bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benefit and costs of surveillance on cancer risk patients: the example of pancreatic cystic tumors
Authors: Cortesi P A , Tamburino D , Facchetti R , Micale M , Mantovani L G , Crippa S , Capurso G 
Published: October 2020

Abstract

Background
Increasing number of expert recommendations and guidelines of cancer surveillance have become available in the last decade. This complex scenario have increased the uncertainty on the most valuable approach to adopt. This study aim to evaluate the case of premalignant pancreatic primarily cystic tumors surveillance, assessing the differences of programmes proposed and applied.

Methods
A review of American, European and International guidelines for surveillance of asymptomatic neoplastic pancreatic cysts was performed to assess the difference of programmes proposed. An amibispective observational study, form 1995 to 2019, was conducted on patients with premalignant pancreatic primarily cystic tumors monitored in 10 centers from 4 European countries. We estimated incidence of pancreatic cancer and surgery intervention for high grade dysplasia (HGD)/Pancreatic cancer. We also assessed the follow-up visits and exams frequency during the surveillance period and the relative mean cost per patient-year.

Results
The guidelines reported significant differences in patient’s stratification, surveillance intensity (frequency of visits-exams), and surveillance duration. In the study conducted, 961 patients were enrolled with a median (IQR) follow-up of 4.47(2.8-7.0) years. HGD or Pancreatic carcinoma was reported by 43(4.4%) patients and 67(7.0%) undergone pancreatic surgery. Within the pancreatic surgery performed, 60.6% was rated as over-treated (None/low-moderate grade dysplsya). A big variability was reported in the surveillance with a median (IQR) visit per patient-year of 0.77(0.49-1.03) and with a mean cost per-patient year of €163.3.

Conclusions
Significant heterogeneity between surveillance approaches was reported in guidelines and clinical practice. Reliable and specific data on efficacy and costs associated to surveillances programmes proposed are needed in order to perform robust assessment and help decision makers in implementing the most valuable one.

Key messages
Significant variability of surveillance programmes proposed and applied for pancreatic cystic are reported in the guidelines and clinical practice. We need more robust efficacy and costs data in order to identify the most valuable surveillances approach to implement in clinical practice and recommend in the national and international guidelines.
Impact of the 2009-2014 economic crisis on suicide attempts and self-harm in Portugal
Authors: Pinheiro V , Nunes B , Pereira da Silva S , Caetano C 
Published: October 2020

Abstract

Background
Following the worldwide economic crisis of 2008, studies have found an increased risk for self-harm and suicide attempts, many of which need hospital care. There is no research in Portugal on the matter. Therefore, our goal was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the hospital admission rates by attempted suicide and self-harm in Portugal.

Methods
A retrospective ecological study, with an interrupted time series analysis of hospital admissions by suicide attempts (data from the national Hospital Mobility Database) in mainland Portugal, between 2003 and 2014, was performed. Resident population data over 15 years old was retrieved from the National Statistics Institute. Poisson regression models were used to compare rates and trends before (2003-2008) and during (2009-2014) the Portuguese economic crisis. All rates were adjusted for seasonality.

Results
A total of 35,077 hospital admission episodes by suicide attempt were retrieved. The mean admission rate was 2.947 per 100 000 inhabitants per month before the crisis, falling to 2.798 during the crisis period. Before the crisis, the total admission rate was decreasing 1% per year. After the crisis erupted, there was a level change, with a sudden increase of 7.9%. The suicide and self-harm admission rate, after 2008, was constant and approximately 38.8% higher than expected if the earlier trend had continued.

Conclusions
There was an increase in the total hospital admission rate by suicide attempts and self-harm during the economic crisis period in Portugal, when compared to the previous period.

Key messages
Economic crisis can pose considerable suicide risks. Urgent action is needed to prevent economic crisis leading to additional suicides.
Building trust and enhancing localization to improve access to women’s health services in Afghanistan
Authors: Rab F R , Stranges S S , Thind A D , Sohani S S 
Published: October 2020

Abstract

Background
Over 34 million people in Afghanistan have suffered from death and devastation for the last four decades as a result of conflict. Women and children have borne the brunt of this devastation. Afghanistan has some of the poorest health indicators in the world for women and children. In the midst of armed conflict, providing essential healthcare in remote regions in the throws of conflict remains a challenge, which is being addressed the Mobile Health Teams through Afghan Red Crescent (ARCS). To overcome socio-cultural barriers, ARCS MHTs have used local knowledge to hire female staff as part of the MHTs along with their male relatives as part of MHT staff. The present study was conducted to explore the impact of engaging female health workers as part of MHTs in conflict zones within Afghanistan on access, availability and utilization of maternal and child health care.

