Monitoring indirect impact of COVID-19 pandemic on services for cardiovascular diseases in the UK.

OBJECTIVE: To monitor hospital activity for presentation, diagnosis and treatment of cardiovascular diseases during the COVID-19) pandemic to inform on indirect effects. METHODS: Retrospective serial cross-sectional study in nine UK hospitals using hospital activity data from 28 October 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown) and for the same weeks during 2018-2019. We analysed aggregate data for selected cardiovascular diseases before and during the epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends. RESULTS: Across nine hospitals, total admissions and emergency department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1%-58.6%) and 52.9% (52.2%-53.5%), respectively, compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown and fell by 31%-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm repair and peripheral arterial disease procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases and specialties between the first case and lockdown (total ED attendances relative reduction (RR) 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020. CONCLUSIONS: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.

Needs of parents of very preterm infants in Neonatal Intensive Care Units: A mixed methods study.

OBJECTIVES: To explore needs of parents of very preterm infants hospitalised in Neonatal Intensive Care Units according to their socioeconomic position, obstetric history and infant's characteristics. METHODOLOGY: Sequential explanatory mixed methods study. Individual quantitative questionnaires (n = 118 mothers; 89 fathers) during infants' hospitalisation; couples-based semi-structured interviews (n = 26) four months after childbirth (July 2013-June 2014). SETTING: All level III public neonatal intensive care units in North Portugal. RESULTS: Mothers valued more information needs than fathers and their overall scores were mainly influenced by age and educational level, while fathers' needs perceptions were influenced by previous children. Despite gender differences, the assurance and proximity needs of parents apply across sociotechnical environments. Qualitative findings added the following needs: instrumental support from the government; regular emotional support from psychologists and social workers; enhancement of privacy to assure family-centred information and comfort; and availability of peers and health professionals as mediators in the provision of coherent information. CONCLUSIONS: The promotion of family-friendly and gender-equality policies is crucial to support family integrated healthcare services. This study raises awareness for developing sensitive conceptual frameworks and instruments to assess parents' needs considering their socioeconomic position and reproductive trajectories, as well as privacy and regular emotional support in the neonatal intensive care unit.

2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030.

OBJECTIVE: To describe the character and composition of the 2015 US adult rheumatology workforce, evaluate workforce trends, and project supply and demand for clinical rheumatology care for 2015-2030. METHODS: The 2015 Workforce Study of Rheumatology Specialists in the US used primary and secondary data sources to estimate the baseline adult rheumatology workforce and determine demographic and geographic factors relevant to workforce modeling. Supply and demand was projected through 2030, utilizing data-driven estimations regarding the proportion and clinical full-time equivalent (FTE) of academic versus nonacademic practitioners. RESULTS: The 2015 adult workforce (physicians, nurse practitioners, and physician assistants) was estimated to be 6,013 providers (5,415 clinical FTE). At baseline, the estimated demand exceeded the supply of clinical FTE by 700 (12.9%). By 2030, the supply of rheumatology clinical providers is projected to fall to 4,882 providers, or 4,051 clinical FTE (a 25.2% decrease in supply from 2015 baseline levels). Demand in 2030 is projected to exceed supply by 4,133 clinical FTE (102%). CONCLUSION: The adult rheumatology workforce projections reflect a major demographic and geographic shift that will significantly impact the supply of the future workforce by 2030. These shifts include baby-boomer retirements, a millennial predominance, and an increase of female and part-time providers, in parallel with an increased demand for adult rheumatology care due to the growing and aging US population. Regional and innovative strategies will be necessary to manage access to care and reduce barriers to care for rheumatology patients.

Population-Based Analysis and Projections of Liver Supply Under Redistricting.

