Tit Albreht | National Institute of Public Health of Slovenia (original) (raw)

Papers by Tit Albreht

European Journal Of Public Health, 2019

European journal of public health, Nov 1, 2019

Slovenian Journal of Public Health, Jul 2, 2014

European journal of public health, Oct 1, 2022

Foodborne and zoonotic diseases such as brucellosis present many challenges to public health and ... more Foodborne and zoonotic diseases such as brucellosis present many challenges to public health and economic welfare. Increasingly, researchers and public health institutes use disability-adjusted life years (DALYs) to generate a comprehensive comparison of the population health impact of these conditions. DALY calculations entail several methodological choices and assumptions, with data gaps and uncertainties to accommodate. The following review identifies existing brucellosis burden studies and analyses their methodological choices and assumptions. Methods/Findings: A systematic search for brucellosis burden calculations was conducted in pre-selected international and grey literature databases. Using a standardized reporting framework, we evaluated each estimate on a variety of key methodological assumptions necessary to compute a DALY. One study reported estimates at the global level, the rest (13) at national or subnational. Most studies retrieved brucellosis epidemiological data from administrative registries. Incidence data were often estimated based on laboratory-confirmed tests. Not all studies included mortality estimates (YLLs) in their assessments due to the lack of data or the assumption that brucellosis is not a fatal disease. Only two studies used a model with variable health states and corresponding disability weights. The rest used a simplified singular health state approach. Wide variation was seen in the duration chosen for brucellosis, ranging from 2 weeks to 4.5 years, irrespective of whether a chronic state was included. Conclusions: Available brucellosis burden assessments vary widely in their methodology and assumptions. Further research is needed to characterize better the total clinical course of brucellosis and estimate case-fatality rate. In addition, reporting of methodological choices should be improved to enhance transparency and comparability of estimates. These steps will increase the value of these estimates for policymakers. Key messages: Inconsistencies in reporting methods and assumptions are found, which hinder transparency and understanding of the methodological choices and the reuse of estimates for prioritization purposes. Thus, there is a need for a more standardized reporting system for DALY estimates, which could resemble a checklist that reports the methodological choices and assumptions.

European journal of public health, Oct 1, 2022

1984/85. It was a step, supported by a few interventions and activities, which facilitated the de... more 1984/85. It was a step, supported by a few interventions and activities, which facilitated the development of several important policy tools. After its closure in 2003, there was some unease, especially in view of the forthcoming biggest enlargement of the EU in 2004. Several activities revived the EU cancer policy and these processes culminated in the adoption of the Europe's Beating Cancer Plan. There were some doubts whether the latter would be feasible but a careful development process at different levels resulted in success. Results: A policy analysis will be presented that will introduce key steps and documents that mark the period between the two milestones-Europe Against Cancer Programme (EACP) and Europe's Beating Cancer Plan (EBCP). We will present the development of various tools as well as the important outcomes of the different policies and interventions triggered by the two documents. The period between 2003 and 2019 will be elaborated in view of the adoption of EBCP. Three Joint Actions and their various outputs with a strong impact on the cancer policy development, contributing also to the development of flagships and actions of EBCP will be presented as well. Lessons: EU top level decisions and policies can be developed harmoniously and to the benefit of both-the EU and the Member States-when launched in a joint process and with the involvement of all the relevant stakeholders. Key messages: EU policy documents are important drivers for the development of health policy tools at both the EU level as well as at the Member State level. A combination of top-level documents with carefully developed policy tools enables the development of cancer policies acting at both EU and Member State level.

European journal of public health, Nov 1, 2018

BMJ Open, Dec 1, 2017

Objective To review evidence-based (EB) recommendations on survivorship care for primary care pro... more Objective To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines. Design and setting Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches. Method EB guidelines in any language published between 2012 and 2017 were collected. EB recommendations on survivorship care relevant for PCPs were extracted and grouped into three categories (recurrence detection, long-term effects and recurrence prevention). The content of the recommendations was analysed and summarised in the number and type of clinical topics addressed. The Appraisal of Guidelines for Research and Evaluation II instrument was used to evaluate the methodological quality of the guidelines. results Six guidelines, of which two were of acceptable methodological quality, were included. One was specifically made for general practitioners. Fifteen clinical topics were identified. Guidelines differed in the clinical topics addressed and for some identical topics in the content of the recommendations. Many recommendations were based on low-quality evidence. Recurrence detection received most attention, physical examination and mammography were often highlighted. Potential complications largely varied in number and type. Intimacy concerns, vaginal dryness, dyspareunia, fatigue, menopausal symptoms, peripheral neuropathy and lymphedema were reported in more than one guideline. Recurrence prevention was mentioned in four guidelines; all recommended physical activity. conclusion The number of EB recommendations in guidelines is limited. Moreover, recommendations differ between guidelines and most are based on low-quality evidence. More high-quality research is needed to develop and adapt guidelines to support PCPs in providing optimal breast cancer survivorship care.

