Framing Binational Challenges of Mental and Cognitive Health Care in Mexican-Origin Older Adults: Consensus Findings

Growth in older populations, and hence in the number of persons living with dementia, is particularly rapid for individuals of Mexican origin living in the U.S. and Mexico. In order to identify influences on cognitive health in this diverse population, the University Texas at Austin and Mexican National Institute of Geriatrics (INGER) organized their second Bridging Conference titled: "Framing Challenges of Cognitive and Mental Health Care in Mexican-origin Older Adults in Mexico and the U.S". In this presentation, we highlight the results of a consensus-building session, during which bi-national expert opinions were generated and synthesized addressing gaps in research, knowledge, and policy, as well as the setting of priorities for immediate action and future research. Reducing barriers to adequate care for those aging-in-place with dementia was a central theme of the identified priorities. Critical areas of identified need, more specifically, included reducing social isolation, caregiver burden, and diminishing retirement income.

Bilateral Renal Tumors in Children: The First 5 Years’ Experience of National Centralization in The Netherlands and a Narrative Review of the Literature

Survival of unilateral Wilms tumors (WTs) is exceeding 90%, whereas bilateral WTs have an inferior outcome. We evaluated all Dutch patients with bilateral kidney tumors, treated in the first five years of national centralization and reviewed relevant literature. We identified 24 patients in our center (2015–2020), 23 patients had WT/nephroblastomatosis and one renal cell carcinoma. Patients were treated according to SIOP-RTSG protocols. Chemotherapy response was observed in 26/34 WTs. Nephroblastomatosis lesions were stable (n = 7) or showed response (n = 18). Nephron-sparing surgery was performed in 11/22 patients undergoing surgery (n = 2 kidneys positive margins). Local stage in 20 patients with ≥1 WT revealed stage I (n = 7), II (n = 4) and III (n = 9). Histology was intermediate risk in 15 patients and high risk in 5. Three patients developed a WT in a treated nephroblastomatosis lesion. Two of 24 patients died following toxicity and renal failure, i.e., respectively dialysis-related invasive fungal infection and septic shock. Genetic predisposition was confirmed in 18/24 patients. Our literature review revealed that knowledge is scarce on bilateral renal tumor patients with metastases and that radiotherapy seems important for local stage III patients. Bilateral renal tumors are a therapeutic challenge. We describe management and outcome in a national expert center and summarized available literature, serving as baseline for further improvement of care.

45. COVID-19 Vulnerability and Data Reporting in Africa: Reflections from Cameroon

Background At the beginning of the COVID-19 pandemic there were many questions about vulnerability and data reporting among African countries. We previously found that policymakers in Cameroon value region-specific risk maps for emerging diseases. Therefore, we created regional vulnerability indices for COVID-19 in Cameroon. As the pandemic grew, we aimed to compare how these predictions related to reported COVID-19 cases in Cameroon and whether additional African countries had available data to assess vulnerability for COVID-19. Methods Using data from the Cameroon 2018 Demographic and Health Survey (DHS), we had constructed an epidemiological vulnerability index based on comorbidities potentially associated with COVID-19 severity. Similarly, we had created a healthcare access index. We then compared these indices with regional COVID-19 cases per population from weekly situation reports in Cameroon. Finally, we identified the availability of DHS data and COVID-19 reporting systems in other African countries. Vulnerability Indices for COVID-19 in Cameroon The epidemiological and healthcare access vulnerability indices constructed for Cameroon are shown along with COVID-19 cases per population. Results Adjusting for data reporting limitations, regions in Cameroon that scored higher on the epidemiological vulnerability index were associated with greater COVID-19 cases per population. We also identified regions with mismatches between high epidemiological vulnerability and low healthcare access. COVID-19 data reporting systems varied among African countries. 29/54 (53.7%) of African countries had recurrent situation reports or online dashboards with subnational COVID-19 data in 2020. Meanwhile, 36/54 (66.7%) of African countries had DHS data reported in the last decade. Conclusion We found that vulnerability indices could be a rapid way of identifying populations at risk for emerging diseases such as COVID-19. This method could be used in other countries that have both recent health surveys from programs such as the DHS and subnational reporting of COVID-19 cases. Indices could be useful for decision-making, but they will need to be refined with national expert input. National situation reports and online dashboards provided subnational COVID-19 data in approximately half of African countries. Therefore, increased baseline health surveys as well as expanded reporting of COVID-19 case data could inform future vulnerability assessments in other countries. Disclosures All Authors: No reported disclosures

