Day 1 :
Parco dei Tigli Psychiatric Clinic | Italy
Time : 09:00-09:40
Giuseppe Borgherini graduated in Medicine and Surgery in 1986, he specialized in Psychiatry at the University of Padua in 1990 and holds a Ph.D. in Psychiatric Sciences at the University of Verona, 1994. He also won the European Erasmus Certificate in anxiety disorders attending internships at the University of Maastricht and Oxford in 1991 and the same year he received a research grant from Martino Arrigoni Foundation for a study on the psychological aspects of heart transplantation in childhood during 1991. From 1994 to 2011 he held a number of positions as a Professor in the graduate schools in psychiatry, internal medicine, clinical psychology, sports psychology, as well as in the residential school psychodynamic psychotherapies, University of Padua. In the same years he managed the inter-university research collaborations, in particular with the London Maudsley Hospital and the Department of Psychiatry University of Geneve, in addition to having led health research projects aimed for the Veneto Region. He is currently a member of the Mental Health Commission of the Veneto Region and the National Commission for psychiatry of Italian Association of Private Hospitals (AIOP), which is also the regional manager for the Veneto. Among the authors of the Italian Treaty of Psychiatry, he has to his credit about 170 publications in national and international journals.
Bipolar disorder (BD) is a mental illness which affects 2.7 % of population worldwide and can have devasting effects on individual health including alcoholism, drug abuse and suicide.
Treatment adherence is a frequent problem in BD (60 % of bipolar is not adherent to medications), causing poor quality of life, high morbidity and mortality. This aspect is consistently predictive of a number of negative outcomes in bipolar samples, and the discontinuation of mood stabilizers places these patients at high risk for relapse. With continued increases in smartphone ownership (4.4 bilioni nel 2017), researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality. In its Mental Health Action Plan 2013–2020, the WHO recommended “the promotion of self-care, for instance, through the use of electronic and mobile health technologies.” And the UK National Health Service (NHS) website NHS Choices carries a short list of online mental-health resources, including a few apps, that it has formally endorsed. The evidence supporting the use of such apps is building. A 2013 review identified more than 1,500 depression-related apps in commercial app stores but just 32 published research papers on the subject. Other shadow on app use in BD regards data protection and accurate scientific information often neglected. Recently a smartphone app that monitors subtle qualities of a person's voice during everyday phone conversations shows promise for detecting early signs of mood changes in people with bipolar disorder, a University of Michigan team reports. Another intriguing study was more recently performed by Prof. Vieta at Barcelona University with the aim to develop and validate a smartphone application to monitor symptoms and signs and empower the self-management of bipolar disorder, offering customized embedded psychoeducation contents, in order to identify early symptoms and prevent relapses and hospitalizations.
AVALIA-T – Galician Agency for Health Technology Assessment | Spain
Keynote: Priority setting of health interventions: Comprehensive review of criteria, approaches and role of health technology assessment agencies
Time : 09:40-10:20
Leonor Varela is a senior officer in the Health Technology Assessment Department (avalia-t) of the Galician Knowledge Assessment Agency, based in Spain. She has a 15 years background in Health Technology Assessment and recognized experience at the national and international level. During her career she has published and lectured extensively on topics related to HTA and health care decision making, and has done exhaustive research in this field. Currently, she holds the position of International Project Manager in avalia-t, and leads two activity centre departments in the on-going European Network for Health Technology Assessment (EUnetHTA) JA3 EU-funded project, which focus on HTA Joint Production and generation of cross border post-launch evidence for medical devices. She is an active member of the International Network of agencies for HTA (INAHTA) and the Health Technology International (HTAi), being the coordinator of the Adaptation of the Spanish INAHTA-HTAi glossary.
Statement of the Problem: Rationalizing healthcare resources constitutes a fundamental challenge to all health care systems. The current work, Commissioned by the Spanish Ministry of Health, was carried out with the purpose of developing an explicit priority setting methodology to support decision making regarding the technologies to be assessed for inclusion in the Spanish NHS service portfolio.
Methodology & Theoretical Orientation: The main aim of the work was to identify and analyse the criteria, approaches and conceptual frameworks used for priority setting internationally which could serve as basis for the development of the national priority-setting framework. For this purpose, a systematic search of the main biomedical electronic databases was performed and additional sources such as web pages of international health technology assessment agencies consulted.
Findings: In general terms, it was found that there are no standardised processes for priority setting, although some consensus and common trends have been identified regarding key elements (criteria, models and strategies, key actors, etc.). Globally, 8 key domain were identified: 1) Need for intervention; 2) Outcomes of intervention; 3) Type of benefit; 4) Economic consequences; 5) Existing knowledge/quality of evidence and uncertainties; 6) Implementation complexity/feasibility; 7) Priority, justice and equity and 8) Context. HTA agencies that were directly involved in supporting coverage decision making considered from 4-12 criteria.
Conclusion & Significance: The following work provides a thorough analysis of the relevant issues and offers recommendations regarding considerations for implementing successful HTA based prioritisation approaches. Findings are envisioned to be useful for different public organisations that are aiming to establish health care priorities.
- Goetghebeur MM, Wagner M, Khoury H, et al. Bridging health technology assessment (HTA) and efficient health care decision making with multicriteria decision analysis (MCDA): applying the EVIDEM framework to medicines appraisal. Med Decis Making. 2012;32:376-88.
