bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rethinking policies and possibilities of sustainable solid waste management system of Dhaka City
Authors: Jerin D , Sara H , Hasan T , Quayyum Z 
Published: October 2020

Abstract

Issues
Solid waste management is one of the biggest concerns in Bangladesh, particularly in Dhaka city at present. This paper aims to find the gaps and challenges in solid waste management policies and implementations and thus, gives an insight towards sustainable solid waste management system in the country.

Description of the Problem
Improper solid waste management is adversely impacting environmental protection, public health and the control of carbon emissions in Bangladesh. As a result solid waste has become a major area of public policy with growing concern.

Lessons
Bangladesh has been experiencing changes in solid waste management since 1983 with the introduction of Dhaka City Corporation Ordinance and later the promulgation of National 3R Policy in 2010. With few exceptions, the overall waste management system cannot be termed as an efficient sequential process of waste minimization, recycling, and disposal based on global standards. Many initiatives are being implemented as part of independent projects by the non-governmental organizations (NGOs) and not always supported by policies. Though the establishment of several secondary transfer stations (STSs) has improved the environmental conditions and cleanliness of the cities, the waste segregation and recycling practices in the pathways from households to landfill do not adhere to the 3R Policy. Both the recyclable and non-recyclable waste are collected and dumped all together at different levels of waste management, i.e. collection from households, dumping at STSs, and later in the landfill without any formal procedures of sorting and recycling. Lack of coordination between implementing agencies is another problem.

Conclusions
Absence of sustainable solid waste management policy and proper execution agency are the main obstacles towards a proper waste management system. This problem is huge and should be addressed immediately to protect the environment and ensure better health of the city population.

Key messages
Even though the formation of STSs is one of the significant changes in the system nowadays, it is not evaluated or monitored under any specific policy or ordinance. In order to implement the existing policies, adequate funding and monitoring bodies should be introduced to the waste management sector.
Decentralization Process in Portugal: impact in the health care system
Authors: Sequeira R , Quinaz Romana G , Campos Fernandes A , Pinho M , Freire Rodrigues E , Isoppo C , Sousa P 
Published: October 2020

Abstract

Problem
Different countries have incorporated models of decentralization in their health reforms to achieve efficiency, by increasing the training of local governments, responsibility and gains in areas such as quality, costs and equity. In Portugal, the 21st government program established the autonomy of local authorities and the democratic decentralization of public administration. Accordingly, a decentralization law was approved and local governments have now a crucial role on health policies.

Description of the Problem
For this framework, a situational diagnosis and an intersectoral approach to policies are needed. This is an observational, analytical and cross-sectional study developed at council level in two Portuguese municipalities. This study aims to: Adjust responses to health needs at the local level; Set priorities by taking into account installed capacity and responses to populations; Promote the articulation between entities; Strengthen the focus on health promotion and healthy lifestyles; Strengthen health interventions in educational communities; Promote the creation of programs at local level, in conjunction with the national level, to reduce inequalities.

Results
The preliminary results in health, social and economic indicators show that this framework, while taking in consideration population characteristics, allows the development of local strategies regarding health services coverage, health services type and medication. At council level, the preliminary results also show a lack of data on healthy lifestyles and social indicators.

Lessons
The implementation of a decentralization process involves a broad range of requirements such as a situational diagnosis, strategies development and a periodic update of quality life and health indicators. Those are needed to assess council level priorities, which allow the development of public policies and interventions, in line with population characteristics, to tackle health inequalities and inequities.

Key messages
Performance improvement of health system is linked to the implementation of local citizen centred policies. These are actions which promote quality of life through health-friendly ecosystems. The local health intervention has contributed to promote inequalities reduction, increasing equity and dynamize new frameworks of organization with individual and community participation.
Analysis of the political process of Denmark’s hospital reform
Authors: Reichebner C , Berger E , Eriksen A 
Published: October 2020

Abstract

Background
The German hospital landscape is characterized by a decentralization of the range of services provided, low levels of specialization and significant overcapacity. This leads to over-, under- and misuse of hospital care, which is not least evidenced by wide variation in quality in the system. In Denmark, since the early 2000s, a continuous restructuring of the hospital landscape has been undertaken. Among other things, hospitals have been rebuilt, many smaller hospitals have closed and the number of emergency rooms has been halved. The aim of the project K:IDD (Hospital: Impulses for Germany from Denmark) is to examine the conditions that have to be created to be able to incorporate parts of the Danish reform into German hospital care, and to leverage these for improved patient care. To learn from the case of Denmark, it is important to understand which circumstances facilitated the reform.

Methods
To analyse the political process behind Denmark's hospital reform using two different sources will be used: (1) A qualitative content analysis of 17 semi-structured expert interviews with political scientists, journalists, politicians, among others and (2) an analysis of the literature about the reform. Kingdon's (1994) multiple stream framework as well as Tsebelis' (1995) Veto-player theory will be used.

