bluuebunny/crossref_metadata_2025 huggingface dataset:
11.A. Skills building seminar: A new framework for developing and evaluating complex interventions
Authors:   Organised by: EUPHA-EPI,   Chair persons: Laurence Moore (UK), Kathryn Skivington (UK)
Published: October 2021

The new MRC/NIHR Framework for Developing and Evaluating Complex Interventions will be introduced (by the authors) for participants to consider using to support their own complex intervention research. This Framework provides updated recommendations on the key considerations and phases of complex intervention research. Previous versions of the framework have been widely used internationally, but there have been many methodological and theoretical developments since they were published. This workshop will provide an overview of the new framework, with further worked examples. The workshop will include time for questions and discussion and support participants to think about how to approach their own complex intervention research.

The workshop will consist of two 20 minute presentations providing information on a different aspect of our new Framework, and this, alongside questions and discussion, will support attendees to:

Consider what makes interventions complex and how this complexity could usefully be handled in intervention research. Critically evaluate and contrast the utility and role of different research perspectives. Understand the core elements of complex intervention research.

At the end of each presentation, we will pose questions related to our Framework's checklist to the audience for their own consideration. As well as having the chat feature enabled and monitored throughout, we will use interactive software, e.g. mentimeter, to allow engagement beyond the question/answer session.

Key messages

The workshop will enable participants to apply the new MRC/NIHR framework for developing and evaluating complex interventions to their own research. Interactive sessions will explore the concepts underpinning the new framework and the practicalities of applying it to specific cases.
Healthcare use of COVID-19 patients within 3 months of diagnosis and associated factors
Authors: Siyve N , Emecen AN , Keskin S , Basoğlu E , Turunc O , Suner AF , Unal B
Published: October 2021

Background and aim

Healthcare utilization of the population changed by the COVID-19 pandemic. There is limited research on the healthcare use of COVID-19 patients. This study aimed to describe the healthcare use of COVID-19 patients within 3 months after diagnosis and to investigate the associated factors.

Methods

Patients older than 18-years who tested positive for SARS-CoV-2 RNA in Dokuz Eylül University Hospital-Turkey in November and December 2020 (n = 3597) were included in this retrospective cohort study. In total, data from 2978 patients were analyzed. Data were collected through telephone interviews. Dependent variables were patient-reported general healthcare use and COVID-19 related healthcare use within 3 months of follow-up. Age, gender, chronic disease history, number of initial symptoms, and hospitalization status were independent variables. Chi-square was used to compare categorical variables. Univariate and multivariate (backward elimination method) logistic regression models were conducted to identify predictive factors.

Results

In total, 32% of the cases sought healthcare within three months of diagnosis while 11.4% of the visits were due to COVID-19. The most common outpatient visits related to COVID-19 included chest diseases (30.3%), the emergency room (29.1%), and internal medicine (16.2%). Backward stepwise selection identified female gender (OR = 1.23, 1.05-1.44), having more than 3 comorbidities (OR = 2.64, 1.95-3.56), hospitalization (OR = 1.54, 1.16-2.03) for general healthcare use, and having more than 5 symptoms (OR = 1.52, 1.13-2.04), having more than 3 comorbidities (OR = 1.65, 1.09-2.43), hospitalization (OR = 1.77, 1.22-2.51) for COVID-19 related healthcare use.

Conclusions

Having comorbidities, the number of initial symptoms, and the need for hospitalization are the main determinants of general and COVID-19 related health care use in three months of COVID-19 infection.

Key messages

Indicators of severe clinical conditions are the main determinants of general and COVID-19 related healthcare use in the post COVID-19 patients. Healthcare resource planning should consider the needs of post COVID-19 patients.
COVID-19 government response measures: analysis in the European Union
Authors: Pinheiro V
Published: October 2021

Introduction

The global spread of COVID-19 has led to a wide range of responses from governments, including in the European Union (EU). Measures involve travel restrictions, school closings, bans on public gatherings, emergency investments in healthcare, contact tracing and social welfare. However, responses have varied in scope, stringency and timing. The aim of this study was to analyse government response measures in the EU and differences across EU countries, in 2020.

Methods

Using Oxford COVID-19 Government Response Tracker indices (Stringency Index, Containment and Health Index, Economic Support Index, Overall Government Response Index; all scored 1-100), estimates were analysed for the EU and each country, in 2020.

Results

While the Stringency, Overall Government Response and Containment and Health indices were generally in line with COVID-19 incidence progression (peak in April-May, decrease in the summer, new increase in the fall and second peak in November-December), for all EU countries, the Economic Support Index showed heterogeneous patterns between countries. In the EU, the Stringency Index ranged from 1,85 to 96,30 (median:54,63; SD:21,07), the highest median in Ireland and the lowest Croatia. The Containment and Health Index ranged from 1,92 to 84,29 (median:52,88; SD:17,77), again with Ireland showing the highest median, but this time, Estonia the lowest. For the Economic Support Index, ranging from 12,50 to 100 (median:75,00;SD:20,36), Cyprus had the highest median, and Germany the lowest. The Overall Government Response Index ranged from 1,67 to 83,78 (median:55,83; SD:18,36), with the highest median in Cyprus and the lowest in Estonia.

