bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing transition to ValueēBased hospital care pathways
Authors: Scardoni A , Sancini S , Ambrosio A , Signorelli C , Odone A 
Published: October 2020

Abstract

Issue
San Raffaele Hospital (OSR) is part of a European alliance of 9 University Hospitals (EUHA) which promotes comparison and excellence in the clinical, research and training strategies.

Description of the Problem
The development of Value-Based (VB) strategies has been active in OSR since March 2019, with multidisciplinary healthcare pathways and with the promotion of patient engagement.

Results
The prostate cancer pathway was identified as a pilot and replicable model to promote the VB culture in different areas, in particular in the field of digitalization, human resources, research, redesigning of paths and outcomes collection. The other clinical pathways progressively launched during 2019 were: breast cancer, stroke, heart failure and pancreatic cancer.
The project was realized by: • setting up a Multidisciplinary disease teams; developing a training course on VB, involving all the healthcare professionals (clinicians and managers);involving patient associations in the development of the pathway;adopting sets of clinical outcomes, Patient-Related Outcome Measures (PROMs) and Patient-Related Experience Measures (PREMs) with a specific collection platform, currently under implementation;identifying new IT support tools, activated from March to December 2019 in 11 Disease Units: HealthMeeting, a platform supporting document and data sharing, connecting different Specialists and performing advanced digital multidisciplinary meetings; DNM-Digital Narrative Medicine, a platform connecting patients with their clinical team, supporting web-based storytelling and personalized therapeutic approach.

Lessons
The introduction of a new shared and patient-centred work model, with the reorganization of spaces, resources and dedicated IT tools, has improved the diagnostic-therapeutic process.

Key messages
The main challenge of hospital transition to VB pathways is organizational and cultural. For VB implementation is needed sustainable use of available resources and IT, to achieve better outcomes.
New public health policy intervention for diabetic foot management in Mexico
Authors: Luna L , Babich S , Garcia-Alva J R , Cuen C , Arzola L , Lopez-Peña G , Laparra H , Lozano R , Anaya-Ayala J E , Hinojosa C A 
Published: October 2020

Abstract

Problem
In Mexico, an estimated 12 million people have diabetes, with complications of diabetes contributing to 25-90% of non-traumatic amputations.

Description of the Problem
We conducted a review through the literature of available studies in English-language databases and libraries, including PubMed and UNAM digital Library to determine the role of teaching first contact health workers and the creation of limb salvage teams in the prevention of amputations. Through this review, we present the basis of our proposal about implementing these strategies to improve a care coordination system for diabetic foot management in Mexico.

Results
There were 25 publications from different countries, 12 eligible for this review. The review emphasizes that the creation of Specialized Diabetic Foot Teams to treat patients and teach first contact medical workers could help to achieve the following objectives which result in the reduction of amputations and improved patient outcomes: Standardize and simplify the diabetic foot clinical examination.
Timely reference of patients with DM with a moderate and high risk of diabetic foot complications.
Timely reference of patients with diabetic foot and peripheral arterial disease to third-level hospitals.
Periodic first-contact health workers training on risk detection and stratification of diabetic foot.

Lessons
Implementing the policy of creation of Specialized Diabetic Foot Teams to treat patients and teach first contact medical workers will contribute to reducing major amputations due to diabetes in our country. We aim to implement a successful policy in Mexico to strengthen the health system and improve outcomes and therefore the quality of life of patients with diabetic foot complications. We aim to serve as a legislative voice for all patients in Mexico facing major amputations and other diabetes complications.

Key messages
New public health policy implementation for diabetic foot management in Mexico. Prevention of major amputations.
Prevalence of second-hand tobacco smoke in relation to smoke-free legislation in the European Union
Authors: Schiavone S , Anderson C , Mons U , Winkler V 
Published: October 2020

Abstract

Background
Second-hand smoke (SHS) is still an important public health problem. With joining the Framework Convention on Tobacco Control (FCTC), all parties acknowledged the health risks of SHS and agreed to implement policies to protect their populations from SHS in public places. The aim of this study was to explore the SHS exposure in restaurants and bars as well as its associations with smoke-free legislation in the European Union.

