Though Health Technology Assessment (HTA) has steadily grown over the past decades, less attention has been paid to the way HTA may prove more responsive to the broader economic, social, and environmental challenges that health systems are facing today. In view of climate change, chronic diseases, an aging population, inequalities, and workforce issues, the HTA community’s unique set of skills nonetheless holds great potential to help decision-makers strengthen many publicly funded health systems around the world.

This article adopts an integrated system-wide perspective guided by the Responsible Innovation in Health (RIH) framework to explore how the HTA community may not only adapt to the speed of innovation but also consider its direction.

Because RIH aims to steer innovation toward a more sustainable pathway, it can help HTA agencies anticipate decision-makers’ informational needs regarding four systemic challenges: (1) equitable access; (2) workforce issues; (3) accountable policy trade-offs; and (4) environmental sustainability. We clarify how key elements of the RIH framework may be used by HTA agencies to: (1) supplement their evaluation process; (2) align their priority-setting or strategic planning activities with their health system challenges; or (3) inform the production of early HTAs, horizon scans, or reports that are broader in scope than a single technology review.

The article concludes with three practical implications that were identified by the Institut National d’Excellence en Santé et Services Sociaux (INESSS) (Québec, Canada) and may inspire other HTA agencies.

To characterise food group consumption, assess the contribution of food groups to energy and micronutrient intake, and estimate usual nutrient intake among adults in rural Sri Lanka.

A baseline survey (December 2020–February 2021) was conducted as part of an agriculture-based, nutrition-sensitive resilience program evaluation. Dietary intake was assessed using telephone-based 24-h recalls (n 1283), with repeat recalls from 769 participants. Mean daily intake of food groups and their contribution to energy and nutrient intakes were calculated. The National Cancer Institute method was used to estimate usual intakes and the prevalence of adequate micronutrient intake (PAI). Differences by sex, district, and wealth were assessed using t tests and ANOVA.

Forty-five rural villages throughout Sri Lanka.

Men and women from households in the program evaluation study area.

On average, grains and coconut milk provided 56 % and 12 % of energy, respectively. Rice, fish, dairy, and pulses were the primary sources of micronutrients. Participants consumed 118 ± 117 g of vegetables and 71 ± 243 g of fruit per day. PAI was < 25 % for calcium, zinc, niacin, folate, and vitamins B6, B12, and C, reflecting low consumption of animal-source foods (80 g/day), whole grains, fruit, and vegetables (F&V). Significant differences in food group consumption by socio-demographic subgroup were observed among districts and wealth quintiles.

We observed high consumption of rice and coconut milk and low prevalence of micronutrient adequacy. We recommend increasing animal-source food, whole grain, and F&V consumption to close nutrient gaps, as well as research to identify effective solutions to increase micronutrient intake.

Improving access to and quality of maternal and infant healthcare are important leverage points to address worsening maternal and infant health disparities in the USA. This study evaluates the comprehensiveness of existing maternal and infant quality-of-care measures to identify aspects of quality that need greater attention in quality measurement.

We conducted a structured, team-based qualitative review of 88 maternal and infant health measures indexed by the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare and Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA). We assessed discrete elements relevant to meaningfulness, feasibility, and usability following AHRQ National Quality Strategy (NQS) criteria, with input from researcher, clinician, and citizen scientist investigators. Descriptive statistics on coded measures were calculated using SPSS.

The most common AHRQ NQS priorities addressed were mortality (60%) and safety (48%). Average scores across elements were 59% for feasibility, 61% for practice usability, and 31% for policy usability. Fewer measures addressed coordination, affordability, or patient engagement in the postpartum period. Only 23% of measures were endorsed by NQF, only 17% of measures had publicly available benchmarks, and only 14% had specifications updated in the year prior to review.

Findings from this study can inform the specification of a comprehensive, updated system for maternal and infant quality-of-care evaluation and can facilitate the development of new quality-of-care measures that address underrepresented maternal and infant health issues.

