Search

Background Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. Methods In the VOICE community—a European healthcare centre cluster intending to address VBHC from theory to practice—information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Results Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. Conclusions To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions. [ABSTRACT FROM AUTHOR]

Even during the third wave of the COVID-19 pandemic health professionals were facing mental health challenges. The aim of this study was to examine the mental health of doctors, nurses and other professional groups in Europe and to identify differences between the professional groups. We conducted a cross-sectional online survey in 8 European countries. We asked for demographic data, whether the participants were exposed to COVID-19 at work, for main information sources about the pandemic, the Depression Anxiety Stress Scales (DASS-21), and major stressors. A MANCOVA was carried out to find predictors of mental health among health care professionals. The sample (N = 1398) consisted of 237 physicians, 459 nurses, and 351 other healthcare professionals and 351 non-medical professionals with no direct involvement in patient care. The mean mental health of all groups was affected to a mild degree. Major predictors for depression and anxiety were the profession group with higher scores especially in the group of the nurses and working directly with COVID-patients. In the third wave of the COVID-19 pandemic, the psychological burden on health professionals has remained high, with being nurse and working directly with COVID19 patients being particular risk factors for mental distress. We found as a main result that nurses scored significantly higher on depression and anxiety than practitioners. [ABSTRACT FROM AUTHOR]

Background The value equation of value-based healthcare (VBHC) as a single figure remains ambiguous, closer to a theoretical framework than a useful tool for decision making. The challenge lies in the way patient-centred outcomes (PCOs) might be combined to produce a single value of the numerator. This paper aims to estimate the weights of PCOs to provide a single figure in the numerator, which ultimately will allow a VBHC figure to be reached. Methods A cohort of patients diagnosed with breast cancer (n  = 690) with a 6-month follow-up recruited in 2019–20 across six European hospitals was used. Patient-reported outcomes (PROs), clinical-related outcomes (CROs), and clinical and socio-demographic variables were collected. The numerator was defined as a composite indicator of the PCOs (CI-PCO), and regression analysis was applied to estimate their weights and consequently arrive at a single figure. Results Pain showed as the highest weight followed by physical functioning , emotional functioning , and ability to work , and then by a symptom, either arm or breast. PCOs weights were robust to sensitivity analysis. The CI-PCO value was found to be more informative than the health-related quality of life (HRQoL) value. Conclusions To the best of our knowledge, this is the first research to combine the PCOs proposed by ICHOM to provide a single figure in the numerator of the value equation. This figure shows a step forward in VBHC to reach a holistic benchmarking across healthcare centres and a value-based payment. This research might also be applied in other medical conditions as a methodological pathway. [ABSTRACT FROM AUTHOR]

Maritime pine (Pinus pinaster Ait.) is native to the western Mediterranean basin and has an economic importance in southwestern Europe. This importance is based on the use of its wood in the construction, furniture, and paper industries. Bark and other parts of the plant, such as resin, needles, and cones, are by-products with potential industrial application. These parts of the tree stand out because of the presence of secondary metabolites, the main ones being phenolic compounds and terpenes. Bark contains both, while other parts of the plant are mainly composed of terpenes. All these compounds have biological potential, mainly antioxidant and antimicrobial properties. The bark has the widest range of industrial applications, and it can be used to obtain dietary supplements and functional foods, adsorbents, and bio-based resins and foams. Resin has a prominent industrial role too, especially in chemical industry. In this manuscript, an overview of these applications is described, opening an innovation opportunity for enterprises to use the by-products and residue of maritime pine. Still, albeit the described application, maritime pine has further applications that are right now being studied under the premises of circular economy. [ABSTRACT FROM AUTHOR]

The study of inequality in higher education is a consolidated topic that includes important contributions from various approaches and fields. In the European context, it is a relevant issue when analysing the impacts of the economic crisis, especially in the countries of Southern Europe. In this article, we present a study of higher education expenditure in Europe, proposing an approach that adapts the Gini coefficient. The most relevant result is that educational inequality is distributed inversely with respect to the distribution of economic inequality, which highlights a case of free-rider behaviour, according to The Logic of Collective Action (Olson, 1965), whereby social groups with higher incomes benefit from the public good. This result can contribute to the debate on how public goods are distributed in an unequal society. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (DM) in older people is a heterogeneous condition that exhibits differential characteristics in comparison with younger adults. DM increases the risk of disability, is associated with dementia and loss of function, and cognition may often be interrelated and more pronounced in older patients with DM than in those without. Aims: Our aim was to evaluate the incidence of functional and/or cognitive impairment in older adults with and without DM, and its associated factors in DM participants. Methods: A 2-year prospective analysis was conducted in a European multicenter prospective cohort (SCOPE study). Older community-dwelling adults (aged ≥ 75 years) underwent a comprehensive geriatric assessment. New functional and/or cognitive decline was explored. Results: Of 1611 participants, 335 (22.0%) had DM at baseline. The percentage of participants scoring at least one ADL impairment and/or cognitive impairment (MMSE < 24) was similar in both groups (9.6%). Factors associated with any new disability in participants with DM in the multivariate analysis were female sex (OR 3.28, 95% CI 1.42–7.56), history of stroke (OR 4.58, 95% CI 1.64–12.7), and greater IADL dependency (OR 1.08 95% CI 1.02–1.15). Discussion: Association between DM and cognitive or functional decline in outpatients of 75 years and older was not found, but factors such as female gender, history of stroke, and IADL dependency could be related. Conclusion: Decline in functional and cognitive status of community-dwelling older adults with DM was similar to participants without DM in a short period of 2 years of follow-up, though several clinical factors may increase its risk in this population. [ABSTRACT FROM AUTHOR]

