A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery.

This scoping review compiled information concerning digital health technologies (DHTs) evolution to support primary health care (PHC) during COVID-19 and lessons for the future of PHC. The identified literature was published during the COVID-19 peak years (2019-2021), retrieved from PubMed, Scopus, and Google Scholar, as well as hand searched on the internet. Predefined inclusion criteria were used, thematic analysis was applied, and reporting followed the PRISMA for Scoping Reviews. A total of 46 studies were included in the final synthesis (40 articles, one book, two book chapters, one working paper, and two technical reports). These studies scrutinized various aspects of DHTs, entailing 19 types of DHTs with 20 areas of use that can be compressed into five bigger PHC functions: general PHC service delivery (teleconsultations, e-diagnosis, e-prescription, etc.); behavior promotion and digital health literacy (e.g., combating vaccine hesitancy); surveillance functions; vaccination and drugs; and enhancing system decision-making for proper follow-up of ongoing PHC interventions during COVID-19. DHTs have the potential to solve some of the problems that have plagued us even prior to COVID-19. Therefore, this study uses a forward-looking viewpoint to further stimulate the use of evidence-based DHT, making it more inclusive, educative, and satisfying to people's needs, both under normal conditions and during outbreaks. More research with narrowed research questions is needed, with a particular emphasis on quality assurance in the use of DHTs, technical aspects (standards for digital health tools, infrastructure, and platforms), and financial perspectives (payment for digital health services and adoption incentives). Supplementary Information: The online version contains supplementary material available at 10.1007/s12553-023-00725-7.

A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery

This scoping review compiled information concerning digital health technologies (DHTs) evolution to support primary health care (PHC) during COVID-19 and lessons for the future of PHC. The identified literature was published during the COVID-19 peak years (2019–2021), retrieved from PubMed, Scopus, and Google Scholar, as well as hand searched on the internet. Predefined inclusion criteria were used, thematic analysis was applied, and reporting followed the PRISMA for Scoping Reviews. A total of 46 studies were included in the final synthesis (40 articles, one book, two book chapters, one working paper, and two technical reports). These studies scrutinized various aspects of DHTs, entailing 19 types of DHTs with 20 areas of use that can be compressed into five bigger PHC functions: general PHC service delivery (teleconsultations, e-diagnosis, e-prescription, etc.);behavior promotion and digital health literacy (e.g., combating vaccine hesitancy);surveillance functions;vaccination and drugs;and enhancing system decision-making for proper follow-up of ongoing PHC interventions during COVID-19. DHTs have the potential to solve some of the problems that have plagued us even prior to COVID-19. Therefore, this study uses a forward-looking viewpoint to further stimulate the use of evidence-based DHT, making it more inclusive, educative, and satisfying to people's needs, both under normal conditions and during outbreaks. More research with narrowed research questions is needed, with a particular emphasis on quality assurance in the use of DHTs, technical aspects (standards for digital health tools, infrastructure, and platforms), and financial perspectives (payment for digital health services and adoption incentives). Supplementary Information The online version contains supplementary material available at 10.1007/s12553-023-00725-7.

Associations between the COVID-19 Pandemic and Hospital Infrastructure Adaptation and Planning-A Scoping Review.

The SARS-CoV-2 pandemic has put unprecedented pressure on the hospital sector around the world. It has shown the importance of preparing and planning in the future for an outbreak that overwhelms every aspect of a hospital on a rapidly expanding scale. We conducted a scoping review to identify, map, and systemize existing knowledge about the relationships between COVID-19 and hospital infrastructure adaptation and capacity planning worldwide. We searched the Web of Science, Scopus, and PubMed and hand-searched gray papers published in English between December 2019 and December 2021. A total of 106 papers were included: 102 empirical studies and four technical reports. Empirical studies entailed five reviews, 40 studies focusing on hospital infrastructure adaptation and planning during the pandemics, and 57 studies on modeling the hospital capacity needed, measured mostly by the number of beds. The majority of studies were conducted in high-income countries and published within the first year of the pandemic. The strategies adopted by hospitals can be classified into short-term (repurposing medical and non-medical buildings, remote adjustments, and establishment of de novo structures) and long-term (architectural and engineering modifications, hospital networks, and digital approaches). More research is needed, focusing on specific strategies and the quality assessment of the evidence.

