bluuebunny/crossref_metadata_2025_split huggingface dataset:
Territorial Coordination Centres and Telenursing: innovation and digitalisation of home care in Italy
Authors: Iodice M , Carini E , Scotellaro M , Martini L , Cosentino M , Roscio G , Borghini A , Mantoan D 
Published: October 2023

Abstract

Issue
After Covid-19, Italy approved the National Recovery and Resilience Plan (NRRP) to boost public health, sustainability and digital innovation, which promotes ecological and digital transition reforms. The strategic health reform redesigned territorial healthcare network by introducing new models of proactive care, as Territorial Coordination Centres (TCCs) and Telenursing.

Description of the problem
TCC is an innovative organisational model, that coordinates taking care by linking services and professionals involved in different care settings. In TCCs are involved nursing staff, that performs a telemedicine service called Telenursing, a way of delivering nursing care directly to the patient's home, through digital health tools. How will TCCs be implemented, using NRRP funds? How will Telenursing impact on home care?

Results
By 2024, 600 TCCs are planned to be implemented and fully operational, across the Country, financed by NRRP (280 bln €). The standard set by the NRRP reform is 1 TCC each 100,000 inhabitants, with 4-6 primary nurses involved (2,400-3,600 nationally). TCCs are organised to be interconnected with every healthcare network setting, including home care. Telenursing, within the TCCs, aims to guarantee proactive, personalised and proximity care, enhancing the home as a privileged place of care. Nurses of TCCs perform health monitoring, assessment, promotion, prevention and education by Telenursing, in order to reduce inappropriate hospital admissions and to increase patient satisfaction, safety and empowerment. By 2026, at least 200,000 people will be assisted through telemedicine tools, as planned in NRRP reform (funding 1 bln €).

Lessons
Italy, pursuing better health outcomes for the population, is investing in strengthening public primary care services and digitalization of services. New strategy aims to improve health of population and decrease health inequalities, while reducing geographical variations.

Key messages
• Telenursing performed by nurses working in TCCs is aimed at improving proactive, personalised and proximity care, supporting patients and caregivers at home.
• By 2024, TCCs will be fully operating to guarantee an innovative system of public primary care, that uses digital tools to manage population in home care, reducing inappropriate hospitalization.
Lung cancer mortality and soil content of arsenic and cadmium: an ecological study in 26 EU countries
Authors: Bartnicka J J , Dyba T , Yunta Mezquita F , Rodriguez Rasero F , Randi G , Jones A , Carvalho R 
Published: October 2023

Abstract

Background
Environmental risk factors, such as exposure to air pollution, are linked with lung cancer. However, potential health impacts of exposure to carcinogenic pollutants in soil are less defined. In this ecological study, we evaluated at a regional scale potential associations between lung cancer mortality and the soil content of two carcinogens: arsenic and cadmium.

Methods
Data on deaths from lung cancer were from EUROSTAT. Soil content of arsenic and cadmium were from the Land use/cover area frame (LUCAS) 2009 survey. Analysis covered 26 EU countries and 21,035 sampling points. Three socioeconomic indicators and seven lung cancer risk factors were included. Data were linked at the NUTS2 level (n = 219) and analysed by negative binomial regression.

Results
After inclusion of significant predictors, the ratio of lung cancer mortality rates in the population resident in the regions within the highest quantile of arsenic concentration in soil, compared to the rest of the dataset, was 1.062 for females (95% CI 1.024 - 1.101) and 1.037 for males (95% CI 1.020 - 1.074). In the regions within the highest quantile of cadmium in soil, compared to the lower quantiles, the ratio of the mortality rates was 1.062 for females (95% CI 1.019 - 1.101) and 1.075 for males (95% CI 1.033 - 1.117). When data were stratified by land cover, significant (p &lt; 0.05) positive associations in males were only shown for cadmium sampled from agricultural land (cropland and grassland) but not from the non-agricultural land.

Conclusions
Higher rates of lung cancer mortality were reported in regions with high concentration of arsenic or cadmium in soil, relative to regions with lower concentration. Due to the ecological design, this study cannot prove causality but is in agreement with other reports linking exposure to arsenic or cadmium and lung cancer. This warrants future investigations at a finer geographical scale, focused on regions with high soil levels of arsenic and cadmium.

Key messages
• Higher lung cancer mortality rates were reported in regions with high concentration of arsenic or cadmium in soil, relative to regions with their lower concentration.
• There was an association between cadmium in soil and lung cancer mortality in males for the subset of sampling points from the agricultural land but not for the non-agricultural land.
Impacts of the COVID-19 pandemic on the breast cancer control pathway in Ireland
Authors: Tierney P A , McDevitt J , Brennan A , Zhang M , Mullooly M , Bennett K , Walsh P M , Murray D 
Published: October 2023

Abstract

Background
The COVID-19 pandemic caused unprecedented disruption to healthcare services worldwide including cancer services. The aim of this study is to assess the impact of the COVID-19 pandemic on aspects of the breast cancer control pathway in Ireland, including case counts, method of presentation, stage distribution, and treatment.