BACKGROUND: To reduce the geographic heterogeneity in liver transplant allocation, the United Network of Organ Sharing has proposed redistricting, which is impacted by both donor supply and liver transplantation demand. We aimed to determine the impact of demographic changes on the redistricting proposal and characterize causes behind geographic heterogeneity in donor supply. METHODS: We analyzed adult donors from 2002 to 2014 from the United Network of Organ Sharing database and calculated regional liver donation and utilization stratified by age, race, and body mass index. We used US population data to make regional projections of available donors from 2016 to 2025, incorporating the proposed 8-region redistricting plan. We used donors/100 000 population age 18 to 84 years (D/100K) as a measure of equity. We calculated a coefficient of variation (standard deviation/mean) for each regional model. We performed an exploratory analysis where we used national rates of donation, utilization and both for each regional model. RESULTS: The overall projected D/100K will decrease from 2.53 to 2.49 from 2016 to 2025. The coefficient of variation in 2016 is expected to be 20.3% in the 11-region model and 13.2% in the 8-region model. We found that standardizing regional donation and utilization rates would reduce geographic heterogeneity to 4.9% in the 8-region model and 4.6% in the 11-region model. CONCLUSIONS: The 8-region allocation model will reduce geographic variation in donor supply to a significant extent; however, we project that geographic disparity will marginally increase over time. Though challenging, interventions to better standardize donation and utilization rates would be impactful in reducing geographic heterogeneity in organ supply.

Resource allocation and organisational features in Swedish primary diabetes care: Changes from 2006 to 2013.

AIMS: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013. METHODS: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013. RESULTS: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low. CONCLUSIONS: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM.

[Future requirements for oncological care: Challenges due to demographic change]. / Herausforderung demographischer Wandel : Künftige Anforderungen an die onkologische Versorgung.

BACKGROUND: One of the major challenges of demographic change in Germany is the increase in the number of cancer patients. Urology is one of the most affected medical disciplines due to bladder and prostate cancer. This quantitative challenge coincides with a qualitative challenge through targeted oncology and a number of innovative drugs. OBJECTIVES: The task becomes even more complicated when considering the parallel increase of other diseases in the same patients. Severe comorbidity may limit oncological options. The future demands for oncology can be summarized as the following: higher incidence of cancer patients, more complex diagnostic workup and treatment, longer overall survival with cancer, increase in comorbidity, and higher need for oncologically trained physicians. High-quality and comprehensive cancer care in all geographic regions needs intensification of basic and healthcare research in close cooperation with networks of treating physicians. CONCLUSION: Oncologists have to be prepared for life-long learning, cooperative patient care, and for integration of other medical professions.

Trends in geographic distribution of nursing staff in Japan from 2000 to 2010: a multilevel analysis.

The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types:public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PHN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased;the RRs per 1-year increment were 1.022 (95% CI:1.020-1.023), 1.021 (95% CI:1.019-1.022), and 1.037 (95% CI:1.037-1.038), respectively. In contrast, AN significantly decreased;the RR per 1-year increment was 0.993 (95% CI:0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.

[The user oriented hospital - chances and challenges for the healthcare industry]. / Das "nutzerorientierte" Krankenhaus - Chance und Herausforderung für die Gesundheitswirtschaft.

Hardly any other part of the healthcare sector is under such a pressure to change as the hospital sector. Hospitals are high-performers in coping with complex changes in modernising patient care, process design, quality, cost-effectiveness and service orientation. But, what really makes value to the patient? Currently, this question is raised with new seriousness. Those hospitals which consequently align their portfolio to value based and 'patient driven' healthcare delivery will succeed by both quality and cost-effectiveness. We receive such messages from the USA. In Germany there are on-going and admonishing pleas since the end of the 1990s not to lose sight of the patients' needs while designing new concepts for healthcare delivery. Future challenges imply not only the renaissance of patient centred care, but also demand for a comprehensive user orientation as a key factor to successful hospital modernisation. This is particularly true of concepts of structured, integrated and regional healthcare delivery. But a consequent alignment of healthcare with value for patients clearly exceeds the focus on integrating hospital and outpatient care. In designing new services of coordinated regional healthcare, hospitals gain strategic options for a single-source healthcare delivery. In terms of business development, user orientation does not only yield important impulses for stronger patient centred care, but also opens up chances for better quality and competitive advantages. Nevertheless, it requires a new understanding of innovation processes which considers value for patients and quality of results and outcome as a relevant scale for measuring effects of change management. Finally, the methods of the assessment of user oriented healthcare delivery are an essential challenge for the evaluation of cooperative healthcare services.

