Public policy for healthy living: How COVID-19 has changed the landscape

Validation of a Slovenian version of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) for use with patients in family medicine

BACKGROUND

Chronic non-communicable diseases are the world's leading cause of death and disability. The emerging field of lifestyle medicine requires equipping healthcare professionals with instruments, knowledge, skills and competencies. Measuring an individual's lifestyle with a valid and reliable instrument is the first step in promoting it. The aim of the study was to validate the Slovenian adaptation of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ).

METHODS

A cross-sectional study was conducted among 666 questionnaire participants, and they were adult participants (aged 18 and above) from family medicine practices with cardiovascular diseases (CVDs) risk factors (e.g., hypertension, high cholesterol) but without a diagnosis of acute CVDs. The questionnaire included demographic data and anthropological measures and a translated English HLPCQ questionnaire. The instrument was translated using the forward-backwards translation method. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki. In addition to assessing the construct validity of the questionnaire, exploratory and confirmatory factor analyses were used to determine content and face validity, and internal consistency reliability.

RESULTS

The mean age of male participants was 41.34 (± 13.220) years, the mean age of female participants was 40.31 (± 11.905) years. The Cronbach's alpha was 0.852, and all questionnaire subscales had positive correlations. Sampling adequacy was confirmed by the Kaiser-Meyer-Olkin (KMO) index (0.851), and Bartlett's test of sphericity was significant (χ² = 4647.694, p < 0.001), indicating suitability for Principal Component Analysis (PCA). PCA revealed a five-factor solution, accounting for 50.67% of the total variance.

CONCLUSIONS

The most influential factors for a healthy lifestyle were daily routine, healthy dietary choices, avoidance of harmful dietary habits, organized physical activity, and social and mental balance. The Slovenian version had high factor validity and reliability. It can be used in Slovenian Community Health Centre to assess an individual's control over various lifestyle dimensions. The instrument also holds potential for use in public health initiatives, supporting early identification of lifestyle-related risk factors and promoting preventive care strategies in the primary care setting.

A scoping review of the roles, challenges, and strategies for enhancing the performance of community health workers in the response against COVID-19 in low- and middle-income countries

BACKGROUND

Global concerns regarding effective response strategies to the COVID-19 pandemic arose amid the swift spread of the virus to low- and middle-income country (LMIC) settings. Although LMICs instituted several measures to mitigate spread of the virus in low resource settings, including task shifting certain demand and supply functions to community actors such as community health workers (CHWs), there remains a lack of synthesized evidence on these experiences and lessons. This scoping review sought to synthesize evidence regarding the roles and challenges faced by CHWs during the fight against COVID-19, along with strategies to address these challenges.

METHODOLOGY

We systematically searched several major electronic databases including PubMed, HINARI, Cochrane Library (Reviews and Trials), Science Direct and Google Scholar for relevant literature. The search strategy was designed to capture literature published in LMICs on CHWs roles during COVID-19 period spanning 2019-2023. Two researchers were responsible for retrieving these studies, and critically reviewed them in accordance with Arksey and O'Malley scoping review approach. In total, 22 articles were included and analysed using Clarke and Braun thematic analysis in NVivo 12 Pro Software.

RESULTS

Community health workers (CHWs) played a vital role during the COVID-19 pandemic. They engaged in health promotion and education, conducted surveillance and contact tracing, supported quarantine efforts, and maintained essential primary health services. They also facilitated referrals, advocated for clients and communities, and contributed to vaccination planning and coordination, including tracking and follow-up. However, CHWs faced significant challenges, including a lack of supplies, inadequate infection prevention and control measures, and stigma from community members. Additionally, they encountered limited supportive policies, insufficient remuneration and incentives. To enhance CHWs' performance, regular training on preventive measures is essential. Utilizing digital technology, such as mobile health, can be beneficial. Establishing collaborative groups through messaging platforms and prioritizing access to COVID-19 vaccines are important steps. Additionally, delivering wellness programs and providing quality protective equipment for CHWs are crucial for their effectiveness.

CONCLUSION

The study found that CHWs are vital actors within the health system during global pandemics like COVID-19. This entails the need for increased support and investment to better integrate CHWs into health systems during such crises, which could ultimately contribute to sustaining the credibility of CHWs programs and foster more inclusive community health systems (CHSs).

