Women's experiences along the ovarian cancer diagnostic pathway in Catalonia: A qualitative study.

BACKGROUND: Early detection of symptoms and prompt diagnosis of ovarian cancer are considered important avenues for improving patient experiences and outcomes. METHODS: This qualitative study used a phenomenological approach to perform patient interviews, collecting individual accounts of the prediagnostic phase in women diagnosed and treated for ovarian cancer in 2016-2017. Purposive sampling was used to obtain a diverse sample of 24 participants, while thematic content analysis was used to extract themes and subthemes from interview data. RESULTS: Three themes and nine subthemes were identified. The first theme was women's delay in recognizing symptoms and seeking care, with subthemes on the lack of knowledge about early signs of ovarian cancer, gender-related barriers and false reassurance from negative test results. A second theme was missed opportunities during healthcare encounters, due to misattribution of women's symptoms by their physicians, underestimation of symptom severity and need for mediation and inadequate tests and/or false negative results. Finally, interviews highlighted the use of resources and alternative healthcare pathways, including complementary/alternative medicines, access to private health care and women's capacity for action and decision-making (agency) about their health. CONCLUSION: Delayed diagnosis of ovarian cancer is rooted in both individual factors (lack of health literacy, reluctance to seek care) and systemic issues (missed opportunities in healthcare encounters, access to timely specialist care). Further research is needed to investigate the extent to which traditional gender roles and socioeconomic inequalities condition women's ability to manage their own health and to interact with health professionals and the health system. PATIENT AND PUBLIC CONTRIBUTION: In addition to the patient participation during the interviews, one author was a representative of a patient association.

Defining and Assessing Public Health Functions: A Global Analysis.

Given the broad scope and intersectoral nature of public health structures and practices, there are inherent difficulties in defining which services fall under the public health remit and in assessing their capacity and performance. The aim of this study is to analyze how public health functions and practice have been defined and operationalized in different countries and regions around the world, with a specific focus on assessment tools that have been developed to evaluate the performance of essential public health functions, services, and operations. Our review has identified nearly 100 countries that have carried out assessments, using diverse analytical and methodological approaches. The assessment processes have evolved quite differently according to administrative arrangements and resource availability, but some key contextual factors emerge that seem to favor policy-oriented follow-up. These include local ownership of the assessment process, policymakers' commitment to reform, and expert technical advice for implementation.

Enhanced labelling on alcoholic drinks: reviewing the evidence to guide alcohol policy.

BACKGROUND: Consumer and public health organizations have called for better labelling on alcoholic drinks. However, there is a lack of consensus about the best elements to include. This review summarizes alcohol labelling policy worldwide and examines available evidence to support enhanced labelling. METHODS: A literature review was carried out in June-July 2012 on Scopus using the key word 'alcohol' combined with 'allergens', 'labels', 'nutrition information', 'ingredients', 'consumer information' and/or 'warning'. Articles discussing advertising and promotion of alcohol were excluded. A search through Google and the System for Grey Literature in Europe (SIGLE) identified additional sources on alcohol labelling policies, mainly from governmental and organizational websites. RESULTS: Five elements were identified as potentially useful to consumers: (i) a list of ingredients, (ii) nutritional information, (iii) serving size and servings per container, (iv) a definition of 'moderate' intake and (v) a health warning. Alcohol labelling policy with regard to these aspects is quite rudimentary in most countries, with few requiring a list of ingredients or health warnings, and none requiring basic nutritional information. Only one country (Australia) requires serving size and servings per container to be displayed. Our study suggests that there are both potential advantages and disadvantages to providing consumers with more information about alcohol products. CONCLUSIONS: Current evidence seems to support prompt inclusion of a list of ingredients, nutritional information (usually only kcal) and health warnings on labels. Standard drink and serving size is useful only when combined with other health education efforts. A definition of 'moderate intake' and recommended drinking guidelines are best suited to other contexts.

Bratislava Statement: consensus recommendations for improving pancreatic cancer care.

Pancreatic cancer is one of the most lethal tumours, and it is the fourth cause of cancer death in Europe. Despite its important public health impact, no effective treatments exist, nor are there high-visibility research efforts to improve care. This alarming situation is emblematic of a larger group of cancer diseases, known as neglected cancers. To address the impact of these diseases, the European Commission-supported Innovative Partnership for Action Against Cancer launched a multi-stakeholder initiative to determine key steps that healthcare systems can rapidly implement to improve their response. A working group comprising 20 representatives from European medical societies, patient associations, cancer plan organisations and other relevant European healthcare stakeholders was organised. A consensus process based on the results of different studies, discussion of research outcomes, and development and endorsement of draft statements resulted in 22 consensus recommendations (the Bratislava Statement). The statement argues that substantial improvements can be achieved in patient outcomes by centralising pancreatic cancer care around state-of-the-art reference centres, staffed by expert multidisciplinary teams capable of providing high-quality care. This organisational model requires a specific care framework encompassing primary, palliative and survivorship care, and a policy environment prioritising the use of quality criteria and performance assessments as well as research investments dedicated to prevention, risk prediction, early detection and diagnosis. In order to address the challenges posed by neglected cancers in general and pancreatic cancer in particular, a specific control strategy tailored to this reality is required.

