There is considerable evidence regarding the efficacy and effectiveness of BRCA genetic testing programs, but whether they represent good use of financial resources is not clear. Therefore, we aimed ...to identify the main health-care programs for BRCA testing and to evaluate their cost-effectiveness.
We performed a systematic review of full economic evaluations of health-care programs involving BRCA testing.
Nine economic evaluations were included, and four main categories of BRCA testing programs were identified: (i) population-based genetic screening of individuals without cancer, either comprehensive or targeted based on ancestry; (ii) family history (FH)-based genetic screening, i.e., testing individuals without cancer but with FH suggestive of BRCA mutation; (iii) familial mutation (FM)-based genetic screening, i.e., testing individuals without cancer but with known familial BRCA mutation; and (iv) cancer-based genetic screening, i.e., testing individuals with BRCA-related cancers.
Currently BRCA1/2 population-based screening represents good value for the money among Ashkenazi Jews only. FH-based screening is potentially very cost-effective, although further studies that include costs of identifying high-risk women are needed. There is no evidence of cost-effectiveness for BRCA screening of all newly diagnosed cases of breast/ovarian cancers followed by cascade testing of relatives, but programs that include tools for identifying affected women at higher risk for inherited forms are promising. Cost-effectiveness is highly sensitive to the cost of BRCA1/2 testing.
Genet Med18 12, 1171–1180.
Highlights•Good knowledge is associated to positive attitudes on vaccines’ efficacy and safety. •Attitudes on usefulness and safety of vaccines influence future immunization choices. •Interventions ...are needed to increase vaccine acceptance in the antenatal period. •Health care professionals should strengthen their capacity to deliver information on vaccinations.
The appropriate application of genomic technologies in healthcare is surrounded by many concerns. In particular, there is a lack of evidence on what constitutes an optimal genetic service delivery ...model, which depends on the type of genetic test and healthcare context considered. The present project aims to identify, classify, and evaluate delivery models for the provision of predictive genetic testing in Europe and in selected Anglophone extra-European countries (the USA, Canada, Australia, and New Zealand). It also sets out to survey the European public health community's readiness to incorporate public health genomics into their practice.
The project consists of (i) a systematic review of published literature and selected country websites, (ii) structured interviews with health experts on the genetic service delivery models in their respective countries, and (iii) a survey of European Public Health Association (EUPHA) members' knowledge and attitudes toward genomics applications in clinical practice. The inclusion criteria for the systematic review are that articles be published in the period 2000-2015; be in English or Italian; and be from European countries or from Canada, the USA, Australia, or New Zealand. Additional policy documents will be retrieved from represented countries' government-affiliated websites. The results of the research will be disseminated through the EUPHA network, the Italian Network for Genomics in Public Health (GENISAP), and seminars and workshops.
The transfer of genomic technologies from research to clinical application is influenced not only by several factors inherent to research goals and delivery of healthcare but also by external and commercial interests that may cause the premature introduction of genetic tests in the public and private sectors. Furthermore, current genetic services are delivered without a standardized set of process and outcome measures, which makes the evaluation of healthcare services difficult. The present study will identify and classify delivery models and, subsequently, establish which are appropriate for the provision of predictive genetic testing in Europe by comparing sets of process and outcome measures. In this way, the study will provide a basis for future recommendations to decision makers involved in the financing, delivery, and consumption of genetic services.
We evaluated whether genetic tests with evidence of clinical and personal utility (i.e. APC and BRCA1/2 tests) are associated with higher satisfaction and a more positive perception of care ...experience than those with undefined utility (i.e. tests for thrombophilia). A cross-sectional survey was performed through telephone interviews to patients tested for deleterious variants in APC or BRCA1/2 genes, or for inherited thrombophilia (FV Leiden and/or FIIG20210A) during a 5-year period (2008-2012). Three aspects of patient experience were assessed: effective communication through pre- and post-test genetic counselling; collaboration between caregivers on the management of patient care; and impact of genetic testing on quality of life. Overall 237 patients had telephone interviews. Multivariate logistic regression analyses showed that patients tested for APC or BRCA1/2 variants were more likely to be satisfied with both pre- and post-test counselling than those tested for inherited thrombophilia (APC vs. thrombophilia, p = 0.039 and 0.005; BRCA1/2 vs. thrombophilia, p = 0.030 and <0.001). Patients tested for APC were more likely to report an improvement in quality of life than those for thrombophilia (OR = 2.97, 95%CI 1.14, 7.72; p = 0.025). A positive association was observed between patients who underwent BRCA1/2 testing, and self-perceived improvement in quality of life (OR = 1.41, 95%CI 0.74, 2.69; p = 0.294). Tests of undefined clinical and personal utility are associated with a lower degree of patient satisfaction with genetic counselling and no clear opinions on changes in quality of life compared with those with well-defined utility.