Seasonal Mortality Patterns Analyzing Epidemiological Impact of COVID-19 on Overall Mortality Rates in Belgrade, Serbia Over Three-Year Period (2020-2023): Mental Health Consequences and Public Health Implications

Background/Objectives: Seasonal variations in mortality rates are well-documented, particularly during the winter months when mortality typically increases. This rise in mortality, ranging from 5% to 25%, is often associated with chronic cardiovascular and respiratory diseases. Understanding these seasonal fluctuations is essential for guiding public health interventions. This study analyzes mortality rates and excess mortality in Belgrade from March 2020 to May 2023, focusing on the impact of the COVID-19 pandemic on overall mortality trends. The primary objective of this study is to assess the impact of the COVID-19 pandemic on mortality rates in Belgrade during the study period. The first secondary objective is to evaluate seasonal variations in mortality, with a focus on the 10.57% overall increase in mortality, and to highlight the 34.23% rise in winter mortality recorded in 2020. The second secondary objective is to assess the effectiveness of public health measures in mitigating excess mortality during this period. Methods: A descriptive epidemiological approach was used to analyze monthly mortality data from the City Bureau of Statistics. Mortality rates were standardized using direct standardization and compared winter (December-February) and non-winter (March-November) periods. Trends, percentage increases, and age-specific mortality were analyzed based on the 2011 census methodology. Results: Mortality rates in Belgrade ranged from 1115.67 to 1267.19 deaths per 100,000 inhabitants, with an average of 1205.62. Standardized mortality rates ranged from 936.49 to 1111.67, averaging 1021.64. The winter months showed higher mortality, averaging 1716 deaths per 100,000, compared to 1558 in the non-winter months. Conclusions: The winter months exhibited significantly higher mortality rates, likely exacerbated by the COVID-19 pandemic. Targeted public health policies and interventions are necessary to reduce seasonal mortality risks during future public health crises.

Blueprints for Better Care: Unveiling the Role of Clinic Design in Enhancing Patient Experience and Efficiency

Background: The rising demand for outpatient care, fueled by improved efficiency, technology, and patient-centered models, necessitates reevaluating clinic design and healthcare delivery. This reassessment should align with evolving patient expectations to enhance care continuity and outcomes. Objective: This research explores how targeted design features affect patient behaviors, movement dynamics, and staff perceptions in outpatient clinics. The goal is to enhance patient experience, improve operational efficiency, and elevate care quality by identifying strategies to boost clinic performance and patient outcomes. Methods: This study utilizes behavior mapping, shadowing observations, surveys, and Gemba walk-throughs across four outpatient clinics to examine how design affects patient experiences and operational workflows. Behavior mapping collected 1179 data points, revealing that waiting for appointments and making phone calls were the most common activities. Shadowing 13 patients identified navigation inefficiencies, particularly the lengthy route from exam rooms to exits and the frequent movement between the scale and waiting area. Surveys and Gemba walk-throughs with 95 staff members highlighted critical design elements that enhance experiences, including aesthetics, acoustics, and room sizes. Feedback indicated a demand for improvements in accessibility, privacy, wayfinding, reduced staff travel distances, and child-friendly features to boost clinic efficiency and patient satisfaction. Conclusion: This study highlights the importance of patient-centered design in outpatient clinics. It shows that improving waiting areas, clinic navigation, privacy measures, and technology integration can enhance patient experience and operational efficiency.

The association of micro and macro worries with psychological distress in people living with chronic kidney disease during the COVID-19 pandemic

BACKGROUND

Psychological distress can be exacerbated by micro (personal) and macro (societal) worries, especially during challenging times. Exploration of this relationship in people with chronic kidney disease is limited.

OBJECTIVES

(1) To identify the types and levels of worries concerning people with chronic kidney disease in the context of the COVID-19 pandemic; (2) to explore the association of worries with psychological distress including depression, stress, anxiety, and health anxiety.

DESIGN AND PARTICIPANTS

A cross-sectional online survey collected data at two time points (Autumn 2020, n = 528; Spring 2021, n = 241). Participants included kidney transplant recipients and people with non-dialysis dependent chronic kidney disease.

MEASUREMENTS

The survey included questions about worry taken from the World Health Organisation COVID-19 Survey, the Depression, Anxiety and Stress Scale, and the Short Health Anxiety Index. Data were analysed using descriptive statistics and multiple regression.