Methods
Data of Eurobarometer surveys 2014 and 2017 were used to estimate prevalence of SHS exposure. We also extracted data on individual confounders such as smoking status, gender, sex, age and information on social economic status. Additionally, we collected data on country specific data on smoking regulations in restaurants and bars from the Tobacco Control Scale to analyse associations with SHS exposure using multilevel logistic regression. Smoking regulations were categorized into the following three categories: partial ban, comprehensive ban with minor exceptions, and complete ban.

Results
Preliminary results on the prevalence of SHS in restaurants showed a decrease from 11.8% (95% confidence intervals (CI) 11.2-12.5) in 2014 to 8.8% (95% CI 8.3-9.3) in 2017. The crude multilevel model controlling only for smoking prevalence resulted in an odds ratio of 0.39 (95% CI 0.19-0.77) for comprehensive ban with minor exceptions and 0.28 (95% CI 0.16-0.50) for complete ban versus partial ban. Odds ratios remained at significant levels when controlling for all available confounders.

Conclusions
Between 2014 and 2017, SHS exposure in restaurants decreased significantly. Furthermore, strong associations with smoking regulations were observed suggesting a high compliance. Many tobacco control policies have been introduced during the last years but several countries need to strengthen their smoke-free tobacco control policies to further reduce SHS exposure preventing death, disease and disability.

Key messages
SHS exposure remains a significant public health challenge. The implementation of effective measures could be strengthened through a convergence of tobacco control strategies and policies among European Union member states.
A public health Italian ethical movement to sustain the beveridge model: health promotion and equity
Authors: Sessa G , Occhini G , Milani C , Marini G , Sarro A 
Published: October 2020

Abstract
Worldwide sustainability of the National Health Systems (NHS) has been facing different challenges, such as population ageing, epidemiologic transition and deep social transformations. All these changes are struggling Italian welfare state and its public NHS. Following the principle of the Right to Health of the Declaration of Human Right and the Italian Constitution, a group of young health professionals from all over Italy founded a campaign called “2018 Primary Health care: Now or Never”(PHC Campaign) reminding WHO report of 2008 “primary Health Care: Now more than never”. This movement promotes a reform of the NHS focusing on comprehensive-PHC (C-PHC) and health promotion to guarantee sustainability of the Beveridge model italian system, fight health inequalities and answer the complexity of population needs in a period of spending cuts.
Since the beginning, the movement started an educational program through the study of the literature and the research of the Italian and international best practices of C-PHC and community health promotion. As a result, to achieve the goal of this project, PHC campaign organized peer education training sessions, educational site-visit of some Italian best practices, lectures and workshops with Italian and foreigner health professionals experts on the field. Several national and regional events had been organized all over Italy. Members of “PHC” Campaign have been invited to write books, news on web-based newspapers on this topic and participate in congresses. To date, PHC campaign might be considered one of the strongest not-institutional voices in Italy in supporting the public beveridge-model NHS
Moved from a strong ethical health policy view underlined the importance of the Right-to-Health and of a C-PHC based NHS, since the beginning, “2018 Primary Health care: Now or Never” Movement identified three asset of action: advocacy, education/knowledge and diffusion.

