Developing Topics.

The numbers affected by Alzheimer’s and other dementias has accelerated pace of increasing and still has no tendency to decrease. Effects of the current therapies are quite modest. These effects contribute to negative attitude toward anti dementia drugs, delaying in establishing a diagnosis, postponing of beginning of pharmacological therapy or refusal of using therapy and disbelief in success of other measures like: life style changing, adoption to a new life habit or using non pharmacological therapies. The outcome of these attitudes is significantly faster cognitive decline which is reflected in changes in behavior with more severe episodes of maladaptive behavior that require additional use of medications such as: antipsychotics, hypnotics, benzodiazepines, anti-depressants and anxiolytics. Unfortunately, although non-pharmacological therapies have a real effect in improving the condition of people with dementia, they are not talked about enough. Professional health meetings do not include non-health professionals who do the hard work of improving a patient's condition every day. Also, health professionals do not refer patients to non-pharmacological therapy although there are science researches which prove efficiency. We want to believe that this is because there are few professional institutions that deal with non-pharmacological interventions, but also experts who have the knowledge, skills and tools for that job. National health and social care systems that either do not recognize these services as useful therapies or offer these services under limited conditions certainly contribute to this serious deficiency. This issue also shows the non-harmonious functioning of the health and social sectors, although non-pharmacological interventions has potential to decline fees these systems. A new generation of AD therapies are passive anti-amyloid immunotherapies that modify the course of the disease. It is expected that only 13% of people with MCI and 17% with mild dementia are eligible for therapy. The task of these products is cleansing the brain from Beta amyloid (Aß) deposits during 18 months. According to the words of producers, therapy allows slowing the decline of executive functions, maintaining social cognition and preserving short-term and working memory. Therapy has side effects which can worse patient health condition. Here we ask: "Where we go wrong and why proper communication with stakeholders regarding anti-amyloid therapies is important? What after antiamyloid therapy?”

Primary Health Care Matters.

APhA advances provider status initiative

In the WHO Western Pacific Region, traditional medicine has extensively been used by communities as part of primary health care which is critical foundation for achieving universal health coverage (UHC).This paper conceptualizes integration of traditional and complementary medicine (T&CM) into national health systems and explores how such integration can contribute to pathways toward UHC. Integration has been variously conceptualized at health system, service delivery, and consumer levels. Integration can be conceptualized based on the level of institutionalization of T&CM in national health systems (i.e. regulation of T&CM, education system, monitoring and health financial scheme). According to it, countries and areas of the Region can be categorized: countries with: ‘well-established integration strategies’; ‘in-process of developing and implementing integration policies’; ‘mixed-level of integration’; or ‘indigenous traditional medicine practiced outside the national healthcare system’.Integration of T&CM may offer pathways to advance five health system attributes essential to achieve UHC, namely: quality; efficiency; equity; accountability; and sustainability and resilience. It can contribute to improving quality of healthcare services through regulation of T&CM products, practitioners and services used by communities; meeting population needs in ageing population and managing non-communicable diseases; improving equitable access to care through health insurance coverage of T&CM; improving accountability by monitoring and use of data for informed-policy decisions on T&CM; and strengthening sustainability and resilience through maximizing potentials of T&CM in managing outbreaks of infectious diseases and disasters. Depending on the level of integration, actions to move forward integration of T&CM as a pathway toward UHC will be various.

The second report of the Committee on the Quality of Health Care in America, Crossing the Quality Chasm: A New Health System for the 21st Century is currently available as an advanced copy (uncorrected proofs). It expands the committee's work beyond the focus on medical and medication error in To Err Is Human: Building a Safer Health System to a larger issue: the need to improve the quality of health care. 2 The new report outlines aims and principles for an improved design for the delivery of care. The text emphasizes that it is written not to present specifics but to present a new perspective on the purpose, intents, interactions, and processes of health care. The authors acknowledge that it will be necessary to redesign structures and processes of organizations and of professionals and their interactions. They also acknowledge that the practices of the nation's health care system, providers, and users must change to include improvements in dissemination and application of knowledge and potential advances in care. They state that the nation's health care system, providers, and users must have access to and use information technology in practice. Changes must be made to fiscal (payment) policies to facilitate new and better options and to reward better outcomes, and health care providers must be better educated. The committee emphasizes that the report was written as a vision of what is possible and that changes must be made to the system to achieve the vision. The first report of the Committee on the Quality of Health Care in America, To Err Is Human: Building a Safer Health System, was summarized previously in this journal (J Managed Care Pharm 2001:62-68). The goals of this continuing education program are to inform readers about this important report and to present the committee's recommendations for building organizational support for change.

