Culturally safe eHealth:what is ‘best practice’ and who determines it?

Background/Objective: Evidence for the relevance, effectiveness, and sociocultural benefits of eHealth interventions with First Nations peoples is growing. In Australia, a research program is preparing a best practice framework (BPF) for eHealth with Aboriginal and Torres Strait Islander people [1]. The 7 phases aim to establish the themes and characteristics of culturally safe eHealth, as voiced by Aboriginal and Torres Strait Islander people. Methods: A systematic literature review and scoping review were conducted (Phases 1 and (ii) what guidelines or best practice evidence should inform eHealth interventions with Aboriginal and Torres Strait Islander people. PROSPERO and Open Science Framework protocols were registered. Search strategies incorporated variations of ‘eHealth’; ‘Aboriginal and Torres Strait Islander health’; ‘guidelines, ethics’. Database searches included WebofScience, Scopus, Cochrane, Embase, CINAHL, PubMed, PsycINFO, plus grey literature. Screening, data extraction and quality assessments were conducted by 3 authors, with narrative analysis to generate themes (Phase 3). Modified Delphi processes will confirm final themes and principles of the BPF (Phases 4-6). Delphi participants will include stakeholders of eHealth feasibility trials, subject matter experts, and community-controlled partners with expertise in Aboriginal and Torres Strait Islander health. Results: The BPF scientific protocol was published in June 2022 [1]. Phases 1&amp;2 commenced November 2022 with findings on-track for release in early 2023. In December 2022, qualitative data collection was completed for several eHealth feasibility trials with Aboriginal and Torres Strait Islander communities. Key findings from stakeholders will contribute to subsequent Delphi processes scheduled for May 2023. Dissemination of the foundational BPF is expected December 2023 (Phase 7). This presentation will highlight key findings from completed research phases. Conclusions: A BPF will contribute to rigorous eHealth innovations that promote genuine co-design, ensure cultural safety and clinical effectiveness for Aboriginal and Torres Strait Islander people.</p

Food classification guidelines across Australia - concordance and implications of differences

Background: Each Australian jurisdiction produces separate food and drink classification guidelines for different institutional settings (e.g., schools) to guide food service providers on what constitutes a nutritious offering. Australian food manufacturers, suppliers and retailers frequently report that it is challenging to align their product range with a multitude of different classification systems. This study aimed to investigate the concordance between guidelines from all Australian jurisdictions across various settings, based on their application to a range of packaged food and drink products. Methods: Products from top selling brands in Australian food service settings across 10 product categories (e.g., sweet snacks) were classified according to each of the 20 state and territory food classification guidelines applying to schools, workplaces, and healthcare settings (primarily ‘traffic light’ classification systems). Product nutrition information was retrieved from manufacturer, supplier, or retailer websites. The level of concordance between each combination of two guidelines using a traffic light’ based classification system was determined by the proportion of products rated as ‘amber’ across both guidelines. Results: 747 food and drink products were assessed. 88% products were classified at the same level of healthiness across all ‘traffic light’-based systems. Concordance in ‘amber’ food classifications ranged between 63% and 96% across guidelines for different jurisdictions. For school guidelines, ‘ice creams and frozen desserts’ had the highest concordance across guidelines (97%); ‘meat and seafood products’ had the lowest concordance (80%). Discrepancies mainly arose from differences in food categories included in guidelines, e.g., the ‘ready-to-eat meals’ category was absent from some guidelines. Conclusions: There is a need for national coordination and greater evidence-based consistency in food classification guidelines across Australian jurisdictions. This will help ensure clarity for businesses on how to better support community health, including food manufacturer product development and reformulation, and food outlets offerings

Public health interventions to promote oral health and well-being in patients with type 2 diabetes: a systematic review

Background and objective: Poor oral health and type 2 diabetes mellitus (T2DM) are chronic conditions affecting a wide proportion of the population. Both conditions share many risk factors and are linked by a chronic inflammation state. This review aimed at identifying public health interventions that could promote oral health and diabetes control in patients with poor oral health and T2DM. Methods: The systematic review was performed according to the PRISMA Statement and registered in the International Prospective Register of Systematic Reviews (PROSPERO registration: CRD42022310974). Seven electronic databases were searched (PubMed, Scopus, Embase, Web of Science, CINAHL, PsycInfo, Cochrane Library) from inception to 21 January 2022, and additional hand searching was performed across reviews’ references. A qualitative analysis was conducted, including all primary studies on diabetic patients, about interventions whose effectiveness and/or feasibility was measured for at least one outcome related to oral health or T2DM. Results: Of the 3153 records obtained after deduplication, 89 studies were considered eligible for inclusion. The most frequently evaluated outcomes were HbA1c and fasting glucose for T2DM, and parameters such as probing depth, bleeding on probing and clinical attachment loss for periodontitis. Most studies assessed the use of non-surgical periodontal treatment (especially scaling and root planing, sometimes corroborated by antibiotics): evidence confirmed effectiveness on periodontal parameters, but was more contrasting regarding T2DM outcomes. Three studies evaluated interventions involving group education for lifestyle modification, which showed to be effective on both outcomes. Also, community-based oral hygiene interventions and glycaemic control appeared to improve T2DM and periodontal outcomes. Conclusions: A variety of interventions are described in the literature. Of those included in this review, many indicated that there is a potential opportunity to promote good oral health alongside T2DM. An integrated approach involving health education, oral hygiene and glycaemic control may offer synergic improvement of both conditions