Conclusions

There was wide variation in response measures across the EU countries, in 2020. The Economic Support Index showed quite a different pattern compared to the other ones. Understanding these trends and patterns allows for mutual learning and better preparedness for future pandemics.

Key messages

There was wide variation in response measures across the EU in 2020, especially in economic support. Understanding these patterns allows for better preparedness in future pandemics.
Characterization of antibody response in asymptomatic and symptomatic SARS-CoV-2 infection
Authors: Marchi S
Published: October 2021

Background

SARS-CoV-2 pandemic is causing high morbidity and mortality burden worldwide. Mechanism of infection, protection or rapid evolution until fatal outcome of the disease remains poorly understood. To elucidate the dynamics of humoral response in SARS-CoV-2 asymptomatic and symptomatic infections, we performed a study to investigate the time course of antibody response in hospitalized COVID-19 patients and asymptomatic SARS-CoV-2 infected subjects.

Methods

Serum samples were collected from 42 hospitalized COVID-19 patients at 6 different time points (hospital admission, day 2, day 6, day 12-14, day 18-20, day 27-30) and from 25 asymptomatic subjects at 3 different time points (at the time of positive swab, 2 months, 6 months). Samples were tested by commercial ELISA for SARS-CoV-2 spike (S) protein IgA, IgM, and IgG and nucleoprotein (NP) IgG, and by micro-neutralization assay.

Results

In patients, titres increased for all antibody classes including neutralizing antibody from day 6 to day 18-20 but at day 27-30 started to decline. A high correlation between S and NP antigens and among antibody classes was found. No significant difference in antibody titres at baseline and by peak antibody level was found between recovered and deceased. 64.0% of asymptomatic subjects were negative to any antibody at any time point. Asymptomatic subjects with positive antibody level had titres well below patients, and neutralizing antibodies were found only in 2 subjects (8.0%).

Conclusions

Our results highlight that COVID-19 patients produce an antibody response to SARS-CoV-2 regardless the outcome. The peak is reached by 3 weeks from hospital admission followed by a sharp decrease. On the contrary, only few asymptomatic subjects develop antibodies at detectable levels, though lower compared to COVID-19 patients. Since neutralizing antibodies were rarely produced, this finding raises the question about the protection of these subjects against reinfection.

Key messages

COVID-19 patients produce an antibody response to SARS-CoV-2 which does not differ between recovered and deceased. Only few asymptomatic SARS-CoV-2 infected subjects develop antibodies and neutralizing antibodies were rarely produced.
Public health policies to tackle the growing burden of multimorbidity: a global agenda
Authors: Galea Gauden
Published: October 2021

The paper will provide a global perspective on current public health policies to tackle the growing burden of multimorbidity both in high-income and low-resource settings. Specifically, over the past two decades, there have been multiple stepwise approaches to non-communicable diseases (NCDs), the development of a process to link the prevention and control of NCDs to health systems, the compilation of evidence linking NCDs to the global development agenda, the implementation of life-course approaches to the prevention of multimorbidity around the world.
COVID-19 passes and public health law: Considerations for surveillance and social justice
Authors: Lingri D , Petelos E , Zeegers D , Valaris S , Favaretti C
Published: October 2021

The first panellist will focus on the jurists view on the legislative proposal on DCC, discuss proportionality of measure, incl. key considerations for DCC and PLF data combinations. A basic overview on the differences between vaccination, certificates, immunity passports and other passes, and the key characteristics of the DCC will be provided. Feasibility in terms of implementing acts across EU Member-States will be elaborated upon, incl. both potential expiry and revocation, as well as potential remedies in case of emerging issues, i.e., right to DCC, but no vaccine, strong contraindication against vaccination, known issues of reduced immunity despite vaccination, etc.

Critical aspects with relevance for both the European and the global dimensions, i.e., GDPR and data transfer agreements, secondary use of health data, human-rights' issues, implications for vulnerable groups, etc., will also be discussed.
Assessing policies for the implementation of new technological interventions to combat COVID-19
Authors: Prainsack Barbara
Published: October 2021

