EuroNews MRPH #18

EuroNews MRPH #18 has been released!

Enjoy the selection of articles written by residents from all over Europe here.

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Vienna Summer Meeting 2019

For the first time in EuroNet history a meeting will be organized in the Austrian Capitol of Vienna. The Vienna Organizing Committee would like to invite you to join us at the EuroNet Summer Meeting where we will focus on vulnerable communities.

Next to new things you will learn, the meeting is a great opportunity to meet and network with fellow residents from around Europe. The meeting and participation will help in strengthening the position of the public health residency program in Austria and increasing the visibility of the program and public health work in Austria.

And if that isn’t enough, join us and enjoy the great culture, music and cool urban vibes of one of the most hospitable cities on the planet!

Location / Venue

The meeting will be held at the Center for Public Health, Kinderspitalgasse 15, 1090 Vienna, location on the U6 line (underground, brown line) by the doorstep of U6 ALSER STRASSE station.

Schedule

There’s a draft available here.

Casa EuroNet / Where to stay

Hostel bookings are welcome at 1070 Vienna Hostel. With the code “Symposium 2019”, when booking through their website, they can make sure EuroNet participants will be staying in the same dormitories (Casa EuroNet style!). Price for a night, including sheets and breakfast buffet, is 20eur/person in a dormitory (or 23.50eur for a bunk bedroom for 2 people).

Transportation

Vienna boasts one of the best public transportation systems in the world (bus, tram, underground and in-city-train) and that basically you are 30-40 min away from any point in this city from wherever you are. The hostel is within walking distance from the venue (15 minutes), however if you want to take public transportation the single tickets price is 2,40€. Taking the train between the Vienna airport and the city centre costs around 4,80€.

Social Programme

A social programme is being organized, and you’ll have to wait a bit longer to get insight on it… but, for a taste of it: there will be a three course dinner (costing 23,50€, drinks not included).

 

[Registration is closed!]

Looking forward to see you in Vienna,
The Vienna Organizing Committee

 

Torino Spring Meeting 2019

Between the 11th and 13th of April we had our Spring Meeting in the lovely city of Turin, Italy.

There were interactive workshops, plenary sessions, working group meetings and a rich social programme! All that can be expected from a EuroNet meeting 🙂 It was a wonderful event, and we're so grateful to have shared these moments with all the attendees. See you soon for the Summer Meeting! Stay tuned for dates and location... soon...

Meanwhile, below you may see some of the pictures taken during the meeting. A big thank you to Jona Blatnik, a Slovenian resident, for her pictures.

Colorectal cancer screening: a Public Health priority in Portugal

In Portugal, as in the rest of Europe, the incidence of cancer has been steadily increasing at a rate of about 3% per year.1,2 This increase is mainly related to the aging of the population and with changes in habits and lifestyles.3

According to the 2018 edition of Health at a Glance: Europe report (Organization for Economic Co-operation and Development – OECD), Portugal has one the lowest avoidable mortality rates in Europe, reflecting greater efficacy in the treatment of patients.4

However, cancer disease remains the second leading cause of death in Portugal after cardiovascular disease5,6, and the leading cause of premature death (defined as death before the age of 70).7

Colorectal cancer is currently one of the major forms of cancer in the world, with significant mortality and morbidity associated. In general, it is more common in older people (most patients are over 60 years at the time of diagnosis, being unusual in people with less than 40 years), in males and in urbanized regions.

According to the latest data from the International Agency for Research on Cancer (World Health Organization), colorectal cancer is currently the third most frequent type of cancer in the world and the second largest cause of death by cancer.

In Europe, it is the second most common type of cancer and the second deadliest. In Portugal, it is the second most frequent type of cancer in males (18,8% of the new cases, after prostate cancer) and females (16,2% of the new cases, after breast cancer) but ranks first in the most prevalent types of cancer for both genders.8

In 2018, Portugal has diagnosed 10 270 new cases of colorectal cancer (more than 20 cases per day), corresponding to 17,6% of the total number of new cases of cancer in the country.8 Despite the increasing therapeutic success in oncological disease, the number of deaths caused by this type of cancer has been increasing, especially in the most advanced ages.5,6 It is currently the second most deadly type of cancer (following lung cancer), accounting for approximately 4214 deaths (about 12 individuals per day)8 and about 12 years of potential life lost.9

The reduction of the mortality and morbidity associated with oncological disease depends mainly on preventive strategies and the early detection of the disease. However, the early stages of colorectal cancer are usually asymptomatic or produce little symptoms. The first manifestation of disease is often the asymptomatic loss of small amounts of blood in the stool, not visible to the naked eye, making the early detection difficult. For this reason, many countries now offer systematic population screening programs.