Sustained alcohol intake, when combined with incomplete treatment, can result in chronic structural changes in the Central Nervous System, including generalized cortical and cerebellar atrophy, amnesic syndromes like Korsakoff’s syndrome, and white matter disorders such as Central Pontine Myelinolysis and Marchiafava-Bignami syndrome. It is crucial to prevent these complications due to their potential for irreversible and debilitating consequences. For Wernicke-Korsakoff syndrome, early recognition and thiamine administration for prevention are paramount, as it arises from thiamine deficiency due to malnutrition caused by persistent alcohol use. In the case of Central Pontine Myelinolysis, which is caused by abrupt fluctuations in serum osmolality, controlled sodium correction is essential.

Through a clinical case and a review of published literature, this study aims to reflect on the importance of preventing neurological injuries associated with chronic alcohol consumption, specifically Wernicke-Korsakoff Syndrome and Central Pontine Myelinolysis.

A literature review was conducted by searching for articles on PubMed using the terms “Alcohol Use Disorder,” “Wernicke-Korsakoff syndrome,” and “Central pontine myelinolysis.” A clinical case is presented, featuring a 50-year-old patient with alcohol use disorder who developed Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis. Considering this case, we reflect on the primary approaches that could have been beneficial in preventing these complications and propose a straightforward method for doing so.

A 50-year-old patient presented with poor general condition, characterized by low weight, significant loss of strength in the limbs and arms, and incoherent speech with anterograde amnesia and confabulation. This condition had progressed to a point where the patient could no longer walk, perform basic self-care tasks such as bathing, dressing, and eating independently, underscoring the severity of his condition. The diagnoses of Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis were established based on clinical manifestations and the presence of hyperintense lesions observed in the central pons on T2/FLAIR axial MRI scans. This clinical case highlights the importance of proper and precocious prevention of complications in patients with alcohol use disorder. The foremost step in preventing these complications is to treat alcohol dependence effectively, even when faced with patient resistance. It’s vital to remain vigilant about potential complications and implement suitable prophylactic measures.

The devastating effects of complications arising from Alcohol Use Disorder, such as Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis, underscore the importance of enhanced attention that clinicians should provide when approaching these patients at all clinical interactions.

None Declared

Health Psychology is aggregated to clinical studies providing physicians, nurses, and psychotherapists with psychodynamics of sick persons, facilitating interpersonal relationships and greater adherence to treatments. How do people deal with illness and treatment from what they symbolize in experiences of becoming ill? Watch & Wait Protocol for patients with rectal cancer is an active surveillance as an alternative approach in surgical medical management. Patients are followed with physical examinations, endoscopy, and imaging. Observation carried out through periodic examinations aims to avoid surgery stage while rectal cancer is maintained.

To interpret emotional meanings attributed by patients, after adhering to the W&W protocol for rectal cancer, to life experiences of watching and waiting for the disease course.

Clinical-Qualitative Method (Turato. Portuguese Psychos. J, 2000 2(1): 93-108). For data collection, the first author used Semi-Directed Interview with Open-ended Questions In-Depth and Field Notes, after acculturation. Sample closed by information saturation (Fontanella et al. Cad Saude Publica. 2008; 24(1): 17-27). Interviews conducted by the first author, a female psychologist. We employed the Seven Steps of the Clinical-Qualitative Content Analysis (Faria-Schützer et al. Cien Saude Colet. 2021; 26(1): 265-274) to construct categories. Theoretical framework was the Balintian Medical Psychology. Findings were validated by peer reviewers from Lab of Clinical-Qualitative Research.