Let's End HepC: Modelling Public Health Epidemiological Policies Applied to Hepatitis C in Spain.

Background: The WHO has defined international targets toward the elimination of hepatitis C by 2030. Most countries cannot be on track to achieve this goal unless many challenges are surpassed. The Let's End HepC (LEHC) tool aims to contribute to the control of hepatitis C. The innovation of this tool combines the modelling of public health policies (PHP) focused on hepatitis C with epidemiological modelling of the disease, obtaining a unique result that allows to forecast the impact of policy outcomes. The model was applied to several countries, including Spain. Methods: To address the stated objective, we applied the "Adaptive Conjoint Analysis" for PHP decision-making and Markov Chains in the LEHC modelling tool. The tool also aims to be used as an element of health literacy for patient advocacy through gamification mechanisms and country comparability. The LEHC project has been conducted in several countries, including Spain. The population segments comprised in the project are: People Who Inject Drugs (PWID), prisoners, blood products, remnant population. Results: A total of 24 PHP related to hepatitis C were included in the LEHC project. It was identified that Spain had fully implemented 14 of those policies to control hepatitis C. According to LEHC's model forecast, the WHO's Hepatitis C elimination goal on reducing the number of patients living with Hepatitis C to 10% can be achieved in Spain by 2026 if current policies are maintained. The model estimates that the total population in Spain, by 2026, is expected to comprise 26,367 individuals living with hepatitis C. Moreover, if the 24 PHP considered for this study are fully implemented in Spain, the elimination goal may be achieved in 2024, with 29,615 individuals living with hepatitis C by that year. Conclusion: The findings corroborate the view that Spain has set great efforts in directing PHP toward Hepatitis C Virus (HCV) elimination by 2030. However, there is still room for improvement, namely in further implementing 10 of the 24 PHP considered for the LEHC project. By maintaining the 14 PHP in force, the LEHC model estimates the HCV elimination in the country by 2026, and by 2024 if further measures are employed to control the disease.

Lessons from the COVID-19 Pandemic for Lifelong Learning

After more than a year of living with the COVID-19 pandemic, much experience has been accumulated by countries around the world. There have been many failures, and there have been some things that have gone well. Adult learning and education in some form has played a significant role in public health since, without the ongoing continuing educational interventions mainly via the mass media, the number of doctors and hospital beds would likely have been insufficient. In this paper we focus on the role of group behaviours in relation to the risk of contagion and we argue that any attempts to define a strategy to combat the pandemic must include a strong commitment to information dissemination and to the training of the populations in order to encourage behaviour change necessary to mitigate the spread of the virus. Against the backdrop of the United Nations Sustainable Development Goals, this article argues for commitment by governments to use adult learning and education as a tool for health prevention and health awareness and to prepare populations for whatever pandemics and national disasters that might emerge in the twenty-first century, the "century of pandemics". We therefore argue that populations must have at least a basic level of literacy and numeracy as foundational skills essential for enabling citizens to receive and act on vital information during a pandemic or disaster in order to engender greater resilience.

Real-World Evidence: The Low Validity of Temperature Screening for COVID-19 Triage.

Background: The COVID-19 pandemic forced health-related organizations to rapidly launch country-wide procedures that were easy to use and inexpensive. Body temperature measurement with non-contact infrared thermometers (NCITs) is among the most common procedures, both in hospital settings and in many other entities. However, practical hospital experiences have raised great doubts about the procedure's validity. Aim: This study aimed to evaluate the validity of the body temperature measured using NCITs among oncological and transplant patients who took the polymerase chain reaction test for SARS-Cov-2 PCR+ and PCR- in a Romanian Hospital. Methods: Body temperature was measured for 5,231 inpatients using NCITs. The cutoff point for fever was equal to or above 37.3°C. Patients then completed a questionnaire about their symptoms, contact, and travel history. Findings: Fever was detected in five of 53 persons with PCR+, resulting in a sensitivity of 9.43% (95% CI, 3.13-20.66%). No fever was verified in 5,131 of 5,171 persons with PCR-, resulting in a specificity of 99.15% (95% CI, 98.86-99.38%). A defensive vision of NCIT procedure (maximum standard error only in favor) had a sensitivity of 15.09% (95% CI, 6.75-27.59%). Conclusions: The use of NCITs in a triage provides little value for detection of COVID-19. Moreover, it provides a false sense of protection against the disease while possibly discriminating individuals that could present fever due to other reasons, such as oncologic treatments, where fever is a common therapeutical consequence. The consumption of qualified human resources should be considered, especially in the context of the shortage of healthcare professionals worldwide.