RESULTS

Worries about loved ones' health, the healthcare system becoming overloaded, losing a loved one, economic recession, and physical health were the highest rated concerns. Worrying about mental health was associated with higher depression, stress, anxiety, and health anxiety. Worrying about physical health was associated with anxiety and health anxiety. Worrying about losing a loved one was associated with health anxiety, and worrying about not being able to pay bills was associated with stress.

CONCLUSIONS

People with kidney disease reported micro and macro worries associated with psychological distress during the COVID-19 pandemic. This study highlights factors that should be considered to improve the mental health and well-being of people with kidney disease.

The use of digital platforms and physical activity practice in a population from southern Brazil: Findings from the PAMPA Cohort

Objective

We aimed to identify the factors associated with using digital platforms for physical activity during the COVID-19 pandemic among adults living in Southern Brazil. We also compared the trajectory of physical activity between users and non-users and by type of digital platform used.

Methods

We analyzed data from the PAMPA (Prospective Study About Mental and Physical Health in Adults) cohort. The study started in June 2020, and tracked participants through three waves (December 2020, June 2021, and June 2022). The exposure variable was usingf digital platforms for physical activity. The outcome measure was minutes per week of physical activity. We employed a generalized linear model with robust variance to explore the interaction between time and the use of digital platforms, adjusting for sociodemographic covariates and the presence of chronic diseases.

Results

The proportion of participants using digital platforms for physical activity declined from 36.8% in 2020 to 25.6% in 2021 and further to 13.5% in 2022. Using digital platforms for physical activity was associated with a higher mean daily physical activity during the COVID-19 pandemic. Participants who used digital platforms were more likely to be physically active when compared to their inactive contemparts throughout the entire study period. Notably, social media emerged with greater influence in the physical activity practice among digital platforms.

Conclusion

Using these platforms had a positive impact on increasing the level of physical activity among the participants.

A cost-consequence analysis of the Xpert Xpress CoV-2/Flu/RSV plus test strategy for the diagnosis of influenza-like illnesses

AIMS

Influenza-like illnesses (ILI) affect millions each year in the United States (US). Determining definitively the cause of symptoms is important for patient management. Xpert Xpress CoV-2/Flu/RSV plus (Xpert Xpress) is a rapid, point-of-care (POC), multiplex real-time polymerase chain reaction (RT-PCR) test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV). The objective of our analysis was to develop a cost-consequence model (CCM) demonstrating the clinico-economic impacts of implementing PCR testing with Xpert Xpress compared to current testing strategies.

METHODS

A decision tree model, with a 1-year time horizon, was used to compare testing with Xpert Xpress alone to antigen POC testing and send-out PCR strategies in the US outpatient setting from a payer perspective. A hypothetical cohort of 1,000,000 members was modeled, a portion of whom develop symptomatic ILIs and present to an outpatient care facility. Our main outcome measure is cost per correct treatment course.

RESULTS

The total cost per correct treatment course was $1,131 for the Xpert Xpress strategy compared with a range of $3,560 to $5,449 in comparators. POC antigen testing strategies cost more, on average, than PCR strategies.

LIMITATIONS

Simplifying model assumptions were used to allow for modeling ease. In clinical practice, treatment options, costs, and diagnostic test sensitivity and specificity may differ from what is included in the model. Additionally, the most recent incidence and prevalence data was used within the model, which is not reflective of historical averages due to the SARS-CoV-2 pandemic.

CONCLUSION

The Xpert Xpress CoV-2/Flu/RSV plus test allows for rapid and accurate diagnostic results, leading to reductions in testing costs and downstream healthcare resource utilization compared to other testing strategies. Compared to POC antigen testing strategies, PCR strategies were more efficient due to improved diagnostic accuracy and reduced use of confirmatory testing.