The second panelist will discuss policy and politics, incl. the role expert bodies and instruments of the European Union, assessing the role of the European Commission and the exchange frameworks with Member-States. In the context of elaboration on how optimal strategies for assessing the impact of new health technology and for evidence-informed policymaking, the role the European Group on Ethics in Science and New Technologies (EGE) will be discussed in more detail, as the independent expert group and multi-disciplinary body appointed by the President of the European Commission to advises on all policies where ethical, societal and fundamental rights issues intersect with the development of science and new technologies. Furthermore, broad long-term implications for globalisation and the relation of the EU to third countries will be examined, as will the significance of such measures for the European Union's Global Health Agenda, and the implications for future decision-making and policies in developing countries too.
COVID-19 registration in people with intellectual disabilities in Dutch long-term care facilities
Authors: Koks-Leensen M , Schalk B , Bakker-van Gijssel E , Cuypers M , van den Bemd M , Nägele M , Naaldenberg J , Leusink GL
Published: October 2021

This study aims to present a nationwide registration of COVID-19 in people with ID living in residential settings, in order to provide insight in COVID-19 epidemiology in this vulnerable group. In a health crisis as the current worldwide COVID-19 pandemic, it is crucial to gain knowledge about the new infectious disease and its effects on health. Identifying risk groups is important for adequate preventative measures and policy-making. People with ID generally have poorer health than others in the general population, with higher prevalence of co-morbidities, risk factors such as obesity, and higher excess mortality rates for infectious diseases. However, there is little reliable knowledge about specific risks and consequences of COVID-19 in the ID population as compared with the general population. To increase this knowledge a nationwide registration system for data on people with ID was set up in Dutch long term care facilities. The registration covered more than 6500 patients with (suspected) Covid-19 infection observed in 2020 and registration is still ongoing. Organizations registered data of their patients with either suspected or confirmed COVID-19 infection, regarding sociodemographics, medical history and COVID-19 infection characteristics. People with ID are vulnerable to COVID-19 at a younger age compared to people in the general population. Case fatality rate was 3-4 times higher among people with ID compared to the general population, and mortality was already higher in younger age groups (40 years and older). Their living circumstances matter: in group home living circumstances more infected people with ID were observed. The etiology of the ID, especially Down syndrome, is an unfavorable predictor. According to these findings, people with ID proved to be vulnerable for COVID-19. Policy makers and care providers should adequately account for this increased vulnerability of the ID population.
Evolution of Primary Health Care appointments in mainland Portugal in 2020
Authors: Gomes FA
Published: October 2021

Background

The COVID-19 pandemic has had an impact on the Portuguese Health Care System. During the first months of the pandemic, there was a great reduction in the number of health rendering services. (1) The aim of this study is to analyse the evolution of Primary Health Care appointments in mainland Portugal, during the whole year of 2020 and to compare it to the period of 2015-2019. The type of appointment and the number of users will also be characterized.

Methods

An observational, descriptive-retrospective, longitudinal, quantitative study was performed. ‘Portal da Transparência' was used as the source of free access data about the Portuguese National Health Service.

Results

The results which are here presented are comparing the year 2020 to the average of 2015-2019. In mainland Portugal, in 2020, there were 7% more Primary Health Care appointments (PHCA). Although there were less PHCA during the first five months of 2020, there was a rise in the number of PHCA since June 2020. In 2020, 59% were distance PHCA, a rise of 113% compared to the average of 2015-2019. There was a fall of 38% on presential PHCA in 2020. The number of presential PHCA was inferior in each month of 2020, in comparison to the homologous month of the average of 2015-2019. The month with less presential PHCA was April 2020 (less 72% than the average of 2015-2019). Regarding domiciliary PHCA, there was a 36% reduction.In mainland Portugal, the number of Primary Health Care users with, at least, one face-to-face or distance PHCA, in 2020 was 6,661,927, 3% less than the average of 2015-2019.

Conclusions

The transition from presential PHCA to distance PHCA that occurred in 2020 due to the COVID-19 pandemic allowed the follow-up of most of the patients. However, there is a need to assess if distance PHCA are as effective as presential PHCA and which are its effects in communities' health.

(1) Vieira A et al. Excesso de mortalidade, mortalidade colateral e resposta dos serviços de saúde em Portugal em tempos de COVID-19

Key messages

In 2020, in mainland Portugal, there was an increase on distance Primary Health Care appointments and a decrease on presential ones. Its impact on population’s health should be assessed.
Comparing health outcomes of care experienced children to children not in care in Scotland 2009-2016
Authors: Allik M , Brown D , Leyland AH , Henderson M
Published: October 2021

Background

Internationally, there is little quantitative evidence on how the health of children who have experienced social care compares to children in the general population. Invariably, available evidence suggests that care experience is related to poorer health, but often this is based on small sample sizes or without comparison to children who have not been in care. The Children's Health in Care in Scotland (CHiCS) study provides the first Scotland-wide evidence on health outcomes of care experienced children (CEC) compared to children in the general population (CGP).

Methods

We undertook an individual level administrative data linkage of social care, morbidity, prescribing, death and birth records from August 2009 to July 2016. The CEC cohort was defined as all school-age children who were in social care in 2009/2010 (n = 13,831) and the CGP cohort includes school-age children who were not in care (n = 649,771). Age-standardized rates per 1000 person-years were calculated for hospitalisation by cause, prescription types and cause of death for both cohorts.