Methods
Analyses used data from the National Cancer Registry Ireland available as of April 2023. For assessments of case counts, 2020 data was compared to ‘expected’ case counts projected from a Joinpoint regression model of the last stable trend in breast cancer cases up to 2019. For assessments of method of presentation, stage distribution, and treatment, 2020 data was compared to equivalent 2019 data.

Results
There was a 23% reduction in number of breast cancer cases diagnosed in in Ireland in 2020 than expected from pre-2020 trends. Comparing methods of presentation, screen-detected tumours showed the largest reduction from 2019 to 2010. There was comparatively little change in numbers of breast cancers presenting through symptoms. Comparing cancer stage from 2019 to 2020, there was a significantly larger reduction in pT1 tumours than in pT2, or pT2-3, or pT2-4 tumours. Similarly, there was a larger reduction in Stage I than in any other stage and in Grade 1 than in Grade 2 or Grade 2-4 cancers. Investigation of breast cancer treatment showed a small reduction in the percentage of cases treated by surgery and by radiotherapy but no apparent change in the percentage of cases receiving chemotherapy/immunotherapy.

Conclusions
Patient behavioural changes, pauses in screening, and restricted healthcare access as a result of COVID-19 likely contributed to the observed reductions in case counts and screen-detection of breast cancer. The reduction in early stage breast cancers in 2020 is likely also related to screening disruption. Treatment modes may have been altered during the pandemic to reduce infection risk to cancer patient in hospitals.

Key messages
• The COVID-19 pandemic caused disruption to the breast cancer control pathway in Ireland.
• Case counts and screen-detection of breast cancer as well as the proportion of early stage breast cancers diagnosed were reduced in Ireland in 2020.
Digitally supported health care; evaluation approaches to a complex intervention embedded in a tria
Authors: Staines A , O'Sullivan B , Davis P , Ferrara L , White C , Degol L , Corrigan T , Musolino N , Wildiers H , Soubreyan P 
Published: October 2023

Abstract

Many important health care interventions do not fit the classic RCT paradigm. Drug trials have struggled with issues of non-compliance and selective withdrawal. Surgical researchers have done extensive work on incorporating operator skills and experience into trial settings. Working on innovative models of care delivery related issues arise. As part of an EU funded multi-centre stepped-wedge trial, GERONTE, of nurse-led, digitally supported, health care coordination for older people with cancer and other significant co-morbidity, we have developed and tested an outline of a novel method of evaluation, drawing on realist evaluation. There are three pieces, first the central trial outcome, quality of life, for those in the trial, analysed by intention-to-treat. Second an economic evaluation, based on care pathways, and collecting costs during the control and intervention phases in 16 centres, in 3 countries. Third, a realist evaluation of implementation, with 3 phases in each site, the first of which is underway.
1) Readiness to implement GERONTE, and documenting current practice, and identifying barriers and facilitators for change with clinical staff, technical staff and administrators;
2) Experience of implementation as the intervention is brought in over the course of the study;
3) Experience in keeping GERONTE running after the initial implementation phase.
Early results show great site to site variability, in practice and in resources, but common barriers are data handling and sharing. In each phase, guided by ideas from participatory rapid appraisal, we stress the rapid feedback to participants, of their response, and the synthesis of responses to support successful implementation. One aim is to prepare an implementation guide to support future deployments of GERONTE and similar projects, drawing on lessons from all 16 sites, and filling a gap in the literature.
GERONTE is funded by the Horizon 2020 research and innovation programme under grant agreement No 945218.

Key messages
• Innovative health care delivery, such as integrated care, requires complex assessment approaches, designed for the specific innovation.
• Site-to-site variability in the implementation of novel care pathways and approaches is the norm, and needs to be considered at design stage.
Health technology assessment of genetic and genomic applications: is it possible to standardize?
Authors: Migliara G , Baccolini V , Pitini E , Leone I , Isonne C , De Blasiis M R , Sciurti A , De Vito C , Marzuillo C , Villari P 
Published: October 2023

Abstract

Background
The assessment of genetic and genomic applications (GGA) has long been used ad hoc frameworks, often based on the ACCE model, while less used are more traditional health technology assessment (HTA) approaches. While ACCE frameworks are mainly focused on technical aspects, HTA ones often include economic and organizational aspects in their assessment. The aim of this study was to develop a framework able to address a comprehensive assessment of GGAs.