- Tanios N, Wagner M, Tony M, et al. Which criteria are considered in healthcare decisions? insights from an international survey of policy and clinical decision makers. Int J Technol Assess Health Care. 2013;29:456-65
- Devlin NJ, Sussex J. Incorporating multiple criteria in HTA. Methods and processes. London 2011
- Tromp N, Baltussen R. Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers. BMC Health Serv Res. 2012;12:454
- Golan O, Hansen P, Kaplan G, et al. Health technology prioritization: which criteria for prioritizing new technologies and what are their relative weights? Health Policy. 2011;102:126-35
Lapland University | Finland
Keynote: Leadership DNA by game theoretic approach: Finding optimal equilibrium for wellbeing and productivity
Time : 10:20-11:00
Marko Kesti works as an adjunct professor of Administrative Science in University of Lapland, Finland. Kesti completed his Ph.D. in 2012 and is now leading the research program dealing with human capital productivity. He has written several books at his research subject and is active in presenting research findings at conferences and seminars. Kesti is utilizing his research in helping organizations to analyze and improve their human capital performance. His analyzing tools and development methods are widely in use at Finnish business and municipal organizations.
Profit unit leader gets information from the scorecards like monthly revenue and profit. Leader will also follow workers working time distribution and maybe notice the employee well-being. Economy and time are usually measured and thus under the focus of controlling. Wellbeing is also one production factor that the leader has created influence. Fundamental leadership problem lies in the difficulty to reliably measure the employee wellbeing and understand its’ connection to work performance. There can be risk for conflicting information when profit reduce and leader thinks it can be improved by increasing time for work. If wellbeing decrease the performance reduces as well which cause more fuss and wasted time, in that case the time for work may increase but the effective working time reduces. Phenomenon seems to be too difficult to understand without practice based learning.
Leadership connection to work wellbeing and business performance is widely studied and the knowledge has increased along the scientific contribution. The paper will present new research findings; so called leadership DNA in game theoretic approach. It combines the economic rules and wellbeing connection to business performance, and also human behavior in game theoretic approach. The introduced Bayesian model will combine conflicting objectives in a learning game where optimal leadership behavior can be trained. Research indicates that learning game will lead to the behavior where competing objectives can be optimized.
Paper will illustrate that organization leadership is a Bayesian Stochastic Strategic Non-symmetric Signalling game. Practical game studies show that leaders can find Nash equilibrium where both employee wellbeing and business economy prosper in long term. To achieve this optimal equilibrium for success there are identified certain management qualities. These qualities are not so easy to acquire in reality but they can be learned through the leadership learning game.
- Kesti, M., Leinonen, J. and Kesti, T. (2017). The Productive Leadership Game: From Theory to Game-Based Learning Supporting Public Entrepreneurship. In Lewandowski, M., Kożuch B. (ed.). Public Sector Entrepreneurship and the Integration of Innovative Business Models, IGI Global.
- Kesti, M., Leinonen, J. and Syväjärvi, A. (2016). A Multidisciplinary Critical Approach to Measure and Analyze Human Capital Productivity. In Russ, M. (ed.). Quantitative Multidisciplinary Approaches in Human Capital and Asset Management (pp 1-317). Hershey, PA: IGI Global. (1-22).
- Kesti, M. & Syväjärvi A. (2012). Human Resource Development Function to both Organizational Performance and Quality of Working Life, Journal of Global Business Review GBR Vol 2 No 1, Global Science and Technology Forum.
- Hu, J. and Wellman, M., P. (1998). Multiagent Reinforcement Learning Theoretical Framework and an Algorithm. Articial Intelligence Laboratory, University of Michigan. USA.
- Smith, J., Q. (2010). Bayesian Decision Analysis: Principles and Practice. Cambridge University Press, New York, USA.
- Healthcare | Mental Health | Public Health | Infectious Diseases
Location: Vasco de Gama 1
Leonor Varela Lema
AVALIA-T | Spain
Lapland University | Finland
University of Utah | USA
Time : 11:25-11:55
Josh has more than 10 years of leadership experience in a vast variety of settings. Most recently, Josh has been responsible for the implementation of Patient-Reported Outcomes throughout the University of Utah’s ambulatory clinics. Prior to this, Josh spent a year as an IT Project Manager at Metlife where he was responsible for several high impact projects. Josh also spent over 8 years in the Air Force as an F-15E WSO and AC-130U Navigator and began his career as a high school math teacher in New Jersey. Josh holds a BS in Mathematics from Virginia Tech, a MS in Aeronautical Science with a Space Studies specialization from Embry-Riddle Aeronautical University and an MBA in Finance from Arizona State University. Josh is also currently enrolled in a Ph.D. program within the Population Health Sciences division within the School of Medicine at the University of Utah. He hopes to graduate in 2019.
Aim: The implementation of Patient Reported Outcomes (PROs) to screen for mental health conditions has traditionally used a manual process of paper and pencil with little standardization throughout a Healthcare System. Patients are typically screened when a provider identifies them as at risk; many patients are not screened. As we move forward into an era of health technology, we can leverage this capability to provide a standardized health outcomes assessment using PROs for mental health screening to all patients.
Methods: We currently administer the PROMIS Depression v1.0 instrument as part of a standard PRO assessment to all patients. PRO assessments are either completed at home or in clinic with a tablet computer. We customize the time between assessments to minimize patient burden, while maximizing relevant data for clinicians. The PHQ-9 is still used as a manual screening process within primary care and mental health. ICD-10 codes identified patients diagnosed with depression; anti-depressant prescriptions identified treated patients. Patients with a PROMIS score of ≥65 or PHQ-9 score of ≥15 were identified as at risk for depression.
Results: Since September 2016, 205,813 unique patients have been seen at the University of Utah Health System. Of the 33,484 (16.3%) patients screened using PROMIS Depression in an automated electronic process, 2,312 were identified as at risk for depression. Of the 6,039 (2.9%) patients screened using the PHQ-9 in a manual process (2.9%), 2,212 being identified as at risk for depression Compared to the manual process, the automated process identified more patients at risk for depression and not diagnosed (982 vs 402) and at risk for depression and not treated with medication (852 vs 226).