Methods
Quantitative descriptive and time-trend analysis were used to evaluate impact of introduction of female health workers. Qualitative data is being analyzed to assess the possibilities and implications of engaging female health workers in the delivery of health services.

Results
Preliminary results show a 96% increase in uptake of services for expectant mothers over the last four years. Average of 18 thousand services provided each month by MHTs, 70% for women and children. Service delivery for women and children significantly increased over time (p &lt; 0.05) after inclusion of female health workers in MHTs. Delivery of maternity care services showed a more significant increase (p &lt; 0.001). Time trend and qualitative analyses is ongoing.

Conclusions
Introduction of female health workers significantly improved uptake of health care services for women and children especially in extremely isolated areas controlled by armed groups in Afghanistan. Engaging with local stakeholders is essential for delivery of health services for vulnerable populations in fragile settings like Afghanistan.

Key messages
Understanding cultural norms results in socially acceptable solutions to barriers in delivery of healthcare services and leads to improvements in access for women and children in fragile settings. Building local partnerships and capacities and using local resources result in safe, efficient and sustainable delivery of healthcare services for vulnerable populations in fragile settings.
The challenge of bringing evidence in decision-making for public health emergencies: can preparedness reach out to HTA?
Authors: Chronaki C E , Miglietta A 
Published: October 2020

Abstract
Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and reliable data is typically lacking.
The process of including data for preparedness and training for evidence-based decision making in public health emergencies is not systematic and is complicated by many barriers as the absence of common digital tools and approaches for resource planning and update of response plans. Health Technology Assessment (HTA) is used with the aim to improve the quality and efficiency of public health interventions and to make healthcare systems more sustainable. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability to share data and to plan coordinated response. Digital health tools have an important role to play in this setting, facilitating use of knowledge about the population that can potentially affected by the crisis within and across regional and national borders. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define and align mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. Activities and policy development in the HTA network could inform this process. The objective of this presentation is to identify barriers for evidence-based decision making during public health emergencies and discuss how standardization in digital health and HTA processes may help overcome these barriers leading to more effective coordinated and evidence-based public health emergency response.
Using novel methodologies to support burden of disease estimates
Authors: Hald T 
Published: October 2020

Abstract
A challenge to estimating burden of diarrheal diseases, particularly in LMICs, where laboratory capacity and surveillance systems are limited, is obtaining valid estimates of etiology proportions of cases. A commonly used method is systematic review of studies reporting pathogen isolation in diarrhea cases. However, studies often differ in design, source population, timeframe, and pathogens included, hampering extrapolation to the target population. In a study co-funded by the Bill and Melinda Gates Foundation and the UK Department for International Development, we explore a novel approach for estimating diarrhea etiology proportions in urban and rural populations in four African countries. We analyse sewage samples using short-read next-generation sequencing (NGS) to determine abundance of genes that can be mapped to specific bacterial genera, providing an estimate of the relative abundance of specific pathogens in each sample. In parallel to collecting sewage samples, a questionnaire-based population survey will estimate diarrheal incidence. By combining results, pathogen-specific incidence will be estimated and compared with incidence estimates from the traditional approach. The application NGS to human sewage has great potential for surveillance of foodborne infections, particularly in resource-poor settings where laboratory capacity for bacterial isolation is limited. First, NGS is a one method takes all approach, as it is based on detection of RNA/DNA, a language common across pathogens. Second, it is culture independent, allowing for real-time data generation and standardized sharing. Finally, few samples are needed to survey large populations for several pathogens at the same time. Thus, surveillance based on NGS of sewage may prove to be an indirect measure of incidence. Although it will not provide an estimate for the true incidence in the population, it will increase our understanding of the burden and as such be a proxy and novel way of ranking diseases.
Rapid-review findings of healthcare inequalities experienced by LGBTI people in 27 EU Member States
Authors: Zeeman L , Sherriff N 
Published: October 2020

Abstract

Background
A recent EU funded pilot project to reduce the health inequalities of lesbian, gay, bisexual, trans and intersex (LGBTI) people has drawn attention to the barriers faced by LGBTI people when they access healthcare.

Methods
A component of a larger Health4LGBTI study will be presented where rapid-reviews were undertaken in 27 EU Member States focusing on the barriers experienced by LGBI people and how they can be reduced.