The ketogenic diet has proven to be effective in many recent studies not only as a weight-losing strategy but also as a valuable add-on therapy in medical conditions such as diabetes and epilepsy. Additionally, frequent conditions such as autism spectrum disorders and Alzheimer disease could have a benefit derived from ketogenic diet metabolic changes. Many of these benefits could be driven by an intestinal microbiota change. While the effects of a ketogenic diet on microbiota should still be thoroughly clarified, as most studies observe an increase in bacterial strains considered neuroprotective such as Akkermansia muciniphila, with a concomitant reduction in some pathogenic strains such as Salmonella spp. it is important to highlight how many studies show a reduction in butyrate-producing strains, leading to a colonic proinflammatory state with increased intestinal permeability and an increase in pathogenic bacterial strains. The Clostridium butyricum strain MIYAIRI 588 (CBM588) is a butyrate-producing strain that was recently approved for human use in Europe due to its safety and effectiveness. The beneficial effect of CBM588 on the human colon could derive from a mucosal layer thickness increase and mucosal immune cell regulation, leading to a reduction in diarrhea and mucosal damage. Additionally, CBM588 could improve systemic insulin sensitivity and reduce the splanchnic organ inflammatory state. Therefore, CBM588 is a bacterial strain that should be considered an add-on when following a ketogenic diet, leading to a reduction in some of the potential gastrointestinal side effects and improving weight management through increased insulin sensitivity and the optimization of the lipid metabolism. [ABSTRACT FROM AUTHOR]

Rural areas can benefit from the development of biorefineries for the valorization of endogenous feedstocks. In this study, a pre-feasibility assessment of an integrated multi-product biorefinery to produce essential oils and biomethane is carried out considering current technical and economic conditions. The proposed concept is based on the steam distillation of forestry biomass for the extraction of essential oils (2900 L/y) followed by biomethane production via syngas methanation using the spent biomass as feedstock (30.4 kg/h). In parallel, the anaerobic treatment of WWTP sludge (5.3 kg/h) is used to produce additional biomethane for mobile applications. The results show that the intended multi-product biorefinery delivers attractive benefits for investors as described by the calculated financial indicators: NPV of EUR 4342.6, IRR of 18.1%, and PB of 6 years. Overall, the pre-feasibility analysis performed in this study demonstrates that the proposed biorefinery concept is promising and warrants further investment consideration via cost and benefit analysis, ultimately promoting the implementation of multi-product biorefineries across Europe. [ABSTRACT FROM AUTHOR]

One quarter of global energy consumption goes towards meeting transport needs. In Europe, the share of energy for transport is much higher and accounts for about a third. Therefore, it is very important to monitor the sustainable development and progress of the sector. This paper seeks to develop a framework for the sustainability assessment of road transport in EU countries and to evaluate the countries' achievements in the last decade. The research adheres to the provision that the developed framework should be easily applied in future studies. Therefore, significant attention is paid to the selection of indicators and their availability, as well as the selection of the research instrument itself. The multi-criteria decision-making (MCDM) technique TOPSIS has been applied for calculations and countries' ranking, in order to compare countries' achievements in the last decade (2010–2020). The last ten years' analysis allows us to identify the direction of individual countries in developing road transport. [ABSTRACT FROM AUTHOR]

Beta-lactam (BL) drugs are the antibiotics most prescribed worldwide due to their broad spectrum of action. They are also the most frequently implied in hypersensitivity reactions with a known specific immunological mechanism. Since the commercialization of benzylpenicillin, allergic reactions have been described; over the years, other new BL drugs provided alternative treatments to penicillin, and amoxicillin is now the most prescribed BL in Europe. Diagnosis of BL allergy is mainly based on skin tests and drug provocation tests, defining different sensitization patterns or phenotypes. In this study, we evaluated 619 patients with a confirmed diagnosis of BL-immediate allergy during the last 25 years, using the same diagnostic procedures with minor adaptations to the successive guidelines. The initial eliciting drug was benzylpenicillin, which changed to amoxicillin with or without clavulanic acid and cephalosporins in recent years. In skin tests, we found a decrease in sensitivity to major and minor penicillin determinants and an increase in sensitivity to amoxicillin and others; this might reflect that the changes in prescription could have influenced the sensitization patterns, thus increasing the incidence of specific reactions to side-chain selective reactions. [ABSTRACT FROM AUTHOR]