Necesidades docentes en Evaluación y Prevención del Riesgo Tóxico: de la Toxicología Experimental a la Reguladora / Educational needs in Toxic Prevention and Risk Assessment: From experimental to Regulatory Toxicology

Se revisan las necesidades formativas para una serie de raas aplicadas de la toxicología derivadas de las áreas fundamentales mecanística y de evaluación toxicológica, que comprenden fundamentalmente la toxicología de sistemas, la evaluación del riesgo y la toxicología reguladora. Son materias necesarias para el desempeño profesional en los organismos nacionales, autonómicos y locales responsables de la regulación e inspección de la comercialización y uso de compuestos industriales, medicamentos, productos cosméticos, alimentarios o fitosanitarios, o de contaminantes ambientales o laborales, así como en industrias y consultorías. Se han identificado más de 25 actividades científicas de gran relevancia realizadas en España desde 1995, con una media de 1,6 actividades por año. Los principales grados de las ciencias de la salud incluyen una asignatura troncal de Toxicología, que puede aparecer como optativa en otros, generalmente de 6 créditos ECTS, con un programa muy uniforme, que incluye entre sus descriptores la estimación del riesgo, la evaluación toxicológica, el empleo de métodos alternativos y las bases de la toxicología reguladora. En relación con los estudios de postgrado, se identifican másteres con una gran variedad de contenidos y enfoques, que en algunos casos cubren un abanico muy amplio de disciplinas, incluyendo las toxicológicas, así como otros que cubren las áreas específicas de la toxicología. De la revisión transversal de los programas docentes de pregrado, postgrado y doctorado en España, se deduce la paulatina adaptación al EEES y la adecuada inclusión en los mismos de materias sobre evaluación experimental de la toxicidad, prevención del riesgo tóxico y toxicología reguladora (AU)

The training needs for a range of applied toxicology branches arising from the fundamental areas of mechanistic and toxicological evaluation, which mainly comprise of systems toxicology , risk assessment and regulatory toxicology , are reviewed. Thet are necessary for professional performance in national, regional and local authorities responsible for regulation and inspection of the marketing and use of industrial chemicals, pharmaceuticals, cosmetics, food or plant protection products or environmental or occupational pollutants, as well as industries and consultancies. There are more than 25 highly relevant scientific activities carried out in Spain since 1995, with an average of 1.6 activities per year . The main bachelor's degrees of the health sciences include a very uniform obligatory subject of T oxicology , which may appear as an option in others, usually with 6 ECTS credits, which includes among its descriptors risk e stimation assessment toxicology, the use of alternative methods and the basis for regulatory toxicology. In relation to postgraduate studies, masters were identified with a variety of topics and approaches, which in some cases cover a very wide range of disciplines, including toxicology and other covering in depth the specific toxicologic areas. From the transversal review of the teaching programs at under graduate, graduate and doctoral degrees in Spain, it was deduced a gradual adaptation to the EHEA and the appropriate inclusion of subjetcs on experimental evaluation of toxicity , toxic hazard prevention and regulatory toxicology (AU)

[Perspectives for professionally sufficient and adequate care of ageing patients]. / Perspektiven einer fachlich angemessenen, bedarfs- und bedürfnisgerechten gesundheitlichen Versorgung für ältere Menschen.

