[Benefits of participatory involvement of patients in the development of a dermatological treatment app-A report from the practice]. / Nutzen der partizipatorischen Mitwirkung von PatientInnen an der Entwicklung einer dermatologischen Therapie-App ­ ein Bericht aus der Praxis.

Approximately 2% of the German population suffer from psoriasis. HybridVITA has developed a mobile application (app) that enables psoriasis patients to independently document the progression of the disease and the current psychological stress at home. The HybridVITA app was created in close collaboration with user groups to ensure optimal adaptation to their needs. Two interactive workshops were held with the user groups and the technical developers of the app as a core element of the developmental process. The workshops identified the needs and suggestions for improvement of the various user groups and formulated user stories for the further development of the app using the Scrum method. The participatory approach of the workshop enabled the project team to gather valuable practical knowledge at an early stage of development. The team's awareness of potential obstacles during the early stages of the project enabled them to proactively identify and address these issues prior to implementing the app in dermatological care. We are confident that a patient-centered and participatory approach to health app development can provide valuable insights for developers.

Using Automated Machine Learning to Predict Necessary Upcoming Therapy Changes in Patients With Psoriasis Vulgaris and Psoriatic Arthritis and Uncover New Influences on Disease Progression: Retrospective Study.

BACKGROUND: Psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) are complex, multifactorial diseases significantly impacting health and quality of life. Predicting treatment response and disease progression is crucial for optimizing therapeutic interventions, yet challenging. Automated machine learning (AutoML) technology shows promise for rapidly creating accurate predictive models based on patient features and treatment data. OBJECTIVE: This study aims to develop highly accurate machine learning (ML) models using AutoML to address key clinical questions for PsV and PsA patients, including predicting therapy changes, identifying reasons for therapy changes, and factors influencing skin lesion progression or an abnormal Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. METHODS: Clinical study data from 309 PsV and PsA patients were extensively prepared and analyzed using AutoML to build and select the most accurate predictive models for each variable of interest. RESULTS: Therapy change at 24 weeks follow-up was modeled using the extreme gradient boosted trees classifier with early stopping (area under the receiver operating characteristic curve [AUC] of 0.9078 and logarithmic loss [LogLoss] of 0.3955 for the holdout partition). Key influencing factors included the initial systemic therapeutic agent, the Classification Criteria for Psoriatic Arthritis score at baseline, and changes in quality of life. An average blender incorporating three models (gradient boosted trees classifier, ExtraTrees classifier, and Eureqa generalized additive model classifier) with an AUC of 0.8750 and LogLoss of 0.4603 was used to predict therapy changes for 2 hypothetical patients, highlighting the significance of these factors. Treatments such as methotrexate or specific biologicals showed a lower propensity for change. An average blender of a random forest classifier, an extreme gradient boosted trees classifier, and a Eureqa classifier (AUC of 0.9241 and LogLoss of 0.4498) was used to estimate PASI (Psoriasis Area and Severity Index) change after 24 weeks. Primary predictors included the initial PASI score, change in pruritus levels, and change in therapy. A lower initial PASI score and consistently low pruritus were associated with better outcomes. BASDAI classification at onset was analyzed using an average blender of a Eureqa generalized additive model classifier, an extreme gradient boosted trees classifier with early stopping, and a dropout additive regression trees classifier with an AUC of 0.8274 and LogLoss of 0.5037. Influential factors included initial pain, disease activity, and Hospital Anxiety and Depression Scale scores for depression and anxiety. Increased pain, disease activity, and psychological distress generally led to higher BASDAI scores. CONCLUSIONS: The practical implications of these models for clinical decision-making in PsV and PsA can guide early investigation and treatment, contributing to improved patient outcomes.

Romania: health system review

This analysis of the Romanian health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance.The Romanian health care system is a social health insurance system thathas remained highly centralized despite recent efforts to decentralize someregulatory functions. It provides a comprehensive benefits package to the 85%of the population that is covered, with the remaining population having accessto a minimum package of benefits. While every insured person has accessto the same health care benefits regardless of their socioeconomic situation,there are inequities in access to health care across many dimensions, such asrural versus urban, and health outcomes also differ across these dimensions.The Romanian population has seen increasing life expectancy and decliningmortality rates but both remain among the worst in the European Union (EU).Some unfavourable trends have been observed, including increasing numbersof new HIV/AIDS diagnoses and falling immunization rates.Public sources account for over 80% of total health financing. However,that leaves considerable out-of-pocket payments covering almost a fifthof total expenditure. The share of informal payments also seems to besubstantial, but precise figures are unknown. In 2014, Romania had the lowesthealth expenditure as a share of gross domestic product (GDP) among theEU Member States.In line with the government’s objective of strengthening the role of primarycare, the total number of hospital beds has been decreasing. However, healthcare provision remains characterized by underprovision of primary andcommunity care and inappropriate use of inpatient and specialized outpatientcare, including care in hospital emergency departments. The numbers ofphysicians and nurses are relatively low in Romania compared to EU averages.This has mainly been attributed to the high rates of workers emigrating abroadover the past decade, exacerbated by Romania’s EU accession and the reductionof public sector salaries due to the economic crisis.Reform in the Romanian health system has been both constant and yetfrequently ineffective, due in part to the high degree of political instability.Recent reforms have focused mainly on introducing cost-saving measures,for example, by attempting to shift some of the health care costs to drugmanufacturers (by claw-back) and to the population (through co-payments),and on improving the monitoring of health care expenditure.

Survey of adverse childhood experiences among Romanian university students: study report from the 2012 survey

A survey on adverse childhood experiences (ACE) was conducted on a representative sample of 2088 young adults (1343 females, and 745 males) from 17 public universities in Romania. The aim of the study was to assess the prevalence of ACE in Romania, and to identify relationships between exposure to ACE and health risk behaviors, and health outcomes. The study findings show a high reported prevalence of physical abuse (26.9%), emotional abuse (23.6%), sexual abuse (12.7%), physical neglect (16.5%), and emotional neglect (26.3%). Female participants reported significantly more often being exposed to sexual and emotional abuse. Overall, 18% of students reported exposure to at least four types of ACE. Exposure to household dysfunctions was also common: 21.9% lived with an alcoholic parent, 17.4% witnessed violent treatment of their mother, 15.6% had experienced parental separation, and 12.9% reported that a household member had a mental illness. ACE were positively associated with engagement in health-risk behaviors in late adolescence and young adulthood, such as smoking, alcohol abuse, illicit drug usage, attempting suicide, running away from home, or multiple sexual partners. Moreover, the exposure to a higher number of ACE increased the probability of having somatic complaints and mental health problems in adulthood. The study results offer inputs for policy makers and health specialists to take measures for reducing and preventing child maltreatment.