Results
The key success factors encouraging to the reform will be presented. In addition potential Veto-Players and institutional settings enabling or hindering the reform will be described. The final assessment of the policy process and comparison to the German context will lead to implementation guidance and recommendations for the German context. Further, alternative courses of action will be presented.

Conclusions
The findings from this analysis can provide important and practical recommendations for the necessary reform of the hospital landscape in Germany, thereby improving hospital care in the long term.

Key messages
The hospital reform in Denmark was possible due to the interaction of different social currents, which ultimately opened a window of opportunity. This could be used as role model for decision-makers, professionals and researchers strive for change in other countries.
Rethinking MS in Europe: Prioritizing integrated services for people with multiple sclerosis
Authors: Battaglia M A , Pugliatti M , Soelberg Sørensen P , Tiu C , Carrascal P , Quoidbach V 
Published: October 2020

Abstract

Background
Multiple sclerosis (MS) is a chronic disease of the central nervous system. Over 750,000 people are affected across Europe. The European Brain Council initiated in 2018 a project RETHINKING MS, calling for change in MS care.

Methods
The research framework included desk research data mapping and expert interviews. A series of clinical and patient-oriented benchmarks along the care process were developed. Data were analysed in collaboration with experts from across Europe to build an interdisciplinary consensus around practical and sustainable policy responses to MS in Europe.

Results
Results indicate that a timely diagnosis is important to enable a prompt initiation of specific drugs and symptomatic treatment which, in turn, can prevent potentially irreversible disability. Care must be individualised to each person and their specific symptoms and needs. Regular monitoring is key to personalise care and provide adequate support but there are often delays to diagnosis and limitations to treatment personalisation due to inadequate access to diagnostic facilities and MS specialists. Access to therapies can also be extremely challenging. The interdisciplinary approach is essential; disease management includes aspects of lifestyle modification, as many 'brain healthy' lifestyle factors may delay progression and relapses. Finally, social care can greatly improve quality of life for people with MS, social workers and occupational therapists can also support people with MS in their professional and daily lives.

Conclusions
Conclusions link timely diagnosis and coordinated care, long-term adaptable support to better quality of life. Primary prevention modification of lifestyle factors

Key messages
Policies for multiple sclerosis in Europe have to be changed. Primary and secondary prevention are possible.
Renewing primary care: the bottom-up experience of an Italian health professional movement
Authors: Sessa G , Milani C , Occhini G , Marini G , Sarro A 
Published: October 2020

Abstract
Sustainability of the National Health Systems (NHS) has been facing different challenges. A community-oriented Comprehensive Primary Health Care (CommOr C-PHC) could help its survival. Such a framework, focused on health promotion, primary prevention, not communicable disease management, requires new capabilities among health professionals. Considering teamwork and interprofessional collaboration (IPC) as PHC core elements, there is growing recognition of the need of interprofessional education (IPE). Nevertheless, italian medical education is distant from other disciplines and mainly based on hospital care settings. Since this situation represents an obstacle to implement a CommOr C-PHC model of health service, new ways of training students and retraining actual health workers should be developed.
The aim of the project is to design IPE programs and to improve IPC within the C-PHC framework, shared learning environments placed in the community were developed.
At the end of 2017 a group of young italian health professionals (public health resident, young general practitioner, social assistant, nurse, medical anthropologist, etc) founded the Campaign “2018 Primary Health care: Now or never”, a cultural movement of public health advocacy. Its goals are: The creation of a common cultural background through the study of PHC evidence and best italian and international practices. Organization of workshops all over Italy: peer education training session, site-visits, lectures with Italian and foreigner health professionals, based on need assessment methods.
Individuation of learning environments placed in the community and in a primary care setting where students can apprehend social determinants of health, exercise critical thinking and develop transprofessional knowledge.

Key messages
Young health professionals from Italy, starting from the need for a different educational framework, based on IPE, created a movement to defend the NHS and promote PHC principles. The success and large participation of a national campaign sustaining PHC and aimed at promoting interprofessional education shows the need for a change in the medical education field.
Liquid biopsy in lung cancer: tertiary prevention potential
Authors: Rubba F , Pepe F , Martello R , Egidio R , De Pascale T , Loperto I , Iervolino A , Malapelle U , Triassi M , Troncone G 
Published: October 2020

Abstract

Background
In the era of personalized therapy liquid biopsy is considered an important diagnostic tool in the clinical management of cancer patients. Tissue specimen represents “gold standard” for molecular evaluation of specific gene targets alterations that lead cancer patients to benefit of a “tailed therapy” based on molecular features of the tumor. This innovative source of nucleic acids was introduced in clinical setting only for NSCLC patients to test Epidermal Grow Factor Receptor (EGFR) mutations when tissue is not available or to monitor acquired resistance mutation after a first line of treatment. The study aimed at assessing the diagnostic potential of liquid biopsy in balanced tertiary screening modeling.

