Building capacity and identifying appropriate support: how can the EU contribute to securing resources for health systems?

European health systems face increasing challenges and demands, while striving to provide high-quality care. The European Union (‎EU)‎ offers support to complement national efforts, but accessing and utilising it can be challenging for Member States. Austria, Belgium, and Slovenia are collaborating on a multi-country project supported by the EU’s Technical Support Instrument, to create an EU Health Resources Hub. This advisory service aims to help Member States access EU funding instruments for their health needs. This article discusses the project’s goals and early learnings, offering insights that could inform future health funding opportunities and policies in Europe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Investigating the aetiopathogenesis of infantile pyloric stenosis: Correlation between clinical and histological - immunohistochemical findings

Infantile hypertrophic pyloric stenosis is one of the most common conditions requiring surgery in the first few weeks of life. However, its aetiology is under investigation and its pathogenesis is not fully understood. A significant amount of research has focused on the aetiopathogenesis of hypertrophic pyloric stenosis. It has been repeatedly suggested that the underlying defect in pyloric stenosis is an intramuscular neuropathy. Interstitial Cells of Cajal (ICC) and nitric oxide (NO) are important factors in pyloric innervation. ICC serves as pacemakers and neurotransmission mediators along the gastrointestinal tract. NO is the primary inhibitory nonadrenergic - noncholinergic neurotransmitter of the enteric nervous system. Interstitial cells of Cajal and NO have been studied independently within the pyloric muscle in patients with pyloric stenosis; both have been found to be decreased. So far, the relationship between interstitial cells of Cajal and NO in pyloric stenosis has not been addressed. The aim of this study is to investigate possible alterations in ICC and NO within the pyloric muscle in patients with pyloric stenosis and if there are alterations, first to quantify them and secondly to correlate them with the aetiopathogenesis of the disease. Specimens of pyloric muscle were obtained from 19 patients with pyloric stenosis undergoing pyloromyotomy. Expressions of ICC and NO were examined using immunohistochemistry for c-kit and nNOS respectively. A semiquantitative analysis was carried out and ICC and NO expressions were classified into four grades. A small number of specimens revealed complete loss of ICC as well as lack or significant reduction of NO. The majority of specimens showed reduced expression of ICC accompanied by reduction in NO expression, to a lesser degree though. The correlation between reductions in ICC and NO expressions is statistically significant. These results suggest that alterations in ICC expression are associated with alterations in NO expression in pyloric stenosis. A possible explanation would be that ICC plays a role in NO expression or vice versa. ICC may affect NO expression due to either their interposition between neurons and smooth muscle cells or their role in nitrergic neurotransmission. Conversely, NO may act as a cytoprotective factor for ICC required for their survival. For either mechanism pyloric stenosis results from lack of NO. Should this be the case, clinical applications might arise with regards to management by either enhancing endogenous NO generation along the gastrointestinal tract or administering exogenous NO.