Conclusions: The use of an automated PRO platform for mental health screening enables a clinician to identify patients at risk that may have otherwise gone unidentified. Our automated platform screened more unique patients than a manual process in the same time frame. The implementation of the automated process is implemented in just under 70% of our total health system’s appointments. By implementing automated PROs, we hope to identify our total population of patients at risk for mental health conditions.
University of Siena | Italy
Time : 11:55-12:25
Domenico Mastrangelo has completed his degree in Medicine and Surgery on October 26th, 1979, at the age of 24. He then specialized in Haematology in 1983 Oncology in 1987, Clinical Pharmacology in 1990 and Ophthalmology in 2010. His experience is in the fields of hematological/oncological epidemiology and laboratory, cell biology, molecular biology. He published more than 100 papers in reputed scientific journals, including chapters in highly reputed scientific books in the fields of ocular oncology, clinical oncology, cancer cell biology, and hematology. He is presently Senior Scientist at the Department of Medical, Surgical, and Neurological Sciences of the University of Siena, Italy.
Background: Vitamin C (ascorbic acid) is an essential nutrient with a number of beneficial functions, for the organism, among which it is worth mentioning its antioxidant activity and its role in the synthesis and stabilization of collagen. The anticancer/anti leukemic properties of Vitamin C are also known since at least 1969, even though the interest in Vitamin C as a potential anticancer molecule has only recently revived, thanks to experiments performed on human tumour cell lines in vitro.
Material and Methods: We used human tumour cell lines derived from retinoblastoma (Y79), uveal melanoma (C918, and OCM1) and human myeloid leukaemia (HL60, K562, U937, NB4, Nb4-R1, and NB4/As) exposed to different concentrations (in the order of magnitude of the millimoles) of the sodium salt of Vitamin C (sodium ascorbate). To evaluate cell viability before and after exposure to Vitamin C (sodium ascorbate), we used a standard flow cytometer and morphological/cytochemical methods, to further characterize the biological events produced by the exposure to the nutrient.
Results: All the cells used in our experiments showed apoptosis, autophagy, autoschizis, and still other forms of cell death degeneration after 1-2 hours exposure to millimolar concentrations of Vitamin C (sodium ascorbate). The apoptotic/cytotoxic effect of Vitamin C showed a peak at around 3 millimoles although Y79 cell lines appeared to be more sensitive than the rest of the cell lines tested.
Discussion: There are at least seven different pathways, through which Vitamin C in high concentration may be cytotoxic for cancer cells. The most commonly accepted cause of cell death, after exposure to millimolar concentrations of Vitamin C is considered the production of H2O2, consequent to the oxidation of the nutrient to dehydroascorbate (DHAA) and subsequent reduction to ascorbate, but other mechanisms, such as the downregulation of hypoxia inducible factor (HIF) are also involved.
In this experience with a variety of human tumour cell lines, we have showed that Vitamin C kills very efficiently different cancer cell, in vitro, being, at the same time, completely harmless for normal cells. The data reported herein imply that Vitamin C in high concentrations, such as those that can be reached by intravenous injection of the nutrient, represents a very promising, natural molecule in the routine treatment of different cancers.
University of Utah | USA
Title: Implementing Patient Reported Outcomes (PROs) for mental health screening throughout a healthcare system
Time : 12:25-12:55
Jenny works as a project implementation lead for the University of Utah Health Professional Data and Analytics team. She oversees the training and implementation of the patient-reported outcomes project throughout the University’s health care system. Jenny has a strong interest in community health, improving patient quality of life, and serving Utah’s vulnerable populations through improved access to health care. Her master’s thesis focused on health care accessibility for low income women in Utah and improvements needed from the health care system and state. Jenny holds a bachelor’s degree in public health from Brigham Young University and a dual master’s degree in health care administration and public administration from the University of Utah.
Objective: The use of Patient Reported Outcomes (PROs) to screen for mental health has traditionally been implemented through a manual process of paper and pencil with little standardization throughout a Healthcare System. Patients are typically screened when the provider identifies them as having a need; many patients are not screened. As we move forward into an era of health technology we can leverage this capability to provide a standardized health outcomes assessment using PROs for mental health screening to all patients. We investigate the rate of identification of depressive symptoms in patients before and after deployment of a standard technology-based screening.
Methods: The University of Utah has over 1 million ambulatory visits per year with over 400,000 unique patients. We currently administer the PROMIS Depression v1.0 instrument as part of a standard PRO assessment to all patients. We customize the time between consecutive repeated PRO assessments based on specialty preference to minimize patient burden, while maximizing relevant data for clinicians. Collected data resides within the electronic health record and is displayed in tabular and normalized graphical forms. We used ICD-10 codes to identify patients diagnosed with depression and anti-depressant prescription to identify treated patients. Summary statistics were generated using R (Version 3.3.2).
Results: At the end of year one, 48,926 patients were seen in practices that used the automated PROs and 16,046 unique patients were screened using an automated PRO platform. These patients generated 22,042 observed scores. A concurrent manual process of screening using the PHQ-2 or PHQ-9 was also used during this timeframe. In these practices, XXXX patients were seen. The PHQ-2 screened 2,543 unique patients with 2,904 scores and the PHQ-9 screened 7,289 patients generating 11,814 scores. There were 911 unique patients who received the automated PRO platform using PROMIS Depression and the PHQ-2 or PHQ-9. Of the patients screened, 1,297 were identified as at risk using the automated PRO platform, which accounts for 1.37% of the 94,488 eligible patient visits. With the manual process, 2,926 were identified as at risk, but this accounts for just 0.7% of the 408,926 eligible patient visits. When comparing the automated platform (PROMIS Depression) to the manual process (PHQ-9), the instruments agreed on the screening results 78% of the time. 66.4% of the patients identified as at risk for depression using the PROMIS Depression or using the PHQ-9 did not previously have a diagnosis of depression or prescription for an antidepressant.
