Geographical Hot Spot Analysis of ATAPS for Policy Planning

Studies on equity of mental health referrals have used qualitative approaches or service utilisation data, however little information is available on spatial equity. The Access to Allied Psychological Services (ATAPS) program enables patients to be referred to mental health professionals for lowcost mental health care to facilitate equality of care

Toward Digitalization of Fishing Vessels to Achieve Higher Environmental and Economic Sustainability

\ua9 2024 The Authors. Published by American Chemical Society. Fishing vessels need to adapt to and mitigate climate changes, but solution development requires better information about the environment and vessel operations. Even if ships generate large amounts of potentially useful data, there is a large variety of sources and formats. This lack of standardization makes identification and use of key data challenging and hinders its use in improving operational performance and vessel design. The work described in this paper aims to provide cost-effective tools for systematic data acquisition for fishing vessels, supporting digitalization of the fishing vessel operation and performance monitoring. This digitalization is needed to facilitate the reduction of emissions as a critical environmental problem and industry costs critical for industry sustainability. The resulting monitoring system interfaces onboard systems and sensors, processes the data, and makes it available in a shared onboard data space. From this data space, 209 signals are recorded at different frequencies and uploaded to onshore servers for postprocessing. The collected data describe both ship operation, onboard energy system, and the surrounding environment. Nine of the oceanographic variables have been preselected to be potentially useful for public scientific repositories, such as Copernicus and EMODnet. The data are also used for fuel prediction models, species distribution models, and route optimization models

Safety assessment of smoked fish related to Listeria monocytogenes prevalence using risk management metrics

[EN] One of the fundamental objectives of European food law is the protection of human health. In this framework, the administration has to ensure that there are control measures from " farm to fork" , which maintain product safety in each stage of the food chain. With this in mind, the objective of this paper was to assess the level of safety of smoked fish in relation to Listeria monocytogenes in the early stages of the chain. This was carried out by evaluating the results obtained by the official control of the Valencian region related to the level of implementation of pre-requisites and HACCP. The prevalence of this organism in the industry and the retail stage was also measured. In order to discern whether these values were within the international consumer protection objectives a practical case focusing on smoked salmon was studied. The results showed that the management system in the industry is effective. However, there is a real increase in the prevalence in the samples taken in the supermarket. The ALOP values estimated for smoked salmon indicated that the level of safety achieved is good in a very high percentage of cases, though governments and the different agents in the food chain must continue working to improve and attain new safety goals. © 2011 Elsevier LtdDoménech Antich, EM.; Amorós, J.; Martorell Alsina, SS.; Escriche Roberto, MI. (2012). Safety assessment of smoked fish related to Listeria monocytogenes prevalence using risk management metrics. Food Control. 25(1):233-238. doi:10.1016/j.foodcont.2011.10.003S23323825

Standardised description of health and social care: A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs)

Background: Evidence-informed planning and interpretation of research results both require standardised description of local care delivery context. Such context analysis descriptions should be comparable across regions and countries to allow benchmarking and organizational learning, and for research findings to be interpreted in context. The European Service Mapping Schedule (ESMS) is a classification of adult mental health services that was later adapted for the assessment of health and social systems research (Description and Evaluation of Services and DirectoriEs - DESDE). The aim of the study was to review the diffusion and use of the ESMS/DESDE system in health and social care and its impact in health policy and decision-making. Method: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1997–2018). Results: Out of 155 papers mentioning ESMS/DESDE, 71 have used it for service research and planning. The classification has been translated into eight languages and has been used by seven international research networks. Since 2000, it has originated 11 instruments for health system research with extensive analysis of their metric properties. The ESMS/DESDE coding system has been used in 585 catchment areas in 34 countries for description of services delivery at local, regional and national levels. Conclusions: The ESMS/DESDE system provides a common terminology, a classification of care services, and a set of tools allowing a variety of aims to be addressed in healthcare and health systems research. It facilitates comparisons across and within countries for evidence-informed planning

