Community care reform in Italy: Get a move on Garattini, Livio; Badinella Martini, Marco; Nobili, Alessandro
European journal of internal medicine,
07/2022, Letnik:
101
Journal Article
The COVID-19 pandemic has put under pressure all the health national systems in Europe and telemedicine (TM) has been an almost unavoidable answer for primary care (PC) services to constrain the ...contagion. PC includes all the healthcare services that are the first level of contact for individuals. General practitioners (GPs) are the pivotal providers of PC throughout Europe. Although GP costs are mainly covered by public services or social insurances in Europe, they are still self-employed physicians everywhere, differently from their colleagues in hospitals who are traditionally employees. TM is a very general term open to various interpretations and definitions. TM can now be practiced by means of modern audio-visual devices and is an alternative to the traditional face-to-face consultation in general practice. Although the adoption of TM seems to be compelling in our era, its practical dissemination in PC has been quite slow so far, and many different concerns have been raised on it. On the whole, TM widespread adoption in PC seems to be more a matter of labor organization and health care funding than of technology and ethics. Larger-scale organizations comprising a wide range of health professionals have become a pressing priority for a modern PC, because working together is crucial to provide high-quality care to patients, and co-location should boost teamwork and facilitate the management of information technology. A national network of large organizations in PC could be rationally managed through local budgets and should increase efficiency by adopting tools such as TM.
Integrated Care in Europe: Time to Get it Together? Garattini, Livio; Badinella Martini, Marco; Nobili, Alessandro
Applied health economics and health policy,
03/2022, Letnik:
20, Številka:
2
Journal Article
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Nowadays integrated care (IC) has become a term adopted across the world underpinning a positive attitude toward defragmentation of service provision inside health and social systems 1.Since lack of ...healthcare coordination is often a major problem for chronic and frail patients, integration has certainly commendable aims 2. Striving for combining parts to form a whole, IC aims at optimizing care and treatments to patients and their caregivers 3. However, while the principles supporting IC are simple, their implementation is more controversial 4. As it often happens in the health literature, IC has rapidly become an umbrella concept open to various interpretations 5. After the launch of an international journal in 2000 including IC in its name, a search conducted a decade later had already found more than 175 definitions 6. Recently, even the European office of the World Health Organization (WHO) issued a working document to provide conceptual clarity on IC models 7. Here, we summarize the current narrative and the main issues of IC. Then, we draw lessons for Europe and finally put forward a few recommendations in the perspective of a long-term harmonization in the European Union (EU).
Despite the fact that vaccine resistance has been typically considered a rare phenomenon, some episodes of vaccine failure have been reported with increasing frequency in intensively-raised ...livestock. Infectious bronchitis virus (IBV) is a widespread avian coronavirus, whose control relies mainly on extensive vaccine administration. Unfortunately, the continuous emergence of new vaccine-immunity escaping variants prompts the development of new vaccines. In the present work, a molecular epidemiology study was performed to evaluate the potential role of homologous vaccination in driving IBV evolution. This was undertaken by assessing IBV viral RNA sequences from the ORF encoding the S1 portion of viral surface glycoprotein (S) before and after the introduction of a new live vaccine on broiler farms in northern-Italy. The results of several biostatistics analyses consistently demonstrate the presence of a higher pressure in the post-vaccination period. Natural selection was detected essentially on sites located on the protein surface, within or nearby domains involved in viral attachment or related functions. This evidence strongly supports the action of vaccine-induced immunity in conditioning viral evolution, potentially leading to the emergence of new vaccine-escape variants. The great plasticity of rapidly-evolving RNA-viruses in response to human intervention, which extends beyond the poultry industry, is demonstrated, claiming further attention due to their relevance for animal and especially human health.
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