Molecular Oncology, May 5, 2023

European cancer research stakeholders met in October 2022 in Heidelberg, Germany, at the 5th Gago... more European cancer research stakeholders met in October 2022 in Heidelberg, Germany, at the 5th Gago conference on European Cancer Policy, to discuss the current cancer research and cancer care policy landscape in Europe. Meeting participants highlighted gaps in the existing European programmes focusing on cancer research, including Europe's Beating Cancer Plan (EBCP), the Mission on Cancer (MoC), Understanding Cancer (UNCAN.eu), and the joint action CRANE, and put forward the next priorities, in the form of the Heidelberg Manifesto for cancer research. This meeting report presents all discussions that shed light on how infrastructures can be effectively shaped for translational, prevention, clinical and outcomes cancer research, with a focus on implementation and sustainability and while engaging patients and the public. In addition, we summarize recommendations on how to introduce frameworks for the digitalization of European cancer research. Finally, we discuss what structures, commitment, and resources are needed to establish a collaborative cancer research environment in Europe to achieve the scale required for innovation.

European journal of public health, Nov 1, 2018

European journal of public health, Oct 1, 2015

 2.8. Conclusions  2.9. References  3. Changes in primary health care centres over the tran... more  2.8. Conclusions  2.9. References  3. Changes in primary health care centres over the transition period in Slovenia   Contents 3.8. Conclusions  3.9. Key points  3.10. References  4. Restructuring Public Health in Slovenia between 1985 and 2006   Slovenian health care in transition 6.2. Material and methods  6.3. Results  6.3.1. Organisation of hospital care in Slovenia  6.3.2. Management of hospitals  6.3.3. Developments in the volume and types of hospital care  6.3.4. Policy choices regarding structure and market orientation  6.3.5. Th e impact of reimbursement system changes on hospital performance measured by ALOS  6.4. Discussion  6.5. Acknowledgements  6.6. Confl icts of interest  6.7. Key points  6.8. References  7. Balancing equity and effi ciency through health care policies in Slovenia in the period 1990-2008  7.1. Background  7.2. Material and methods  7.3. Results  7.3.1. Th e context  7.3.2. Developments in economic and demographic indicators-the socioeconomic background  7.3.3. Reform goals, processes and outcomes  7.3.4. Introduction of a Bismarckian health insurance system with a single insurer for CHI  7.3.5. Introduction of co-payments for a range of services, covered to a diff erent extent by the compulsory insurance  7.4. Discussion  7.4.1. 'Health and wealth'  7.4.2. Introduction of a social health insurance system and of additional sources of funding  7.5. Conclusions  7.6. References  8. Discussion  8.1. Main fi ndings  8.2. Methodological aspects  8.3. Slovenia's similarities and diff erences in comparison with the other countries of central and Eastern Europe (CCEE)  8.4. Implications for stakeholders in the Slovenian health care  8.4.1. Implications for the Ministry of Health (MoH)   Contents 8.4.2. Implications for the health insurers  8.4.3. Implications for health professionals  8.4.4. Implications for the public health institutes  8.4.5. Implications for the health care providers  8.4.6. Implications for citizens  8.5. Implications for other countries in the region  8.6.References  Summary  Samenvatting  Acknowledgements  Dankwoord  Curriculum Vitae-English  Curriculum Vitae-nederlands  1 Professor Anton Dolenc, MD, PhD at the Congress of the Slovene Medical Society in May 1992, Maribor, Slovenia. (HIIS) were considered controversial while the infl uence of the public providers' association is perceived as marginal. Conclusions: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS aff ected their situation. Th e challenges for the future will be in preserving their public health functions, in increasing effi ciency and in establishing clearly defi ned relations with private providers.