SARS-COV-2: SIR Model Limitations and Predictive Constraints

Background: The main purpose of this research is to describe the mathematical asymmetric patterns of susceptible, infectious, or recovered (SIR) model equation application in the light of coronavirus disease 2019 (COVID-19) skewness patterns worldwide. Methods: The research modeled severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) spreading and dissemination patterns sensitivity by redesigning time series data extraction of daily new cases in terms of deviation consistency concerning variables that sustain COVID-19 transmission. The approach opened a new scenario where seasonality forcing behavior was introduced to understand SARS-COV-2 non-linear dynamics due to heterogeneity and confounding epidemics scenarios. Results: The main research results are the elucidation of three birth- and death-forced seasonality persistence phases that can explain COVID-19 skew patterns worldwide. They are presented in the following order: (1) the environmental variables (Earth seasons and atmospheric conditions);(2) health policies and adult learning education (HPALE) interventions;(3) urban spaces (local indoor and outdoor spaces for transit and social-cultural interactions, public or private, with natural physical features (river, lake, terrain). Conclusions: Three forced seasonality phases (positive to negative skew) phases were pointed out as a theoretical framework to explain uncertainty found in the predictive SIR model equations that might diverge in outcomes expected to express the disease’s behaviour.

COVID-19 and the Use of Masks by Children. Statement From the Association of Schools of Public Health in the European Region and the European Academy of Paediatrics.

Despite the fact that the use of masks and respirators in adults has already reached a consensus in almost all countries and for situations in which they are recommended, this is not the case for the use of mask by children. This statement, regarding the usage of mask by children, has been jointly produced by the Association of Schools of Public Health in the European Region (ASPHER) and the European Academy of Paediatrics (EAP). It provides recommendations on the size of the mask, the material and ergonomics of children's masks. The authors also discuss the psychological dimension of children when they are asked to wear a mask. Moreover, they tackle the difficulties of children with disabilities.

Adult learning and education as a tool to contain pandemics: The COVID-19 experience.

In combating pandemics, more can be gained by changing citizens' behaviours than by relying solely on the medical route. In the current COVID-19 pandemic, the struggle to contain the outbreak and push back new infection figures will ultimately be won by training citizens how to avoid creating secondary transmission chains. The COVID-19 pandemic highlights the relationship between individual behaviour and group risk. Mass training of all social strata of a country's entire population is therefore critical in mitigating the pandemic. The authors of this article argue that adult learning and education (ALE) can play a pivotal role particularly in countries where average literacy levels are low, as these are usually the same countries in which healthcare systems are more fragile. This article explains why ALE, especially the promotion of health literacy as part of ALE (which is itself part of lifelong learning), is necessary to enable individuals to make informed health-related decisions. Research has shown that low- or non-literate individuals are less responsive to health education, less likely to use disease prevention services, and less likely to successfully manage chronic disease than literate citizens. The authors refer to the evaluation of the health literacy aspect of a large-scale adult literacy campaign launched in South Africa in 2008 which has yielded measurable outcomes and proved that the intervention had enabled adults to better understand health messages. They stress the importance of populations having at least a basic level of literacy and numeracy skills to enable them to receive and act on vital information during a pandemic or disaster. They argue that ALE should in fact be understood as an inherent element of every national emergency strategy, both in terms of prior preparation for possible future emergencies (such as pandemics, earthquakes, tornados, flooding, bushfires etc.), and in terms of reaction to a given emergency such as the current COVID-19 pandemic.

