TELEMEDICINE IN ORTHODONTICS: THE REMOTIZATION OF ORTHODONTIC RECORDS FOR DIAGNOSIS AND THERAPY

Objective: Aim of this study was to assess the effectiveness of Dental Centers connected to each other managing orthodontic records. The secondary aim was to carry out epidemiological studies and to evaluate their compliance with local health policies.Methods: Cloud Computing Technology and Video chat systems were used. Epidemiologic data from four orthodontic Centers were collected. Prevalence of the skeletal class and the IOTN (Index of Orthodontic Treatment Need) were determined.Results: Tele epidemiology provided a sample of 1501 patients. 7% presented skeletal class III and 36 % skeletal class II. The IOTN Index was grater in Clinic of Monza and Bergamo than the other Centers.Conclusions: Cloud and Video chat systems are fundamental tools for improving efficiency in Tele Orthodontics. Epidemiological studies are useful for manage the Dental Centers and for planning health policies regarding prevention, education and economic support

Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill & Melinda Gates Foundation

Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% 10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% 5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million 6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million 2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million 1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million 67.7-90.8] DALYs or 55.5% 48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million 22.3-48.6] DALYs or 24.3% 15.7-33.2]), high fasting plasma glucose (28.9 million 19.8-41.5] DALYs or 20.2% 13.8-29.1]), ambient particulate matter pollution (28.7 million 23.4-33.4] DALYs or 20.1% 16.6-23.0]), and smoking (25.3 million 22.6-28.2] DALYs or 17.6% 16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries

Telemedicine innovation service: the new role of patient

New technologies are playing an increasingly important role in all stages of the health production process providing more effective responses when assisting chronically ill or elderly. In this context, the convergence of information technology, telecommunications and medicine has led to the birth of telemedicine: a quick response providing remote diagnosis and distant treatment (telecare) to citizens far from the healthcare facilities or to those unable to leave their homes. It thus becomes important, for health policy as well, to identify the drivers that improve the value generated by the healthcare system and the quality of health services, pursuing innovation generation. In this context the main aim of this work is to investigate the changes in doctor-patient relationship due to the introduction of new technologies. Going more in depth, which are the main drivers of value in service innovation development

Teleservices and quality of life a new health orientation

In the last years a new dynamic medical approach emerged by the interrelationships among biological, psychological and sociological elements. Health takes a key role connected with more subjective aspects linked to life quality dimensions redefined by the emerging number of elderly, chronic patients and by the needs of disabled people. All this requires a non-stop and customised assistance guaranteed by the integration between medical services and social ones. The health system\u2019s priorities, thus, become quality, efficiency, care suitability and customised medical supply. To attain these goals, in a complexity characterised context, organisations need to develop and strengthen relationships. The purpose of this paper is to analyse how relationships structure themselves and their impact on the different actors, investigating about their strategic-organisational approach. Furthermore the development of interdependent relationships has been recently helped and increased by new technologies, determining the birth of telemedicine-telehealth services. Therefore this paper relates on how technology determines the technical and/or functional quality of medical services and on the consequent impact on health sector (product and/or process innovation). To reach these purposes two significant cases will be presented: the Italian-French Dante and Aditech project, experimented in two residencies and based on a remote aged/disabled patient\u2019s monitoring; and the San Martino Hospital\u2019s IMA 118 project (Genoa) targeted to guarantee a prompt intervention in case of myocardial infarctio

La qualit\ue0 nella rete dei servizi sanitari. Il network dei teleservizi

The socio-economic and technological changes that characterize the context in which service companies and health work, brings organizations to pay special attention not only to processes but also to the way in which these are conveyed. The objective of efficiency is thus combined with the search of the effectiveness. The proposal of an innovative health service increasingly requires the development of interconnected relationships between different actors belonging to different business, social and technological areas. The new technologies emerging in the social-health context, support the development of interorganizational relationships, strengthening resource sharing. The main purpose of this work is to investigate the emergence of innovative services supporting the social -health network. As underlined by the telemedicine-telehealth cases investigated, the strengthening of relationships between interconnected actors having different skills allows the sharing of resources that are considered essential for the development of quality in teleservices

The service innovation in healthcare network

Ageing population and chronic diseases are main issues for the Italian Healthcare System, requiring the development of service innovations. What are the drivers to develop service innovation in healthcare? In which way service innovation, particularly teleservices, can create value in health context? What are the key actors involved in the generation of value related to healthcare service innovation? This paper discusses the case of SPIDER@Lecco which aim is to create a rehabilitation ecosystem to offer new telemedicine services. This project turns out to be interesting for its open innovation perspective. The development of innovative healthcare services requires to overcome the technology push approach adopting a collaborative approach. The collaboration among heterogeneous actors characterized by different competences outlines the Healthcare Network

The delivery of a new health service and the patient management approach

Growing demand for health care has increased interest in improving the attention on quality for health services. The quality of health services is founded on patient satisfaction that requires his/her active role in the care process delivery. In this context the main aim of this work is to investigate how the introduction of an innovative service (Acute Pain Service) implies a review of the internal processes and a new approach to manage the relationship with the patient. The research is founded on a systematic combination of the continuous interaction between theory and the empirical world. The research adopted a case study approach as a suitable method for studying the process of service innovation that characterize Humanitas Mater Domini Hospital (Castellanza - Italy). The research is founded on an explorative research that implied several steps 1) participant observation of the service encounters 2) semi-structured interviews to patients 3) semi structured interviews to nurses, doctors and managers involved in new service delivery in order to map the different processes (blueprint). The main results concern the alignment of different health operators’ perspective. The combining of different maps allowed the emerging of a new patient’s management approach. The offering of Acute Pain Service increased the quality of all health services delivered by the hospital raising the satisfaction of patient’s needs

From health service quality to health system quality. A network innovation adoption and diffusion

Growing demand for health care due to the ageing of the population, rising costs, constrained resources, and evidence variations in clinical practice have increased interest in improving the attention on quality for health services. Quality in this context is mainly based on two dimensions: access and effectiveness. But, due to the challenging environment, to the objectives of the health services and to the structure of the NHS, this is no more sufficient. Attention to issues such as service innovation, attributes and conditions for its adoption and diffusion, patient\u2019s centered care via technological supports, lead to a new scenario of health care services based on the sharing of competencies of different actors belonging to a net system. Those are the elements on which the present work focuses. In this context the main aim of this work is to investigate the link between quality in health services and adoption and diffusion of innovation thanks to a network approach. Quality in health services is reached through the network. The network allows a particular process of services innovation adoption and diffusion that produces not only technical but also relational quality. In this way the quality of a specific innovative service generates benefits also for the health system considered as a whole. In the conceptual framework previously described, this work goes more in depth in the features of the several actors that are involved in the generation of new services and upstream in analyzing which are the conditions for an improved quality of health services thanks to the adoption and diffusion of innovations. In particular the attention is focused on the resources provided by the different actors belonging to the network and on the characteristics of each organization involved in the creation of the innovative services. After a literature review this work investigates the case of an Italian innovative health service provided by a rehabilitative structure, Villa Beretta, a detached ward of the Valduce Hospital. The paper emphasizes how the development of the innovative services presented are based on the interrelationships of several actors specialized in different core activities. More and more the hospitals have to face complex needs. For this reason the hospitals need to attract several actors that provide specific resources. In this way the focus is centered on how those actors cooperate in order to grant value not only to their health performances but also to the entire system