The World Bank eBooks, Dec 1, 2021

European journal of public health, Mar 25, 2014

Health is delayed; therefore, the coordination and management of the newly developed services is ... more Health is delayed; therefore, the coordination and management of the newly developed services is not optimal. Furthermore, a strong political support is needed to provide funding for these activities after the developmental phase. This requires additional work from all stakeholders to increase the visibility of public health and make it an important item on the government agenda. A renewed Hungarian public health strategy and programme based on the values, principles and priorities of the World Health Organization's Health 2020 would be able to give an adequate policy framework to further actions. 5

International Journal of Public Health, Apr 1, 2007

To develop cross-culturally applicable health indicators. An interview survey was conducted in 4 ... more To develop cross-culturally applicable health indicators. An interview survey was conducted in 4 communities of Austria, Italy and Slovenia, targeting a total sample of 800 subjects aged 18 to 70 years. 19 health indicators were assessed: among them self-reported ill-health, health behaviour, personal and social resources. Descriptive statistics were used for the comparison of the communities and multiple logistic regression to analyse correlating factors to the self-reported state of health in the different communities. The study results demonstrate that the distribution of health indicators varies greatly over the 4 communities. Furthermore the correlations of health behaviour and health resources with self-reported health status are not homogenous in the different communities; in some cases they are even inverse. This study illustrates the need for the development of a sound theoretical background and for careful application of cross-cultural health indicators.

PubMed, Feb 1, 2001

A period of changes in what had previously been public health insurance began in Slovenia in 1992... more A period of changes in what had previously been public health insurance began in Slovenia in 1992. A new legislation introduced a mixed public-private insurance, the share of GDP allocated for health care insurance in Slovenia equaled the EU average, and the financing of the public health insurance has been balanced up - until now. For the first time since Slovenia gained independence, the compulsory health insurance is planning a 6% reduction in its income. The way to the solution of the problem lies in a political consensus on the public health issues in Slovenia, but it is still unclear whether it can be reached. A successful political agreement on the adequate amount of health care, granted to the Slovenian citizens by the public health insurance, should secure its balanced financing, which is about to be disturbed.

PubMed, Jun 1, 1999

The health care system in Slovenia has undergone significant changes since 1992. The objectives w... more The health care system in Slovenia has undergone significant changes since 1992. The objectives were primarily economic and not medical, since the level of medical services rendered has been fairly high and there were limited needs for improvements. Many changes, such as privatization, have not yet achieved their main objective - improved efficiency and quality. We have, however, observed many positive results, such as the awareness of medical staff that the quality of the national health care system should not be taken as granted but should be based and developed on extremely careful planning. Health care reform packages are being designed primarily to address one important problem: cost containment. An important part of the reform was moving the major part of the health care budget outside of the state budget to make it more transparent and controllable and its use more subject to its primary intention.

European Journal Of Public Health, 2019

European journal of public health, Nov 1, 2019

Slovenian Journal of Public Health, Jul 2, 2014

European journal of public health, Oct 1, 2022

Foodborne and zoonotic diseases such as brucellosis present many challenges to public health and ... more Foodborne and zoonotic diseases such as brucellosis present many challenges to public health and economic welfare. Increasingly, researchers and public health institutes use disability-adjusted life years (DALYs) to generate a comprehensive comparison of the population health impact of these conditions. DALY calculations entail several methodological choices and assumptions, with data gaps and uncertainties to accommodate. The following review identifies existing brucellosis burden studies and analyses their methodological choices and assumptions. Methods/Findings: A systematic search for brucellosis burden calculations was conducted in pre-selected international and grey literature databases. Using a standardized reporting framework, we evaluated each estimate on a variety of key methodological assumptions necessary to compute a DALY. One study reported estimates at the global level, the rest (13) at national or subnational. Most studies retrieved brucellosis epidemiological data from administrative registries. Incidence data were often estimated based on laboratory-confirmed tests. Not all studies included mortality estimates (YLLs) in their assessments due to the lack of data or the assumption that brucellosis is not a fatal disease. Only two studies used a model with variable health states and corresponding disability weights. The rest used a simplified singular health state approach. Wide variation was seen in the duration chosen for brucellosis, ranging from 2 weeks to 4.5 years, irrespective of whether a chronic state was included. Conclusions: Available brucellosis burden assessments vary widely in their methodology and assumptions. Further research is needed to characterize better the total clinical course of brucellosis and estimate case-fatality rate. In addition, reporting of methodological choices should be improved to enhance transparency and comparability of estimates. These steps will increase the value of these estimates for policymakers. Key messages: Inconsistencies in reporting methods and assumptions are found, which hinder transparency and understanding of the methodological choices and the reuse of estimates for prioritization purposes. Thus, there is a need for a more standardized reporting system for DALY estimates, which could resemble a checklist that reports the methodological choices and assumptions.