To record symptoms experienced by people with HIV/AIDS, and describe useful self-care strategies and how symptoms impact on daily life. A questionnaire was used with self-reported answers and descriptions of how symptoms impact on daily activities and suggestions for useful self-care strategies. Four hundred and twenty-two (n = 422) HIV-positive persons from seven sites in the USA and one site in Norway (n = 20) answered the questionnaire. In this article subjective symptom descriptions from the Norwegian sample are presented along with self-care strategies and their effectiveness. Findings revealed the Norwegian sample to be a little older, maybe less anxious and depressed, than participants in the larger study. This difference might be explained by the structure of the national social and health care system in Norway, where treatments, medications and social services are available to all citizens without cost. Respondents described a number of related symptoms as well as their subjective explanations of what triggered the symptoms. Most of the self-care strategies were learnt by trial and error. Community health providers, nurses and physicians should become more knowledgeable about the symptoms that infected persons struggle with, as well as the impact these symptoms have on routine daily self-care activities and a person's quality of life. There is need for more research about helpful self-care strategies to assist HIV-positive persons to manage their symptoms and to disseminate these to community health providers and support groups for HIV infected persons.

The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context? We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal. to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services, (3) provide accessible and timely information that helps to improve provision of cost-effective health care at an institutional level and promotes system-wide efficiency; (4) minimize transaction and administrative costs of the health care system; and (5) establish channels for population participation in governance while also protecting individual privacy. The results indicate that Taiwan has high levels of achievement in two criteria while falling short in the other three. Major lessons we learned from this study are that HIT exists to serve a health care system, and the national health care system context dictates how one assesses its HIT. There is a large body of literature published on the implementation of HIT and its impact on the quality and cost of health care delivery. The vast majority of the literature, however, is focused on a micro institutional level such as a hospital or a bit higher up, on an HMO or health insurance firm. Few have gone further to evaluate the implementation of HIT and its impact on a national health care system. The lack of such research motivated this study. The major contributions of this study are (i) to develop a framework that follows systems thinking principles and (ii) propose a process through which a nation can identify its objectives for HIT and systematically assess its national HIT system. Using Taiwan's national health care system as a case study, this paper demonstrated how it can be done.

The implementation of the Mental Health Nursing Specialty in Andalusia. A community approach

The Obligation of Nursing Leaders to Implement the “Future of Nursing” Report

This is a documentary, exploratory, descriptive study, which is part of a multicenter international study assessing the national health systems with a care model based on primary health care of Brazil, Spain, Italy, and Portugal, funded by the Brazilian National Research Council (CNPq, acronym in Portuguese). It aims to identify the basic health legislation, the right to health, and the doctrinal and organizational principles of each country with a focus on the impact of social determinants of health on the national health systems. The results showed these countries have similar legislation and doctrinal principles, with a constitutional right to health, based on primary health care, and with a care model of the family health type. The challenges identified were low birth rate and high life expectancy at birth in European countries and criteria for access to medication and care financing. Based on our findings, the countries with higher investment in a structural basis, ensuring more dignified, solid, and vigilant socioeconomic and sanitary conditions, provide an important differentiation in responsiveness and sustainability of the national health system and direct impact on the quality of life.

<h3>Abstract</h3> <h3>Introduction</h3> Cognitive impairments are prevalent in Huntington’s disease (HD), occurring many years prior to clinical diagnosis and are the most impactful on quality of life of patients. Cognitive interventions and exercise have been found to be efficacious in improving cognitive function in several clinical populations (e.g., older adults with mild cognitive impairment and dementia). However, the utility of cognitive interventions has not been systematically reviewed in HD. This systematic review aims to examine the efficacy of cognitive and physical interventions on cognitive function in HD. <h3>Methods</h3> Electronic databases (MEDLINE, EMBASE, PsycINFO, CENTRAL) were searched through till 10 May 2021 for interventional studies investigating the effect of cognition-oriented treatments and physical exercise on cognitive function in individuals with HD, compared to any control or no control. The primary outcome is change on objective measures of cognition. Additional outcomes include change in psychosocial, functional and neuroimaging measures. Variations of effects based on population and study factors will be considered. Risk of bias will be assessed using the Cochrane RoB 2 tool and ROBINS-I tool. Where appropriate, outcomes will be pooled using random-effects meta-analyses, heterogeneity will be examined using tau² and I² statistics, and moderators will be examined using meta-regression models. <h3>Discussion</h3> This review will systematically evaluate the efficacy of cognitive and physical interventions on improving cognitive function in HD. The eligibility criteria and planned analyses will allow for a comprehensive assessment of certainty in the evidence that will inform future trials and clinical practice. <h3>Registration</h3> This protocol was registered on PROSPERO (CRD42021259152).