Exercise echocardiography for the assessment of pulmonary hypertension in systemic sclerosis: a systematic review

BACKGROUND: Pulmonary arterial hypertension (PAH) complicates the course of systemic sclerosis (SSc) and is associated with poor prognosis. The elevation of systolic pulmonary arterial pressure (sPAP) during exercise in patients with SSc with normal resting haemodynamics may anticipate the development of PAH. Exercise echocardiography (ExEcho) has been proposed as a useful technique to identify exercise-induced increases in sPAP, but it is unclear how to clinically interpret these findings. In this systematic review, we summarize the available evidence on the role of exercise echocardiography to estimate exercise-induced elevations in pulmonary and left heart filling pressures in patients with systemic sclerosis. METHODS: We conducted a systematic review of the literature using MEDLINE, Cochrane Library and Web of Knowledge, using the vocabulary terms: ('systemic sclerosis' OR 'scleroderma') AND ('exercise echocardiography') AND ('pulmonary hypertension'). Studies including patients with SSc without a prior diagnosis of PAH, and subjected to exercise echocardiography were included. All searches were limited to English and were augmented by review of bibliographic references from the included studies. The quality of evidence was assessed by the Effective Public Health Practice Project system. RESULTS: We identified 15 studies enrolling 1242 patients, who were mostly middle-aged and female. Several exercise methods were used (cycloergometer, treadmill and Master's two step), with different protocols and positions (supine, semi-supine, upright); definition of a positive test also varied widely. Resting estimated sPAP levels varied from 18 to 35 mm Hg, all in the normal range. The weighted means for estimated sPAP were 22.2 ± 2.9 mmHg at rest and 43.0 ± 4.3 mmHg on exercise; more than half of the studies reported mean exercise sPAP ≥40 mmHg. The assessment of left ventricular diastolic function on peak exercise was reported in a minority of studies; however, when assessed, surrogate variables of left ventricular (LV) diastolic dysfunction were associated with higher sPAP on exercise. CONCLUSIONS: We found very high heterogeneity in the methods, the protocols and the estimated sPAP response to exercise. LV diastolic dysfunction was common and was associated with greater elevation of sPAP on exercise.info:eu-repo/semantics/publishedVersio

Exercise-induced pulmonary hypertension in scleroderma patients: a common finding but with elusive pathophysiology

BACKGROUND: The etiology of exercise-induced pulmonary hypertension (exPH) in systemic sclerosis (SSc) remains a complex task, as both left ventricle (LV) diastolic dysfunction and pulmonary vascular disease can contribute to its development. We determined the incidence of exPH in SSc and examined the association between pulmonary artery systolic pressure (PASP) and tissue Doppler-derived indexes of pulmonary capillary wedge pressure (PCWP). METHODS: Thirty-eight patients with SSc were studied, using a cycloergometer protocol; 10 were excluded due to resting PH or absence of tricuspid regurgitation (TR); TR and mitral E-wave velocities, LV outflow tract time-velocity integral and LV septal E'-wave were measured before and in peak exercise to calculate cardiac output (CO), PCWP and pulmonary vascular resistance (PVR). RESULTS: Mean age of diagnosis was 57.9 ± 8.9 years. At a mean workload of 64 ± 29 Watts, 48% of patients increased PASP ≥ 50 mmHg. PCWP, assessed by the E/e' ratio, did not change significantly during exercise (10.2 ± 3.1-10.0 ± 5.1; P = NS). Only 3 patients had elevations of the E/e' ratio ≥ 13 during exercise; 2 of them had an exercise PASP ≥ 50 mmHg, yielding a proportion of exPH due to elevated LV filling pressures of 2/11 (18%). Patients with exPH had lower DLCO and had more frequently the diffuse SSc. CONCLUSION: The elevation of PASP during exercise in most patients of this cohort seems to be related to a reduced pulmonary vascular reserve, and not to an increase in PCWP. Further studies are warranted to determine the therapeutic, as well as prognostic implications of these findings.info:eu-repo/semantics/publishedVersio