Most cancers of the colon and rectum develop from polyps or adenomas. These lesions are benign but have a significant risk of developing dysplasia, and therefore are considered pre-malignant. The screening programs aim to detect cancer in its initial phase but also to identify and remove these precursor lesions.

Due to the increasing number of cases, the screening for colorectal cancer is now considered a Public Health priority in Europe, and Portugal makes no exception.

Although the significance of the colorectal cancer screening program is unanimously proven (it has the potential do reduce mortality rates by at least 20%)3, there is no international consensus on the methodology that should be used. The strategies vary according to the human and financial resources available and the characteristics of each country. The most validated diagnostic exams currently in use are fecal occult blood tests (FOBT), rectosigmoidoscopy and complete colonoscopy. The fecal immunochemical test (FIT) is currently the most commonly used primary screening test worldwide and has been shown to contribute to increased participation rates, with appropriate sensitivity and cost-effectiveness10.

Portugal follows the European guidelines and has been developing the foundations for the implementation of a comprehensive population screening program. Thus, in Portugal, screening should be offered to the asymptomatic population aged between 50 and 74 years. As in most European countries, the primary screening test is the FIT, performed every 2 years. The convocation of patients for screening is ensured through their General Practitioners11.

In case of a positive result in the FIT (cut off of 100 ng/mL), the patient should be referred for colonoscopy, under informed consent and within the scope of the Portugal National Health Service, in an average period of no more than 30 days.

The referral algorithm after colonoscopy varies depending on the result of the exam and is performed according to the recommendations of the European Society of Gastrointestinal Endoscopy (ESGE)11.

Population-based screening programs for cancer have evolved significantly in Portugal during the last few years, with expansion of the geographic coverage, increased numbers of patients screened, and significant improvement in adherence rates. However, screening for colorectal cancer continues to present low countrywide coverage (about 19%)1, with significant regional asymmetry.

Portugal is currently making efforts to extend colorectal cancer screening throughout the country and to create the channels to adequately screen all the eligible individuals. As a result of the acknowledgement as a Public Health priority and the ongoing efforts, it is expected that in a few years, Portugal will be able to effectively reduce this problem.

Fábio Ricardo Elias Sousa Gomes

PH resident Aveiro, Portugal

References:

  1. Portugal. Ministério da Saúde. Direção-Geral da Saúde. Programa Nacional para as Doenças Oncológicas 2017. Lisboa: Direção-Geral da Saúde; 2017.
  2. Portugal. Ministério da Saúde. Direção-Geral da Saúde. Direção de Serviços de Informação e Análise. A Saúde dos Portugueses 2016. Lisboa: Direção-Geral da Saúde; 2016.
  3. Portugal. Ministério da Saúde. Direção-Geral da Saúde. Relatório de Monitorização e Avaliação dos Rastreios Oncológicos 2016. Lisboa: Direção-Geral da Saúde; 2017.
  4. Organisation for Economic Co-operation and Development. OECD Health Division. Health at a Glance: Europe 2018. Paris: OECD Publishing; 2018.
  5. Portugal. Instituto Nacional de Estatística. Causas de morte 2016. Lisboa: Instituto Nacional de Estatística; 2018.

A National Immunisation Information System in Italy

The Ministry of Health has recently established a National Immunisation Information System (IIS), through the Ministerial Decree of 17 September 2018 published in the Gazzetta Ufficiale n. 257/20181. The aim of the electronic registry is to facilitate estimation of vaccine coverage, monitor the nation-wide implementation of the National Immunisation Plan (NIP) throughout the national territory; and to provide information both to the international bodies and for administrative tasks.

The need to create a single IIS from 21 regional registers was agreed upon in the State-Regions Conference of 19 January 2017, and highlighted on the National Immunisation Plan 2017-20192. The Ministerial Decree of 17 September 2018 defines the information that all Italian regions and autonomous provinces must provide to the Ministry of Health, including:

1) vaccinated individuals;

2) individuals to be vaccinated;

3) subjects already immunised after natural infection;

4) subjects temporarily or permanently exempted for health reasons;

5) doses and timing of administrated vaccines.

