Sustainable development in Wales and other regions in Europe: achieving health and equity for present and future generations

The United Nations 2030 Agenda for Sustainable Development (2015), complemented by the WHO European policy framework and strategy for the 21st century, Health 2020, represents a milestone for human and planetary development. This publication proposes ways of maximizing opportunities to implement these agendas at the national and regional levels across the WHO European Region. Through the Welsh example and case studies from the Czech Healthy Cities National Network and the regions of North Rhine-Westphalia (Germany), Kaunas (Lithuania), Pomurje (Slovenia), and Västra Götaland (Sweden), it aims to enhance understanding of the key role of regions in translating global priorities into effective policies and actions, providing practical examples, which can serve as blueprints for others. The publication maps the sustainable-development journey in the United Kingdom (Wales) from the heart of its constitution to inclusion in Welsh legislation through the Well-being of Future Generations (Wales) Act 2015. It describes the structure of the Act and experience gained in connection with its implementation, focusing on the health sector. It also identifies enablers, challenges and opportunities related to sustainable development in Wales. The activities described in the case studies are framed according to the Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being, recently adopted by the WHO Regional Committee for Europe. The key messages drawn from the common experiences of the regions reinforce the need to invest in improving the determinants of health.

Health diplomacy: european perspectives

Global processes – such as climate change, pandemics and modern societies’ patterns of unsustainable consumption – gave health diplomacy new relevance, making it central to health governance at global and regional levels, and integral to foreign policy in many countries. This book is part of the WHO Regional Office for Europe’s response to the WHO Regional Committee for Europe’s 2010 request that it strengthen the capacity of diplomats and health officials in global health diplomacy. It presents 17 case studies that illustrate recent developments in the WHO European Region. The examples range from negotiating for health in the Paris Agreement on climate change and the pursuit of the Sustainable Development Goals, to placing antimicrobial resistance on the global agenda and showing the relevance of city health diplomacy. Chapters review subregional efforts in south-eastern Europe and central Asian countries; progress on road safety in the Russian Federation; experience with integrated health diplomacy in Malta and Switzerland; Germany’s activities in the Group of 7 and Group of 20; the work of WHO country offices from a diplomacy perspective and the collaboration between WHO and the European Union; and training to increase capacity for health diplomacy in diplomats and health officials. A discussion of future challenges for health diplomacy concludes this unique compilation. This publication was tabled as a background document during the Sixty-seventh session of the Regional Committee for Europe, Budapest, 11–14 September 2017.

Dacron graft intussusception technique for treatment of type a aortic dissections: technical notes and preliminary results

Abstract Introduction: Optimal surgical management for acute type A aortic dissection (AAAD) remains unclear. The in-hospital mortality rate is still high (15%), and the intraoperative bleeding is an independent risk factor for hospital mortality. Objective: The aim of our study was describe a new method for aortic anastomosis in the repair of AAAD and report the hospital mortality and bleeding complications. Methods: Between January 2008 and November 2014, 24 patients, 16 male, median age 62 years, underwent surgical treatment of AAAD. The surgical technique consisted of intussusception of a Dacron tube in the dissected aorta, which is anastomosed with a first line of 2-0 polyester everting mattress suture and a second line of 3-0 polypropylene running suture placed at the outermost side. Open distal anastomosis was performed with bilateral selective antegrade cerebral perfusion in 13 (54.1%) patients. Results: Cardiopulmonary bypass and aortic clamping time ranged from 75 to 135 min (mean=85 min) and 60 to 100 min (mean=67 min), respectively. The systemic circulatory arrest ranged from 29 to 60 min (mean=44.5 min). One (4.1%) patient required reoperation for bleeding, due to the use of preoperative clopidogrel. The postoperative bleeding was 382-1270 ml (mean=654 ml). We used an average of 4.2 units of red blood cells/patient. There were two (8.3%) hospital deaths, one due to intraoperative bleeding and another due to mesenteric ischemia. The average length of stay in the intensive care unit and hospital was 44 hours and 6.7 days, respectively. Conclusion: This new method for surgical correction of AAAD was reproducible and resulted in satisfactory clinical outcomes.