Key messages
The experience showed the importance of health professionals engagement in public health topics such as sustainability of public NHS in order to promote a reform towards health promotion and equity. PHC Campaign is an example of how a bottom-up ethical movement on public health from different Health professionals could actively contribute to promoting cultural and health policy change.
Anthropological analysis on recent covid-19 infection in Italy
Authors: Sironi V A , Riva M A 
Published: October 2020

Abstract
The recent epidemic caused by the Covid-19 virus, which originated in China and then spread rapidly, can rightly be defined as the real 'first' epidemic in the social era. In an increasingly globalized world other recent epidemics (but more circumscribed, even if severely more lethal, such as Ebola and Sars) have been experienced with less media and emotional involvement, while the recent epidemic due to the new coronavirus has generated deserving reactions of analysis from an anthropological and social point of view, rather than on a health aspect. In Italy the epidemic event provoked sometimes excessive and irrational psychological reactions (from an unjustified panic to an irresponsible underestimation) and a cognitive distortion on anthropological level (wrong perspective perception of the pathological event). It has also generated disproportionate social repercussions at national level (refusal of stay for subjects coming from the lands in which diseased people are present) and at international level (foreclosure of landing of Italian tourists in some foreign countries). There was also incorrect medical information (confusion between infected - asymptomatic and/or non-hospitalized paucisymptomatic -, real patients with important symptoms - hospitalized - and sometimes in need of intensive care, subjects - the elderly and carriers of other serious diseases - died not for but with the Covid-19 infection) generated and amplified also by the pounding informative role of the mass media and by the news (often inaccurate and generating fake-news) spread in real time through social media.

Key messages
Irrational reactions must be avoided. Correct medical information are indispensable.
How are the women in Germany? The Women’s Health Report of German Federal Health Reporting
Authors: Prütz F , Hintzpeter B , Krause L , Saß A-C 
Published: October 2020

Abstract

Issue
The aim of Federal health reporting (GBE) is to continuously provide up-to-date information on the population's health and healthcare utilisation in Germany. Since women and men differ significantly in terms of health and disease, health reporting should always take gender into account.

Description of the Problem
A new report on women's health in Germany is published in mid-2020 by the Robert Koch Institute (RKI), containing data on women's health situation, health behaviour and health care. GBE publications are based on a comprehensive database, including official statistics, RKI health monitoring data, routine data and cancer registry data. We will present exemplary data on key indicators of the report.

Results
Life expectancy of women in Germany has been rising for many decades. With currently 83.2 years, it is at the EU average. Cardiovascular diseases are still the leading cause of death, accounting for 40% of all deaths. The second leading cause of death in women is cancer. With about 69,000 new cases per year, breast cancer is most common, although incidence and mortality rates have significantly declined. 53% of women in Germany are overweight (EU: 44%), 22% undertake health-enhancing physical activities at least once a week (EU: 10%), the 30-day prevalence of binge drinking is 19% (EU: 10%). Women with a migration background have a lower prevalence of risky alcohol consumption and practice physical activities less frequently. A low birth rate and the postponement of the first birth to a later age are characteristic for Germany (summarized birth rate: 1.57). The caesarean section rate slightly decreased to 30.5% in 2017. In 2018 there were 100,986 terminations of pregnancy, with a declining trend.

Lessons
The Women's Health Report provides an overview of key issues of women's health in Germany. These can help to improve prevention and health care. In some areas (e.g. benign gynaecological diseases), there are still data gaps in spite of high prevalences.

Key messages
The Women's Health Report of Federal Health Reporting is published in mid-2020 and provides an overview of key issues of women's health in Germany. Women’s life expectancy in Germany has been rising for many decades and is currently 83.2 years, with cardiovascular diseases and cancer still being the most common causes of death.
The Operational Control Unit in the Health Protection Agency of the Metropolitan City of Milan
Authors: Dadda F , Nicolosi D 
Published: October 2020

Abstract

Issue
Lombardy health system (SSL) separates the function of purchasing health benefits from the provision of services. Hospitals may be public or private and must be accredited and contracted with SSL to be refunded.

Description of the Problem
The Health Protection Agency of the Metropolitan City of Milan covers about 3,500,000 inhabitants and 54 hospitals. The SSL has funded 548,250 episodes of ordinary hospitalization and Day Hospital. Total reimbursement of these admissions was 2,175,426,335 € with an average reimbursement of 3,697€ per average hospitalization of 7 days. The main diagnoses were cardiovascular (16.1%) and muscular-skeletal diseases (13.2%); the main reasons for hospitalization are birth and delivery (5.3 and 4.2% of admissions); hip and knee replacements absorbed 5.9% of total reimbursements and 2.7% of hospitalizations.