Conclusions: The use of an automated PRO platform for mental health screening enables a clinician to identify patients at risk that may have otherwise gone undetected. Our automated platform was able to screen more unique patients in the same time frame as compared to a manual process even with implementation of the automated process in just under 50% of our total clinics’ appointments. By implementing PROs in all clinics, we hope to identify our total population of patients at risk for mental health issues.
Hospital Egas Moniz | Portugal
Time : 13:40-14:10
Fernando Pimentel-Santos is a clinician scientist, focusing his work on understanding the challenges of early diagnosis and personalized therapy in axial Spondyloarthritis through genetic and –omic approaches. Fernando completed his Ph.D. in 2012 at the NOVA Medical School, NOVA University of Lisbon. Fernando is member of international research consortia for Spondyloarthritis, The International Genetics of AS (IGAS) and The Ibero-American Registry of Spondyloarthritis (RESPONDIA). He is also full member of Assessments Spondyloarthroarthritis International Society (ASAS). Fernando has published over 35 papers, with first or senior author publications in in peer-reviewed journals indexed to PubMed/Medline. Invited referee for several journals and associated Editor of Acta Reumatológica Portuguesa and Frontiers in Medicine. He was awarded with several scientific grants.
Background: Targeting humoral immunity has been proved effective in several inflammatory rheumatic diseases (IRD). Though clinical trials have shown some efficacy of B-cell depletion in ankylosing spondylitis (AS), results are less convincing. Other studies have revealed an association between mutations and expression of immune regulatory genes suggesting a B-cell dysfunction in the development and progression of AS. Yet, there is still lack of data describing B-cell subsets in AS, how these compare to other IRD and an evaluation of B cell compartment homeostasis in the pathophysiology of this disease.
Objective: To assess and compare the immature, naive and antigen differentiated subsets of peripheral B-cell compartment in AS with those in healthy controls (HC) and other IRD.
Methods: Patients (pts) with AS, RA and SLE according to respective classification criteria were included in this study. Pts under biologic DMARDS were not included. Sociodemographic and clinical variables were recorded. Blood samples were collected for quantification of inflammatory markers (ESR and CRP), immunoglobulin serum levels and assessment of B-cell immature transitional stages and mature subsets by flow cytometry. Mann-Whitney and Fisher´s exact test were used for comparison of AS with other groups.
Results: Overall, 60 pts and 12 HC were included. All patient groups presented similar and rather low levels of inflammation, as measured by CRP, ESR and immunoglobulins, in addition to a decreased lymphocyte count by comparison with HC. There were no differences in the B-cell counts between AS pts and HC, and both groups had inturn higher B-cell counts than RA and SLE pts. Regarding B-cell subsets, the immature transitional compartment of AS pts was found in normal range, but not in the RA and SLE groups. In fact, the latter presented a significant decrease in all transitional cell maturity stages (T1-T3). The next step in B-cell differentiation is mature naïve cells, also found in normal levels in AS and decreased in RA and in particular in SLE. AS pts presented slightly higher counts of CD27+IgD+ MZ-like and class able to switch memory cells with reference to HC and these cell numbers were found to be low in RA and even more decreased in SLE pts. Switched memory CD27+IgD-B-cells were reduced in all patient groups, however, only SLE pts presented highly decreased cell levels.
Conclusions: We found that while a severe dysfunction is present in the homeostasis of the B-cell compartment in RA and in particular SLE pts, which are lymphopenic in both immature and mature B-cell compartments, it appears that AS pts are not affected in the same way. At this stage, functional studies appear to be necessary in order to identify differences in key mechanisms of B cell development and differentiation that play a role in the aetiology and progression of these inflammatory rheumatic diseases. Our first results, however, establish that pathophysiological mechanisms involving B-cells clearly differentiate AS from RA and SLE.
Schneider Children's Medical Center and Clalit Health Service | Israel
Title: Prenatal testing and termination of future pregnancies in Arab mothers of children with severe defects: Impact of Moslem cleric or physician on the decision making
Time : 14:10-14:40
Lutfi A. Jaber is one of the foremost experts in the field of consanguinity and the problems associated with consanguineous marriages. This is still a major problem in many countries in the Middle East and Asia and Professor Jaber has studied it intensively and written many articles about the issue. As a pediatrician who is Director of a busy pediatric clinic in a large Arab town in Israel and who also works in the Department of Neurology at a large tertiary children’s hospital, he sees first-hand every day the consequences of these marriages as the various illnesses among the children he treats. He is also a Professor in the Sackler Faculty of Medicine, Tel Aviv University, Israel. By teaming up with colleagues in the Department of Genetics at a local tertiary medical centre, he also contributes to on-going research into the genetic conditions that result from consanguineous marriages.
Statement of the Problem: The risk among children of first-cousin parents for severe congenital malformations and genetic diseases is 2.7 times higher than that of children born to unrelated parents. To reduce the number of babies born with these conditions, in addition to reducing the rate of consanguineous marriages an important factor is the willingness of families to agree to termination of pregnancy (TOP) when prenatal tests have established beyond doubt that the foetus is affected.
The purpose of this study is investigating the attitudes of Israeli Arab women with children with severe congenital defects to prenatal testing and termination in future pregnancies and the impact of inclusion of a Moslem cleric or physician on the decision-making process.