This contribution deals with the question of how existing health care systems can be sufficiently and adequately adapted to ageing patients in general, and to patients with special needs for nursing care and assistance. Simultaneously, it advocates explicit consideration of the dimensions of social inequality and health hazards related to biographical factors. It demonstrates that health care involves much more than just adequate medical care in the event of illness. The reasons that change is needed are given and reform options for relevant segments of health care (such as medical practitioners, hospital care, health care for patients in need of nursing care, palliative care, prevention and rehabilitation) are presented. Special emphasis is placed on standards and guidelines relating to old age morbidity and integrated health care systems as well as rehabilitation, prevention and health promotion. A key role is attributed to the qualification of health services staff. More intensive research into health care and health services in respect of the elderly is also advocated.

[Shaping the future of vocational rehabilitation of adults: eight fields of action as starting points for a cross-actor innovation process]. / Die Zukunft der beruflichen Rehabilitation Erwachsener gestalten: Acht Handlungsfelder als Ausgangspunkt für einen akteursübergreifenden Innovationsprozess.

Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scientific Expert Group RehaFutur had been commissioned to elaborate cornerstones for the medium- and long-term development of vocational rehabilitation of adults with disabilities (re-integration). Initial questions inter alia were as follows: Which function should vocational rehabilitation have in a service- and knowledge-oriented working world that will increasingly be affected by demographic change? How can disabled persons' right to occupational participation by way of vocational rehabilitation, a right stipulated both under the German constitution and in German law, be realized as needed also in the future? Various fields of action have been derived on the basis, for one, of an investigation of the factors, social law, social and education policy as well as European, influencing vocational rehabilitation and, for the other, of an evaluation of current labour market and demographic developments. Dealt with in the fields of action outlined are the aspects: equitable opportunities of access, developmental and needs orientation, closeness to the real occupational and working world, as well as the role of self-determination and self-responsibility. The fields of action are to be understood as framework concept for shaping a cross-actor innovation process. Sustainable vocational rehabilitation is characterized in particular by the fact that it is specifically targeted at promoting disabled persons' self-determination and self-responsibility actively using these in the process and that it strengthens an independent lifestyle, ensures social participation by inclusive structures; also, it facilitates continued participation in working life by ongoing education involving holistic development of professional and personal competencies oriented towards the individual's resources and potentials, safeguarding it by systematic networking with companies. The concept presented for vocational rehabilitation of adults with disabilities encompasses a change of paradigms which service carriers and providers will have to face jointly and including the service users, the rehabilitants.

Medicamentos, globalización y países en desarrollo / Medication, globalization and developing nations

Se repasan los problemas pendientes relacionados con los medicamentos desde la perspectiva de los países subdesarrollados y las opciones para abordarlos (AU)

[Geriatrics-quo vadis? The system of geriatric care]. / Geriatrie-quo vadis?Zur Struktur geriatrischer Versorgung.

The authors describe the current and perspective structure of geriatric care in hospital and rehabilitation units. First the specific needs of elderly patients with various medical problems (multiple morbidity) are described. Furthermore the article analyses optimised structures of geriatric care. These visions are not limited to care in hospital and rehabilitation units but include prevention and long term care for elderly people as well.

[Developing a network for psychosomatic medicine and psychotherapy in Austria]. / Zur Entwicklung eines Netwerks für Psychosomatik und Psychotherapie in Osterreich.

In Austria additional in-patient treatment facilities for psychosomatic patients are currently established. In this context an advisory board of the planned psychosomatic clinics suggests to develop a network for psychosomatics and psychotherapy. This suggestion focuses on four goals: further integration of specialised psychosomatic care into general medical care; further promotion of general psychosomatic care in primary health care; increasing acceptance of psychotherapy among psychosomatic patients in need of psychotherapeutic interventions; decreasing the number of chronic psychosomatic disorders by early and adequate treatment. The proposed network should involve three levels of cooperation: the primary care level, the specialised psychosomatic-psychotherapeutic level and the institutional level of planning future structural developments according to the actual needs and demands. Such a network should also facilitate a common approach regarding the admission of patients, in-patient treatment and post-treatment care. A need inventory and an implementation analysis involving all levels of cooperation as well as the patients perspective are regarded as a prerequisite for the implementation of the network.