Results

Initial results show that CEC experienced higher average rates of mortality, prescriptions, and different types of hospitalisations during the study period (not adjusted). There are substantial differences in the types of prescriptions and reasons for hospital admission between the cohorts; CEC are more likely to be prescribed antidepressants (rate of 260.2 per 1000 person-years for CEC compared to 114.4 for GCP) and to attend psychiatric outpatient appointments (rate of 163.2 compared to 32.6). Care experienced young women have higher rates of medical abortions (rate of 11.3 compared to 6.1).

Conclusions

The results from this study indicate that CEC are more likely to contact the health services, particularly for mental and sexual/reproductive health reasons, and these problems may track into adulthood. Interventions to reduce inequalities in health for CEC should focus on these areas.

Key messages

CEC had higher rates of mortality, prescriptions, and hospitalisations during the study period. CEC are more likely to contact the health services for mental and sexual/reproductive health reasons.
The Integrated Local Plan for Health Promotion of the Lombardy Region:a planning tool for prevention
Authors: Olivadoti S , Calloni L , Capriulo AP , Celata C
Published: October 2021

Issue

The Health Protection Agencies (ATS) of the Lombardy Region play a role in the governance through the technical-methodological support to achieve health objectives. Through Local Health Promotion Plans (PIL), ATS are tasked with programming campaigns for health promotion and prevention of NCDs at the territorial level, following regional (PRP) and national (PNP) guidelines. The PIL foster the integration of different sectors and activate non-health policies, through networks and stakeholders from different territories. The COVID-19 pandemic has further highlighted the need for an integrated and, intersectorial plan able to promote the development of partnerships, in order to focus more on the social and environmental determinants of health. This strategy guarantees responses to the needs of the population during an emergency, as well as equitable and sustainable prevention programs.

Description of the problem

As part of its planning activities, each ATS defines and annually updates the PIL according to a methodology consistent with the regional situation and, based on analyses of health and the equity context. Implementation of the PIL is part of the prevention performance indicators and it is monitored at the regional level through collaborative work networks encompassing, research, training and sharing of best practices.

Results

The comparative reading of the 8 PIL makes it possible to identify the contents defined in the various territories, highlighting of intersectorial relations present at the regional level. The mapping of interventions clearly highlights the settings in which the greatest number of resources are invested (school and work), thus becoming a tool for planning action programs in subsequent years.

Lessons

In addition to being a planning tool, the PIL allows the sharing of the local health profile and priorities with all territorial actors, becoming one of the tools in which the Health Profile is declined.

Key messages

The analysis of PIL is the starting point for the systemization of good practices, identifying possible organizational synergies and the preventive effects of the actions and programs implemented. Comparative reading of PIL allows for benchmarking of health promotion interventions.
Cross-domain collaboration: the Dutch Combined Lifestyle Intervention
Authors: Bekker M , Wagemakers A
Published: October 2021

Background

In the Netherlands, the policy-making process to realize funding for the Combined Lifestyle Intervention (CLI) by health insurance lasted twelve years. Since January 2019, the health care components of the CLI are covered by the Health Insurance Act. We aimed to identify policy design decisions, processes and implementation willingness and capacity of stakeholders.

Methods

We conducted an institutional policy analysis using backward mapping. We composed a timeline (2007-2019) based on public documents and interviewed 22 key stakeholders, representing policy-making institutions, care professions, health insurers and CLI-owners.

Results

Three main design decisions (out of 15) are: 1) including lifestyle coaching in the CLI.; 2) excluding the physical activity component for funding by health insurance and 3) health insurers and municipalities having own policies, resulting in a variety of contracts with health care providers and local differences in the CLI offer.

Decision-making was mainly based on scientific evidence. However, not all stakeholders were represented in policy-making. The CLI requires collaboration between care professionals and lifestyle coaches, a new profession linking the medical and social domain. Vested and new stakeholders faced competing interests, which tempered their willingness and capacity to implement the CLI.

Conclusions

The CLI sets a new standard - at the interface of indicated and selective prevention - by incorporating (non-medicalised) lifestyle coaching. Although the CLI is embedded in a single insurance-based scheme (instead of across domains), it institutionalizes cross-domain collaboration without providing the necessary resources. Collaborative prevention requires cross-domain trusting implementation networks, including vested stakeholders, field innovators and citizens, to avoid conflicts, and build adaptive and responsive prevention policies.

