Littérature scientifique sur le sujet « Health, sustainability, Lombardia »

Objective: International agencies report the importance of health promotion in planning educational strategies and school management in response to the COVID-19 pandemic. This study aimed to identify the benefits of using a Health Promoting School (HPS) approach to guide educational and school policy during the COVID-19 epidemic in Italy, the main objectives and practices to be implemented, and the challenges likely to be faced. Design: A three-phase qualitative and participatory approach: (1) identification of study objectives and relevant data, (2) data collection through an online form using open-ended questions (14 participants), and (3) online meetings to analyse the findings and reach consensus (17 participants). Setting: Educational leaders from the HPS Network in the Lombardy region in northern Italy participated in the study. Method: Qualitative content analysis was undertaken. Answers were coded into meaningful units and then grouped under higher-order headings. Codes, subcategories, categories and themes were identified. Results: Results suggested high potentiality, significance and sustainability of the HPS model during the pandemic. Objectives and actions relevant to each HPS component were identified. Adaptations to content and methodology, timing, continuity and inequalities requiring specific forms of intervention were identified. Conclusion: This study sought to develop an HPS model relevant to implementation during the COVID-19 epidemic and identified specific lines of action during this challenging period.

Abstract. Scientific evidence has demonstrated that deterioration of ambient air quality has increased the number of deaths worldwide by appointing air pollution among the most pressing sustainability concerns. In this context, the continuous monitoring of air quality and the modelling of complex air pollution patterns is critical to protect population and ecosystems health. Availability of air quality observations has terrifically improved in the last decades allowing – nowadays – for extensive spatial and temporal resolved analysis at both global and local scale. Satellite remote sensing is mostly accountable for this data availability and is promising to foster air quality monitoring in support of traditional ground sensors measurements. In view of the above, this study compares observations from the Sentinel-5P mission of the European Copernicus Programme (the most recent Earth Observation platform providing open measurements of atmospheric constituents) with traditional ground measurements to investigate their space and time correlations across the Lombardy region (Northern Italy). The correlation analysis focused on nitrogen dioxide. The use of data collected during the COVID-19 pandemic allowed for a parallel exploration of the lockdown effects on nitrogen dioxide emissions. Results show a marked decrease in nitrogen dioxide concentrations during the lockdown and an overall strong positive correlation between satellite and ground sensors observations. These experiments are preparatory for future activities that will focus on the development of satellite-based air quality local prediction models, aiming at improving the granularity of the ground-based information available for air quality monitoring and exposure modelling.

Abstract Introduction: Neoadjuvant pertuzumab+trastuzumab+chemotherapy (TPC) combo is a well established treatment for HER2+ high-risk (EBC) as recommended by International and National guidelines. However, notwithstanding EMA approval, in some European countries (i.e Italy and France) pertuzumab drug-access is prevented by the NHS decision not to reimburse the drug in a value-driven sustainability balance. This study aims to estimate the cost and consequences of TPC vs. the same combo w/o pertuzumab (TC) in the neaodjuvant treatment of high-risk HER2+ eBC to better understand the value of TPC regimen. Methods: With a Markov model, we simulated the costs and consequences associated to TPC or TC neoadjuvant treatments, using 5 years time horizon and Italian Lombardy region Health System point of view. The model includes nine health states: Neoadjuvant treatment; Surgery; Invasive disease-free Survival (IDFS) with pathological complete response (pCR), IDFS with residual disease (RD), non-metastatic recurrence, remission, first-line treatment and subsequent-lines for metastatic cancer, and death. Transition probabilities and utilities were derived from relevant clinical trials and literature. For each neoadjuvant treatment, the model estimates: direct (drug, administration, hospitalization, disease management), indirect (patients’ loss of productivity), total costs and different outcomes, as cumulative incidence of metastatic recurrence, days of work lost, days with activity impairment, IDFS life years, and quality adjusted life years (QALY). Costs and outcomes were estimated per 100-treated patients. An alternative scenario analysis with a 10-year time horizon and a deterministic sensitivity analysis was performed to assess the impact of model time horizon and parameters value. Results: The estimated costs and outcomes for TPC and TC are reported in Table 1. TPC produces a total direct cost reduction of €75,630 per 100-treated patients, a small increase of TPC neoadjuvant treatment costs (+4.8%) is offset by the lower cost of metastatic treatment and management (-20.4%). Considering also the indirect costs, TPC is associated to a cost reduction of €124,956 per 100-treated patients. The cost saving is associated to a reduction of 5-year cumulative incidence metastatic recurrence (8.32% vs 10.42%, -20.14%), a reduction of days of work loss (-548 days) and days with activity impairment (-283 days) and a 10.5 QALY gained per 100-treated patients. Using a 10-year time horizon, the value of TPC compared to TC increases. Probabilities of pCR with TPC and TC were the parameter with the higher impact on model results. Conclusion: Use of TC instead of TPC in high-risk HER2+ EBC derives a marginal savings (4.8%) according to the first year of our cost-consequence analysis. However, this negligible savings comes with the need for a heavily and long-lasting adjuvant cytotoxic therapy escalation because of a lower clinical activity of TC vs TPC. Moreover, according to medium-term cost-consequence analysis (5 years) the early negligible savings is overwhelmed by the subsequent increase in costs for the patients’ management, because of the lower clinical efficacy of TC vs. TPC. In Italy, the lack of pertuzumab in the neoadjuvant setting of high-risk HER2+ eBC is questionable; our results support the opportunity to reconsider the pertuzumab availability in Italy and reduce inequalities within Europe. Cost and consequences of neoadjuvant treatments for high-risk HER2-Positive Early-Stage Breast Cancer: trastuzuamb+pertuzumab+chemotheraphy (TPC) vs trastuzumab+chemotheraphy (TC) IDFS, Invasive disease-free Survival; QALY, quality adjusted life years. Citation Format: Alberto Zambelli, Marina Elena Cazzaniga, Nicla La Verde, Elisabetta Munzone, Ippazio Cosimo Antonazzo, Lorenzo Giovanni Mantovani, Anna Mancuso, Daniele G. Generali, Paolo Angelo Cortesi. A cost-consequence analysis of pertuzumab in the neoadjuvant treatment of high-risk HER2+ Early-Stage Breast Cancer (EBC): health-economic considerations for drug availability in Italy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-01.

