Establishing a Pulmonary Nodule Clinic Service for Early Diagnosis of Lung Cancer - Review of International Options and Considerations for Greece.

Early diagnosis of lung cancer in pulmonary nodules identified by computed tomography (CT) may be critical in reducing the epidemiological burden of the disease, particularly in countries where such a burden is considerably high and risk factors for lung cancer very prevalent. The establishment and operation of pulmonary nodule clinics (PNCs), ie, multidisciplinary services that watch and evaluate nodules found through deliberate screening efforts or as incidental findings, is increasingly becoming a key tool to implement such early-intervention, cancer-risk management policies elsewhere in the world. This review aims to research and present in a structured manner findings from published sources on options and considerations for setting up a PNC in a country such as Greece. These refer to the type of services a PNC would provide to optimize diagnosis of suspect pulmonary nodules, its structure and organization, including processes, human resources and technology infrastructure, its target audience, ie, who would be eligible to use its services, and the expected outcomes of its operation, in terms of a set of key performance indicators. Our review also revealed critical key success factors that should be considered when designing the introduction of a PNC in a health care setting, including optimal referral pathways, aligned clinical decision making and patient preferences and participation/empowerment. Our findings may inform health care systems with a high lung cancer burden and no available PNC service on options and considerations before introducing such a service in their respective settings.

Health Literacy in Individuals at Risk for Alzheimer's Dementia: A Systematic Review.

BACKGROUND: Health literacy (HL) refers to the capacity to access, understand, appraise and apply information for decision-making and acting in health-related matters. In the field of Alzheimer's disease (AD), expanding technologies of early disease detection, disease course prediction and eventually personalized prevention confront individuals at-risk with increasingly complex information, which demand substantial HL skills. Here we report current findings of HL research in at-risk groups. METHODS: Search strings, referring to HL, AD, amyloid and risk, were developed. A systematic review was conducted in PUBMED, Cochrane Library, PsycINFO, and Web of Science to summarize the state of evidence on HL in at-risk individuals for Alzheimer's dementia. Eligible articles needed to employ a validated tool for HL, mention the concept or one dimension (access, understand, appraise and apply information for decision-making and acting). RESULTS: 26 quantitative and 9 qualitative studies addressing at least one dimension of HL were included. Overall, there is evidence for a wish to gain knowledge about the own brain status and risk of dementia. Psychological distress may occur and the subjective benefit-risk estimation may be modified after risk disclosure. Effects on lifestyle and planning may occur. Overall understanding and appraisal of information related to AD risk seem variable with several impacting factors. In mild cognitive impairment (MCI) basic HL skill seem to be affected by cognitive dysfunction. CONCLUSIONS: Systematic assessment of HL in at-risk population for AD is sparse. Findings indicate the paramount importance of adequate communication with persons at risk, being sensitive to individual needs and preferences. Substantial research needs were identified.

Fear of catastrophic health expenditures and unrealistic expectations from supplementary health insurance: ethnic differences.

BACKGROUND: In Israel, the whole population is covered by comprehensive universal health insurance. Despite that, most of the population purchases supplementary health insurance (SHI). It has been shown that individuals purchase more health insurance and preventive medicine when they are uncertain of their state of health, while a majority may not fully understand basic concepts in their health insurance coverage. The purpose of this study was to examine the role of fear of catastrophic health expenditures and unrealistic expectations in purchasing SHI, which does not cover expenses for life-threatening illnesses. METHODS: A cross-sectional survey was conducted among random samples of 814 Jews and 800 Arabs in Israel. A structured questionnaire was administered by telephone using random digit dialling. Log-linear regression was used to identify factors associated with reasons for purchasing SHI and expectations from SHI. RESULTS: The most common reason for purchasing SHI was fear of catastrophic health-related expenditures (41%). The most important service expected from SHI was 'cancer medications' (mean 4.68 [standard deviation 0.87]). Differences in the reasons for purchasing SHI and in expectations from SHI were found according to population group, age, gender and education. CONCLUSIONS: Consumers' misconceptions and fear of catastrophic health expenditures are major factors leading to the purchase of SHI, despite universal health coverage. Improved and accessible information should help consumers make informed decisions as to whether or not to purchase SHI.

Participación en la toma de desiciones sanitarias por parte de los menores de edad según desarrollo moral, y marco normativo venezolano / Participation in health decisions by minors under development moral and legal framework for Venezuela

El presente artículo tiene como propósito establecer la participación que pueden tener los menores de edad en la toma de decisiones en la práctica sanitaria, según su desarrollo moral y el marco normativo venezolano. En los procedimientos se realizó la revisión bibliográfica, desde los clásicos hasta lo más reciente sobre el tema y se aplicó un método analítico. Se concluyó: que es fundamental una deliberación participativa con el menor, incluyéndolo en un proceso serio, honesto y sincero que exige escuchar al niño antes de los 12 años y solicitar su asentimiento de 12 a 17 años; los niños y adolescentes, pueden llegar a tomar decisiones con la adecuada ayuda por parte de familiares, equipo de salud, y otros expertos, que los apoyen en el desarrollo de una comprensión de los problemas y en la demostración de su capacidad de decisión, promoviendo el desarrollo de su independencia y responsabilidad; los profesionales de la salud requieren de formación ética y psicológica, para lograr una verdadera relación de ayuda en función del bienestar superior para con sus pacientes menores de edad y sus familiares