L'apprentissage et l'éducation des adultes, un outil pour endiguer les pandémies : l'expérience du COVID-19 ­ Dans la lutte contre les pandémies, on peut obtenir de meilleurs résultats en changeant les comportements des citoyens qu'en se fiant uniquement à la solution médicale. Dans le cas de la pandémie de COVID-19 qui nous préoccupe actuellement, nous gagnerons le combat mené pour contenir l'épidémie et réduire le nombre de nouvelles infections en apprenant aux citoyens comment éviter de créer des chaînes de contamination secondaire. La pandémie de COVID-19 met en relief la relation entre le comportement des individus et les risques pour le groupe. Pour la faire régresser, il est par conséquent crucial d'éduquer massivement toutes les couches sociales de la population d'un pays. Les auteurs de cet article affirment que l'apprentissage et l'éducation des adultes peuvent jouer un rôle déterminant dans les pays ayant un faible niveau d'alphabétisme, qui sont d'ordinaire également ceux où les systèmes de santé sont plus fragiles. Cet article explique pourquoi l'apprentissage et l'éducation des adultes, en particulier la promotion de l'alphabétisation sanitaire dans le cadre de l'apprentissage et de l'éducation des adultes, sont nécessaires pour permettre aux individus de prendre des décisions éclairées en matière de santé. Des recherches ont montré que les personnes illettrées ou analphabètes étaient moins ouvertes à l'éducation en matière de santé, qu'il était moins probable qu'elles s'adressent à des services de prévention des maladies et qu'elles avaient moins de chances de réussir à gérer des maladies chroniques que des citoyens instruits. Les auteurs renvoient à l'évaluation du volet d'alphabétisation sanitaire qui faisait partie d'une campagne d'éducation des adultes lancée à vaste échelle en Afrique du Sud en 2008. Il fournit des résultats quantifiables et prouva qu'il avait permis aux adultes de mieux comprendre les messages sanitaires. Les auteurs soulignent également l'importance pour les populations de posséder tout au moins des bases de lecture, d'écriture et de calcul pour pouvoir recevoir des informations vitales pendant une pandémie ou un cataclysme et être à même d'agir en fonction. Ils affirment qu'il conviendrait de considérer l'apprentissage et l'éducation des adultes comme faisant partie intégrante de toute stratégie d'urgence nationale, tant pour ce qui est de la préparation à d'éventuelles crises à venir (pandémies, tremblements de terre, tornades, inondations, feux de brousse, etc.) qu'en ce qui concerne la réponse à une situation d'urgence donnée comme c'est par exemple le cas de la pandémie de COVID-19.

El aprendizaje y la educación de adultos como herramienta para contener las pandemias: la experiencia de COVID-19 ­ En la lucha contra las pandemias, el cambio del comportamiento de los ciudadanos podría ser más beneficioso que confiar únicamente en la vía médica. En la actual pandemia COVID-19, la lucha para contener el brote y hacer retroceder las nuevas cifras de infección se ganará en última instancia capacitando a los ciudadanos para evitar la creación de cadenas de transmisión secundarias. La pandemia COVID-19 pone de relieve la relación entre el comportamiento individual y grupal de riesgo. Como consecuencia, la capacitación masiva de todos los estratos sociales de toda la población de un país es fundamental para mitigar la pandemia. Los autores de este artículo sostienen que el aprendizaje y la educación de adultos (EAA) podrían desempeñar un papel fundamental, principalmente, en los países en los que los niveles medios de alfabetización sean bajos, ya que suelen ser los mismos países en los que los sistemas de salud son más frágiles. En este artículo se explica por qué el EAA, especialmente la promoción de la alfabetización en materia de salud como parte del EAA (que a su vez forma parte del aprendizaje a lo largo de toda la vida), es necesaria para que las personas puedan tomar decisiones informadas en materia de salud. Las investigaciones han demostrado que las personas con bajo nivel de alfabetización o analfabetas responden menos a la educación sanitaria, tienen menos probabilidades de utilizar los servicios de prevención de enfermedades y menos probabilidades de gestionar con éxito las enfermedades crónicas que los ciudadanos alfabetizados. Los autores señalan una evaluación sobre el valor de la alfabetización en materia de salud de una campaña de alfabetización de adultos a gran escala iniciada en Sudáfrica en 2008, que ha dado resultados válidos y ha demostrado que la intervención ha permitido a los adultos comprender mejor los mensajes sobre la salud. Además, subrayan la importancia de que las poblaciones tengan por lo menos un nivel básico de conocimientos de lectura, escritura y aritmética que les permita recibir información importante y actuar en consecuencia durante una pandemia o un desastre. Sostienen que el EAE debe entenderse, de hecho, como un elemento inherente a toda estrategia nacional de emergencia, tanto en lo que respecta a la preparación previa para posibles emergencias futuras (como pandemias, terremotos, tornados, inundaciones, incendios forestales, etc.), como en lo que respecta a la reacción a una emergencia determinada, como la actual pandemia COVID-19.