Sample had 10 patients, 3 female and 7 male, from 52 to 77 years. Interviews carried out from October 2022 to March 2023. We constructed 03 categories: 1) Fate out of hands - “I get sick just coming in here.” There is an apprehension experienced in each medical evaluation to check the clinical condition because the symbol of waiting is not having the own destiny in the hands. 2) Psychic defence - “Sometimes I even thought if I had to live on a grant for the rest of my life or die!” Imagining the worst is a psychic defence because if this probability occurs, the mind has already begun its elaboration. 3) Life upside down - “I was going to have the surgery, use a bag, my life was going to be upside down.” Anxiety generated by waiting is a mental disorganizing.

Attitudes of observing and waiting carry different symbolisms to those who work with scientific thinking and who experience the observation of their own disease and the wait for what conduct they will receive. Observing oneself in illness requires acceleration of changes in ego identity. Waiting in front of illness asks the ego to think the worst. It is not a volitional choice. Preparing for the worst is a defensive necessity in the emotional sphere to avoid surprises that take to mental rupture.

None Declared

Individuals with mental health disorders often lack access to appropriate care, including psychosocial rehabilitation programs, which are considered essential for their recovery. In 2019, as part of the intervention by the Community and Mental Health Service, at Hospital de Magalhães Lemos, we initiated a psychoeducational group for patients with psychotic spectrum disorders, with the purpose of providing our patients with comprehensive information about their condition and effective management strategies. Our 8-week program consisted of 16 sessions, including icebreaker activities, discussion of certain themes, sharing of experiences and practice of stress management techniques.

The aim of this study was to assess and quantify the impact of our 2023 program.

Out of a total of 20 patients interviewed for our program in 2023, 16 began the program and 12 completed it. The program’s evaluation was based on several assessment tools, including a sociodemographic questionnaire, a knowledge assessment questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Insight and Treatment Attitudes Questionnaire (ITAC), the World Health Organization Quality of Life (WHOQOL), and the Medication Adherence Rating Scale (MARS). We also created a health agenda to organize an individual plan of care.

Our findings indicated an improvement in insight and attitudes towards treatment by 8.6%, an enhancement in treatment adherence by 5%, and an increase in knowledge by 11.9%. In terms of quality of life, we observed a slight improvement in the psychological domain by 0.6% and in the social domain by 1.2%. Regarding the impact on psychotic symptomatology, there was an average decrease in 4 points in the negative subscale and in 3 points in the general psychopathology subscale, whereas the positive subscale remained unchanged. None of the patients required hospitalization during this period.

Our study revealed some improvement in nearly all the evaluated parameters. There was an improvement of the therapeutic relationship, which we believe has contributed to lower scores in the negative symptoms and general psychopathology subscale. As for the study limitations, we acknowledge that we will need to expand our sample through additional programs in the next years, to include it in early intervention psychosis programs and to re-evaluate our patients’ outcomes after a more extended follow-up period, particularly if they continue to participate in our monthly mutual support group. Additionally, we must consider potential study biases, including the subjectivity of PANSS evaluations and the influence of other confounding factors, such as changes in treatment regimens during the program.

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Schizophrenia has progressively been seen as a multifactorial disease, with its pathogenesis including immune dysfunction. Studies have leaned into the activation of brain inflammation, influencing the development of schizophrenia in certain subgroups of patients. Additionally, the role of the T helper (Th17) cells and neuromediators associated are implicated in the pathophysiology of psoriasis, a chronic immune-mediated dermatological condition. A significantly elevated risk was found with 41% increased odds of schizophrenia compared with subjects without psoriasis. The concomitant diagnosis of both illnesses has motivated further investigation into their shared pathways.

Characterize the prevalence of psoriasis in patients with schizophrenia and mutual involved mechanisms.

Retrospective analysis of inpatients of a Portuguese Psychiatry department with the established diagnosis of Schizophrenia, between 2018 and 2022. Additionally a literature review on the topic was conducted.