Methods
We analysed the most important HTA model currently used in EU, the EUnetHTA HTA Core Model, to identify any possible shortcomings in the evaluation of GGAs. The Sapienza framework, based on a previous systematic review of GGAs assessment frameworks, was used as a reference. The HTA Core Model applications were than used as a basis for an assessment framework for GGAs, classified according to ‘GGA function/Use setting’ pairs.

Results
The Sapienza framework found full correspondence in the HTA Core Model. The “Screening Technology” application was suitable for diagnostic, pre-symptomatic, predictive and carrier GGAs when used in screening settings. The “Diagnostic Technologies” application was appropriate for the pairs ‘Diagnostic/Diagnosis', ‘Pre-symptomatic/Diagnosis', ‘Prognostic/Staging’ and ‘Pharmacogenetic/Staging', although it may require additional considerations, such as the need of screening in case of germline mutations, the use of appropriate accuracy measures for prognostic GGAs, or the evaluation of the clinical utility of pharmacogenetic/prognostic GGAs.

Conclusions
The proposed methodology aims to be a flexible tool that allows the GGA assessment according to a shared and validated methodology already in use for the HTA of medical devices, considering for their technical aspect, the clinical utility, the economic value, and the delivery models. Indeed, the HTA Core Model seems to fit the needs of GGAs assessment. However, some peculiarity of GGAs should be carefully considered during the HTA.

Key messages
• The EUnetHTA Core Model can provide a comprehensive framework for the evaluation of genetic and genomic applications, allowing a standardization with the procedures usually used for medical devices.
• Some peculiar characteristics of genetic and genomic applications must be taken into consideration during their evaluation.
A theoretical framework for developing a health impact assessment implementation model in
Ireland
Authors: O'Mullane M , Purdy J , Pursell L , Archibong U , McHugh S 
Published: October 2023

Abstract

Background
A Health Research Board (HRB) four-year research study, which commenced in January 2023, seeks to explore the process of carrying out Health Impact Assessments (HIAs) with a view embedding the approach as normal practice in local and national policy development in Ireland.

Methods
A theoretical framework has been constructed to develop an HIA implementation model. The framework is based on the all-island Institute of Public Health Ireland's HIA guidance. The theoretical framework will examine factors affecting HIA implementation, using both the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). An action research methodological approach will be used to gather data on the experiences that participants will reflect on while doing the HIA. Participants included in the study will be the members of the two HIA Steering Groups created for each HIA (12 participants in each HIA) and policy end-users of the HIA evidence from the city council and government ministries (20 participants for each HIA).

Results
The theoretical framework will be applied to two HIAs, in order to generate data in creating the HIA implementation model. HIA 1, commencing October 2023, will be conducted on the local government Cork City Development Plan. HIA 2, commencing January 2025, will be carried out on the Irish Government's Climate Action Plan. Preliminary results on the application of the theoretical framework to HIA 1 will be presented, as well as reflections for the planned HIA 2.

Conclusions
For the first time in Ireland and beyond, a theoretical framework has been developed employing innovative methodological approaches to building a contextualised HIA implementation model. Using action research in assessing the implementation of HIA, with a view to analysing the lived experience of Steering Group members as they conduct the HIAs, and policy end-users, will ensure an enhanced HIA implementation model.

Key messages
• The development of an innovative theoretical framework for the study of HIA.
• The building of HIA capacity in Ireland using the newly revised Institute of Public Health guidance.
Cost-effectiveness analysis of child eye health interventions in India
Authors: Mannava S , Shamanna B R 
Published: October 2023

Abstract

Background
India has 4.8 million blind persons including 250,000 blind children, and 35 million visually impaired individuals. Prevalence of blindness is 0.36%, it was 1% two decades ago due to significant public health programs towards prevention and treatment by various stakeholders. Time is opportune for cost-effectiveness analyses of these programs. There is a lack of research evidence related to quality-of-life utility values for eye health conditions in India. This study aims to develop utility values for vision impairment and conduct cost-effectiveness analysis of eye health interventions for childhood vision impairment.

Methods
Cross-sectional questionnaire-based study. 306 Children aged 4-16 years of age with unaddressed vision impairment included. Random sampling was done at a tertiary eye hospital in central India. EQ-5D-Y-3L questionnaire along with VAS score was used to measure utility measures for each of the vision impairment levels. Vision impairment was defined based on WHO classification. Mixed methods were used to collect cost data related to interventions, sensitivity analyses were performed to account for uncertainties. The protocol was approved by institutional ethics committee of university of Hyderabad (UH/IEC/2020/222).

Results
Median utility value of mild and moderate vision impairment is 0.8 (95% CI 0.7-0.9), severe vision impairment is 0.7 (95% CI 0.65-0.75), and for blindness is 0.55 (95% CI 0.44-0.72). Willingness to pay (WTP) is USD 2,935. ICERs for mild, moderate, severe vision impairment and blindness are USD 81, USD 367, USD 44, USD 954 respectively.