Results
The Operational Control Unit (NOC) evaluate settings and duration of hospital stays, diagnosis and procedures encoding on hospital discharge forms (SDO) and compilation of clinical documentation quality assurance. NOC make yearly inspections on a specific percentage of hospitalizations decided by the Lombardy Region by a targeted sampling mode or by a validation of hospitals' self-evaluations.

Lessons
In 2019 NOC evaluated 40,040 hospitalizations with targeted sampling mode that meant a total refund of 156,374,990 € and economic cuts in 19.2% of cases, that is 9,236,586 € (5.9% of the original reimbursement). In 2,428 cases NOC made changes in diagnosis or procedures of SDOs, in 916 cases reduced days of hospitalization, in 1,408 cases turned admissions into outpatient services and in 982 cases they applied a refund reduction due to quality failures in clinical documentation. Concerning self-evaluations, all admissions related to 2019, NOC analyzed 35,424 hospitalizations for a total refund of 130,781,615 € and modified 4,168 of them, the 11.8% of the total sample, returning an economic cut of about 5,259,532 €.

Key messages
NOC in 2019 evaluated 75,464 hospitalizations in 54 hospitals amending 11,838 admissions, the 15.7% of the total, returning an economic cut of 14,496,118 €, about the 5% of the total amount. NOC activities can have a remarkable impact on correct reimbursement of hospitalizations.
Biosimilar formulations of gonadotropins in a central Italian region: use patterns and time trends
Authors: Rosa A , Belleudi V , Addis A , Ciardulli A , Pacchiarotti A , Davoli M , Kirchmayer U 
Published: October 2020

Abstract

Background
Gonadotropins (Gonas) are hormones that play a central role in the follicular growth of women but also useful in male infertility. Gonas used for infertility treatment in women are available as urinary extracts or recombinants. In 2015, the first biosimilar of follitropin alfa was authorised.

Objectives
We aimed to evaluate use patterns, temporal and spatial variations of Gonas biosimilar formulations in an central Italian region.

Methods
From administrative healthcare databases of Lazio region, we extracted prescriptions that have occurred over the years 2015-2019. Gona's use was grouped as treatment with urinary (u) and recombinant (r). Special focus was made on biosimilar r-Gona. Use patterns were investigated with respect to characteristics of the patients treated, time trends, differences among local health units and type of prescribing physician.

Results
For the study period, we retrieved 136,333 Gona dispensations for 22,325 patients. The 10,927 r-Gona biosimilar dispensations (8.01% of all claims, of which 99.43% Bemfola®, and 0.57% Ovaleap®), were mostly referred to women, aged 18-45 years, (87.11% of all patients). Median age was 37 years for women, 38 for men. Since its authorisation, biosimilar r-Gona steadily gained market from 2015 (0,4% of claims) to 2017 (22,7%) followed by a decrease in 2019 (4,3%). Biosimilars claims are more frequent in treating men (10,8%) than women (6,1%). Most biosimilar prescriptions were issued by general practitioners (86.4%), followed by specialists (10.2%) and others. Biosimilar use patterns varied between different local health units (IQR 3.2%-8,5%).

Conclusions
In clinical pratice, r-Gona biosimilar dispensation, 8,8% of Gonas. are mostly prescribed from general practitioners and are proportionately more targeted at men than women. Further investigation is needed.