Results
LGBTI people may experience discrimination in healthcare settings based on their gender identity and gender expression, sexual orientation or sex characteristics where heterosexuality, binary gender and assumed male/female sex characteristics were upheld as the norm. Encouraging promising practices in various health settings were evident where the barriers faced by LGBTI people were addressed. The session will present measures required to reduce the barriers faced by LGBTI people via appropriate training of health professionals combined with the efforts of researchers, policy makers and LGBTI people as targeted action across all health systems.

Conclusions
Although encouraging promising practices were evident, much remains to be done, to ensure healthcare becomes equally accessible to all.
The potential and current use of mHealth-based self-quantification tools for primary prevention
Authors: Nittas V 
Published: October 2020

Abstract
The panellist Vasileios Nittas will discuss about the potential and current use of mHealth-based self-quantification tools for primary prevention; key barriers and facilitators; their ethical, structural and contextual implications - as well as their impact on developing robust, evidence-based digital (public) health policies.
Building capacity for public urban mental health – example of Reflecting Citizens workshops
Authors: Jevtic M 
Published: October 2020

Abstract
Novi Sad is a shelter of six languages, and the place of encounter of different cultures, of nurturing diversity through jokes, recipes, literature, music, works of art. Diversity and colourful customs in Novi Sad are not just the reflection of positive movements, but also serious events, wars, big migrations, internal and external migrations. Today Novi Sad (and our region) are home of 21 ethnicities, with six official languages, complicated administration, and wish to live in peace.
Having in mind the contents and matrix which are developing in the Reflective citizens (RC) workshops, the idea was born that RC could become part of all activities of the city of Novi Sad, as tool to develop the dialogue of citizens in cultural spaces of Novi Sad, the European capital of culture in 2021.
The idea that Reflective Citizens migrate (move) through different cultural spaces and that thus (in contact with cultural contents) hypotheses, ideas and actions are born, which will in positive communication make contributions to the significance of all cultural values, is justifiable and in time gives a visible, positive result.
Reflecting citizens workshop could be seen as a method for building capacity concerning developing innovative concepts for public urban mental health.
Reflective Citizens workshops contribute in improving health in community through fostering dialogue and mutual reflection. Also, Reflective Citizens workshops are open space for all citizens who want to contribute to dialog, multiculturalism, tolerance, thus contributing quality of life, social environment and mental health also.
Health tourism and public health: when novelty crosses the added value of multilateralism
Authors: Saboga-Nunes L , Amaral A 
Published: October 2020

Abstract

Background
Of the EU citizens, 5% get medical treatment in another EU country (MTT), 33% are willing to travel to get MTT and 53% willing to travel for better quality MTT (Statista 2018). In Portugal between 2017 and 2018 almost 1000 patients were treated in another EU country (cost/mean of 10 thousand Euros). Portugal has increase hindrances in disease care at the NHS. The private sector increased its market share (attracting specialists out of the NHS). While waiting lists, as shortness of human resources prevails, have no sign of changing in the near future, European regulations create expectations to receive appropriate timely MTT. To deal with the complexity of the topic a study case based on cataract disease, will be used. As national strategies try to fill precise gaps to answer specific disease conditions, Medical Tourism (MT) demand can be seen as a strategy to decrease inequalities of access?

Methods
A tracer methodology, looking at cataracts treatment in the population, is used to understand how demand increase can be mitigated with a European answer of MTT.

Results
Although Portugal has the highest rate of cataract operations in the EU28 (14 operations per thousand inhabitants (2015)) demand is not answered by the NHS, with a wating list of 194 days for the first consultation and about 100 days of waiting lists to get operated (and increasing over recent years). Regional municipalities have tried to overcome this NHS failure by offering its populations treatment vouchers in another countries. Nevertheless, the National Audit Office ruled as illegal such initiatives and moreover, at the NHS, cataract operations are not allowed in another country.

Conclusions
Although very rare and specific disease conditions have been allowed to be answered by MTT, common and increasingly debilitated conditions, e.g. cataracts, remain inaccessible for citizens in proper and due time while MT stands as an open option.
An extended comparative analysis using vignettes of dental care coverage
Authors: Fattore G , Winkelmann J , Panteli D , Allin S 
Published: October 2020

Abstract

Background
Virtually all European countries state to guarantee universal healthcare coverage to their citizens. However, there is evidence, although scarce, that dental care is a special case as coverage is very limited in some countries and there are major differences across national jurisdictions. This comparative study tries to better understand how dental care is covered in Europe and Canada through the use of five vignettes presenting dental services for specific patients.