Η υπερτροφική πυλωρική στένωση αποτελεί μία από τις συχνότερες χειρουργικές παθήσεις που αντιμετωπίζονται στις πρώτες εβδομάδες της ζωής. Ωστόσο η αιτιολογία της είναι ακόμη υπό διερεύνηση και η παθογένειά της δεν είναι πλήρως κατανοητή. Σημαντικός αριθμός μελετών έχει επικεντρωθεί στην αιτιοπαθογένεια της υπερτροφικής πυλωρικής στένωσης και επανειλημμένα έχει υποστηριχθεί ότι πρόκειται για μορφή ενδομυϊκής νευροπάθειας. Τα κύτταρα Cajal και το οξείδιο του αζώτου (ΝΟ) αποτελούν σημαντικές παραμέτρους της πυλωρικής νεύρωσης. Τα κύτταρα Cajal λειτουργούν ως βηματοδότες του εντερικού νευρικού συστήματος και ως μεσολαβητές στη νευρομεταβίβαση κατά μήκος του γαστρεντερικού σωλήνα. Το ΝΟ αποτελεί το βασικό μη αδρενεργικό μη χολινεργικό νευροδιαβιβαστή του εντερικού νευρικού συστήματος. Τα κύτταρα Cajal και το ΝΟ είχαν μελετηθεί μέχρι πρόσφατα ανεξάρτητα το ένα από το άλλο στον πυλωρικό μυ ασθενών με υπερτροφική πυλωρική στένωση και είχαν βρεθεί και τα δύο μειωμένα. Η έκφραση των κυττάρων Cajal δεν είχε συσχετιστεί μέχρι πρόσφατα με την έκφραση του ΝΟ στην πυλωρική στένωση. Ο σκοπός της παρούσας μελέτης είναι να εκτιμήσει τις μεταβολές των κυττάρων Cajal και του ΝΟ στον πυλωρικό μυ ασθενών με υπερτροφική πυλωρική στένωση, και εφόσον παρατηρούνται μεταβολές, να τις προσδιορίσει ποσοτικά και να τις συσχετίσει με την αιτιοπαθογένεια της νόσου. Δείγματα πυλωρικού μυός ελήφθησαν κατά τη διάρκεια πυλωρομυοτομής από 19 ασθενείς με υπερτροφική πυλωρική στένωση. Η έκφραση των κυττάρων Cajal και του ΝΟ εκτιμήθηκαν μετά από ανοσοϊστοχημικές χρώσεις με c-kit και nNOS αντίστοιχα. Ακολούθησε ημιποσοτική ανάλυση των αποτελεσμάτων και κατάταξη της έκφρασης των κυττάρων Cajal και του ΝΟ σε τέσσερις βαθμούς. Σε μικρό αριθμό των δειγμάτων η έκφραση των κυττάρων Cajal απουσίαζε πλήρως. Στα δείγματα αυτά η έκφραση του ΝΟ είτε απουσίαζε είτε ήταν ασθενής. Στην πλειονότητα των δειγμάτων η έκφραση των κυττάρων Cajal ήταν μειωμένη και συνοδευόταν από μικρότερου βαθμού μείωση της έκφρασης του ΝΟ. Η συσχέτιση μεταξύ της έκφρασης των κυττάρων Cajal και του ΝΟ είναι στατιστικά σημαντική. Από τα αποτελέσματα προκύπτει ότι η διαταραχή της έκφρασης των κυττάρων Cajal συνοδεύεται από διαταραχή της έκφρασης του ΝΟ. Αυτό σημαίνει ότι τα κύτταρα Cajal ενδεχομένως επηρεάζουν την έκφραση του ΝΟ ή αντίστροφα. Τα κύτταρα Cajal επηρεάζουν την έκφραση του ΝΟ μέσω της θέσης τους μεταξύ νευρικών και μυϊκών κυττάρων και του ρόλου τους στη νιτρεργική νευρομεταβίβαση. Το ΝΟ επηρεάζει την έκφραση των κυττάρων Cajal λειτουργώντας ως κυτταροπροστατευτικός παράγοντας, απαραίτητος για την επιβίωσή τους. Και με τους δύο μηχανισμούς, η πυλωρική στένωση εξηγείται μέσω της έλλειψης του ΝΟ. Στην περίπτωση αυτή και εφόσον υπάρξει ένας ασφαλής τρόπος είτε αύξησης της ενδογενούς παραγωγής του ΝΟ είτε εξωγενούς χορήγησής του, υπάρχουν δυνατότητες κλινικών εφαρμογών στην αντιμετώπιση της νόσου

Looking South : Facing North

The collaborative text work 'Looking South : Facing North' by Susan Brind & Jim Harold contained observed fragments within the area of the Buffer Zone that separates North from South Cyprus: an area that the artists had previously gained access to but which Turkish and Greek Cypriots are not permitted to enter. The artists invited co-collaborators from ARC, The Department of Architecture, University of Nicosia: links with the Department having been built through the network of the Creative Centre for Fluid Territories (CCFT). The intention was to work together, using a combination of the local knowledge of the co-collaborators, along with the artists' own detailed knowledge of both sides of the Buffer Zone within the walled city of Nicosia; to site the text works in locations that gave citizens living in both the North and the South of the City access to a document of images that neither are physically able to see. The co-collaborators negotiated and made the final selection of sites and chose the mode of documentation attached to this output