Key messages

Interventions in the field of prevention require incentives for collaboration based on cross-domain trusting implementation networks. Politics around collaborative prevention requires a balanced stakeholder level playing field to avoid conflicts around vested interests and to facilitate stable responsive prevention policies.
Impact of the COVID-19 pandemic on emergency healthcare utilization: a cohort study
Authors: Chou YC , Yen YF , Chu DC , Hu HY
Published: October 2021

Background

Emergency department (ED) crowding is a burden on public health, so understanding the characteristics of frequent ED users is a key concern of the healthcare system and policy makers. This study aims to examine the characteristics and healthcare-seeking behaviors in frequent ED users before and during the COVID-19 pandemic.

Methods

A retrospective observational study was conducted on ED users aged 18 years and over admitted to Taipei City Hospital in February 2019-January2020 (before pandemic) and February 2020-January2021 (during pandemic) (N = 120,011). Frequent and ED users were defined as patients with four or more ED visits in a year. Multivariate logistic regression was used to identify the predictors of frequent ED use before and during the COVID-19 pandemic.

Results

Monthly emergency department visits were significantly lower during the pandemic (by 10.1-26.8%). Frequent ED patients had shorter lengths of stay in the ED during the pandemic (212.5 vs.233.9 minutes; P < 0.0001). The proportion of ED patients receiving chest CT examination during the pandemic has increased by 0.5-0.6%. After adjusting for sociodemographic factors, triage status, mode of arrival, and copayment exemption, patients with a triage status of level 4-5 (AOR=1.60, 95% CI: 1.13-2.28), diagnosis of pneumonia (AOR=1.85, 95% CI: 1.07-3.17), giddiness (AOR=2.85, 95% CI: 1.82-4.45), dyspnea (AOR=1.85, 95% CI: 1.00-3.39), or chronic kidney disease (AOR=5.05, 95% CI: 2.66-9.59) were more likely to be frequent ED visitors during the pandemic.

Conclusions

Since SAR-CoV-2 is highly contagious, it is imperative to educate non-emergent patients to utilize outpatient medical services rather than emergency medical services to reduce the risk of COVID-19 outbreaks at the ED.

Key messages

This study found that the utilization of emergent medical services during the COVID-19 pandemic significantly decreased by 10.1%–26.8% compared to before the COVID-19 pandemic. The lengths of stay in frequent ED users during the COVID-19 pandemic were significantly shorter than that in frequent ED users before the COVID-19 pandemic.
Changes of perceived risk and mental well-being during two waves of COVID-19 pandemic in Czechia
Authors: Dalecká A , Šlachtová H , Tomášková H , Maďar R , Skýbová D
Published: October 2021

Background

The COVID-19 pandemic has been negatively affecting many people's daily life. The strict preventive measures might have contributed to psychological distress, fear and fatigue. Therefore, it is crucial to build trust and ensure effective communication from the government to maintain public awareness. This study focuses on the comparative analysis of public health risk perception of COVID-19 during the pandemic.

Methods

The questionnaire surveys were conducted online during the first (April 2020) and second (November-December 2020) waves of the pandemics. The health risk concerns, perceived mental well-being and compliance with the adopted measures of the population were evaluate for potential development in time. The impact of age, gender and socio-demographic factors were tested. The average values of the 5-point Likert scale were tested for differences by Mann-Whitney and Kruskal-Wallis tests on the significance level 5% and analyzed using the SW STATA v.15.

Results

From a sample of 9,168 (1st survey) and 1,042 (2nd survey) Czech respondents aged 40 years, respectively 45 years in average, the present results showed that individual health concerns increased with age, while descending trend toward younger age was observed in terms of mental health. The perceived risk of COVID-19 substantially elevated over the observed period (p < 0.001) as well as compliance with the measures (p < 0.001). Further, 27% of the respondents self-evaluated their mental health as bad or very bad that was analysed as a significantly worsening (p < 0.001). Moreover, 66% of respondents evaluated communication of the government as unsatisfactory that was in relation with a low compliance with measures.

Conclusions

This study contributes to understanding the development of the risk perception as a public response to COVID-19 pandemic. A divergence among the generation was observed. More focused communication of government might be required to enhance public trust.

Key messages

Compliance with the measures substantially elevated over the pandemics that is in relation with low government trust. Mental well-being has been significantly worsened over the COVID-19 pandemics.
Environment related practices for emergency response to infectious disease outbreak on cruise ships
Authors: Chrysikou E , Hernandez Garcia E , Savvopoulou E , Haldane J , Satoh H
Published: October 2021

Issue/problem

COVID-19 pandemic halted cruise operations globally. This project explored strategies and measures that could be adopted internationally for mitigating a disease outbreak on-board of a cruise ship by bringing evidence-based recommendations for an emergency response against current COVID-19 outbreak and future infectious threats.

Description of the problem

Research took place in October 2020-March 2021. Methods comprised of: a) consultation sessions with five international experts on public health, epidemiology, tourism and cruise management, b) both systematic and narrative literature reviews. Present guidance analysed why cruise ships promote an opportunistic environment for infectious outbreaks, along with a strategy for reducing the risks among passengers and crew.