This paper aims to establish the participation that may have minors in decision-making in health care practice, according to their moral and legal framework in Venezuela. The procedures conducted the literature review, from the classics to the latest on the subject and applied an analytical nematode. It concluded that participatory deliberation is essential to the child, including it in a serious process, honest and sincere that requires listening to the child before age 12 and apply for consent from 12 to 17 years, children and adolescents, may reach appropriate decisions with help from family, health team and other experts to support them in developing an understanding of the problems and to demonstrate the ability of decision, promoting the development of independence and responsibility, health professionals require ethical and psychological training to achieve a real relationship based aid to higher welfare with their minor patients and their families

Doenças infecciosas emergentes e a emergência das doenças: uma revisão conceitual e novas questões / Emerging infectious diseases and the emergence of diseases: a conceptual revision and new issues

Contrariamente às expectativas de erradicação das doenças infecciosas, constata-se a emergência, mundial, de doenças desconhecidas para a ciência ou consideradas erradicadas ou sob o controle dos serviços de vigilância epidemiológica. Neste artigo, pretende-se caracterizar o debate sobre as doenças infecciosas emergentes e analisar o conceito difundido pelas publicações dos Centros de Controle e Prevenção de Doenças (CDC) dos Estados Unidos e pelas contribuições das ciências humanas. A revisão da literatura nacional e internacional sobre a temática aponta as ambiguidades na definição das categorias "doença nova" e "doença emergente" e as diferenças entre o conceito de doenças infecciosas emergentes e o estudo da emergência das doenças. Enquanto o primeiro inclui o estudo de infecções específicas e foca a análise no organismo, no paciente e na população humana, o segundo, menos trabalhado, envolve as dimensões epistemológicas do conhecimento médico e da ecologia das doenças infecciosas emergentes, no nível sistêmico (no ecossistema e populações de parasitos e hospedeiros, quaisquer que sejam as espécies, e no comportamento sociocultural), e demanda a integração de várias disciplinas acadêmicas.

Contrary to expectations concerning the eradication of infectious diseases, it has been emerged, diseases worldwide that were unknown to science or considered to be eradicated or under control by epidemiological surveillance services. In this paper we outline the emergent infectious diseases debate and analyze the concept spread through publications from the Centers for Disease Control and Prevention (CDC) of the United States and through human science point of view. The review of national and international literature suggests some ambiguities in the definition of the categories "new disease" and "emerging disease" and the differences between the concept of emerging infectious diseases and the study of the emergence of diseases. Whilst the first concept includes the study of specific infections and focuses the analysis on the organism affected, on the patient and on the human population; the second concept - less studied - encompasses the study of the epistemological dimensions of medical knowledge and the ecology of emerging infectious diseases. This concept focuses on the systemic level - on the ecosystem and populations of parasites and hosts (whatever the species) and on the socio-cultural behavior - and demands the integration of various academic disciplines.

Acceso a los servicios de salud en seis ciudades de Colombia: limitaciones y consecuencias / Access to health services in six Colombian cities: limitations and consequences

Objetivo comprender las características del acceso al Sistema General de Seguridad Social en Salud (SGSSS), desde la perspectiva de los médicos, enfermeras, administradores y usuarios. Metodología: bajo la teoría fundada se presenta un estudio realizado en seis ciudades de Colombia: Barranquilla, Bucaramanga, Bogotá, Leticia, Medellín y Pasto, para la cual se realizaron entrevistas en profundidad a profesionales de la salud vinculados en la prestación de servicios y grupos focales con usuarios de los servicios. Resultados: los hallazgos señalan que el aseguramiento se convirtió en un fin en sí mismo y estar afiliado al SGSSS no garantiza el acceso efectivo a los servicios. El predominio del mercado, la rentabilidad financiera de las aseguradoras, impone mecanismos de contención de costos por encima del derecho de la salud. Hay limitaciones desde las normas, los planes de beneficios que generan barreras administrativas, geográficas, económicas y culturales desde los diferentes actores involucrados en la cadena de las decisiones. Adicionalmente, se visualizan carencias éticas individuales e institucionales, el clientelismo y la corrupción en el manejo de los recursos, que sumados a la pobreza y dispersión geográfica de algunas comunidades, hacen que se limite aún más el acceso a los servicios de salud.

Objective: To understand the characteristics of access to the General System of Social Security in health (SGSS), from the perspective of doctors, nurses, administrators and users. Results: The findings indicate that insurance has become an end in itself, and being affiliated that insurance has become an end in itself, and being affiliated to SGSSS does not guarantee effective access to services. The dominance of the market, the financial profitability of insures, imposed cost-containment mechanisms over the right to health. There are limitations from the rules, benefit plans that create geographical, economic and cultural barriers from the various actors involved in the chain of decisions. Additionally, display individual and institutional ethical shortcomings, clienteles and corruption in the management of resources, coupled with poverty and geographical dispersion of communities, mean that further limiting access to health services.