Methods
Experts from each country were asked to state whether the following situations were covered by their statutory systems: a) scaling and polishing to remove plaque deposits and calculus for an adult; b) treatment for caries including fillings and root canal treatment for an adult; c) prosthetic rehabilitation for an elderly; d) fillings and repairs for a seven-year old girl with serious tooth decay; e) orthodontic treatment for a 13 old boy.

Results
Preliminary analysis of the vignettes from 10 countries show that there is a large variation between countries in who delivers dental care, how much it costs and who pays for it.

Conclusions
Full coverage of dental care is rare in Europe and the extent of coverage varies greatly across countries in Europe and also in comparison to Canada.
Policies to prevent non-communicable disease: implementation trends in 194 countries 2015–2020
Authors: Holmer H , Allen L 
Published: October 2020

Abstract

Background
Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide. The WHO proposed 19 “Best Buy” policies to prevent NCDs, mainly addressing four leading risk factors: tobacco, alcohol, unhealthy diets and insufficient physical exercise. Yet, little is known about how implementation has changed over time and the role of geopolitical factors. This study addresses that crucial gap.

Methods
We calculated policy implementation scores for all 194 WHO member states from the 2015, 2017 and 2020 WHO NCD Progress Monitor Reports. We analyzed global trends across the three years for all countries and by geopolitical group and used linear regression to assess association with health, economic and political indicators.

Results
The global average implementation score in 2020 was 47.0% (SD 19.8%), compared to 44.9% (SD 19.1%) in 2017 and 39.0% (SD 19.3%) in 2015. Implementation scores varied by income level (p &lt; 0.001), with high-income countries' average implementation score over twice that of low-income countries (59.7% vs. 28.9%). Implementation improved for all policies in 2015-2020 except the three alcohol policies which decreased. Implementation scores were associated with the proportion of deaths due to NCDs (β 0.8, 95% confidence interval 0.7-0.9, p &lt; 0.001); however, on average, countries with a greater increase in the proportion of deaths due to NCDs were less likely to implement NCD policies (p &lt; 0.001).

Conclusions
Implementation of policies to prevent NCDs is improving over time, but the average implementation score remains below 50% and progress is uneven. Our findings suggest the need to increase implementation of recommended interventions, particularly in low- and middle-income countries and where the proportion of NCD deaths is growing fastest, and to urgently address the decreasing level of implementation of alcohol interventions.

Key messages
Implementation of recommended, cost-effective policies to prevent NCDs is improving but remains low, and alcohol policies are decreasing. Low-income countries, and countries where the proportion of deaths due to NCDs is growing the fastest, are least likely to have recommended policies in place to prevent NCDs.
Automated HIV screening in the emergency department –earlier diagnosis, improved clinical outcomes
Authors: Vaz Pinto I , Guimaraes M , Castro V , Santos C , Galiano A , Friaes J , Bile A , Casqueira A 
Published: October 2020

Abstract

Background
HIV/AIDS is a public health problem worldwide because undiagnosed patients maintain onward transmission. To stop viral transmission an upscale in diagnostics is needed so that more patients start treatment; patients on treatment and with undetectable viral load do not transmit the virus to other persons (“Treatment as Prevention”).

Objectives
We aimed at identifying more HIV infections in the emergency Department (ED) and at doing so earlier in the course of disease.

Methods
we designed an automated and clinician independent HIV screening project in the ED. Electronic Medical Record (EMR) automatically generates a request for HIV antibody (HIV Ab) test when a patient: a) is 18-65 years of age and has a request for any blood test; b) is not identified in the EMR as being HIV infected; c) does not have an HIV Ab in the EMR in the previous year. Nursing staff receive a visual warning of patients' eligibility for screening and an extra tube label is printed out for HIV testing. The patient is informed of screening at the moment of blood drawing and an &lt;&lt;opt-out &gt;&gt; strategy is applied (optional verbal informed consent or &lt;&lt;opt-out &gt;&gt; of screening).

Results
In 16 months, a total of 21.487 people were eligible for screening. 18.072 HIV Ab screening tests were done. The opt-out rate was 6.3% and there were 44 new HIV diagnostics (prevalence rate 0.24%). Late presenting patients (baseline CD4 counts &lt;350) dropped from an average of 56% in the previous 6 years at our institution to 36.3%. Median CD4 count at diagnostics went up from 192 to 388 cells/mm³.

Conclusions
An automated and clinician independent HIV screening program in the ED proved to be successful at identifying more HIV patients and at tackling the problem of late presentation. Diagnosing early in the course of infection is beneficial for the individual patient, but also represents a gain in general public health because onward transmission is stopped by starting antiretroviral treatment.

Key messages
Early diagnosis through universal screening. Treatment as prevention.