The IIS should be linked to the national databases of communicable diseases and adverse events.

The national IIS will aggregate individual records from the regional registries and, through a more precise estimate of vaccination coverage, will improve the monitoring activities of the programs in place, and identify areas where extraordinary interventions are required. Furthermore, in order to maintain updated regional vaccine registries, the national IIS will make available to the Regions information related to citizens who will modify their residence. The Ministry of Health will have access only to anonymised information. The first upload of files from the regional authorities is expected by April 2019.

The last update of Italian regional IISs characteristics and functionalities are presented elsewhere3.

 

Vincenza Gianfredi

PH resident,  University of Perugia, Italy

 

References:

1. Ministero della Salute [Ministry of Health]. Decreto del Ministero della Salute: Istituzione dell’Anagrafe nazionale vaccini [Decree of Ministry of Health: Establishment of a National Immunisation Information System] 17 September 2018 published in the Gazzetta Ufficiale n. 257/2018

2. Ministero della Salute [Ministry of Health]. Piano Nazionale di Prevenzione Vaccinale 2017-2019 [National Plan of Vaccination Prevention 2017-2019]. 3 Apr 2018. Rome: Ministry of Health; 2018. Available from: http://www.salute.gov.it/imgs/C_17_pubblicazioni_2571_allegato.pdf

3. D’Ancona F, Gianfredi V, Riccardo F, Iannazzo S. Immunisation Registries at regional level in Italy and the roadmap for a future Italian National Registry. Ann Ig. 2018 Mar-Apr;30(2):77-85. doi: 10.7416/ai.2018.2199.

Internships Team 2019 – Call for action!

Dear EuroNetters,

A new year has just begun and the new board is working hard to make 2019 another amazing one for EuroNet!

I want to start this first communication as new Internships Lead by thanking my predecessor Julio and all the people that have been working hard on the Internships projects during 2018, your work has been precious for the development of the 2019 plan, and any future collaboration on the new projects will always be truly appreciated.

The main goals for 2019 are resumable in the following points:

  • To increase the number of Internships applications
  • To develop new communication and application strategies about internships and mobility for Public Health residents inside the EU
  • To strengthen and expand collaboration with partners and with the National Associations of Public Health residents

The main actions to achieve these goals will require a strong involvement of endeavoured residents, not only those who already are actively participating to EuroNet activities (members of National Commissions), but also of those who still are not fully engaged, but play a role inside their National Associations or simply are interested in working on mobility and helping their colleagues achieving internships periods.

Another important action, in order to try to raise the number of possible positions, is to engage in new partnerships that could provide internships and trainings or grants for summer schools and similar projects. At the same time, strengthening the already existent collaborations, in continuity with the previous board´s excellent work, might also lead to new opportunities of this kind.

The main actions to achieve these goals will require a strong involvement of endeavoured residents, not only those who already are actively participating to EuroNet activities (members of National Commissions), but also of those who still are not fully engaged, but play a role inside their National Associations or simply are interested in working on mobility and helping their colleagues achieving internships periods.

Another important action, in order to try to raise the number of possible positions, is to engage in new partnerships that could provide internships and trainings or grants for summer schools and similar projects. At the same time, strengthening the already existent collaborations, in continuity with the previous board´s excellent work, might also lead to new opportunities of this kind.

The results of this work can contribute to the formation of a working group, to the creation of workshops about this theme or can be used for whatever other useful scopes that will cross our path.

So, to be short, the plan is settled, now I need YOU!!!

If you are interested in joining the Internships Team, just send me an email (internships@EuroNetmrph.org), I will be extremely pleased to welcome you in the team and we can start working together.

There is of course a lot of room for plan improvement and for you to add new ideas, the work to do is not little but it´s going to be fun, interesting and never overwhelming!

And keep in mind that during the meeting in Torino we will have time to know each other and have the chance to organize the main part of the work.

This call for action is of course open to any PH resident, whether this is the first time you are reading the newsletter or not, just join if interested or simply curious!

Join the Internships, Stay for the Net!

Internships Lead

Robin Thomas