Methods
The cases relating to 5 years of activity regarding to molecular diagnostics performed on liquid biopsy specimens in the Predictive Diagnostic laboratory of AOU Federico II were reviewed. Laboratory data were collected in SPSS. Non parametric analysis were performed in order to test the differences between patients WILD TYPE or not. A multivariate logistic model was performed in order to assess the effect of mutation, age and sex, on the tumor progression. The results of the revision concern 515 total cases (almost of all plasma or peripheral blood) allowed to evaluate the liquid biopsies for women and men. The average age of the Patients is 66.3 years, and the 25 percentile is 59 years.

Results
The cases are 221 basal and 294 by progression. The cases with mutation, as expected, have an OR 4,15 compared to the basal to have a tumor progression (95% IC: 2,7 - 6,3) regardless of sex and age. The mutations detected were 131 from different types of pulmonary carcinomas.

Conclusions
Working on case data, specifying the characteristics of the Patients with mutations will drive a further estimate in tertiary prevention screening designs.

Key messages
In the last five years, the liquid biopsy has been used for different purposes in oncology. To specify the characteristics of the Patients with mutations will drive a further estimate in tertiary prevention screening designs.
Cryptosporidium oocysts: are they still a risk for human population? A case study in Italy
Authors: Pignata C , Bonetta S i , Bonetta S a , Cacciò S M , Sannella A R , Gilli G , Carraro E 
Published: October 2020

Abstract
Over the past decade, several outbreaks of cryptosporidiosis have been reported in many EU countries in association with the consumption of contaminated drinking water, recreational waters, food consumption and contact with animals. The aim of this study was to evaluate the occurrence of Cryptosporidium oocysts in a drinking water treatment plant (DWTP) located in a rural area of northern Italy. Influent and effluent samples at the DWTP, together with tap water samples from a public fountain were collected for three years (2013-2016). All samples were analysed for the presence of Cryptosporidium spp. oocysts by the EPA Method 1623 based on immunomagnetic separation (IMS)/immunofluorescence assay (IFA), complemented by 4,6-diamidino-2-phenylindole (DAPI) staining. The detection has been implemented with a reverse transcriptase-PCR (RT-PCR) protocol to evaluate the oocyst viability. The results highlighted a high variability of oocyst concentrations in all samples (mean 4.3 - 5.8/100 L) and a high percentage variability of the DAPI-positive specimens (mean 48.2% - 40.3%). Conversely, RT-PCR did not reveal the presence of any viable C. parvum and C. hominis oocysts. A nested PCR targeting Cryptosporidium 18S ribosomal DNA was carried out in two water samples to deepen the understanding of the obtained results. This test revealed the presence of a particular Cryptosporidium genotype associated with wild animals in the river and in tap water. Although the recovered Cryptosporidium genotype is not a human pathogen, its presence demonstrates the existence of a potential pathogen Cryptosporidium spp. contamination risk. Moreover, these results underline the importance of considering unconventional (not bacterial) biological contaminations (protozoa) in water resources in rural areas, including those of developed countries.

Key messages
The supply source and the drinking water treatment plant examined represent a classic example of a system that requires continuous monitoring to guarantee population health. Cryptosporidium oocysts may still be a Public Health problem even in industrialized countries, especially in rural and mountain areas.
Assessing the implementation of population based cervical cancer screening in Amadora, Portugal
Authors: Leite A , Pereira S , Vaz D , Smet T , Portilheiro C , Calé E , Morgado P 
Published: October 2020

Abstract

Background
Population-based cervical cancer screening (CCS) are deemed to be more cost-effective than opportunistic screening and to reduce inequalities. Implementation in Portugal has been heterogeneous, at the regional level. In Amadora healthcare cluster (Lisbon area), implementation started in April 2018 in a pilot unit and was scaled-up. We aimed to assess population-based CCS implementation in Amadora.

Methods
Population-based CCS targets women aged 30-65, and utilises liquid-based cytology with partial HPV genotyping (HPV16/18 and other high-risk HPV - hrHPV). Samples positive for other hrHPV undergo a cytology. HPV16/18+ and other hrHPV+ with ≥ASCUS (atypical squamous cells of undetermined significance) are referred to colposcopy. We assessed implementation according to key indicators extracted from our information system: geographic coverage, number of tests, positive results, positive predictive value of referral (number of cervical intraepithelial neoplasia-CIN/number colposcopies).