Introdução: As plantas medicinais são capazes de fornecer fármacos de grande importância clínica, a exemplo dos monoterpenos. Estes são conhecidos por apresentarem uma variedade de efeitos em diferentes sistemas biológicos, justificando a necessidade de pesquisas para investigação do potencial terapêutico e tóxico. Com o avanço tecnológico, modelos in silico vêm sendo amplamente aplicados para a avaliação de potenciais atividades farmacológicas e de toxicidade de compostos em ambientes metabólicos de mamíferos. Objetivo: Avaliar os efeitos farmacológicos e toxicológicos do monoterpeno Neral com finalidade odontológica, utilizando uma metodologia in silico. Metodologia: Inicialmente utilizou-se o software Pubchem® para o desenho da molécula, em seguida a análise da probabilidade da atividade da molécula foi realizada com o software Pass Online®. Na análise dos parâmetros farmacológicos, foi avaliado a biodisponibilidade oral teórica do Neral, pela “Regra dos Cinco” de Lipinski com o software Molinspiration Cheminformatics. Finalmente, os parâmetros toxicológicos bem como o estudo teórico sobre o efeito carcinogênico, o teste de AMES e a toxicidade oral aguda foi efetuada no programa admetSAR. Resultados e Conclusão: No Pass Online a molécula do Neral possui 14 possíveis atividades farmacológicas relacionadas à Odontologia, dentre elas potencial antifúngico, anti-inflamatória e antibacteriana; no Molinspiration a molécula do Neral demonstrou estar de acordo com as cinco regras propostas por Lipinsk, logo, apresentando boa biodisponibilidade oral teórica e, pelo teste de toxicidade do admetSAR, apesar de apresentar baixo risco de toxicidade teórica oral, revelou leve potencial carcinogênico.Descritores: Disponibilidade Biológica; Toxicidade; Plantas Medicinais; Odontologia.ReferênciasLima GR. 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The cœteris paribus trend of growth of the Lombardia Hospital System epidemiological, demographic, economic and financial variables analyzed in this research in the period 1997-2009 is not sustainable in the long-term, for the purpose of this research to the year 2050. Even if in the period 2002-2009 some financial and epidemiological adjustment has indeed been attempted (as highlighted by the Financial Function), in particular with yearly activity budgetary financial constraints and compulsory transfers from acute to ambulatory care (as highlighted by the Epidemiological Function), by means of which short-term financial equilibrium has temporarily been maintained, this same adjustment does not guarantee long-term epidemiological, demographic, economic and financial sustainability (as highlighted by the Sustainability Function). The Italian Ministero dell’Economia e delle Finanze is indeed intervening in curbing the growth rate of public health expenditure by fixing it at a definite percent of the national gross domestic product (circa 7.2%). Most of the savings are based on the reduction of personnel. Since health funds are pooled and equally allocated on a risk adjusted capitarian basis, the same savings will be required on the part of Lombardia. However, if savings are to be made, the underlying epidemiological trends (increase in complexity, invariance in the acute inpatient cases length of stay, increase in intensity), as highlighted by the Epidemiological Function, have to be addressed as well, which introduces the bi-faced question if such savings are sustainable or if their epidemiological effects are acceptable. If there is an almost general consensus among both health operators and regulators in Italy and Lombardia that both effectiveness and efficiency are the main drivers of the long term sustainability of a health system, it appears from the first applications of the model presented here that the Italian and Lombardia Hospital System is still governed by a tendency to manage the short term effects of rising medical, labor and variable costs in general, than by a much more challenging direct intervention into the epidemiological and operational parameters governing the health system in the long term. Certainly, an excellent clinical effectiveness has been achieved, even if, in order to be sustainable in the long term, increases in clinical quality must be proportional to the reduction in the economic waste of financial resources, both in the form of excess costs of the public providers and excess profits in the private ones. Once again, the authors of this paper argue that there can be no health without equity, no equity without quality, and no quality without sustainability.