The Impact of the COVID-19 Pandemic on Influenza Vaccination Attitudes and Actions in Spain's Adult Population

Seasonal influenza is an acute respiratory infection caused by the influenza virus which constitutes a significant public health issue associated with high morbidity and mortality. The aim of this study was to investigate changes in attitudes, perceptions, and practices regarding influenza vaccination in the Spanish adult population during the COVID-19 pandemic, as well as their vaccination intentions, with special attention paid to those over 65 years old and in high-risk groups. To this end, a cross-sectional study was conducted through 2219 telephone interviews, and the results were compared with results obtained a year earlier. Regarding the reasons for deciding to get vaccinated in the 2022/23 season, a significant increase was observed in vaccine confidence (36.7% vs. 42.8%), social responsibility (32.5% vs. 43.8%), and in awareness of the importance of vaccination due to COVID-19 (21.7% vs. 25.4%). Advanced age (OR 2.8, 95% CI 2.0-3.9), belonging to high-risk groups (OR 2.7, 95% CI 2.0-3.7), and prior vaccination (OR 25.3, 95% CI 19.5-32.7) emerged as significant predictors for the intent to receive the influenza vaccine in the 2022/23 season. Continuously observing shifts in perceptions and behaviors related to influenza immunization is crucial to pinpoint factors that may influence the willingness to receive the vaccine and, in this way, design public health strategies that achieve a greater acceptance of it.

Wastewater Monitoring for Infectious Disease: Intentional Relationships between Academia, the Private Sector, and Local Health Departments for Public Health Preparedness

The public health emergency caused by the COVID-19 pandemic stimulated stakeholders from diverse disciplines and institutions to establish new collaborations to produce informed public health responses to the disease. Wastewater-based epidemiology for COVID-19 grew quickly during the pandemic and required the rapid implementation of such collaborations. The objective of this article is to describe the challenges and results of new relationships developed in Detroit, MI, USA among a medical school and an engineering college at an academic institution (Wayne State University), the local health department (Detroit Health Department), and an environmental services company (LimnoTech) to utilize markers of the COVID-19 virus, SARS-CoV-2, in wastewater for the goal of managing COVID-19 outbreaks. Our collaborative team resolved questions related to sewershed selection, communication of results, and public health responses and addressed technical challenges that included ground-truthing the sewer maps, overcoming supply chain issues, improving the speed and sensitivity of measurements, and training new personnel to deal with a new disease under pandemic conditions. Recognition of our complementary roles and clear communication among the partners enabled city-wide wastewater data to inform public health responses within a few months of the availability of funding in 2020, and to make improvements in sensitivity and understanding to be made as the pandemic progressed and evolved. As a result, the outbreaks of COVID-19 in Detroit in fall and winter 2021-2022 (corresponding to Delta and Omicron variant outbreaks) were tracked in 20 sewersheds. Data comparing community- and hospital-associated sewersheds indicate a one- to two-week advance warning in the community of subsequent peaks in viral markers in hospital sewersheds. The new institutional relationships impelled by the pandemic provide a good basis for continuing collaborations to utilize wastewater-based human and pathogen data for improving the public health in the future.

The Impact of COVID-19 on the Social Determinants of Cardiovascular Health

Cardiovascular disease is the leading noncommunicable disease and cause of premature mortality globally. Despite well established evidence of a cause-effect relationship between modifiable lifestyle behaviours and the onset of risk of chronic disease, preventive approaches to curtail increasing prevalence have been ineffective. This has undoubtedly been exacerbated by the response to COVID-19, which saw widespread national lockdowns implemented to reduce transmission and alleviate pressure on strained health care systems. A consequence of these approaches was a well documented negative impact on population health in the context of both physical and mental well-being. Although the true extent of the impact of the COVID-19 response on global health has yet to be fully realised or understood, it seems prudent to review effective preventative and management strategies that have yielded positive outcomes across the spectrum (ie, from individual to society). There is also a clear need to heed lessons learned from the COVID-19 experience in the power of collaboration and how this can be used in the design, development, and implementation of future approaches to address the longstanding burden of cardiovascular disease.

A united approach to promoting healthy living behaviours and associated health outcomes: a global call for policymakers and decisionmakers

Chronic disease pandemics have challenged societies and public health throughout history and remain ever-present. Despite increased knowledge, awareness and advancements in medicine, technology, and global initiatives the state of global health is declining. The coronavirus disease 2019 (COVID-19) pandemic has compounded the current perilous state of global health, and the long-term impact is yet to be realised. A coordinated global infrastructure could add substantial benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical must be supported by unified approaches that maximise public health. We present a call to action for established public health organisations and governments globally to consider the lessons from the COVID-19 pandemic and unite with true collaborative efforts to address current, longstanding, and growing challenges to public health.