Results

Results were organised under four main themes: a) advice on surface interactions and virus viability; b) prevention and control measures; c) suggestions on short and long term responses; d) advice on thermal and ventilation conditions and how they affect virus transmission. The guidance was very similar to other built environment contexts, ignoring the particularities of sociospatial interactions in cruise ships. Moreover, there was limited provision for the wellbeing and mental health during the outbreak.

Lessons

This project summarised recommendations for the preparedness of cruise ships during a pandemic from ports, off-board and on-board measures to repatriation. Demonstrated the importance of spatial characteristics in the preparedness of a ship. Pointed the effect pandemic can have upon crew and passengers. This needs to be taken into account when operations restart. Cruise experience would have to change due to covid-19, especially when social activity on board has to be restricted. The importance of future studies focusing on how this change will impact cruise industry arose, including crew hygiene, safety and supporting mental health during outbreaks.

Key messages

Multi-disciplinary approach on providing a set of recommendations for emergency response to infectious disease outbreak on cruise ships including environmental preparedness. Actions should include also the mental health of crew and passengers on copying with stress during infectious outbreaks.
Policy communication for health and sustainability: comparison of food-based dietary guidelines
Authors: Aguirre Sánchez L , Teschner R , Malinverno N , Jungbluth N , van der Horst K , Marques-Vidal P , Suggs LS
Published: October 2021

Background

Food-based dietary guidelines (FBDGs) provide advice on what constitutes a healthy diet, influencing both decision-making at the policy level, and educational programs addressed to consumers. There is a growing body of literature that allows to estimate the health and environmental impacts of the wide adoption of FBDG at the country and global levels. This unlocks the possibility of evaluating the most sustainable dietary guidelines from a communication perspective. This study aims at answering what are the key converging messages and main differences in the communication of FBDG that have a high environmental potential, and what of those FBDG do communicate a sustainability purpose in an explicit way.

Methods

A mixed-method comparative review of FBDGs with a two-stage sampling process was developed. Building on Springmann et al (2020) we identified the countries where the wide population adoption of dietary guidelines would have the highest potential of reducing food-related greenhouse gas emissions (GHGe) while delivering positive health outcomes. In a second stage, a purposeful sample of FBDGs was designed to cover countries from different WHO regions, income levels, and languages.

Results

This study is in progress and results are preliminary. Out of the initial sample of identified FBDG with a GHGe reduction potential of more than 25 percent, a few of them, Germany, Brazil, Sweden, Netherlands, and France had been previously identified in the literature as having sustainability-based recommendations. Other guidelines with similar GHGe reduction potential, such as those of Switzerland and Italy also address sustainability in an explicit way.

Conclusions

FBDGs have been traditionally focused on health and nutrition messages. Several countries have updated recommendations considering the environmental impacts of food consumption. Not all the FBDG with a high environmental potential explicitly communicate sustainability concerns.

Key messages

Several countries can improve their health and climate change outcomes by promoting a wider adoption of their official dietary guidelines. Communication is a key aspect of this process.
Adoption of Telemedicine During the COVID-19 Pandemic: Perspectives of Primary Healthcare Providers
Authors: Lintz J
Published: October 2021

Background

As the pandemic has unfolded across an array of communities worldwide, telemedicine has been promoted and scaled up to attend to and reduce person-to-person transmission of COVID-19 in the U.S. and internationally. This study examined the major barriers to adoption of telemedicine among primary healthcare providers at a primary care clinic in north Texas during the pandemic.

Methods

A self-administered questionnaire was mailed to 67 primary healthcare providers at a primary care clinic in north Texas, with a 70% percent response rate (n = 47). The survey collected information on perceived barriers to telemedicine adoption and experience with telemedicine in the last 12 months. In addition to descriptive statistics, multiple logistic regression was conducted to determine characteristics related to use of telemedicine in the past year. Chi-square tests were also performed to examine the relationship between the number of perceived barriers and telemedicine usage.

Results

Results revealed that the lack of reimbursement was a significant obstacle to telemedicine adoption. Plus, the number of perceived barriers to telemedicine usage was negatively associated with using telemedicine.

Conclusions

The findings suggested that the barriers to using telemedicine existed across an array of situations and that decreasing these obstacles would be critical in encouraging future telemedicine adoption among providers during and after the pandemic. This will especially be the case for primary care practices where scarce financial resources have been a traditional problem for such providers.-This complicacy is likely to be amplified owing to the inimical effects of the pandemic, during and after its potential containment or successful management of it.

