Contextual determinants of CHILDREN'S health care and policy in Europe

BACKGROUND: The main objective of this study was to explore the contextual determinants of child health policies. METHODS: The Horizon 2020 Models of Child Health Appraised (MOCHA) project has one Country Agent (CA) in all 30 EU and EEA countries. A questionnaire designed by MOCHA researchers as a semi-structured survey instrument asked CAs to identify and report the predominating public and professional discussions related to child health services within the last 5 years in their country and the various factors which may have influenced these. The survey was issued to CAs following validation by an independent Expert Advisory Board. The data were collected between July and December 2016. The data was qualitatively analysed using software Nvivo11 for data coding and categorization and constructing the scheme for identified processes or elements. RESULTS: Contextual determinants of children's health care and policy were grouped into four categories. 1) Socio-cultural determinants: societal activation, awareness, communication, trust, freedom, contextual change, lifestyle, tolerance and religion, and history. 2) Structural determinants which were divided into: a) external determinants related to elements indirectly correlated with health care and b) internal determinants comprising interdependent health care and policy processes. 3) International determinants such as cross-nationality of child health policy issues. 4) The specific situational determinants: events which contributed to intensification of debates which were reflected by behavioural, procedural, institutional and global factors. CONCLUSIONS: The influence of context across European countries, in the process of children's health policy development is clearly evident from our research. A number of key categories of determinants which influence child health policy have been identified and can be used to describe this context. Child health policy is often initiated in reaction to public discontentment. The multiple voices of society resulted, amongst others, in the introduction of new procedures, action plans and guidelines; raising levels of awareness, intensifying public scrutiny, increasing access and availability of services and provoking introduction of structural changes or withdrawing unfavourable changes

How does societal reaction to children's health issues contribute to health policy in Europe? Results of a survey

BACKGROUND: In the European context the awareness of societal responsibility for children's health has increased with greater attention to children's rights and child empowerment processes. Child health issues are considered particularly sensitive; thus, they often provoke strong societal reactions, which, as a consequence, influence national health policies across Europe. Effectiveness of societal influences increases with the involvement of various actors in the context. METHODS: A qualitative approach was used to identify the level of societal involvement in health decision-making. A questionnaire was sent to the Country Agents (CAs) of the Models of Child Health Appraised (MOCHA) project. CAs are contact points in each of the 30 participating in the project countries and were asked to identify strong public and professional discussions related to child health services in their countries. Data collection was undertaken between July and December 2016. RESULTS: Based on 71 case studies, we identified eight thematic patterns, which characterize societal reactions to the currently worrisome child health issues across Europe. We devoted our attention to the three most controversial: child vaccination, child poverty and child abuse. The cases described by the CAs show the broad perspective in the perception of child health problems. Child health issues involve the public and raise nationwide debates. Public concerns were directly or indirectly related to child health and depicted the national overtone. CONCLUSIONS: Concerns in Europe about child health care are twofold: they are devoted to systemic issues (indirect patient orientation) and to child health and well-being (direct patient orientation). The phenomenon of societal responsibility for children's health is important for the support of public acceptance of child health policy

242. Analiza ekspresji EGFR i angiogenezv w utkaniu niedrobnokomórkowego raka płuc oraz związku z czasem przeżycia pacjentów w stadiach zaawansowania klinicznego I-IIIA