European journal of public health, Oct 1, 2022

1984/85. It was a step, supported by a few interventions and activities, which facilitated the de... more 1984/85. It was a step, supported by a few interventions and activities, which facilitated the development of several important policy tools. After its closure in 2003, there was some unease, especially in view of the forthcoming biggest enlargement of the EU in 2004. Several activities revived the EU cancer policy and these processes culminated in the adoption of the Europe's Beating Cancer Plan. There were some doubts whether the latter would be feasible but a careful development process at different levels resulted in success. Results: A policy analysis will be presented that will introduce key steps and documents that mark the period between the two milestones-Europe Against Cancer Programme (EACP) and Europe's Beating Cancer Plan (EBCP). We will present the development of various tools as well as the important outcomes of the different policies and interventions triggered by the two documents. The period between 2003 and 2019 will be elaborated in view of the adoption of EBCP. Three Joint Actions and their various outputs with a strong impact on the cancer policy development, contributing also to the development of flagships and actions of EBCP will be presented as well. Lessons: EU top level decisions and policies can be developed harmoniously and to the benefit of both-the EU and the Member States-when launched in a joint process and with the involvement of all the relevant stakeholders. Key messages: EU policy documents are important drivers for the development of health policy tools at both the EU level as well as at the Member State level. A combination of top-level documents with carefully developed policy tools enables the development of cancer policies acting at both EU and Member State level.

European journal of public health, Nov 1, 2018

BMJ Open, Dec 1, 2017

Objective To review evidence-based (EB) recommendations on survivorship care for primary care pro... more Objective To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines. Design and setting Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches. Method EB guidelines in any language published between 2012 and 2017 were collected. EB recommendations on survivorship care relevant for PCPs were extracted and grouped into three categories (recurrence detection, long-term effects and recurrence prevention). The content of the recommendations was analysed and summarised in the number and type of clinical topics addressed. The Appraisal of Guidelines for Research and Evaluation II instrument was used to evaluate the methodological quality of the guidelines. results Six guidelines, of which two were of acceptable methodological quality, were included. One was specifically made for general practitioners. Fifteen clinical topics were identified. Guidelines differed in the clinical topics addressed and for some identical topics in the content of the recommendations. Many recommendations were based on low-quality evidence. Recurrence detection received most attention, physical examination and mammography were often highlighted. Potential complications largely varied in number and type. Intimacy concerns, vaginal dryness, dyspareunia, fatigue, menopausal symptoms, peripheral neuropathy and lymphedema were reported in more than one guideline. Recurrence prevention was mentioned in four guidelines; all recommended physical activity. conclusion The number of EB recommendations in guidelines is limited. Moreover, recommendations differ between guidelines and most are based on low-quality evidence. More high-quality research is needed to develop and adapt guidelines to support PCPs in providing optimal breast cancer survivorship care.

Molecular Oncology, May 5, 2023

European cancer research stakeholders met in October 2022 in Heidelberg, Germany, at the 5th Gago... more European cancer research stakeholders met in October 2022 in Heidelberg, Germany, at the 5th Gago conference on European Cancer Policy, to discuss the current cancer research and cancer care policy landscape in Europe. Meeting participants highlighted gaps in the existing European programmes focusing on cancer research, including Europe's Beating Cancer Plan (EBCP), the Mission on Cancer (MoC), Understanding Cancer (UNCAN.eu), and the joint action CRANE, and put forward the next priorities, in the form of the Heidelberg Manifesto for cancer research. This meeting report presents all discussions that shed light on how infrastructures can be effectively shaped for translational, prevention, clinical and outcomes cancer research, with a focus on implementation and sustainability and while engaging patients and the public. In addition, we summarize recommendations on how to introduce frameworks for the digitalization of European cancer research. Finally, we discuss what structures, commitment, and resources are needed to establish a collaborative cancer research environment in Europe to achieve the scale required for innovation.

