Tervisetehnoloogiate hindamise arendamisest ja tulevikust Euroopas ja Eestis

TTH kui tegevusvaldkond on viimase 20 aasta jooksul olnud aktuaalne nii Euroopas kui ka kogu maailmas. TTH põhieesmärk on pakkuda tervisepoliitika ja praktika otsustusprotsessile tõenduspõhist alust, tagades olemasolevate ressursside otstarbekohase kasutamise. TTH arendamine Eestis koostöös FINOHTA, DACEHTA ning teiste Euroopa institutsioonidega on Eesti tervishoiusüsteemile heaks väljakutseks ning võimaluseks. Eesti Arst 2008; 87(6):456−46

Weighed scalar averaging in LTB dust models, part I: statistical fluctuations and gravitational entropy

We introduce a weighed scalar average formalism ("q-average") for the study of the theoretical properties and the dynamics of spherically symmetric Lemaitre-Tolman-Bondi (LTB) dust models models. The "q-scalars" that emerge by applying the q-averages to the density, Hubble expansion and spatial curvature (which are common to FLRW models) are directly expressible in terms of curvature and kinematic invariants and identically satisfy FLRW evolution laws without the back-reaction terms that characterize Buchert's average. The local and non-local fluctuations and perturbations with respect to the q-average convey the effects of inhomogeneity through the ratio of curvature and kinematic invariants and the magnitude of radial gradients. All curvature and kinematic proper tensors that characterize the models are expressible as irreducible algebraic expansions on the metric and 4-velocity, whose coefficients are the q-scalars and their linear and quadratic local fluctuations. All invariant contractions of these tensors are quadratic fluctuations, whose q-averages are directly and exactly related to statistical correlation moments of the density and Hubble expansion scalar. We explore the application of this formalism to a definition of a gravitational entropy functional proposed by Hosoya et al (2004 Phys. Rev. Lett. 92 141302). We show that a positive entropy production follows from a negative correlation between fluctuations of the density and Hubble scalar, providing a brief outline on its fulfillment in various LTB models and regions. While the q-average formalism is specially suited for LTB and Szekeres models, it may provide a valuable theoretical insight on the properties of scalar averaging in inhomogeneous spacetimes in general.Comment: 27 pages in IOP format, 1 figure. Matches version accepted for publication in Classical and Quantum Gravit

EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2013. Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union.

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a Scientific Opinion on the nutrient requirements and dietary intakes of infants and young children in the European Union. This Opinion describes the dietary requirements of infants and young children, compares dietary intakes and requirements in infants and young children in Europe and, based on these findings, concludes on the potential role of young-child formulae in the diets of infants and young children, including whether they have any nutritional benefits when compared with other foods that may be included in the normal diet of infants and young children. The Panel concluded on the levels of nutrient and energy intakes that are considered adequate for the majority of infants and young children, and evaluated the risk of inadequate nutrient intakes in infants and young children in living Europe. Dietary intakes of alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), iron, vitamin D and iodine (in some European countries) are low in infants and young children living in Europe, and particular attention should be paid to ensuring an appropriate supply of ALA, DHA, iron, vitamin D and iodine in infants and young children with inadequate or at risk of inadequate status of these nutrients. No unique role of young -child formulae with respect to the provision of critical nutrients in the diet of infants and young children living in Europe can be identified, so that they cannot be considered as a necessity to satisfy the nutritional requirements of young children when compared with other foods that may be included in the normal diet of young children (such as breast milk, infant formulae, follow-on formulae and cow\u2018s milk)

The Effect of Postoperative Complications After Minimally Invasive Esophagectomy on Long-term Survival: An International Multicenter Cohort Study

BACKGROUND: Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. OBJECTIVE: Although the short-term effect on complications is increasingly being recognized, the impact on long-term survival remains unclear. This study aims to investigate the association between postoperative complications following MIE and long-term survival. METHODS: Data were collected from the EsoBenchmark Collaborative composed by 13 high-volume, expert centers routinely performing MIE. Patients operated between June 1, 2011 and May 31, 2016 were included. Complications were graded using the Clavien-Dindo (CD) classification. To correct for short-term effects of postoperative complications on mortality, patients who died within 90 days postoperative were excluded. Primary endpoint was 5-year overall survival. RESULTS: A total of 915 patients were included with a mean follow-up time of 30.8 months (standard deviation 17.9). Complications occurred in 542 patients (59.2%) of which 50.2% had a CD grade ≥III complication [ie, (re)intervention, organ dysfunction, or death]. The incidence of anastomotic leakage (AL) was 135 of 915 patients (14.8%) of which 84 patients were classified as a CD grade ≥III. Multivariable analysis showed a significantly deteriorated long-term survival in all patients with AL [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.25-2.24]. This inverse relation was most distinct when AL was scored as a CD grade ≥III (HR 1.83, 95% CI 1.30-2.58). For all other complications, no significant association with long-term survival was found. CONCLUSION: The occurrence and severity of AL, but not overall complications, after MIE negatively affect long-term survival of esophageal cancer patients

Defining Benchmarks for Transthoracic Esophagectomy A Multicenter Analysis of Total Minimally Invasive Esophagectomy in Low Risk Patients

Objective: To define "best possible" outcomes in total minimally invasive transthoracic esophagectomy (ttMIE). Background: TtMIE, performed by experts in patients with low comorbidity, may serve as a benchmark procedure for esophagectomy. Patients and Methods: From a cohort of 1057 ttMIE, performed over a 5-year period in 13 high-volume centers for esophageal surgery, we selected a study group of 334 patients (31.6%) that fulfilled criteria of low comorbidity (American Society of Anesthesiologists score = grade III), mostly related to pulmonary complications (25.7%), anastomotic leakage (15.9%), and cardiac events (13.5%). Benchmark values at 30 days after hospital discharge were = 23 for lymph node yield. Benchmarks at 30 and 90 days were <= 1.0% and <= 4.6% for mortality, and <= 40.8 and <= 42.8 for the comprehensive complication index, respectively. Conclusion: This outcome analysis of patients with low comorbidity undergoing ttMIE may serve as a reference to evaluate surgical performance in major esophageal resectio