Methodology & Theoretical Orientation: We investigated how many of 250 women (50% in consanguineous marriages) with babies with severe congenital anomalies had undergone prenatal testing and how many had refused recommended TOP; ascertained why they refused TOP, and investigated whether they would have changed their decision had they been able to talk to a Moslem cleric or a Moslem doctor.
Findings: The main recommended tests that were done are carriers of thalassemia, late ultrasound, triple test and early ultrasound. Thirty-five percent refused to consider TOP at all, 22% agreed, and 35% agreed provided it was carried out prior to 120 days gestation. Of those who refused, 50% did so on religious grounds and in 30% the reason was unclear. When we asked those who had refused whether the addition of a Moslem religious cleric to the committee would cause them to change their opinion, 46% said it would, but only 28% said they would change their mind if a senior Moslem physician were added.
Conclusion & Significance: Severe congenital anomalies resulting from consanguinity continue to cause major problems and additional strategies are required to reduce these.
- Al-Matary Abdulrahman and Jaffar Ali (2014) Controversies and considerations regarding the termination of pregnancy for Foetal Anomalies in Islam. BMC Medical Ethics Feb 5;15: 10.
- Jaber Lutfi and Halpern Gabrielle J. (2014) Consanguinity – its Impact, Consequences and Management. Bentham e Books.
- Gitsels-van der Wal JT, Manniën J, Gitsels LA, Reinders HS, Verhoeven PS, Ghaly MM, Klomp T, Hutton EK. (2014) Prenatal screening for congenital anomalies: exploring midwives' perceptions of counseling clients with religious backgrounds. BMC Pregnancy Childbirth Jul 19 ;14:237.
- Basel-Vanagaite, L., Taub, E., Halpern, G.J., et al. (2007)Genetic screening for autosomal recessive nonsyndromic mental retardation in an isolated population in Israel.European Journal of Human Genetics, 15, 250-253.
- Ahmed S. , Atkin K., Hewison J., et al. (2006) The influence of faith and religion and the role of religious andcommunity leaders in prenatal decisions for sickle celldisorders and thalassaemia major. Prenatal Diagnosis, 26, 801-809.
Instituto Universitário de Lisboa (ISCTE-IUL) | Portugal
Time : 14:40-15:10
Felipa de Mello-Sampayo was the coordinator of the project PTDC/EGE-ECO/104157/2008, entitled "Health and Economic Growth". Under this project, she developed and published two key papers related to a dynamic stochastic model for the optimal timing of a treatment switch, and applied to problems in medical decision taking Gastrointestinal Stromal Tumor (GIST) and HIV. The first, entitled "The Timing and Probability of Treatment Switch under Cost Uncertainty: An Application to Patients with Gastrointestinal Stromal Tumor", Value in Health, 2014, Vol. 17, and the second entitled "HIV patients' decision of switching to second-line antiretroviral therapy in India, Aids Care, 2015.
Research has been limited on the effect of quality on the elderly despite their rapidly increasing share in medical spending. We exploited the spatial variation of medical spending and use in the US, employing a spatial regression design. A focus of the study was whether and to what extent medical spending varies by service type. We addressed the question by using Medicare data that contain accurate and detailed spending information for nearly all medical services provided.
Methods: Using Medicare regional data, we first examine the impact of the heterogeneous effects of the quality of care on elderly’s Medicare spending at the aggregate level. We then delve into details and examine whether the quality effects are heterogenous by service type. We use advances in Geographically Weighted Regression (GWR) to estimate what can be thought of as spatially moving clusters of structural covariations. We also employ spatial regression models that likewise relax the assumption of spatial independence.
Findings: We find that at the aggregate level poor quality of the healthcare increases Medicare spending (SMS) and thus costs per beneficiary. Second, quality effects are heterogeneous, and their impact varies both spatially and by the type of medical service. In particular, Clinics and Ambulatory Surgical Centers services stand out for their high positive effect of hospital readmissions, a proxy for poor quality of continuity of care. We also find that poor quality of continuity of care decreases the use of Outpatients Dialysis Facilities, Physician Procedures, and Tests. Lower quality in terms of primary care access decreases the spending in Ambulatory Surgical Centers, Evaluation and Management Services, Physician procedures, Imaging, and Drugs. Third, we find that the effect of health risk status on medical spending differs by treatment type.
Conclusions: Reducing geographic variation in healthcare spending would not necessarily improve the overall quality of medical practice. Reducing payments to high-spending areas and increasing payments to low-spending areas reduces spending variation but the results on the quality of care will be ambiguous, since we found the quality effects to be heterogeneous both spatially and by services.
- Moscone, F., Knapp, M. and Tosetti, E. (2007a), `SUR model with spatial effects: an application to mental health expenditure.', Health Economics 16, 1403 -08.
- Moscone, F., Tosetti, E. and Knapp, M. (2007b), `Mental health expenditure in England: a spatial panel approach.', Journal of Health Economics 26, 842 -864.
- Fukushima, K., Yamamoto, S. and Lizuka, T. (2016), `Patient cost sharing and medical expenditures for the elderly.', Journal of Health Economics 45, 115 -30.
- Rettenmaier, A. J. and Wang, Z. (2012), `Regional variations in medical spending and utilization: a longitudinal analysis of US Medicare population.', Health Economics 21, 67 -82.
- Skinner, J., Chandra, A., Goodman, G. and Fisher, E. F. (2008), `The elusive connection between health care spending and quality.', Health Affairs, Web Exclusive p. 119 -23.