European journal of public health, Nov 1, 2018

European journal of public health, Oct 1, 2015

 2.8. Conclusions  2.9. References  3. Changes in primary health care centres over the tran... more  2.8. Conclusions  2.9. References  3. Changes in primary health care centres over the transition period in Slovenia   Contents 3.8. Conclusions  3.9. Key points  3.10. References  4. Restructuring Public Health in Slovenia between 1985 and 2006   Slovenian health care in transition 6.2. Material and methods  6.3. Results  6.3.1. Organisation of hospital care in Slovenia  6.3.2. Management of hospitals  6.3.3. Developments in the volume and types of hospital care  6.3.4. Policy choices regarding structure and market orientation  6.3.5. Th e impact of reimbursement system changes on hospital performance measured by ALOS  6.4. Discussion  6.5. Acknowledgements  6.6. Confl icts of interest  6.7. Key points  6.8. References  7. Balancing equity and effi ciency through health care policies in Slovenia in the period 1990-2008  7.1. Background  7.2. Material and methods  7.3. Results  7.3.1. Th e context  7.3.2. Developments in economic and demographic indicators-the socioeconomic background  7.3.3. Reform goals, processes and outcomes  7.3.4. Introduction of a Bismarckian health insurance system with a single insurer for CHI  7.3.5. Introduction of co-payments for a range of services, covered to a diff erent extent by the compulsory insurance  7.4. Discussion  7.4.1. 'Health and wealth'  7.4.2. Introduction of a social health insurance system and of additional sources of funding  7.5. Conclusions  7.6. References  8. Discussion  8.1. Main fi ndings  8.2. Methodological aspects  8.3. Slovenia's similarities and diff erences in comparison with the other countries of central and Eastern Europe (CCEE)  8.4. Implications for stakeholders in the Slovenian health care  8.4.1. Implications for the Ministry of Health (MoH)   Contents 8.4.2. Implications for the health insurers  8.4.3. Implications for health professionals  8.4.4. Implications for the public health institutes  8.4.5. Implications for the health care providers  8.4.6. Implications for citizens  8.5. Implications for other countries in the region  8.6.References  Summary  Samenvatting  Acknowledgements  Dankwoord  Curriculum Vitae-English  Curriculum Vitae-nederlands  1 Professor Anton Dolenc, MD, PhD at the Congress of the Slovene Medical Society in May 1992, Maribor, Slovenia. (HIIS) were considered controversial while the infl uence of the public providers' association is perceived as marginal. Conclusions: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS aff ected their situation. Th e challenges for the future will be in preserving their public health functions, in increasing effi ciency and in establishing clearly defi ned relations with private providers.

The World Bank eBooks, Dec 1, 2021

European journal of public health, Mar 25, 2014

Health is delayed; therefore, the coordination and management of the newly developed services is ... more Health is delayed; therefore, the coordination and management of the newly developed services is not optimal. Furthermore, a strong political support is needed to provide funding for these activities after the developmental phase. This requires additional work from all stakeholders to increase the visibility of public health and make it an important item on the government agenda. A renewed Hungarian public health strategy and programme based on the values, principles and priorities of the World Health Organization's Health 2020 would be able to give an adequate policy framework to further actions. 5

International Journal of Public Health, Apr 1, 2007

To develop cross-culturally applicable health indicators. An interview survey was conducted in 4 ... more To develop cross-culturally applicable health indicators. An interview survey was conducted in 4 communities of Austria, Italy and Slovenia, targeting a total sample of 800 subjects aged 18 to 70 years. 19 health indicators were assessed: among them self-reported ill-health, health behaviour, personal and social resources. Descriptive statistics were used for the comparison of the communities and multiple logistic regression to analyse correlating factors to the self-reported state of health in the different communities. The study results demonstrate that the distribution of health indicators varies greatly over the 4 communities. Furthermore the correlations of health behaviour and health resources with self-reported health status are not homogenous in the different communities; in some cases they are even inverse. This study illustrates the need for the development of a sound theoretical background and for careful application of cross-cultural health indicators.

PubMed, Feb 1, 2001

A period of changes in what had previously been public health insurance began in Slovenia in 1992... more A period of changes in what had previously been public health insurance began in Slovenia in 1992. A new legislation introduced a mixed public-private insurance, the share of GDP allocated for health care insurance in Slovenia equaled the EU average, and the financing of the public health insurance has been balanced up - until now. For the first time since Slovenia gained independence, the compulsory health insurance is planning a 6% reduction in its income. The way to the solution of the problem lies in a political consensus on the public health issues in Slovenia, but it is still unclear whether it can be reached. A successful political agreement on the adequate amount of health care, granted to the Slovenian citizens by the public health insurance, should secure its balanced financing, which is about to be disturbed.

PubMed, Jun 1, 1999

The health care system in Slovenia has undergone significant changes since 1992. The objectives w... more The health care system in Slovenia has undergone significant changes since 1992. The objectives were primarily economic and not medical, since the level of medical services rendered has been fairly high and there were limited needs for improvements. Many changes, such as privatization, have not yet achieved their main objective - improved efficiency and quality. We have, however, observed many positive results, such as the awareness of medical staff that the quality of the national health care system should not be taken as granted but should be based and developed on extremely careful planning. Health care reform packages are being designed primarily to address one important problem: cost containment. An important part of the reform was moving the major part of the health care budget outside of the state budget to make it more transparent and controllable and its use more subject to its primary intention.