Psychological Drivers of Individual Differences in Risk Perception: A Systematic Case Study Focusing on 5G

What drives people’s perceptions of novel risks, and how malleable are such risk perceptions? Psychological research has identified multiple potential drivers of risk perception, but no studies have yet tested within a unified analytic framework how well each of these drivers accounts for individual differences in large population samples. To provide such a framework, I harnessed the deployment of 5G—the latest generation of cellular network technology. Specifically, I conducted a multiverse analysis using a representative population sample in Switzerland (Study 1; N = 2,919 individuals between 15 and 94 years old), finding that interindividual differences in risk perceptions were strongly associated with hazard-related drivers (e.g., trust in the institutions regulating 5G, dread) and person-specific drivers (e.g., electromagnetic hypersensitivity)—and strongly predictive of people’s policy-related attitudes (e.g., voting intentions). Further, a field experiment based on a national expert report on 5G ( N = 839 individuals in a longitudinal sample between 17 and 79 years old) identified links between intraindividual changes in psychological drivers and perceived risk, thus highlighting potential targets for future policy interventions.

Sustainability of hospital-based midwife-led antenatal care consultation — a qualitative study

Background All evidence-based knowledge and improvement strategies for quality care must be implemented so patients can benefit from them. In Germany, national expert standards (NES) contribute to quality care in nursing and midwifery. The NES defines for several action levels a dedicated level of quality, which is operationalized by structure, process, and outcome (SPO) criteria. An NES to promote normal childbirth was developed and implemented in 2014. The first action level involves midwife-led antenatal consultation (ML-AC) being conducted in a structured way. Most implementation processes aim to accomplish sustainability, but implementation studies rarely use definitions or a theory of sustainability, even when assessing sustainability. This lack led to the assumption that intervention sustainability after implementation is still a largely unexplored domain. The aim of this study is to investigate the sustainability of midwife-led antenatal consultation (ML-AC) implemented at two hospitals, in Germany. Methods In a qualitative approach, 34 qualitative interviews were conducted (between March and October 2017) using semi-structured interview guides. All interviews were transcribed verbatim, anonymized and analyzed thematically using framework method. Four groups of stakeholders in two hospitals offering ML-AC were interviewed: managers (n = 8), midwives conducting ML-AC (n = 10), pregnant women who attended ML-AC (n = 8), and physicians working in obstetrics (n = 8) at the hospitals. Results The interviewees identified key benefits of ML-AC on a personal and unit level, e.g., reduced obstetric interventions, easier admission processes. Furthermore, the participants defined key requirements that are needed for routinized and institutionalized ML-AC, such as allocating working time for ML-AC, and structural organization of ML-AC. All study participants saw a need to establish secure long-term funding. Additionally, the interviewed staff members stated that ML-AC topics need evaluating and adapting in the future. Conclusions Implementing ML-AC in the hospital setting has led to manifold benefits. However, reimbursement through the health care system will be needed to sustain ML-AC. Hospitals implementing ML-AC will need to be aware that adaptations of the NES are necessary to accomplish routinization and institutionalization. After initial implementation, sustaining ML-AC will generally require on-going monitoring and evaluating of benefits, routinization/institutionalization and further development.