Cel pracyWciąż niezadowalające wskaźniki przeżycia pacjentów z rakiem płuca, mimo radykalnego leczenia operacyjnego, skłaniają do poszukiwań nowych czynników prognostycznych. Wiadomym jest, że receptor naskórkowego czynnika wzrostu (EGFR) wpływa na wzrost komórek guza i jego progresję, jak również tworzenie przerzutów – głównie poprzez oddziaływanie na tworzenie nowych naczyń krwionośnych. Jego prognostyczna rola u pacjentów z niedrobnokomórkowym rakiem płuca (NRP) jest niejasna. Natomiast gęstość naczyń krwionośnych (GNK), będąca miernikiem angiogenezy w guzie, jest podawana jako marker prognostyczny w wielu nowotworach. Celem naszego badania była ocena zależności między ekspresją EGFR i GNK w utkaniu guza nowotworowego a przeżyciem pacjentów z NRP.Materiał i metodyBadaniem objęto 75 pacjentów z NRP w stadiach zaawansowania klinicznego I-IIIA. Wycinki z guza pobierano z materiału operacyjnego, utrwalonego w formalinie. Na uzyskanych skrawkach parafinowych wykonywano odczyny immunohistochemiczne z zastosowaniem monoklonalnego przeciwciała przeciw receptorowi naskórkowego czynnika wzrostu oraz monoklonalnego przeciwciała przeciw CD31.WynikiWśród 75 pacjentów było 5 kobiet (6.7%) i 70 mężczyzn (93.3%) w wieku od 42 lat do 74 lat (średnio 59 lat). W badanej grupie chorych stwierdzono raka płaskonabłonkowego u 53 pacjentów (70.7%), gruczolakoraka u 11 chorych (14.7%) i raka wielkokomórkowego także u 11 pacjentów. Analizując uzyskane dane nie stwierdzono istotności statystycznej między ekspresją EGFR i czasem przeżycia pacjentów. Również GNK nie miała istotnego wpływu na przeżycie pacjentów. Jedynie stan węzłów chłonnych (cecha N; p<0.05), typ histologiczny raka (p<0.001) oraz wiek (p<0.05) w badanej grupie chorych miały istotny statystycznie wpływ na czas przeżycia.WnioskiUzyskane w tym badaniu wyniki nie są zgodne z wynikami innych doniesień mówiących o tym, że ekspresja EGFR i GNK w NRP mogą być traktowane jako czynniki prognostyczne. Należy jednak podkreślić, że analizowana grupa pacjentów była mała, a większość chorych (59 pacjentów, 78.7%) znajdowała się w stadium znacznego zaawansowania nowotworu

When Covid-19 first struck: analysis of the influence of structural characteristics of countries - technocracy is strengthened by open democracy

Context: The Covid-19 pandemic hit the developed world differentially due to accidental factors, and countries had to respond rapidly within existing resources, structures, and processes to manage totally new health challenges. This study aimed to identify which pre-existing structural factors facilitated better outcomes despite different starting points, as understanding of the relative impact of structural aspects should facilitate achieving optimal forward progress. Methods: Desk study, based on selecting and collecting a range of measures for 48 representative characteristics of 42 countries’ demography, society, health system, and policy-making profiles, matched to three pandemic time points. Different analytic approaches were employed including correlation, multiple regression, and cluster analysis in order to seek triangulation. Findings: Population structure (except country size), and volume and nature of health resources, had only minor links to Covid impact. Depth of social inequality, poverty, population age structure, and strength of preventive health measures unexpectedly had no moderating effect. Strongest measured influences were population current enrolment in tertiary education, and country leaders’ strength of seeking scientific evidence. The representativeness, and by interpretation the empathy, of government leadership also had positive effects. Conclusion: Strength of therapeutic health system, and indeed of preventive health services, surprisingly had little correlation with impact of the pandemic in the first nine months measured in death- or case-rates. However, specific political system features, including proportional representation electoral systems, and absence of a strong single party majority, were consistent features of the most successful national responses, as was being of a small or moderate population size, and with tertiary education facilitated. It can be interpreted that the way a country was lead, and whether leadership sought evidence and shared the reasoning behind resultant policies, had notable effects. This has significant implications within health system development and in promoting the population’s health