Advanced education in nursing is essential to provide safe, high quality and efficient health services in line with population needs. However, there is an almost complete lack of studies on how ...nurses view the usefulness of post-graduate education for their current employment and for professional advancement.
To evaluate how nurse graduates view the quality, relevance and applicability of the knowledge and skills acquired during the Master of Science in Nursing (MSN) degree.
Multicentre cross-sectional study.
A multicenter cross-sectional study was carried out through an online questionnaire mailed (July 2014–June 2015) to 560 nurses who obtained the MSN degree from 23 Italian universities in the academic year 2010–2011.
A total of 426 nurses completed the survey (response rate 76.1%), 80% of whom believed they had acquired knowledge and skills useful in their professional life after graduation. A multiple logistic regression model highlighted the characteristics of nurse graduates who judged the master's course relevant for their present role. In brief, they are expert nurses (OR=3.41, 95% CI=1.54–7.54) who achieved professional growth after the course (OR=5.25, 95% CI=2.67–10.33) and who judged the course very good or excellent (OR=2.16, 95% CI=1.04–4.52). Only 8% of the respondents achieved a full professional growth after the course.
In Italy, MSN courses are able to provide a high level of skills and competencies. However, given the low rate of professional growth after the course, specific policies should increase the employment rates of new master's graduate nurses.
•Few studies analyze quantitatively how nurses perceive the utility of their advanced education.•The course allowed respondents to acquire knowledge and skills useful for their job.•Nurses and midwives encounter difficulties to put into practice knowledge and skills acquired.•Nurses and midwives should be encouraged to take higher degree courses.•Specific policies to increase career advancement and to enlarge the pool of nursing faculty should be implemented.
This article was originally published under an incorrect license. This has now been amended and is available under a CC BY-NC-ND 4.0 license. The PDF and HTML versions of the paper have been modified ...accordingly.
Health promotion and prevention activities should tackle health inequalities to reduce disparities in health among disadvantaged populations. This study aimed to assess the extent to which the ...Italian Regions considered health inequalities during the planning of prevention activities, to detect geographical differences and to identify the possible determinants of differences in attention to health inequalities.
The 19 Regional Prevention Plans (RPPs) developed by Italian Regions within the National Prevention Plan (NPP) 2010-2013 were assessed using a specific tool to address the level of attention to health inequalities. Univariate and multivariate analyses were performed to identify regional characteristics associated with a higher level of attention to health inequalities.
Of the 702 projects included in the 19 RPPs, only 56 (8.0 %) specifically addressed issues related to health inequalities. The results of the multivariate analysis showed that a higher level of attention was associated with the macroarea of intervention 'prevention in high-risk groups', with the higher quality of the Strategic Plan Section of the RPP and with the higher percentage of migrants in the Region in 2010. Moreover, projects that addressed the topic of health inequalities were more likely to be developed in the Northern Regions, in Regions with a lower level of 'linking social capital' and with a Higher Regional Health Care Expenditure (RHCE) as a percentage of Regional Gross Domestic Product (RGDP) in 2010.
The level of attention to health inequalities in the regional planning process of prevention activities 2010-2013 in Italy is low. The results of this study supported the new round of prevention planning in Italy, and highlight the urgent need to increase the number of policies and interventions able to reduce health inequalities.
Background. Literature on the evaluation of the Master’s Degree in Nursing is scarce. The objective of this pilot study was to test a questionnaire aimed at monitoring the activities of nurses after ...receiving the Master’s degree.
Methods. An electronic questionnaire was administered to 36 graduates who obtained the Master’s degree during the academic year 2010/2011.
Results. Almost 80% of the participants judged their level of improvement in knowledge and skills during the course to have been satisfactory, but the level of implementation of these competencies at work was quite low.
Conclusion. Competencies acquired during the Master’s degree course are not always put into practice.
Currently web health portals are moving away from providing institutional and administrative types of information towards a more interactive type of communication focused on providing citizens and ...health care professionals various services associated with health promotion and on facilitating access to healthcare services. The aim of this study was to provide guidance in the planning and conduction of online health promotion and protection communication activities that will contribute to the process of community empowerment repeatedly called upon by the WHO. For this purpose, the authors conducted an analysis of the epidemiology of the determinants of health and disease in Italy as well as two systematic revisions of the literature regarding web-based health information needs of citizens and the efficacy of health promotion and preventative interventions administered via the internet. Although current scientific evidence suggests that some interventions (e.g. expert systems or tailored interventions) are more effective with respect to others (e.g. online support groups or other types of interventions), common sense suggests that public health computer platforms such as the " citizens' channel" of the Ministry of Health web portal should implement hybrid models, i.e. models that contain various types of interventions, and should provide access to both general information and to interactive and personalized programs.
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