The reach of Spanish-language YouTube videos on physical examinations made by undergraduate medical students.

This study was conducted to evaluate the performance and reach of YouTube videos on physical examinations made by Spanish university students. We analyzed performance metrics for 4 videos on physical examinations in Spanish that were created by medical students at Miguel Hernández University (Elche, Spain) and are available on YouTube, on the following topics: the head and neck (7:30), the cardiovascular system (7:38), the respiratory system (13:54), and the abdomen (11:10). We used the Analytics application offered by the YouTube platform to analyze the reach of the videos from the upload date (February 17, 2015) to July 28, 2017 (2 years, 5 months, and 11 days). The total number of views, length of watch-time, and the mean view duration for the 4 videos were, respectively: 164,403 views (mean, 41,101 views; range, 12,389 to 94,573 views), 425,888 minutes (mean, 106,472 minutes; range, 37,889 to 172,840 minutes), and 2:56 minutes (range, 1:49 to 4:03 minutes). Mexico was the most frequent playback location, followed by Spain, Colombia, and Venezuela. Uruguay, Ecuador, Mexico, and Puerto Rico had the most views per 100,000 population. Spanish-language tutorials are an alternative tool for teaching physical examination skills to students whose first language is not English. The videos were especially popular in Uruguay, Ecuador, and Mexico.

The effects of the financial crisis on primary prevention of cancer.

The present financial crisis will affect primary cancer prevention through several avenues: personal lifestyle choices, exposure to environmental risk factors, decisions made in the private sector and public policy on cancer prevention. Whilst it is clearly problematic to reach solid conclusions on a direct connection between economic crises and cancer mortality, we can identify trends that provide guidance for further action. For some lifestyle choices such as smoking or diet, we argue that public policy may channel existing tendencies during times of crisis for clear added value. In other areas, including research and health system investments, we will make the case that the resources not used now for cancer prevention efforts will lead to increased costs (both financial and human) down the road. Policy makers face a clear choice: they can follow a cost contention strategy, which may reduce expenditure in the short-term only to increase it in the long-term, or they can use the financial crisis as an opportunity to make difficult choices in terms of health service rationalisation, whilst at the same time strengthening evidence-based prevention policies. In short, we argue that despite the scarcity of funds and the governmental priorities on economic recovery, cancer prevention is more relevant now than ever.

Self-assessments of the essential public health operations in the WHO European Region 2007–2015: experiences and lessons from seven Member States

This report describes the findings of seven case studies of Member States of the WHO European Region (Cyprus, Estonia, Poland, the Republic of Moldova, Slovakia, the former Yugoslav Republic of Macedonia and Uzbekistan) that carried out self-assessments of the essential public health operations (EPHOs) from 2007 to 2015, using successive versions of the Self-assessment tool for the evaluation of essential public health operations and services in the WHO European Region. The case studies show that the EPHO self-assessment tool is a valid instrument for evaluating public health capacities and services at the country level, and an effective process for strengthening intersectoral networks and building capacity and consensus around public health issues. This report also presents the findings of a brief documentary review of the seven corresponding self-assessment reports. The review shows that there is still much work to be done to strengthen public health in the Region; there are gaps and areas for improvement in every single essential operation, but particularly in those requiring intersectoral collaboration. In closing, this report presents specific steps that the WHO Regional Office for Europe, Member States and partner organizations can take to support the strengthening of EPHOs in the Region.

Аргументы в пользу инвестиций в общественное здоровье: Укрепление потенциала и служб общественного здравоохранения в Европе. Один из важнейших элементов новой Европейской региональной политики здравоохранения – Здоровье-2020

Экономический кризис привел к росту спроса и сокращению ресурсов для сектора здравоохранения. Наблюдается выраженная тенденция к росту затрат на медико-санитарное обслуживание для отдельных лиц, сектора здравоохранения и всего общества в целом. Меры общественного здравоохранения могут способствовать решению этой проблемы. Фактические данные показывают, что меры профилактики могут быть эффективными с точки зрения затрат, обеспечивая эффективное использование вложенных средств и окупаемость инвестиций как в краткосрочной, так и долгосрочной перспективе. Настоящий краткий доклад по вопросам общественного здравоохранения указывает на быструю окупаемость затрат сектора здравоохранения и других секторов на осуществление мер, которые способствуют росту физической активности и здоровой занятости; решению проблем в области жилищных условий и психического здоровья; и снижению уровня дорожно-транспортного травматизма и насилия. Программы вакцинации и скрининга в большинстве случаев являются затратоэффективными. Меры вмешательства на общепопуляционном уровне требуют, в среднем, в пять раз меньше затрат, чем меры, принимаемые на индивидуальном уровне. В настоящем докладе приводятся примеры мер вмешательства, обеспечивающие быструю окупаемость инвестиций, а также подходы, позволяющие добиться положительных результатов на более долгосрочную перспективу. Инвестиции в затратоэффективные меры вмешательства в целях снижения затрат в секторе здравоохранения и других секторах могут способствовать построению устойчивых систем здравоохранения и развитию экономики стран в будущем.