Esculetin, a coumarin derivative, exerts in vitro and in vivo antiproliferative activity against hepatocellular carcinoma by initiating a mitochondrial-dependent apoptosis pathway

This study investigated the in vitro and in vivo antiproliferative activity of esculetin against hepatocellular carcinoma, and clarified its potential molecular mechanisms. Cell viability was determined by the MTT (tetrazolium) colorimetric assay. In vivo antitumor activity of esculetin was evaluated in a hepatocellular carcinoma mouse model. Seventy-five C57BL/6J mice were implanted with Hepa1-6 cells and randomized into five groups (n=15 each) given daily intraperitoneal injections of vehicle (physiological saline), esculetin (200, 400, or 700 mg·kg-1·day-1), or 5-Fu (200 mg·kg-1·day-1) for 15 days. Esculetin significantly decreased tumor growth in mice bearing Hepa1-6 cells. Tumor weight was decreased by 20.33, 40.37, and 55.42% with increasing doses of esculetin. Esculetin significantly inhibited proliferation of HCC cells in a concentration- and time-dependent manner and with an IC50 value of 2.24 mM. It blocked the cell cycle at S phase and induced apoptosis in SMMC-7721 cells with significant elevation of caspase-3 and caspase-9 activity, but did not affect caspase-8 activity. Moreover, esculetin treatment resulted in the collapse of mitochondrial membrane potential in vitro and in vivo accompanied by increased Bax expression and decreased Bcl-2 expression at both transcriptional and translational levels. Thus, esculetin exerted in vitro and in vivo antiproliferative activity in hepatocellular carcinoma, and its mechanisms involved initiation of a mitochondrial-mediated, caspase-dependent apoptosis pathway.

Taking a participatory approach to development and better health: examples from the Regions for Health Network

If the ultimate goal of all development is to improve the prerequisites for long-term survival and the well-being of the population in a region, then this entails action for increased social inclusion and a more equitable distribution of the social determinants of health. The intentional consequences of participatory approaches go far beyond the health sector and more into the realm of creating positive sustainable social change. Through the engagement of stakeholders, recognizing the value of each person’s contribution to the process is not only practical but also collaborative and empowering in finding solutions together. WHO’s Health 2020 policy calls for a whole-of-government and whole-of-society approach that involves a range of stakeholders at all levels. This publication documents the experiences of participatory approaches taken by Region Skåne (Sweden) and three case studies: the Autonomous Province of Trento (Italy), the Autonomous Community of Andalusia (Spain) and Wales (United Kingdom).

Tackling health inequities: from concepts to practice: the experience of Västra Götaland

Despite remarkable health gains, inequities persist between and within countries in the WHO European Region and Sweden is no exception. Actions to effectively tackle health inequities need to be carried out at all levels of government. Regions have a key role to play in tackling health inequities in that they are close to their populations and have the power and skills to develop efficient public health policies that may contribute in reducing health disparities by changing the distribution of social determinants of health. The report is about the process that the Region of Västra Götaland followed to mainstream the health equity dimension in its regional health plan and which resulted in the Action Plan for Health Equity in Region Västra Götaland. This publication is an account of the factors that made it possible, but it also presents a fair account of the obstacles encountered and the measures to overcome them. The report is a good illustration of how whole-of-government and whole-of-society approaches proposed by Health 2020 have been implemented in a real setting.

Improving the lives of children and young people: case studies from Europe, volume 3: school

As part of the European review of social determinants of health and the health divide, experts were commissioned to write case studies addressing childhood and inequality. They identified promising developments with international resonance, described the issues they addressed and how they were led and put into operation, and set out the emerging evidence of their effectiveness.This diverse collection of case studies is presented in three volumes reflecting a “life-course” approach: Volume 3 addresses school, with examples from Croatia, Cyprus, Denmark, Finland, France, Germany, Italy, Lithuania, the Netherlands, Spain and Sweden. Volumes 1 and 2 address the early years and childhood. Some of the case studies review major national policy developments and frameworks, others deal with specific national initiatives or with local projects driven by community organizations, and a few focus on transnational initiatives. They are not necessarily a comprehensive overview of childhood and health in the WHO European Region, but provide examples of innovative practice that will inform and inspire policy-makers, practitioners, managers, educators and researchers, committed to improving the lives of children and young people at country and European levels.

Improving the lives of children and young people: case studies from Europe, volume 1: early years

As part of the European review of social determinants of health and the health divide, experts were commissioned to write case studies addressing childhood and inequality. They identified promising developments with international resonance, described the issues they addressed and how they were led and put into operation, and set out the emerging evidence of their effectiveness.This diverse collection of case studies is presented in three volumes reflecting a “life-course” approach: Volume 1 addresses the early years, with examples from Greece, the Netherlands, Portugal, Sweden and the United Kingdom. Volumes 2 and 3 address childhood and school. Some of the case studies review major national policy developments and frameworks, others deal with specific national initiatives or with local projects driven by community organizations, and a few focus on transnational initiatives. They are not necessarily a comprehensive overview of childhood and health in the WHO European Region, but provide examples of innovative practice that will inform and inspire policy-makers, practitioners, managers, educators and researchers, committed to improving the lives of children and young people at country and European levels.