Doctor Moliner Hospital | Spain
Time : 15:10-15:40
Maria Jose Merino Plaza is a Pharmacist specialized in Clinical Analysis, responsible for the clinical analysis laboratory of Doctor Moliner Hospital, a medium stay Hospital in Valencia, Spain since 1994 Master in Quality Management. Since 2010 she is responsible for quality of the center and is very committed to the exciting topics related with Job Satisfaction and Patient Safety Culture. At the moment she is conducting her Ph.D. on Quality of Care and Patient Safety in a Hospital of medium stay Hospital in collaboration with the University of Granada, Spain. Among her professional competences can be highlighted the management of multidisciplinary human teams, the definition and implementation of quality management mechanisms and the high analytical, relational, interpersonal, organizational and empathy skills.
Statement of the Problem: Recently, more importance has been given to the human factor and the organizational climate due to their influence on the motivation of the professionals and the improvement of performance. Some studies indicate that job satisfaction may be related to patient safety.
Aim: To evaluate the relationship between Safety Culture and Job Satisfaction in a medium-stay hospital, showing the relationships between the dimensions that define both constructs and identifying the dimensions with the greatest impact on both variables.
Methodology & Theoretical Orientation: Cross-sectional study conducted in 2015, using the Basque Health Service Job Satisfaction Survey and the Spanish version of the "Hospital Survey on Patient Safety" questionnaire (Agency for Healthcare Research and Quality). Result Variables: High Job Satisfaction and High Degree of Perceived Security (score ≥75th percentile).
Predictor Variables: Socio-demographic characteristics and perception of the evaluated dimensions. The association between variables was quantified by adjusted Odds Ratio and the 95% Confidence Interval.
Findings: The mean Job Satisfaction was 7.21 (SD = 2.01) and the mean of Perceived Safety was 7.48 (SD = 1.98). The 75th percentile of the distribution in both cases was 9. The socio-demographic variables had little significance, while a positive perception of many of the considered dimensions was associated with high perception of the result variables. In the data analysis were obtained multiple significant correlations and cross-relations between the dimensions that define both constructs, as well as between the degree of satisfaction of the dimensions considered and the outcome variables.
Conclusion & Significance: The dimensions that define Work Satisfaction and Safety Culture present cross-relationships with each other and with the outcome variables, indicating that both constructs are related. These results reinforce the idea that if an adequate climate is created and Job Satisfaction increases, health workers improve their performance and increase Patient Safety.
- Merino-Plaza MJ, Carrera-Hueso FJ, Roca-Castelló MR, Morro-Martín MD, Martínez-Asensi A, Fikri-Benbrahim N. Relación entre la satisfacción laboral y la cultura de seguridad del paciente. Gac Sanit. 2017; In press
- Merino-Plaza MJ, Carrera-Hueso FJ, Castillo-Blasco M, Martínez-Asensi A, Martínez-Capella R, Fikri-Benbrahim N. Evolución de la cultura de seguridad del paciente en un hospital de media-larga estancia: indicadores de seguimiento. An. Sist. Sanit. Navar. 2017; 40: 43-56
- Merino-Plaza MJ, Carrera-Hueso FJ, Arribas-Boscá N, Martínez-Asensi A, Nebot-Sanchez MC, Fikri-Benbrahim N. Job Satisfaction evolution in a Medium-Stay Hospital: Variables related an monitoring indicators. Cad Saude Publica. Under review.
- Merino-Plaza MJ, Carrera-Hueso FJ, Arribas-Boscá N, Martínez-Asensi A, Trull-Maravilla E, Fikri-Benbrahim N. Burnout en el personal de un Hospital de crónicos. Rev Saude Publ. Under review.
- Sensibilidad del medio XG para el aislamiento de Salmonella, Shigella y Yersinia. Publicado en la Revista Enfermedades infecciosas y microbiología clínica 1996; 14 (6): 72-73
Instituto Tecnologico de Costa Rica | Costa Rica
Title: Quantitative detection of Helicobacter pylori by real time PCR in drinking Water— Environmental and public health risk significance
Time : 16:00-16:30
Virginia Montero Campos is microbiologist and Clinical Chemistry. She has experience in industrial microbiology and environmental microbiology and has a Ph.D. in Natural Sciences. In her doctorate she specialized in environmental toxicology, experiences that join with the investigation of diseases related to the environment. She is a member of the International Medical Geology Association (IMGA). According to this scope of study she has related the high incidence of gastric cancer of Costa Rica with environmental factors specific to her country. She is currently investigating the relationship between Mesoamerican Nephropathy and geographic and environmental variables of a very specific area of her country
Helicobacter pylori (H. pylori) are bacteria considered to be present in half of the population and it is a public health problem worldwide. Most patients infected with H. pylori show no clinical symptoms; nonetheless, approximately 10% to 20% of these patients will develop peptic ulcers and 1% will develop gastric cancer. The International Agency for Research on Cancer has classified H. pylori as a Group 1 carcinogen, recognized as the only bacteria capable of producing cancer. Samples of drinking water (n = 44) from aqueducts with chlorination treatment in selected areas with high prevalence of gastric cancer were analyzed in Costa Rica. Samples of drinking water from Panamá (n = 44) from aqueducts supplying untreated water for human consumption in the province of Chiriquí were also analyzed. The molecular marker of H. pylori, glmM, was used and to optimize the Real Time PCR (qPCR) technique, annealing temperature, concentration of primers and probe were standardized; also, by analyzing different standard curves, the best reaction conditions that allowed detecting and quantifying the gene were determined. The LightCycler® 480 II (LC480II) equipment from Roche Diagnostics GmbH was used, as well as the Absolute Quantification Analysis by means of the Second Derivative Maximum Method. In the case of the samples from Costa Rica, it was determined that 79.5% were positive for H. pylori; removing outlier high average, quantification of bacteria was determined in 3.6 × 103 copies/100 mL. For Panamá it was determined that 86% of the samples were found positive for the presence of H. pylori; removing outlier high average quantification of bacteria was determined at 3.3 × 102 copies/100 mL. The difference in values between the aqueducts in both countries revealed an environmental distribution of the bacteria of epidemiological interest in each case.