A sample of 94 patients admitted was obtained. The majority of patients were male (80,1%). The prevalence of the diagnosis of Psoriasis was 6,4% (n=6). A previous epidemiological study conducted in the Portuguese general population concluded that the prevalence of psoriasis is on average 4,4%, which is inferior to the value obtained in our sample. Other studies that measured the relationship between both diagnoses corroborated our results, documenting higher prevalences of psoriasis in patients with schizophrenia than the general population.

The relationship between psoriasis and schizophrenia seems to be bidirectional, with schizophrenia patients having higher risk of psoriasis and psoriasis patients having higher risk of schizophrenia. This could be explained by multiple mechanisms, mainly the activation of Th17 cells but also the fact that there may be a genetic susceptibility due to proximal chromosome loci associated with both diseases (chromosome 6p21.3). This information is essential in providing care to patients because treatment must be carefully adapted. It has been demonstrated that atypical antipsychotics might worsen psoriatic manifestations and immunosuppressive agents are linked to psychotic episodes and worse mental health. Thus, there should be increased alertness for the detection of these conditions in patients with either one of them.

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Alcohol and illicit drug use are highly prevalent among the homeless population. Religiosity and spirituality (RS) have been widely associated with lower substance use. However, evidence of this relationship among the homeless is still scarce.

To assess the association between RS and the use of alcohol and illicit drugs among the homeless population of a large Brazilian urban center.

This cross-sectional study was conducted in São Paulo, Brazil. Aspects such as spirituality (FACIT-Sp12), religiosity (P-DUREL), religious-spiritual coping (Brief-RCOPE), and self-applied questions about current substance use (alcohol and illicit drugs) were evaluated. Adjusted Logistic Regression models were performed.

A total of 456 homeless individuals were included, with an average age of 44.5 (SD=12.6) years. More than half of the participants used alcohol (55.7%) weekly and 34.2% used illicit drugs weekly. The adjusted Logistic Regression models identified that aspects of RS were associated with a lower propensity for alcohol and illicit drug use, whereas negative religious-spiritual coping strategies were associated with a higher propensity for the use of both.

The prevalence of alcohol and illicit drug use among participants was high. Positive RS and religious-spiritual coping were significant protective factors against the use of these substances. Conversely, negative religious-spiritual coping strategies were associated with risk factors.

None Declared

A 56-year-old patient diagnosed with bipolar affective disorder type II, who remains stable, with no manifest episodes, thanks to aripiprazole 60mg daily.

The aim is to carry out a brief review of the use of the drug as the only stabiliser in bipolar affective disorder.

A 56-year-old patient, who has been suffering from episodes of hypomania since the age of 40, with episodes of depression. After poor tolerance to the use of the usual stabilisers, and the impossibility of using antidepressants due to hypomanic swings, it was decided to start treatment with aripiprazole orally, up to a maximum of 60mg daily. Despite the fact that the patient, with this treatment, had no side effects and remained more stable psychopathologically, the patient did not comply adequately with the correct dosage, due to his rotating work shifts. This fact explained that although he acknowledged an improvement, he continued with episodes of depressive symptoms lasting several days followed by episodes of hypomanic characteristics.

For this reason, it was decided to change treatment to aripiprazole long-acting injectable, in order to ensure linear blood levels of the drug. Initially, it was decided to prescribe 400mg every 28 days. However, after the first administration, 20 days later, the patient began to show dysphoric mood, with marked emotional lability, living in an egodystonic manner. For this reason, the dose was increased to 600mg on a monthly basis. Since then, after a year and a half with the same treatment, the patient has been stable and in line. There has been no further decompensation of the underlying psychopathology and no side effects.

Aripiprazole in TAB is superior to placebo in type I patients, mainly affecting manic and mixed episodes, but not so much in depressive episodes. It has also been observed that it not only acts in the acute phases, but also has a stabilising function, preventing manic episodes.

One study showed that up to 65% of patients on oral aripiprazole in whom it was replaced by AOM remained clinically stable. In the same study, approximately 50% of those who completed 52 weeks of follow-up were able to maintain clinical stability.

None Declared