Etiología de las opacidades severas del esmalte: una evaluación basada en un estudio prospectivo médico y social en 17000 niños / Aetiology of severe demarcated enamel opacities: an evaluation based on prospective medical and social data from 17000 children

Durante los años 70s, los odontólogos describieron una prevalencia creciente de un nuevo tipo de alteración en el esmalte. Este era muy específico, con áreas de demarcado esmalte hipomineralizado y se encontraba en su mayoría en los primeros molares permanentes y en los incisivos. Diferentes estudios trataron de relelar la etiología de estas alteraciones, pero hasta ahora no se han encontrado factores claramente relacionados. El propósito del presente trabajo fue evaluar los factores etiológicos de las opacidades demarcadamente severas (OSD) en los primeros molares permanentes en una gran cohorte de niños incluidos en el proyecto "Todos los niños del sudeste de Suecia" (ABIS). Se llevó a cabo un estudio prospectivo de los niños de 5 condados suecos nacidos entre el 1º de octubre de 1997 y el 1 de octubre de 1999, un total de 17000 niños que fueron seguidos desde su nacimiento y fueron registrados un gran número de factores sobre nutrición, enfermedades, medicación, infecciones, situación social, etc. Con la ayuda de 89 clínicas del Servicio Dental Público, en la misma área, se realizaron exámenes preliminares de los niños nacidos entre octubre 1º de 1997 y octubre 1º de 1999. Se analizaron 595 niños con opacidades severamente marcadas (OSD) en los primeros molares. Estos niños, y un grupo control de 1200 niños seleccionados al azar fueron luego invitados para ser examinados por odontopediatras. En estos exámenes se identificaron 224 casos severos, como así también 253 niños sin ninguna alteración en el esmalte. Fueron analizados estos dos grupos. No hubo ninguna correlación entre OSD y las variables del banco de datos del ABIS. Los análisis muestran que no existe asociación entre OSD y datos pre, peri y neonatales. Sin embargo, hemos encontrado una asociación positiva entre OSD y el alimento a pecho por más de 6 meses.

Managing chronic conditions: experience in eight countries

One of the greatest challenges facing health systems in the 21st century is the need to address the growing burden of chronic diseases, which are complex and require a long-term, multifaceted response. This book examines the health system response to this rising burden in eight countries: Denmark, England, France, Germany, the Netherlands, Sweden, Australia and Canada. It provides a detailed assessment of the current situation, a description of the policy framework and future scenarios, as well as evaluation and lessons learned. With many health systems still largely built around an acute, episodic model of care, health professionals, policy-makers and patient organizations can learn valuable lessons from the many different strategies being implemented and begin to develop effective responses to this common challenge.

Retail prices of essential drugs in Brazil: an international comparison / Precios minoristas de medicamentos esenciales en Brasil: comparación internacional

OBJECTIVES: Price is a key obstacle for consumer access to essential drugs, especially in developing countries. This study sought to compare the retail prices of essential drugs on the private market in Brazil with that of two international pricing standards. METHODS: The retail price of all drugs on Brazil's Essential Drugs List, July 2000 edition, were compared to the retail price of the same drugs on the Swedish market and on a referential bulk-price indicator from low-cost suppliers on the international market. Ratios of Brazil's prices to Sweden's prices and Brazil's prices to the international bulk mean price-per-unit for each drug were calculated. Using linear regression analysis, the ratios were also studied in relation to the number of manufacturers. RESULTS: For the 132 drugs that were listed on both Brazil's and Sweden's lists, unitary retail prices in Brazil were 1.9 times higher. Of the 94 drugs found on both Brazil's list and the international unit-price indicator, Brazil's national mean unit prices were 13.1 more expensive. No relationship was found between the number of manufacturers for each product and the ratios of prices. CONCLUSIONS: Average retail prices of essential drugs in Brazil are significantly higher than in Sweden. Furthermore, international bulk prices indicate that drugs are brought to market by Brazil's private pharmacies at prices that may be excessively high in relation to production costs, creating high profit margins. The expected price-lowering effects of competition were not identified.