Canadian Melanoma Conference Recommendations on High-Risk Melanoma Surveillance: A Report from the 14th Annual Canadian Melanoma Conference; Banff, Alberta; 20–22 February 2020

Introduction: There are a lack of established guidelines for the surveillance of high-risk cutaneous melanoma patients following initial therapy. We describe a novel approach to the development of a national expert recommendation statement on high-risk melanoma surveillance (HRS). Methods: A consensus-based, live, online voting process was undertaken at the 13th and 14th annual Canadian Melanoma Conferences (CMC) to collect expert opinions relating to “who, what, where, and when” HRS should be conducted. Initial opinions were gathered via audience participation software and used as the basis for a second iterative questionnaire distributed online to attendees from the 13th CMC and to identified melanoma specialists from across Canada. A third questionnaire was disseminated in a similar fashion to conduct a final vote on HRS that could be implemented. Results: The majority of respondents from the first two iterative surveys agreed on stages IIB to IV as high risk. Surveillance should be conducted by an appropriate specialist, irrespective of association to a cancer centre. Frequency and modality of surveillance favoured biannual visits and Positron Emission Tomography Computed Tomography (PET/CT) with brain magnetic resonance imaging (MRI) among the systemic imaging modalities available. No consensus was initially reached regarding the frequency of systemic imaging and ultrasound of nodal basins (US). The third iterative survey resolved major areas of disagreement. A 5-year surveillance schedule was voted on with 92% of conference members in agreement. Conclusion: This final recommendation was established following 92% overall agreement among the 2020 CMC attendees.

Publics, Scientists and the State: Mapping the Global Human Genome Editing Controversy

Literature on scientific controversies has inadequately attended to the impact of globalization and, more specifically, the emergence of China as a leader in scientific research. To bridge this gap in the literature, this article develops a theoretical framework to analyse global scientific controversies surrounding research in China. The framework highlights the existence of four overlapping discursive arenas: China's national public sphere and national expert sphere, the transnational public sphere and the transnational expert sphere. It then examines the struggles over inclusion/exclusion and publicity within these spheres as well as the within- and across-sphere effects of such struggles. Empirically, the article analyses the human genome editing controversy surrounding research conducted by scientists in China between 2015 and 2019. It shows how elite scientists negotiated expert–public relationships within and across the national and transnational expert spheres, how unexpected disruption at the nexus of the four spheres disrupted expert–public relationships as envisioned by elite experts, and how the Chinese state intervened to redraw the boundary between openness and secrecy at both national and transnational levels.

Variability in the assessment of children’s primary healthcare in 30 European countries

Background The high variability in the types and number of measures adopted to evaluate childcare across European countries makes it necessary to investigate country practices to identify trends in setting national priorities in the assessment of child well-being. Objective This paper intends to investigate country practices under the lens of variability to explore possible trends in setting national priority in the evaluation of childcare. In particular, it analyses variability considering to what extent this depends on the tendency of adopting a broad vision (i.e. selecting measures for a larger variety of aspects) or whether this is influenced by the choice of adopting an in-depth approach (i.e. using more measures to analyse a specific aspect) Methods An ad hoc questionnaire was administered to a national expert in each country and yielded 352 measures. To analyse variability, the breadth in the number of aspects considered was explored using a convergence index, while the depth in the distribution of measures in each aspect was investigated by computing a coefficient of variation. Countries were grouped by adopting a hierarchical clustering approach. Results There is a high variability across countries in the selection of measures that cover different aspects of childcare. Preferences in the distribution of measures are significant even at the domain level and in countries that use a limited number of measures and become more evident at the category and sub-category levels. The statistical analysis clusters countries in four main groups and two outliers. The in-depth distribution of measures focused on a specific aspect shows a homogeneous pattern, with the identification of two main groups of countries. Conclusions A limited set of measures are shared across countries hampering a robust comparison of paediatric models. The selection of measures shows that the evaluation is closely related to national priorities as resulting from the number and types of measures adopted. Moreover, a range of a reasonable number of measures can be hypothesized to address the quality of childcare under a multi-dimensional perspective.