Physical activity and exercise in dementia : an umbrella review of intervention and observational studies

Background: Dementia is a common condition in older people. Among the potential risk factors, increasing attention has been focused on sedentary behaviour. However, synthesizing literature exploring whether physical activity/exercise can affect health outcomes in people with dementia or with mild cognitive impairment (MCI) is still limited. Therefore, the aim of this umbrella review, promoted by the European Geriatric Medicine Society (EuGMS), is to understand the importance of physical activity/exercise for improving cognitive and non-cognitive outcomes in people with dementia/MCI. Methods: Umbrella review of systematic reviews (SR) (with or without meta-analyses) of randomized controlled trials (RCTs) and observational (prospective and case-control in people with MCI) studies based on a systematic literature search in several databases. The certainty of evidence of statistically significant outcomes attributable to physical activity/exercise interventions was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Among 1,160 articles initially evaluated, 27 systematic reviews (4 without meta-analysis) for a total of 28,205 participants with dementia/MCI were included. No observational study on physical activity/exercise in MCI for preventing dementia was included. In SRs with MAs, physical activity/exercise was effective in improving global cognition in Alzheimer’s disease and in all types of dementia (very low/low certainty of evidence). Moreover, physical activity/ exercise significantly improved global cognition, attention, executive function, and memory in MCI, with a certainty of evidence varying from low to moderate. Finally, physical activity/exercise improved non-cognitive outcomes in people with dementia including falls and neuropsychiatric symptoms. SRs, without meta-analysis, corroborated these results. Conclusions: Supported by very low to moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and non-cognitive outcomes in people with dementia and MCI, but RCTs, with low risk of bias/confounding, are still needed to confirm these findings

Deprescribing tool for STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk) items

Background: Health care professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, a deprescribing tool was developed by a European expert group for STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) items. Methods: STOPPFall was created using an expert Delphi consensus process in 2019 and in 2020, 24 panellists from EuGMS SIG on Pharmacology and Task and Finish on FRIDs completed deprescribing tool questionnaire. To develop the questionnaire, a Medline literature search was performed. The panellists were asked to indicate for every medication class a possible need for stepwise withdrawal and strategy for withdrawal. They were asked in which situations withdrawal should be performed. Furthermore, panellists were requested to indicate those symptoms patients should be monitored for after deprescribing and a possible need for follow-ups. Results: Practical deprescribing guidance was developed for STOPPFall medication classes. For each medication class, a decision tree algorithm was developed including steps from medication review to symptom monitoring after medication withdrawal. Conclusion: STOPPFall was combined with a practical deprescribing tool designed to optimize medication review. This practical guide can help overcome current reluctance towards deprescribing in clinical practice by providing an up-to-date and straightforward source of expert knowledge

Association between number of medications and mortality in geriatric inpatients : a Danish nationwide register-based cohort study

Purpose: To explore the association between the number of medications and mortality in geriatric inpatients taking activities of daily living and comorbidities into account. Methods: A nationwide population-based cohort study was performed including all patients aged C65 years admitted to geriatric departments in Denmark during 2005-2014. The outcome of interest was mortality. Activities of daily living using Barthel-Index (BI) were measured at admission. National health registers were used to link data on an individual level extracting data on medications, and hospital diseases. Patients were followed to the end of study (31.12.2015), death, or emigration, which ever occurred first. Kaplan-Meier survival curves were used to estimate crude survival proportions. Univariable and multivariable analyses were performed using Cox regression. The multivariable analysis adjusted for age, marital status, period of hospital admission, BMI, and BI (model 1), and further adding either number of diseases (model 2) or Charlson comorbidity index (model 3). Results: We included 74603 patients (62.8% women), with a median age of 83 (interquartile range [IQR] 77-88) years. Patients used a median of 6 (IQR 4-9) medications. Increasing number of medications was associated with increased overall, 30-days, and 1-year mortality in all 3 multivariable models for both men and women. For each extra medication the mortality increased by 3% in women and 4% in men in the fully adjusted model. Conclusion: Increasing number of medications was associated with mortality in this nationwide cohort of geriatric inpatients. Our findings highlight the importance of polypharmacy in older patients with comorbidities

Impact on COVID-19 hospitalisation rates of Maltese elderly following achievement of 70% first dose vaccine coverage.

We studied COVID-19 hospitalisation rates in elderly Maltese residents, aged 80 years and older, after national attainment of 70% first-dose coverage of COVID-19 vaccine in this age cohort. The milestone resulted in almost 50% reduction of hospital admissions, as confirmed by time series modelling using national SARS-CoV-2 infection rates as the comparator. The reduction was not seen in younger, as yet unvaccinated, age groups, where hospital admissions actually increased during the same period following a third wave of infections.</jats:p

30th European Congress on Obesity (ECO 2023)

This is the abstract book of 30th European Congress on Obesity (ECO 2023