Determination of sp³ fraction in ta-C coating using XPS and Raman spectroscopy

The paper presents results of studies on the structure of tetrahedral amorphous carbon films (ta-C) with a thickness in the range from 20 to 280 nm, deposited using pulsed vacuum arc technique with an electromagnetic Venetian blind plasma filter. The results of the phase structure analysis, obtained using visible Raman spectroscopy and UV Raman spectroscopy methods, showed a strong dependence of the results on the presence, on the surface of synthesized thin carbon films, even of a minimum number of microparticles. The presence of microparticles in the deposited coatings strongly affects the accuracy of the measured data, used next for calculation the ID/IG, IT/IG ratios and determination of the G-peak dispersion, for all coating thicknesses, which pointed to significant diversification in sp³ -bonds content in deposited films.Представлены результаты исследования структуры тетраэдральных аморфных углеродных пленок (tа-С) толщиной в интервале 20…280 нм, осажденных методом импульсной вакуумной дуги с электромагнитным жалюзи плазменного фильтра. Результаты фазово-структурного анализа, полученные методами спектроскопии комбинационного рассеяния света в видимом и УФ-диапазонах, демонстрируют сильную зависимость результатов от наличия на поверхности тонких углеродных пленок микрочастиц даже в минимальном количестве. Присутствие микрочастиц в осажденных покрытиях сильно влияет на точность измеренных данных, используемых далее для вычисления соотношений ID/IG, IT/IG и определения дисперсии G-пика для покрытий всех толщин, что приводит к значительному разбросу данных при оценке связей в осажденных пленках.Представлені результати дослідження структури тетраедральних аморфних вуглецевих плівок (tа-С) завтовшки в інтервалі 20…280 нм, осаджених методом імпульсної вакуумної дуги з електромагнітним жалюзі плазмового фільтра. Результати фазово-структурного аналізу, що отримані методами спектроскопії комбінаційного розсіяння світла у видимому і УФ-діапазонах, демонструють велику залежність результатів від наявності на поверхні тонких вуглецевих плівок мікрочасток навіть у мінімальній кількості. Присутність мікрочасток в осаджених покриттях дуже впливає на точність виміряних даних, що використовувалися для обчислення співвідношень ID/IG, IT/IG і визначення дисперсії G-піка для покриттів усієї товщини, що призводить до значного розкиду даних при оцінці зв'язків в осаджених плівках

Tailored communication methods as key to implementation of evidence-based solutions in primary child health care.

Background: Evidence-based policies should underpin successful implementation of innovations within child health care. The EU-funded Models of Child Health Appraised project enabled research into effective methods to communicate research evidence. The objective of this study was to identify and categorize methods to communicate evidence-based research recommendations and means to tailor this to stakeholder audiences. Methods: We conducted an online survey among national stakeholders in child health. Analysis of the most effective strategies to communicate research evidence and reach the target audience was carried out in order to ensure implementation of optimal child health care models at a national level. Results: Representatives of stakeholders from 21 of the then 30 EU MS and EEA countries responded to the questionnaire. Three main approaches in defining the strategies for effective communication of research recommendations were observed, namely: dissemination of information, involvement of stakeholders and active attitude towards change expressed in actions. The target audience for communicating recommendations was divided int

Circulating cardiovascular biomarkers in recurrent atrial fibrillation: data from the GISSI-atrial fibrillation trial.

Objective. We evaluated the prognostic role of circulating cardiovascular biomarkers in patients with a history of recent atrial fibrillation (AF).Background. Predicting long-term maintenance of sinus rhythm in patients with AF is difficult.Methods. Plasma concentrations of three specific cardiac markers [high-sensitivity troponin T (hsTnT), N-terminal probrain natriuretic peptide (NT-proBNP) and mid-regional proatrial natriuretic peptide (MR-proANP)] and three stable fragments of vasoactive peptides [mid-regional proadrenomedullin (MR-proADM), copeptin (CT-proAVP) and CT-proendothelin-1 (CT-proET-1)] were measured at baseline and after 6 and 12 months in 382 patients enrolled in the GISSI-AF study, a prospective randomized trial to determine the effect of valsartan to reduce the recurrence of AF. The association between these markers, clinical characteristics and recurrence of AF was tested by univariate and multivariate Cox models.Results. Mean patient age was 68 \ub1 9 years (37.2% females). A total of 84.8% of patients had a history of hypertension. In total, 59.7% qualified for history of AF because of successful cardioversion, 11.8% because of two or more episodes of AF in the 6 months preceding randomization and 28.5% because of both. Patients in AF at 6 or 12 months (203 (53.1%) with first recurrence) had significantly higher concentrations of most biomarkers. Despite low baseline levels, higher concentrations of hsTnT {adjusted hazard ratio (HR) [95% confidence intervals (CIs) for 1 SD increment] (1.15 [1.04-1.28], P = 0.007), MR-proANP (1.15 [1.01-1.30], P = 0.04), NT-proBNP (1.24 [1.11-1.39], P = 0.0001) and CT-proET-1 (1.16 [1.01-1.33], P = 0.03) independently predicted higher risk of a first recurrence of AF. Changes over time of MR-proANP tended to predict subsequent recurrence (adjusted HR [95%CI]) (1.53 [0.98-2.37], P = 0.06).Conclusion. Circulating markers of cardiomyocyte injury/strain and endothelin are related to recurrence of AF in patients in sinus rhythm with a history of recent AF