1-Montero V, Arias S, Valdés B, Jarquin M (2015). Quantitative Detection of Helicobacter pylori by Real Time PCR in Drinking Water—Environmental and Public Health Risk Significance. OJMM 5(3): 118-127.
2- Montero V, Hernández A, Camacho J (2014). Culture and Molecular Identification of Helicobacter pylori in Drinking Water from Areas of High and Low Incidence of Gastric Cancer in Costa Rica. OJMM 4(4): 261-269.
3- Montero V, Puente Allen (2016). Continuous-Flow Removal of Arsenic in Drinking Water by Filtering down through Fe3O4@SiO2 Magnetic Composite. JWARP 8(5): 619-630.
4- Montero V, et al (2011). Hallazgo de la bacteria Helicobacter pylori en agua de consumo humano y su relación con la incidencia de cáncer gástrico en Costa Rica. Tecnología en Marcha 24(3) 3:14.
5- Montero V, Quesada J, Ledezma A, Sandoval JA (2010). Determinación de arsénico en abastecimientos de agua para consumo humano de la provincia de Cartago, Costa Rica. Acta Med Costarric 52(2): 96-101
Kuwait University | Kuwait
Title: Clinical presentations of HHV-6 infection in infants and children in Kuwait: A retrospective study
Time : 16:30-17:00
Nada M. Madi is Assistant Professor in the Department of Microbiology, Faculty of Medicine at Kuwait University where she has been a faculty member since January 2015. She completed her Ph.D. and MSc. At Faculty of Medicine, Kuwait University and her undergraduate study at Faculty of Science, Kuwait University. Her research interest lies in the area of developing advanced techniques in viral diagnostics such as metagenomics approach for the detection of viruses causing different diseases such as respiratory tract infections and gastroenteritis. Currently, she works as Quality Control Manager and a member of the Health and Safety Committee at the Faculty of Medicine.
Clinical manifestations of human herpes virus 6 (HHV-6) have not been clearly defined, and the role of HHV-6 in human disease among infants and children in Kuwait remains to be fully elucidated. A retrospective study covering the period between 2008 to 2014 was conducted on infants and children aged one month and five years. Blood and CSF samples from infants and children who presented with symptoms suggestive HHV-6 infection were subjected to PCR test for HHV-6. Results showed that 9.3% (n=42) of infants and children were positive for HHV-6. Fever was the most noticeable symptoms, presented in 50% (n=21) of the patients. Also, neutropenia was highly associated with HHV-6 infection, where it presented in 35.8% (n=15) of infants and children. Our results provided valuable information about the clinical outcome of HHV-6 infection among infants and children in Kuwait.
- Madi N, Al-Qasser M, Abdul Khalik D, Edan R, Al-Nakib W. Clinical Utility of Viral Load Management of CMV Infection in SOT Patients in Kuwait. Transplant Proc. 2015 Jul-Aug; 47(6):1802-7.
- Chehadeh W, Al-Qaseer M, Albaksami O, Altawalah H, Suhail Ahmad, Madi N, John SE, Al-Nakib W. Phylogenetic analysis of HIV-1 subtypes and drug resistance profile in treatment-naïve people from Kuwait. J Med Virol. 2015 Sep 14; 87(9):1521-6.
- Madi N, Al-Tawala H, Abdul Khalik D, Al-Nakib W.A Relatively High Number of Pregnant Women in Kuwait Remain Susceptible to Rubella: A Need for an Alternative Vaccination Policy. Med Princ Pract. 2014; 23(2):145-8.
- Madi N, Al-Tawalah H, Al-Nakib W. Clinical Presentations of HHV-6 Infection in Infants and Children in Kuwait: A Retrospective Study. AIM. 2014; 4: 1088-11094.
- Al-Tawalah H, Madi N, Al-Qaseer M. Prevalence of blood-borne viruses in the dialysis unit, Mubarak Al-Kabeer Hospital, Kuwait. KMJ. 2014; 47(1): 30-32.
FLACSO Mexico | Mexico
Title: Evaluation of affirmative policies in health: Discourses, attitudes and practices about racism, inequalities and actions against racism in Brazil
Time : 17:00-17:30
Cristina Gomes has her expertise in poverty and inequalities, and particularly in policy evaluation of public policies to improve health, education and wellbeing. She adopts triangulated methodologies, combining quantitative and qualitative approach to evaluate policies on poverty, wellbeing, health and education from an integrated framework.
Statement of the Problem: Racism in Brazil is structural, reflects more than four centuries of slavery and it is reproduced in institutions and civil society, in daily and family life. After 13 years promoting the inclusion of black population in public services this research evaluates the implementation of the National Policy for Integral Health of Black Population in health services in the municipality of Camacari, State of Bahia, Brazil.
Methodology & Theoretical Orientation: A triangulated methodology was applied, including a quantitative Survey, participant observation, in-depth interviews and focal groups with workers of public and private health services. The questionnaire included the staff profile: socio-demographic, family and work conditions, and their perceptions, attitudes and practices on racism and race inequalities and policies.
Findings: The workers recognize that racism exists in Brazil. However, their speeches indicate the predominance of a modern or subtle type of racism, based more on social prejudices than on color, mainly among high school professionals, such as physicians, nurses social workers, etc. Less educated workers, like technicians, receptionists and watchmen present higher proportions of prejudices based on color, or traditional racism, compared to the more educated workers.
