin-Pelissier S
Published: October 2020

Background

Metastatic breast cancer (MBC) may require inpatient palliative care (IPC) but literature suggests age-related disparities in palliative care delivery. This study, based on real-world data, aimed to assess the cumulative incidence function (CIF) of IPC delivery and if age is an independent factor, taking into account the competing risk of death.

Methods

The national multicenter ESME (Epidemio-Strategy-Medical-Economical)-MBC cohort includes consecutive MBC patients treated in the 18 French Comprehensive Cancer Centers. IPC identification used ICD-10 palliative care coding. Main analysis first estimated pseudo values of 2-year and 8-year CIF of IPC. Linear regression models estimated the mean changes of pseudo-values (2 models: 2-year and 8-year CIF of IPC).

Results

Our analysis included 12375 patients, 5093 (41.2%) of whom were aged 65 or over. The median follow-up was 41.5 months (95% CI, 40.5-42.5). The CIF of IPC was 10.3% (95% CI, 10.2-10.4) and 24.8% (95% CI, 24.7-24.8) at two and eight years, respectively. At two years, among triple-negative patients, young patients (<65 yo) had a higher CIF of IPC than older patients after adjusting for cancer characteristics, centre, and period (65+/<65: β=-0.05; 95% CI, -0.08 to -0.01). Among other tumour subtypes, older patients received short-term IPC more frequently than young patients (65+/<65: β = 0.02; 95% CI, 0.01 to 0.03). At eight years, outside large centres, IPC was delivered less frequently to older patients adjusted to cancer characteristics and period (65+/<65: β=-0.03; 95% CI, -0.06 to -0.01).

Conclusions

We found a relatively low CIF of IPC and that age influenced IPC delivery. Young triple negative and older non-triple negative patients needed more short-term IPC. Older patients diagnosed outside large centres received less long-term IPC. These findings highlight the need for a wider implementation of IPC facilities and for more age-specific interventions.

Key messages

Our study highlighted particular challenge for older MBC patients diagnosed outside large French Comprehensive Cancer Centers. By identifying age at MBC diagnosis as a factor of IPC delivery, this report supports a wider implementation of IPC facilities and more age-specific interventions.
Cultural dance significantly improves hypertension management
Authors: Look M , de Silva M , Ahn H J , Austin Seabury A , Vegas J K , Kim C , Dillard A , Gonsalves J , Haumea S , Kaholokula J K
Published: October 2020

Hypertension (HT), uncontrolled blood pressure (>140/90 mmHg), is the leading preventable cause of premature death globally and a major risk factor for coronary heart disease, stroke, and other conditions. European and African regions have the highest prevalence rates at about 40% of adults. The U.S. has comparable rates and disturbing disparities in non-White minority groups. Native Hawaiians (NH), an indigenous U.S. population, are 70% more likely to have HT; 4 times more likely to have coronary heart disease or stroke than Whites. Hula, the cultural dance of NH, offers promise of a culturally responsive strategy for HT control.

We conducted a randomized clinical trial with a waitlist control to test the impact of a hula-based cultural dance intervention (CDI) on systolic blood pressure (SBP) in 263 NH with HT. All participants received HT education (e.g. diet, exercise, medication) during 3 1-hr sessions over 2 weeks, then randomly assigned to CDI (n = 131) or waitlist control (WC; n = 132). The CDI received 6 months of hula (2 1-hr sessions/week x 3 months, then 1 lesson/mth x 3 months with self-directed practice), with group activities to reinforce HT education. WC only received the initial HT education, then offered hula after the study. Assessments were done at 0-, 3- and 6-month, with 12-month for CDI only.

Baseline characteristics were balanced between groups, except for weight. Adjusting for weight and baseline SBP in intent-to-treat analysis, CDI achieved significant reductions (p < .05) in SBP (-15.3 mmHg; SE = 1.6) compared to WC (-11.8 mmHg, SE = 1.7). From 6 to 12 months, CDI maintained their SBP (mean change: 1.47 mmHg, SE = 1.26; p = .16) improvements at 12 months. CDI were more likely to achieve SBP reduction ≥ 10 mmHg than WC, 60% vs 48% (p = .03), respectively.

A CDI based on the NH cultural dance significantly improved HTN management in NH with uncontrolled SBP. Improvements were comparable to the best proven non-medication treatment of HT.

Key messages

Improving elevated blood pressure control with at-risk populations can be effectively and innovatively achieved by utilizing culturally responsive strategies, such as cultural dance interventions. Leveraging and aligning community strengths and health objectives leads to innovation and empowerment.
The Requirements of Developing Countries' Health Systems Facing with COVID-19: A Case Study of Iran
Authors: Ghanbarzadegan A , Bastani P , Emadi F , Mohammadpour M , Pourmohammadi K , Javanmardi S
Published: October 2020

Background

Epidemic COVID-19 in 2020 was one of the crises that confronted the Islamic Republic of Iran's health system as a developing low-income country with many challenges. The purpose of this study is to explain the requirements of similar health systems in facing epidemics such as COVID-19 as well as sharing experiences of Iran.

Methods

The present study was a qualitative study using content analysis of the Iranian Ministry of Health website (behdasht.gov.ir) during the official onset of COVID-19 in Iran (February 20) to March 7, 2020. To Integrate data, interviews with experts were used. In this regard, 4 national health policymakers and 5 provincial health managers were interviewed. After implementation using 8-step content analysis method, data were analyzed using MAXQDA software by research team members who had no conflict of interest.

Results

The findings show that the disease began on February 20, 2020, with two cases of death from COVID-19 in Qom province in central Iran and within two weeks it has widely affected 31 provinces, with 4747 approved cases and 124 deaths. According to the results, the Islamic Republic of Iran's health system faced five major challenges to confronting with COVID-19: 1- Medical consumables supply 2- Hospital beds allocation and intensive care units (ICU) equipment 3-The lack of a comprehensive COVID-19 protocol in the country 4- the lack of a single command authority to deal with the crisis 5- Insufficient public health literacy and information as a result of social anxiety.

Conclusions

Experiences of this case indicate that health systems require policy action to prevent and control diseases rather than other implementations. In this regard, training should be given to children and adolescents, at-risk persons and health system staff. In addition, to confront with COVID-19, an integrated policy implementation team should be established in collaboration with the health sector and other relevant bodies.

Key messages

It seems obvious that policy implementation requires to prepare the country for future contingencies. A comprehensive National Prevention Protocol needs to be developed.