Conclusions
The utility value of 0.55 for blindness correlates with existing literature. ICERs for various levels of vision impairment show the interventions to be cost-effective. There is a significant improvement in utility values post intervention. The utility measures are recommended to be used to evaluate eye health programs, and as advocacy tools for preventive eye care.

Key messages
• There is a significant improvement in utility values post-intervention and the interventions are highly cost-effective.
• Important decision-making tool for allocating scarce resources to preventive eye care services.
Work disability trajectories before and after common mental disorder among youth in private sector
Authors: Amin R , Rahman S , Björkenstam E , Helgesson M , Mittendorfer-Rutz E 
Published: October 2023

Abstract

Background
Little is known regarding work disability (sick leave and disability pension) among young employees in the private sector with common mental disorder (CMD) i.e. depression, anxiety and stress-related disorders. We aim to identify a) trajectory groups of work disability among young private sector employees in Sweden 3 years before and 6 years after a CMD diagnosis and b) investigate if sociodemographic, work- and health-related factors were associated with trajectory membership.

Methods
A longitudinal nationwide register-based study was conducted including all individuals aged 22-29 years, gainfully employed who had a CMD diagnosis in specialised healthcare or had prescribed antidepressant (N = 12,121) in 2014 (Y0), with follow-up from Y-3 - Y + 6. Group-based trajectory analysis was used to identify groups of individuals who followed similar trajectories of months of work disability. Multinomial logistic regression was used to determine associations between sociodemographic, work and health-related factors and trajectory membership.

Results
We identified three trajectories. Most individuals were in the ‘constant low’ trajectory with almost no work disability (57%) from Y-3 - Y + 6, followed by an ‘increasing low’ trajectory (36%) of around 1 month work disability each year and a ‘fluctuant high’ trajectory (7%) reaching 7 months of work disability in Y + 3 and declining to 5 months in Y + 6. Being women, low education and history of specialised healthcare use for musculoskeletal disorder was associated with belonging in the ‘increasing low’ and ‘fluctuant high’ trajectories. Work-related factors i.e. occupational class (non-manual/manual work) and branch (e.g. healthcare) had weak to no association with any trajectory membership.

Conclusions
Among young individuals working in the private sector, women, those with low education and those with musculoskeletal disorder require special attention regarding their return-to-work process following a CMD diagnosis.

Key messages
• Most (57%) young private sector employees had almost no work disability (WD) during 6 years after a common mental disorder (CMD) while 7% had almost 7 months of WD still 3-4 years after CMD.
• Women, those with low education and with musculoskeletal disorder require special attention regarding their return-to-work process following a CMD diagnosis among young private sector employees.
Working conditions and self-efficacy among users of psychotherapeutic consultation at work
Authors: Weber J , Hansmann M , Kohl F , Heming M , Angerer P 
Published: October 2023

Abstract

Introduction
Psychotherapeutic consultation at work (PT-A) aims to prevent sickness absence and to facilitate return to work by offering early intervention and treatment for employees with (subclinical) symptoms of mental disorders. PT-A specifically considers work-related aspects to increase occupational self-efficacy, which is a predictor for work ability and return to work. This study investigates which psychosocial working conditions are related with occupational self-efficacy among employees who enrolled for PT-A.

Methods
This cross-sectional analysis uses baseline data of 536 participants of a randomized controlled trial (friaa-study) investigating the effect of PT-A in Germany. Psychosocial working conditions were measured by the Copenhagen Psychosocial Questionnaire (COPSOQ) using the following subscales: quantitative and emotional demands, decision authority, possibilities for development, leadership quality and social support. Occupational self-efficacy was measured by the short form of the Occupational Self-Efficacy Scale. Associations between psychosocial working conditions and occupational self-efficacy are calculated by multiple linear regression.

Results
Quantitative job demands are negatively (b=-0.118, SE = 0.047, p&lt;.05) and possibilities for development (b = 0.284, SE = 0.049, p&lt;.001) are positively associated with occupational self-efficacy. Interactions between sex and decision authority (b = 0.228, SE = 0.097, p&lt;.05) and social support (b=-0.273, SE = 0.101, p&lt;.05) suggest that occupational self-efficacy is only associated with social support among male and only associated with decision authority among female participants.

Conclusions
Results suggest that psychosocial working conditions and particularly quantitative job demands, decision authority, possibilities for development and social support should be addressed during PT-A. However, longitudinal data ought to shed light on the causal relationships between working conditions and occupational self-efficacy.

Key messages
• Results suggest that adverse psychosocial working conditions are related to lower levels of occupational self-efficacy among users or PT-A.
• It might therefore be useful to address psychosocial working conditions with employees visiting PT-A.