Results
As of 30 August 2019, CCS were in place in 4 of the 9 units, potentially covering 20904 women (48.4% of the target population). 1797 womem performed screening within the programme. Invitation for screening is currently implemented in 1 of the 4 units. Screening results were available for 1702 women, 11,1% were HPV+. From these, 26,5% were HPV 16/18+ and 86.2% positive for other hrHPV. Among the latter, 63.2% were negative for intraepithelial lesion and 36.8% were ≥ASCUS. Overall, of these 189 women, 51.3% (n = 97) were referred for colposcopy. Colposcopy results were available for 37 women, of which 13 had a CIN. PPV of referral was 35.1% (95%confidence interval: 20.7;52.6).

Conclusions
Despite being a population-based screening most tests are still opportunistic. There is still a limited number of colposcopies results but the current PPV of referral is low and requires further investigation. Implementation towards a full population-based screening in Amadora should continue.

Key messages
Implementation of a population-based cervical cancer screening in Amadora, Portugal is underway but most screening tests are still applied in an opportunistic manner. A limited number of results is avaliable to estimate positive predictive value of referral to colposcopy. Results available indicate a value of 35.1%, which requires further investigation.
Tobacco industry tactics in response to extensive tobacco control legislation in Israel
Authors: Bar-Zeev Y , Berg C , Kislev S , Geva H , Godinger E , Abroms L , Levine H 
Published: October 2020

Abstract

Issue
Tobacco control in Israel has been lagging, and smoking rates have remained stable in the last decade (∼20%). In 2018, landmark legislation was passed to go into effect during 2019- 2020. The tobacco and vaping industry employed several tactics to circumvent and test the ability to enforce the new legislation. Examining industry responses to legislative reform in Israel may inform policy and enforcement internationally.

Description of the Problem
Resulting from strong political will, supportive media, and a strong coalition of tobacco control advocates, the legislation involves: 1) advertising bans in all media, excluding print press; 2) point-of-sales display bans; 3) plain packaging with textual health warning labels; and 4) extending the legislation to include also vaping products. Industry tactics to circumvent/test this legislation were communicated through an active social media group of tobacco control coalition members who shared information regarding such tactics in all geographical areas in Israel and via different media outlets.

Results
Various measures employed by the industry included, for example, print media advertisements with branded elements in the background (prohibited by law); new signs and display boxes for heated tobacco products and e-cigarettes, at the point-of-sale, that say “An alternative to cigarettes”; distributing branded tin cases for cigarettes; Highlighting different brands online and in print media using colors and fonts that are not allowed as part of plain packaging, and including branded elements inside the cigarette package

Lessons
Anything not specifically covered or detailed or verbiage that is open to interpretation provides an opening for the industry to circumvent the legislation intentions. It is crucial that legislation be as specific and detailed as possible, anticipate industry efforts to identify such 'loopholes', and compel industry compliance through efficient enforcement.

Key messages
In response to extensive tobacco control legislation in Israel, the tobacco industry employed various tactics to bypass legislative efforts. Tobacco control legislation and regulation need to use detailed wording to prevent alternative interpretations by the tobacco industry.
Health care network for chronic conditions: an intervention and evaluation in the health system
Authors: Cardoso C S , Baldoni N R , Melo C F , Rezende L O , Noronha K , Oliveira C D L , Quintino N D , D`Alessandro T A L , Andrade M V 
Published: October 2020

Abstract

Background
Health assessments are necessary for the (re) formulation of effective public policies and to guarantee the quality of care offered. This study aim to evaluate the perception of health professionals concerning the institutional capacity of the health system to care for Chronic Conditions (CC) after intervention in a medium-sized municipality in Minas Gerais, Brazil.

Methods
It is a panel study with evaluation before, during and after an intervention in the health system with a focus on three CC, i.e., i) diabetes; ii) hypertension; and iii) pregnant women. Health care professionals from primary and specialized care units were interviewed using the Assessment of Chronic Illness Care (ACIC) scale, which was applied in nine focal groups organized by health care unit.

Results
A total of 240 professionals participated of this evaluation, being 94, 63 and 82 participants in 2013, 2015 and 2018 respectively. The ACIC scores showed an positive evolution in the capacity of the health system to care for CC over the years. In the first wave the global score was 5.40 (basic capacity), while in the third wave the score was 9.38 (optimal capacity), with a significant increase in the scores (p &lt; 0.01).

Conclusions
An important gain in the institutional capacity of the municipality was evidenced for the care of chronic conditions after intervention in the health system. Such an enhancement of the health system to operate in the CC might be sustainable over the time. Furthermore, its impact may directly reflect on the health indicators of the population.

Key messages
The results showed a strengthening of the local health system. These findings can subsidize other municipalities with a similar reality in the organization of the health care network and, consequently improve the care provided to chronic conditions.