Maximum efficiency of surfaces that exploit solar energy, including Photovoltaic Panels and Thermal collectors, is achieved by installing them in a certain inclination (tilt). Most common approach is to select an inclination angle equal to the location's latitude. This is based on the astronomical calculations of the sun's position throughout the year but ignores meteorological factors. Cloud coverage and aerosols tend to change the direct irradiance but also the radiance sky distribution, thus horizontal surfaces receive larger amounts than tilted ones in specific atmospheric conditions (e.g., cases of cloud presence). In the present study we used 15 years of data, from 25 cities in Europe and North Africa in order to estimate the optimal tilt angle and the related energy benefits based in real atmospheric conditions. Data were retrieved from Copernicus Atmospheric Monitoring Service (CAMS). Four diffuse irradiance, various models are compared, and their differences are evaluated. Equations, extracted from solar irradiance and cloud properties regressions, are suggested to estimate the optimal tilt angle in regions, where no climatological data are available. In addition, the impact of cloud coverage is parameterized using the Cloud Modification Factor (CMF) and an equation is proposed to estimate the optimal tilt angle. A realistic representation of the photovoltaic energy production and a subsequent financial analysis were additionally performed. The results are able to support the prognosis of energy outcome and should be part of energy planning and the decision making for optimum solar power exploitation into the international clean energy transitions. Finally, results are compared to a global study and differences on the optimal tilt angle at cities of Northern Europe is presented. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections can occur in different care units and can affect both patients and healthcare professionals. Bacteria represent the most common cause of nosocomial infections and, due to the excessive and irrational use of antibiotics, resistant organisms have appeared. The most important healthcare-associated infections are central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site, soft tissue infections, ventilator-associated pneumonia, hospital acquired pneumonia, and Clostridioides difficile colitis. In Europe, some hospitalized patients develop nosocomial infections that lead to increased costs and prolonged hospitalizations. Healthcare-associated infection prevalence in developed countries is lower than in low-income and middle-income countries such as Romania, an Eastern European country, where several factors contribute to the occurrence of many nosocomial infections, but official data show a low reporting rate. For the rapid identification of bacteria that can cause these infections, fast, sensitive, and specific methods are needed, and they should be cost-effective. Therefore, this review focuses on the current situation regarding healthcare-associated infections in Europe and Romania, with discussions regarding the causes and possible solutions. As a possible weapon in the fight against the healthcare-associated infections, the diagnosis methods and tests used to determine the bacteria involved in healthcare-associated infections are evaluated. [ABSTRACT FROM AUTHOR]

Despite the importance of vegetation uptake of atmospheric gaseous elemental mercury (Hg(0)) within the global Hg cycle, little knowledge exists on the physiological, climatic, and geographic factors controlling stomatal uptake of atmospheric Hg(0) by tree foliage. We investigate controls on foliar stomatal Hg(0) uptake by combining Hg measurements of 3569 foliage samples across Europe with data on tree species' traits and environmental conditions. To account for foliar Hg accumulation over time, we normalized foliar Hg concentration over the foliar life period from the simulated start of the growing season to sample harvest. The most relevant parameter impacting daily foliar stomatal Hg uptake was tree functional group (deciduous versus coniferous trees). On average, we measured 3.2 times higher daily foliar stomatal Hg uptake rates in deciduous leaves than in coniferous needles of the same age. Across tree species, for foliage of beech and fir, and at two out of three forest plots with more than 20 samples, we found a significant (p<0.001) increase in foliar Hg values with respective leaf nitrogen concentrations. We therefore suggest that foliar stomatal Hg uptake is controlled by tree functional traits with uptake rates increasing from low to high nutrient content representing low to high physiological activity. For pine and spruce needles, we detected a significant linear decrease in daily foliar stomatal Hg uptake with the proportion of time during which water vapor pressure deficit (VPD) exceeded the species-specific threshold values of 1.2 and 3 kPa, respectively. The proportion of time within the growing season during which surface soil water content (ERA5-Land) in the region of forest plots was low correlated negatively with foliar Hg uptake rates of beech and pine. These findings suggest that stomatal uptake of atmospheric Hg(0) is inhibited under high VPD conditions and/or low soil water content due to the regulation of stomatal conductance to reduce water loss under dry conditions. Other parameters associated with forest sampling sites (latitude and altitude), sampled trees (average age and diameter at breast height), or regional satellite-observation-based transpiration product (Global Land Evaporation Amsterdam Model: GLEAM) did not significantly correlate with daily foliar Hg uptake rates. We conclude that tree physiological activity and stomatal response to VPD and soil water content should be implemented in a stomatal Hg model to assess future Hg cycling under different anthropogenic emission scenarios and global warming. [ABSTRACT FROM AUTHOR]