Conclusion & Significance: The results adhere to the cultural approach on racism as ideology (Miles and Brown, 2003), associated to the level of education. However affirmative policies are rejected by most workers regardless of their level of education. Recognizing that racism, inequalities and injustices exist does not allow people to assume a commitment to act collectively to compensate or eliminate the effects of these injustices in their daily life or work, or to support actions to promote real equality.
- ALENCAR, José A. Ponha-se no seu lugar: Resenha de DANIEL, G. Reginald. Machado de Assis – Multiracial identity. Philadelphia: The Pennsylvania State University Press, 2012, 330p. Fundação Casa de Rui Barbosa Rio de Janeiro (RJ), Brasil. Machado de Assis em linha, Rio de Janeiro. v. 6, n. 11, p. 134 - 139, junho 2013.
- ARAÚJO, Carla L. F. (2010) O quesito cor/raça em formulários de saúde: a visão dos profissionais de saúde. Revista Enfermagem - UERJ, v. 18, n. 2, p. 241-246.
- ARAÚJO, Edna M. (2009) A utilização da variável raça/cor em Saúde Pública. Interface-Comunicação, Saúde, Educação, v. 13, n. 31, p. 383-394, 2009.
- Bonilla-Silva, Eduardo, (2006) Racism without racists : color-blind racism and the persistence of racial inequality in the United States / Eduardo Bonilla-Silva.—2nd ed.
- BOYLE, Kevin. (2005). Dimensions of Racism. Proceedings of a Workshop to commemorate the end of the United Nations Third Decade to Combat Racism and Racial Discrimination. New York and Geneva. OHCHR and UNESCO
- BRASIL. Ministério da Saúde (2007). Política nacional de saúde integral da população negra. Brasília. Editora do Ministério da Saúde.
- BRASIL. Ministério da Saúde (2005). A saúde da população negra e o SUS: ações afirmativas para avançar na equidade. Brasília: Editora do Ministério da Saúde.
- CEBES. (2013) Saúde em Debate. Rio de Janeiro, Revista do Centro Brasileiro de Estudos em Saúde. v. 37, n. 99, out/dez
- MILES R, BROWN M (2003) Racism. Routledge Taylor and Francis Group. London and New York. 2nd ed.
- OSORIO, Rafael Guerreiro. (2003) O Sistema Classificatório de “Cor ou Raça” DO IBGE. Texto para discussão 996, IPEA. Brasília.
Nuclear Research Center of Draria | Algeria
Time : 17:30-18:00
Zohra is a Researcher at Nuclear Research Center of Draria - Algeria since 1998. She is a rigorous analyst in Neutron Activation Analysis; who is interested in the improvement of public health, she works on the analysis of medicinal plants from her country: Natural product, compared with chemical drugs, efficient, cheap. But Crude product, composition not harmless, his work contribute to bring people’s attention on what they take and she researches for new Path to Treatment and Healing and try to creates a Natural Health Products Ingredients Data base ( HNPID)- Algeria with a team of scientists.
Seven elements have been determined using neutron activation analysis technique usually quite for herbs analyses. The essential elements found in Aristolochia Longa in this work may be potentially correlated with their therapeutic effect. However there is a need to investigate the toxic composition of Bereztem. It is clear the people using this plant especially the cancer patients in association or not with another therapy for economic considerations and or hope of cure should pay attention because the aristolochic acid contains. This acid is Very dangerous. The aristolochic acids Nephropathy (NAA) called also Chinese plants Nephropathy NCP is a diseases identified for the women having followed a Chinese slimming diet in 1992 , and a new American study reveals that this Acid is more carcinogen than the tobacco. When The Aristolochic Acid extracted from a medicinal plant is traditionally used in China to cure some diseases, the arthritis and the other inflammations. Dr. Selda and his colleagues show the direct toxicity of the Aristolochic acid on the human gene TP53 (gene suppressor of cancer).
Methodology & Theoretical Orientation: The medicinal plant Aristilochia Longa is collected from Taourirt Aden Algerian village situated in Kabylia region Northern Algeria. The root was washed extensively in distillated water as to remove superficial dust. The dry and hard form of this part was ground in a steel mortar; the fine powder obtained was prepared for neutron Activation Analysis.
Findings: it is possible to separate the useful from the toxic fractions of plant, instead to banned the use of herbal remedy containing acid Aristolochic. Five elements were quantified in certified AIEA standards IAEA-V10 and IAEA-SL1 for checking the accuracy of our procedure. It was noteworthy the most of the values obtained from this work are in good agreement with the certified values. The Z-score values for all elements were |Z|<3, which means that the results obtained are acceptable. the elemental concentrations obtained from this work shows the usefulness of using INAA for the elemental determination, the La, K, Br, As are present at trace levels and the Cr, Sb was found at minor level and Na at the major level.
- Cherif H.S, F. Said et al (2009) Identification et caracterisation de Quelques Composés chimiques chez Aristolochia Longa.nr.3- 4 : 71- 72.
- Jean-pierre Cosyns (2004) Aristolochic Acid-and ochratoxin A- DNA adducts: possible markers of Balkan endemic nephropathy and associated urotherial tumors Medicine and Biology 11,N°1 : 1- 4.
- Chung-Hsin Chen et al (2012) Aristolochic acid – associated Urotherial cancer in Taiwan PNAS /may 221 / 109 / n° 21 : 8241- 8246.
- Jian Qing Yu, Zhi Xiong Liao et al (2007) Composition , Antimicrobial activity and cytotoxicity of essential oils from Aristolochia mollissima : Environmental Toxicology and Pharmacology 23 : 162-167.
- Bachir et al. (2012) Aristolochia Longa aqueous extract triggers the mitochondrial pathway of apoptosis in BL41 Burkitt’s lymphoma cells : International Journal of Green Pharmacy : 45-49.