Key messages

Instructive to healthcare providers in the United States and around the globe vis-à-vis developing a holistic strategic plan of action to address the key barriers in the adoption of telemedicine. To motivate healthcare providers to utilize telemedicine, a variety of administrative, financial, and technical barriers should be remedied during the pandemic.
mHealth to support healthy lifestyle in early stroke prevention
Authors: Mälstam E , Patomella AH , Guidetti S , Asaba E
Published: October 2021

Background

A healthy lifestyle is a strong mediator for reducing the risk for cardiovascular diseases, including stroke. mHealth apps can be an integral part of disease prevention and to support self-management of different chronic conditions and the use of apps have increased. It is however crucial that digital tools that are developed for implementation in healthcare are explored in target populations. A digitally augmented intervention called ‘Make My Day' has been developed for Swedish Primary health care setting to support a change toward healthy behaviours and habits in everyday life for persons at risk for stroke. The aim of the study was to explore experiences of this new intervention which integrated a mobile app and onsite group sessions for persons who have been identified with a risk for stroke.

Methods

A qualitative design was utilized comprising interviews and observations conducted over 18 months with persons (n = 12) at risk for stroke. A constant comparative method was utilized.

Results

Preliminary findings show that the app contributed to opportunities for the participants to discover own strengths, weaknesses, current activity patterns, as well as keep track of lifestyle habits and risk factors. The app nudged the participants to incorporate healthy everyday routines. Suggested improvements of the app included automated and personally tailored options for registrations and feedback. The utility of the app also depended on how well it accounted for aspects of participants literacy levels.

Conclusions

mHealth apps can offer support in incorporating health promoting behaviours and everyday routines as part of lifestyle-based stroke prevention. Increased personalization and tailoring was however important for user satisfaction.

Key messages

mHealth apps can promote increased awareness of current activity patterns, keep track of lifestyle habits and risk factors and serve as nudging to incorporate healthy everyday routines. Personal relevance and literacy levels are important to consider in stroke prevention mHealth apps to promote motivation to behaviour change and use of mHealth apps.
Digital sexual and reproductive health resources for women living in a migrant camp in Serbia
Authors: Graham A
Published: October 2021

Prior to Covid-19 (C19), I delivered sexual and reproductive health (SRH) educational workshops to refugee/migrant women in a migrant camp in Belgrade, Serbia. SRH education and access are key to the public health for all but specifically this vulnerable population. C19 and a national lockdown meant an alternative, none face to face delivery method was required. Migrant camps exist throughout Europe, and restrictions due to C19 continue across the world increasing the applicability of this practice in many settings. My previous experience informed my knowledge for course content, however not suitable delivery methods. Most women had mobile phones, however barriers to accessing online content included intermittent internet access, low computer literacy, inadequate privacy, and need for translation. Following research into alternative formats, over a number of months we piloted; texts +/- attachments, voice messages, video streaming, online videos to download. The questions posed were 1. Which format was the most accessible/acceptable to the women? 2. When the format was decided, how many women would access the content and was this number comparable to the workshops? The feedback showed texts with links to unlisted YouTube videos with burned subtitles were best, enabling download when internet access/privacy allowed and requiring minimal computer skills. We created an SRH programme of 5-minute videos with feedback obtained via text. Each video has 4-21 views (averaging 8 and continuing to increase) at time of submission, comparable or more than the workshops. This innovative practice delivers SRH information to women in this migrant camp. It doesn't replace workshops but when access is restricted it can be used independently, or ordinarily as a supplementary tool to workshops. It is applicable in any setting when access is restricted. Benefits include; choice of when/where/how to access; repeat views; potential for wider reach/scaling to reach larger populations.

Key messages

These carefully designed digital resources have allowed non-English speaking migrant women in a migrant camp to continue accessing sexual and reproductive health education during Covid-19 lockdowns. This innovative practice of delivering information to vulnerable, hard to reach groups is applicable in many settings when face to face access is restricted.
Patient experience with telemedicine in primary care during the COVID pandemic: a qualitative study
Authors: Tulupova E , Dobiášová K , Kopsa Těšinová J
Published: October 2021

Background

The Czech Republic is one of the countries with the low rate of digitization of health care processes, and the current legislation provides only isolated elements of electronic health care. Due to the COVID-19 pandemic, general practitioners (GPs) in the Czech Republic, as in other countries, had to rapidly switch to telemedicine visits. Information on patient perspectives about these visits is lacking. Our study aims to understand patients' perceptions about telemedicine visits at GPs during COVID-19, and to identify barriers and benefits of telemedicine in primary care.

Methods

A qualitative approach was applied. 40 semi-structured interviews were conducted (25 with patients who had telemedicine visits with a GP, and 15 with representatives of patients' organisations). Data was analysed using a thematic analysis.

Results

It has been shown that telemedicine visits took place mainly through telephone and email communication, without using the full potential of telemedicine. The absence of legal regulation and guidelines for telemedicine and the implementation of telemedicine in primary care without prior adaptation generates a number of problems in the patient-physician relationship. In some cases, the unregulated use of telemedicine leads to inequalities in access to healthcare. Persistent medical paternalism has also been shown to significantly affect telemedicine visits in primary care.

