404 research outputs found
VALUE-BASED EVIDENCES TO FACE THE NEW CHALLENGES OF HEALTH PROMOTION IN A SUSTAINABLE HEALTHCARE SYSTEM
No full textThirty years ago, starting from a new awareness of the limits of biomedical power and healthcare
services to solve all population‟ health problems, the Ottawa Conference coined a New Public
Health by defining Health Promotion (HP) as “the process of enabling people to increase control
over and to improve their health and well-being”. Since then and over the next 30 years, several
programs have been developed all over the world to translate HP concepts into practical actions and
many health successes have been achieved as well. Nowadays, even if the global health context has
strongly changed, the original principles of HP still provide a solid ground for action, being the
community engagement and empowerment of women and men still at the heart of any health
strategy, in a shared responsibility of all society‟s sectors approach. However, since now HP
promotion efforts have been directed toward priority health problems in a issue- settings-based
approach, but in a sustainable and ethical prospective this will be not enough now: a deeper
attention on effectiveness is request and an evidence- and value-based HP approach is needed to
support the Public Health community and the policy-making, including the new challenges related
to Public Health Genomics
Policy di genomica in Sanità Pubblica: risultati di una survey condotta tra i Chief Medical Officers.
No full textPolicy; Genomica in Sanità Pubblica; Surve
Indicatori di performance per una nuova governance delle Direzioni Sanitarie ed Ospedaliere. Strumenti per nuovi professionisti leader che hanno qualcosa da dire e non solo da ridire.
No full textIndicatori di performance; governance Direzioni Sanitarie ed Ospedaliere; leadershi
Evoluzione del concetto di salute e revisione degli indicatori tradizionali: l’esempio del tasso di mortalità infantile.
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Cost effectiveness of aortic valve therapies: a systematic review of the literature
No full textBackground: Systematic review on the cost effectiveness of transcatheter aortic valve implantation (TAVI) to standard aortic valve replacement and medical management in high-risk elderly patients with severe aortic stenosis. Evidenced based systematic reviews are the core methodologies in health economics for evaluating cost effectiveness and medical effectiveness. Clarity and transparency of these reports can help to provide health care interventions accurately and reliably.
Methods: In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses, a systematic review on current literature for cost-effectiveness of TAVI, standard aortic valve replacement, and medical management for elderly patients with high-risk severe aortic stenosis was performed. Inclusion and exclusion criteria are defined through initial screening of keywords, titles, abstracts and subsequently full texts screening. A checklist according to preferred reporting items for systematic reviews and meta-analyses is used to evaluate and extract qualitative information for the synthesis of this systematic review. Incremental cost effectiveness ratio is used to measure effectiveness through life years gained or quality adjusted life years. Drummond checklist was used to further assess the quality of the included studies.
Results: The systematic literature search identified 4 primary publications (derived from 52 citations) for patients with high risk aortic stenosis with transcatheter aortic valve implantation versus standard aortic valve replacement and medical management that fulfilled the inclusion criteria. Tremendous discrepancy in incremental cost effectiveness ratio is demonstrated with operable patients similar to Cohort A of the PARTNER trial (€749,416 and €39,577). Inoperable patients similar to Cohort B of the PARTNER trial suggest notable differences in favour for transcatheter aortic valve implantation with an increase in quality adjusted life years (0.06 verses 1.6 respectively). With lifetime horizon to transcatheter aortic valve implantation there is a more comparable incremental cost effectiveness ratio in the literature (€38,260 and €37,432). Lowest incremental cost effectiveness ratio witnessed in the technical inoperable group at €26,482. Lifetime horizon of 10 years with transcatheter aortic valve implantation differ (€39,388 versus €19,947). Overall, a review of the literature suggests TAVI usage in patients for severe aortic stenosis who are not eligible for surgery. All the studies were overall judged of medium-high quality.
Conclusion: Transcatheter aortic valve replacement is more cost effective with a lifetime horizon for the treatment of patients with high-risk aortic stenosis compared with medical management with those ineligible for standard aortic valve replacement. Further cost effectiveness research is needed in the stratifications of patient risk and patient co-morbidities for those candidates eligible for surgery
Il ruolo delle infezioni da Chlamydia nel determinismo delle malattie cronico-degenerative: una nuova sfida per i sistemi sanitari
No full textLe infezioni da Chlamydia stanno riscuotendo una rinnovata attenzione da quando è stato postulato che proteine rilasciate da questi batteri intracellulari possono generare fenomeni di autoimmunità e l’insorgenza di diverse malattie, come l’Alzheimer, l’aterosclerosi, l’arterite reumatoide, la sclerosi multipla e numerose altre ancora. Questo breve articolo ha lo scopo di stressare il problema che, negli Stati Uniti, rappresenta già una emergenza sanitari
The accreditation system of Italian medical residency programs: fostering quality and sustainability of the National Health Service
No full textSummary. Background and aim: In June 2017, University and Health Ministries jointly enacted a decree imple-menting a new accreditation system for the Italian post-graduate medical schools (residency programs). We report the innovations introduced through the reform. Methods: Universities were called to submit post-gradu-ate medical school projects to the National Observatory on medical residency programs, the inter-institutional committee responsible for the entire accreditation process, through an interactive web platform. The adherence to minimum standards, requirements and the performances were measured. After this first assessment, universities were asked to provide programs of improvement for critical schools. At the end of the evaluation, residency schools were proposed for a full or a partial accreditation. Results: Of the 1,431 post-graduate medical school projects submitted to the National Observatory by 37 public and 4 private Universities, 672 (47.0%) obtained a full accreditation, 629 (43.9%) a partial accreditation, with a gap to be filled within a two-year period according to a specific improvement programme, while 130 (9.1%) were not accredited. Further, 1,254 out of the 1,301 schools with a full or partial accreditation were activated according to the available public financial resources, excluding those performing the lowest. Annual surveys were in place to investigate the residents’ level of satisfaction concerning the quality of the training programs. The National Observatory further devel-oped an experimental methodology to conduct on-site visits to support quality improvement. Conclusions: This reform can be considered an important initiative to guarantee high standards in the quality of care and to face the challenge of sustainability for the National Health System. (www.actabiomedica.it)
Trevor Watkins. 2023. Becoming Neolithic. The Pivot of Human History (London and New York: Routledge, 232p., 47 b/w figs., ISBN 978-0-415-22152-8)
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