ValueCare (2019-2024) was a project, funded by the Horizon2020, that was based on the implementation of the Value Based Healthcare (VBHC) model across Europe, delivering an efficient outcome-based integrated care for older people facing multiple chronic health conditions to improve their quality of life, as well as the sustainability of health and social care systems in Europe. The basic assumption of the VBHC model, which foresees the involvement and empowerment of patients and their families from the very beginning and at all stages, is that the value of care is the results obtained and the patient's experience divided by the costs and energy used to achieve these results (Carman et al. 2013). The oral presentation will aim (a) to highlight the process of applying the VBHC model (b) to show the results achieved in the 7 pilot sites supported by a scalable ICT solution and (c) to present the book, giving participants the opportunity to download it from the project website. In applying the VBHC model, 2 basic criteria were considered (a) the entire care cycle and (b) the adoption of a time and activity-based costing system (TDABC) (Kaplan &amp; Anderson, 2004) and inverse understanding value as the unit increase in investment, per citizen, required to stabilise or improve the given clinical condition. The healthcare practitioners’ experience component was included in the formula as an addendum to the variation in outcomes (Zanutto, Ceron &amp; Haat, 2024) and was measured using the Metro mapping tool: a method for designing and optimising care pathways, devised by Ingeborg Griffioen. The older people’s health outcomes were collected through self-reported questionnaires, which were developed on the ICHOM standards. Each pilot site had a different clinical condition and therefore could add additional evaluation questionnaires. An important assumption in the project was the attempt to apply the 6 building blocks of Porter's agenda (Harvard Business School, Institute for Strategy and Competitiveness): 1. Organise in integrated care practice units (IPUs). 2. Measure outcomes &amp; costs for every patient 3. Move to bundled payment for conditions 4. Integrate multi-site care delivery systems 5. Expand geographical reach 6. Build an integrated Information technology platform It is mentioned as an attempt because the results showed that 3 blocks were applied: the creation of IPUs, the measurement of outcomes and costs, and the creation of an integrated technology platform. The application of the remaining ones is part of the project's sustainability plan. In conclusion, the project proposed more efficient use of resources and coordination of care in a context that ensured the trust of users and policy makers on data access, protection and sharing and standardisation that can be replicated across the EU. The project thus awarded VBHC certification by the VBHC Center Europe in Amsterdam and published its results in the book ‘The ValueCare experience: Creating value for older people with chronic conditions in Europe with a transition towards outcome-based integrated care supported by technology’ edited by Oscar Zanutto, Sara Ceron and Hein Raat in September 2024.

This survey aimed to analyse healthy citizens (HC), cancer patients and their caregivers (CP&CG) perception about cancer care among six different Italian regions. The survey for HC was conducted by a multinational market research institute (IPSOS) through a computer-assisted web interviewing system, using a dataset of people who had consented to be interviewed for previous studies. CP&CG were interviewed by patient advocates using paper questionnaires. HC completed 1831 questionnaires between May and June 2019; CP&CG filled 1779 questionnaires between May and October 2019. 55% of all interviewees felt they were adequately informed about cancer, with no disparities between regions. Overall, population was satisfied with the National Health Care System (HCS), CP&CG more than HC, probably for their personal positive experience. There were different satisfaction levels between regions regarding components of the pathway of care, but agreement about health workers' 'human component'. Forty-three per cent of the interviewed were informed about genetic tests, 47% about innovative drugs. The percentage was greater among CP&CG (51% and 61% respectively). Italian people were overall satisfied with HCS although with significant different perceptions between regions. Moreover, some critical issues were highlighted as low adherence at screening invitation and genetic tests. Understanding people's perception regarding HCS is crucial to support health policies and to improve the performance of HCS.

High Blood Pressure in Sub-Saharan Africa: The Urgent Imperative for Prevention and Control.

Introduction: Memory impairment associated with age (DEMAE) is a relatively benign disorder, which can be quite common due to the fact that it is linked to normal aging and the evident increase in life expectancy in the world and national, with a larger population of elderly people and the consequent increase in chronic diseases, typical of this population segment.Objective: To evaluate the result of an educational intervention in patients with mild dementia and its impact on the quality of life of the caregiver. Methods: An educational intervention was carried out on patients with a diagnosis of mild dementia in the Madruga municipality from September 2015 to February 2016. The universe was made up of 110 elderly people. The sample consisted of 16 patients who were assigned to the study group together with the 16 caregivers and 16 to the control group by random assignment. Variables such as cognitive impairment, associated symptoms, and quality of life were controlled. The information was collected from interviews, caregiver surveys and the Minimental Test that were applied to the patients before and after the intervention. Results: The negativism, fear, distractibility and communication of patients improved. A slowing of cognitive decline was found in the study group and progressed in the control group. The caregiver's quality of life improved.Conclusions: Behavioral symptoms improved, the evolution of the disease was delayed in the study group and progressed in the control group. The caregiver's quality of life improved. Keywords: Dementia; quality of life; educative intervention.