Conclusions

The results of the research will be used for the proposal of legislative changes in the field of distance care. Telemedicine guidelines will be created, considering the specifics of primary care. An educational program for patients on the improvement of their digital health literacy and on communication in healthcare using digital technologies will be created.

Project funding: TL04000105 Digital literacy in primary health care: COVID-19 as a challenge for the development of information communication technologies, Technology Agency of the Czech Republic.

Key messages

Implementation of telemedicine in primary care, without prior adaptation to a new way of communication, generates problems in the patient-physician relationship. The absence of legal regulations and guidelines for telemedicine can lead to inequalities in access to healthcare.
Postmenopausal women with osteoporosis – The effect of exercise on markers of quality of life
Authors: Gustafsson H , Marini S , Wright SAI , Maffei F , Dallolio L
Published: October 2021

Background

Osteoporosis (OP) is a major and increasing health problem worldwide, especially in European countries, where the modern, sedentary lifestyle from an early age leads to brittle bones later in life. Patients affected by OP tend to move less and have a lower quality of life (QoL). This study aims to evaluate how OP affects individual markers for QoL in postmenopausal women and assess the influence of exercise on these markers.

Methods

The EQ-5D questionnaire was administered to evaluate Mobility, Self-care, Usual Activities, Pain/Discomfort and Anxiety/Depression in a sample of Italian women with osteoporotic vertebral fractures, aged 60-75. Markers linked to QoL were compared for these women with those of an average female Italian population (AFIP) of similar age. Concurrently, a 6-month exercise trial was conducted, in which the OP patients were divided into two groups: an exercise group (EG) and a control group (CG). The QoL was assessed for both groups at the end of the trial.

Results

A larger proportion of OP patients reported some problems with Mobility as compared to the AFIP (37.5% versus 31.2% respectively, p = 0.001) and in performing Usual Activities (45% versus 23.9%, p = 0.002). OP patients (77.5%) experienced some Pain/Discomfort, compared to 48.1% of the AFIP (p = 0.001). Anxiety/Depression was reported by 40% of OP patients and 18.8% of the AFIP (p = 0.001). Concerning the exercise trial, the results indicated a positive trend for Mobility and Usual Activities in the EG, while the CG markers remained unchanged.

Conclusions

Overall, results confirm that OP significantly affected QoL in postmenopausal women. In particular, OP negatively influenced the markers Mobility, Usual Activities, Pain/Discomfort and Anxiety/Depression. Exercise programs tailored to OP patients can improve some markers linked to QoL. Evidence suggests that health policy makers in Europe can consider including OP-adapted exercise programmes in guidelines for OP management.

Key messages

Osteoporosis negatively affects the quality of life for postmenopausal women. In particular, Mobility, Usual Activities, Pain/Discomfort and Anxiety/Depression markers were affected. Exercise can improve some markers linked to quality of life (Mobility and Usual Activities). Thus, it could be proposed as a treatment for osteoporosis in postmenopausal women.
6-10-14 for Health - as an example of an interdisciplinary model of care for a patient with obesity
Authors: Metelska P , Brzeziński M , Jankowski M , Niedzielska A
Published: October 2021

Issue

Overweight and obesity are public health challenges of growing importance in Poland. The fastest increase has been observed in children and adolescents. Some studies show that 22% of elementary school children are currently (2013) overweight or have obesity (IZZ), compared with no more than 15% in 1990 (WHO Europe, 2012).

Description of the problem

The “6-10-14 for Health” is the first comprehensive health programme implemented in Poland, focused on long-term health behaviour change both among children with obesity and their families. Screening tests are carried out at Gdańsk schools. Children who are diagnosed with excess body weight are invited to the second level of programme. Target groups are children in Gdansk, aged 6, 9-11 and 14 years, their parents and the school environment. Timeline: 2011-2021

Results

effects: Approximately 400-450 new patients join the programme every year. Programme participants receive annual care from an interdisciplinary team of specialists including a paediatrician, dietitian, specialist in physical activity and a psychologist. The effect of one year's participation in the programme is the reduction of excess body weight in 75% of participants. More then 2000 patients have complieted the Programme. The programme is accredited by the European Association for the Study of Obesity and is funded by the City of Gdańsk. changes: Further implementation of the Programme depends on providing funds from the City of Gdańsk. However, it seems that the 6-10-14 for Health is one of the city's health priorities. The challenge in the field of weight reduction programs is to provide care that will not lead to stigmatization of patients

Lessons

The work on designing the model has already resulted in creation of network of specialists from different backgrounds and allowed sharing different scopes, how to use limited resources for the benefit of children and adolescens.

Key messages

The proposed care model is fully possible to implement in the care system. So far, sharing knowledge and experience, the program has been implemented in several other local governments. In the era of the COVID19 pandemic, all activities aimed at the prevention and early treatment of obesity become even more important.