Key messages
More and more men and women are using artificial insemination techniques; it is important to monitor fertility drug use patterns. In times of savings for the economic system,the use of the biosimilar drugs is of increasing interest.
Temporal trends in female breast cancer mortality in a state in Legal Amazon
Authors: Oliveira J C S , Galvão N D , Souza B S N , Andrade A M C S , Cabral J F , Caló R S , Silva A M C 
Published: October 2020

Abstract

Background
Breast cancer is the fifth most common cause of death from cancer in women worldwide. In Brazil, mortality rates are increasing. Therefore, the aim of this study is to analyze breast cancer mortality between 2000 and 2018 in Mato Grosso, a Brazilian state in Legal Amazon.

Methods
Ecological study analyzing temporal trends. Data were extracted from the Mortality Information System. The selected variables were: sex (female), cause of death (C-50, in the 10th revision of the International Classification of Diseases - ICD 10), age (less than 50 years-old, equal or older than 50 years-old) and year of death (2000-2018). Resident population data were obtained from the Ministry of Health's database (DATASUS) for calculation of breast cancer annual mortality rates. Temporal trends were estimated using linear regression. All analyses were done in the STATA 14.0.

Results
Between 2000 and 2018, 2,276 deaths from breast cancer were registered in women. Of these, 756 (33.2%) in the youngest age group and 1,520 (66.8%) in the oldest age group. A statistically significant increase in breast cancer mortality was found for both age groups (p &lt; 0.001). In the annual mortality rates analysis, women in the youngest age group had the lowest rate in 2003 (1.98 deaths/100,000 women) and the highest rate in 2018 (7.88 deaths/100,000 women). The oldest age group had the lowest mortality rate in 2000 (21.48 death/100,000 women) and the highest rate in 2017 (47.09 deaths/100,000). The mean mortality rate was 5.69 for the youngest age group and 33.19 for the oldest age group. The annual percentage of change was 33.31 for the youngest group and 62.49 for the oldest group.

Conclusions
There is a statistically significant increase in female breast cancer mortality rate in Mato Grosso, one of the Brazilian states in Legal Amazon. It is imperative to invest in breast cancer screening to enable the reduction of the mortality rate of the disease.

Key messages
Our study presents information of breast cancer in a state from Legal Amazon that has increased death rates by the years 2000 to 2018. Besides breast cancer is relevant in Brazil, this is the first analysis from this specific data, potential to support improvement in disease control.
Travel Clinics, where we are and where we are going: a national survey in Italy
Authors: Canale A , Giardi F , Giorgi S , Lopalco P , Tomasi A 
Published: October 2020

Abstract

Background
In a world where travelling can play a central role among human activities, due to the migratory flows increase and to the facilitation of exchanges between distant countries, the need to ensure healthcare to all travellers becomes a key point among healthcare activities. The aim of the study is to assess Italian Travel Clinics activity, critical issues, requirements and tips for improvement.

Methods
During the period from May to September, the Italian Society of Travel Medicine and Migrations (SIMVIM), performed a national on-line survey addressed to all Italian Travel Clinics.

Results
More than a third of Italian Travel Clinics replied the survey (79 clinics). The results show that on average for each clinic there are 4 healthcare workers (2 physicians, 1 nurse and 1 health worker), about 10 hours/week are dedicated to the clinic, the users are 18 and the Visiting Friends and Relatives (VFR) are 17%. In only 25% of cases the clinic is open access and in 80% there is a digital immunization registry. More than 70% of the healthcare workers have the last update in the two-year period of 2017/2018. Major critical issues are shortage of staff, limited opportunities to update, absence of a dedicated software, expensive vaccinations particularly for VFR, reduced visibility of the clinic and difficulties in accessing, Travel Clinics not sufficiently integrated into the National Health System.

Conclusions
Italian Travel Clinics are carring out a good service to ensure healthcare to the greatest number of travellers, but there is extensive room of improvement.

Key messages
We should create a network where Travel Clinics work together with General Practitioners, Pediatricians, other Specialists, Pharmacists, travel agents and above all with stakeholders. In this way Travel Clinics can involve an increasing number of travellers through an active offer of vaccinations and a careful risk assessment based on professional skills and expert knowledge.