OBJETIVO: Los precios constituyen un obstáculo clave para el acceso del consumidor a los medicamentos esenciales, especialmente en los países en desarrollo. El objetivo de este estudio fue comparar los precios minoristas de los medicamentos esenciales en el mercado privado de Brasil con los de dos estándares internacionales de precios. MÉTHODS: Se compararon los precios minoristas de todos los medicamentos de la Lista de Medicamentos Esenciales de Brasil, edición de julio de 2000, con los precios minoristas de los mismos medicamentos en el mercado de Suecia y los indicadores de precios mayoristas de referencia de suministradores de bajo costo en el mercado internacional. Se calculó la razón entre los precios de cada medicamento en Brasil y en Suecia y entre los de Brasil y los precios mayoristas internacionales promedio por unidad. Se empleó el análisis de regresión lineal para estudiar también las razones según el número de productores. RESULTADOS: Los precios unitarios minoristas de los 132 medicamentos contenidos tanto en la lista de Brasil como en la de Suecia fueron 1,9 veces mayores en Brasil. De los 94 medicamentos que están tanto en la lista de Brasil como en el indicador internacional de precios unitarios, los precios unitarios nacionales promedio en Brasil fueron 13,1 mayores. No se encontró relación entre el número de productores de cada medicamento y la razón de precios. CONCLUSIONES: Los precios minoristas promedio de los medicamentos esenciales en Brasil son significativamente mayores que en Suecia. Además, según los precios mayoristas internacionales, las compañías farmacéuticas privadas de Brasil pudieran estar sacando al mercado medicamentos con precios excesivamente altos en relación con los costos de producción, lo que origina elevados márgenes de ganancia. No se encontró el efecto esperado de reducción de precios debido a la competencia.

Closing the health inequalities gap : an international perspective : / written by Iain K. Crombie ... [et al.]

This report presents an analysis of official documents on government policies to tackle inequalities in health from 13 developed countries. All countries recognize that health inequalities are caused by adverse socioeconomic and environmental circumstances. However they differ in their definitions of inequalities and in their approaches to tackling the problem. Sweden and Northern Ireland have structured their overall public health policy to tackle the underlying determinants of inequalities in health. England is the only country with a separate comprehensive policy. Most countries also have policies on poverty, social inclusion, and social justice. These are motivated by a concern for human rights and dignity and deal primarily with the underlying causes of health inequalities. While broadly setting the same overarching goal, policies on health inequalities show many different features. Policymakers face two challenges: to ensure that strategies to tackle the macroenvironmental factors feature in policy on inequalities in health, and to ensure that health becomes a prominent issue in social justice policy. Few countries have a coordinated approach to tackling inequalities in health

Risk of dementia and alcohol and wine consumption: a review of recent results

The term dementia refers to a clinical syndrome of acquired intellectual disturbances produced by brain dysfunction. Dementia may result from a wide variety of disorders, including degenerative (e.g. Alzheimer's disease, AD), vascular (e.g. multi-infarct dementia), and traumatic (e.g. head injury). Long-term abuse of alcohol is related to the development of the Wernicke-Korsakoff's syndrome or alcohol dementia. However, light to moderate alcohol intake might also reduce the risk of dementia and AD. In Bordeaux (France), a population-based prospective study found that subjects drinking 3 to 4 standard glasses of wine per day (> 250 and up to 500 ml), categorized as moderate drinkers, the crude odds ratio (OR) was 0.18 for incident dementia (p < 0.01) and 0.25 for Alzheimer's disease (p < 0.03), as compared to the non-drinkers. After adjusting for age, sex, education, occupation, baseline cognitive performances and other possible confounders, the ORs were respectively 0.19 (p < 0.01) and 0.28 (p < 0.05). In the 922 mild drinkers (< 1 to 2 glasses per day) there was a negative association only with AD, after adjustment (OR = 0.55; p < 0.05). The inverse relationship between moderate wine drinking and incident dementia was explained neither by known predictors of dementia nor by medical, psychological or socio-familial factors. These results were confirmed from data of the Rotterdam study. Light-to-moderate drinking (one to three drinks per day) was significantly associated with a lower risk of any dementia (hazard ratio 0.58 [95 percent CI 0.38-0.90]) and vascular dementia (hazard ratio 0.29 [0.09-0.93]). No evidence that the relation between alcohol and dementia varied by type of alcoholic beverage was found. Stroke constitutes one of the most common causes of serious functional impairment in developed countries. Ischaemic strokes represent about 80 percent of all strokes. Several studies have been published and the overall conclusion is that heavy drinking is a risk factor for most stroke subtypes. Regular light to moderate drinking seemed to be associated with a decreased risk for ischaemic stroke.