When Right-Wing Populism Becomes Distorted Public Health Communication: Tracing the Roots of Jair Bolsonaro's Epidemiological Denialism

This article delineates key links between right-wing populism and epidemiological denialism. Building on a comparative analysis of central tropes from Brazilian president Jair Bolsonaro's 2018 campaign and his public-facing response to the COVID-19 pandemic, we argue that his engagement during both periods employs two key elements of right-wing populism: Antielitism, or the view that the political establishment is irredeemably disconnected from the citizenry, and anti-pluralism, or the blaming of political and social problems on scapegoat populations. During the COVID-19 outbreak, this denigration of public trust fuels denialism or the systemic attempt to downplay severity to minimize public response. Developing a thematic analysis around Bolsonaro's speeches, interviews, and personal social media, we address how anti-elitist and anti-pluralist strategies from the 2018 campaign inform the pandemic response. These include the discrediting of governmental bodies, the villainization of progressive activists, and the assignation of blame on foreign actors. Our goal is to provide an in-depth case study of how communication bolstering epidemiological denialism is propagated-an increasingly vital conversation as right-wing populism and health misinformation proliferate.

The 2022 monkeypox outbreak: A UK military perspective.

With the emergence of SARS-CoV-2 and now monkeypox, the UK Defence Medical Services have been required to provide rapid advice in the management of patients with airborne high consequence infectious diseases (A-HCID). The Defence Public Health Network (DPHN) cadre, consisting of closely aligned uniformed and civilian public health specialists have worked at pace to provide evidence-based recommendations on the clinical management, public health response and policy for monkeypox, with military medicine and pathology clinicians (primarily infectious disease physicians and medical microbiologists). Military environments can be complicated and nuanced requiring specialist input and advice to non-specialists as well as unit commanders both in the UK and overseas. DPHN and military infection clinicians have close links with the UK National Health Service (NHS) and the UK Health Security Agency (UKHSA), allowing for a dynamic two-way relationship that encompasses patient management, public health response, research and development of both UK military and national guidelines. This is further demonstrated with the Royal Air Force (RAF) Air Transport Isolator (ATI) capability, provided by Defence to support the UK Government and UKHSA. Military infectious disease clinicians are also embedded within NHS A-HCID units. In this manuscript we provide examples of the close interdisciplinary working of the DPHN and Defence clinicians in managing military monkeypox patients, co-ordinating the public health response, advising the Command and developing monkeypox policy for Defence through cross-government partnership. We also highlight the co-operation between civilian and military medical authorities in managing the current outbreak.

Implications for the design of a Diagnostic-Decision Support System to reduce time and cost to diagnosis in paediatric shoulder instability

Keywords: Shoulder;Instability;Diagnostic Decision Support System Purpose: Diagnosis of shoulder instability in children, is difficult and recurrent rates of instability are high (70–90%). Time to a formal diagnosis is normally two years diagnostic delays can lead to poorer outcome and long-term complications e.g. shoulder arthritis (odds ratio 19.3). There is a need to improve diagnostic accuracy and prevent the development of long-term complications. Healthcare services are increasingly drawing upon technological solutions to improve diagnostic accuracy and efficiency, particularly within the context of the COVID-19 pandemic and subsequent ‘Rebuilding of the NHS’ strategy. A Diagnostic Decision Support System (DDSS) has the potential to reduce time to diagnosis and improve outcomes for patients. The aim of this study was to elicit physiotherapists clinical decision-making processes and develop a concept map for a future DDSS in shoulder instability. Methods: A qualitative study, using modified nominal focus group technique, involving three clinical vignettes, was used to elicit physiotherapists decision-making processes. Participants from across four separate clinical sites were recruited within their capacity as physiotherapists with a specialist interest in paediatric shoulder instability. All focus group sessions were audio recorded and transcribed verbatim. Thematic analysis was conducted according to the stages of Braune and Clarke. Results: Twenty-five physiotherapists, (18F:7M) from four separate clinical sites participated. The themes identified related to • Variability in diagnostic processes and lack of standardised practice 1. Differences in diagnoses and diagnostic processes 2. Differences in diagnoses and diagnostic processes 3. Diagnostic process occurs over a long period of time 4. Diagnostic test choices influenced by factors beyond objective markers associated with the patient injury 5. Planning for prognosis influenced by factors beyond assessment findings 6. Trust in staff relationships • General distrust in individuals or modes of medicine used outside of the department • Unity within the department • Knowledge and attitudes towards novel technologies for facilitating assessment and clinical decision making and 1. Lack of knowledge and rejection of 3D motion capture. Conclusion(s): No common structured approach towards assessment and diagnosis was identified. Decision-making processes were not explicit, therefore, limiting the ability to develop a DDSS around current practice. Several systematic biases were identified in the assessment of paediatric shoulder instability, most notably regarding gender. Lack of knowledge, perceived usefulness, access, and cost were identified as barriers to adoption of new technology. Impact: Based on the information elicited a conceptual design of a future DDSS has been developed. Implementation of a DDSS may act as a vehicle for establishing wider consensus in practice and alert clinical end users of potential bias in order to mitigate against it. These findings have wider implications for the training and education of physiotherapists regarding assessment and clinical decision-making. Use of more objective measures, derived from technology, and used alongside an appropriate DDSS may reduce bias and the negative effects on patient outcomes. Development of any subsequent DDSS and software will need to address the barriers identified which are likely to limit the use of novel technology in practice. There is a risk that even if additional information and technology was available to clinicians, they would not use it. Funding acknowledgements: This work was supported by the Keele University, Faculty of Natural Sciences Research Development Fund under Grant C3700-0958.

169 Improving the care of lung cancer patients of borderline fitness for surgery: a case study by the Accelerate, Coordinate and Evaluate Programme (ACE) programme

Background: There is wide variation in resection and other radical treatment rates for lung cancer patients in the UK. Many patients pose complex problems around staging and assessment of fitness for radical treatment, one such group being those patients deemed ‘borderline fit' for surgery. Cancer Research UK's ACE Programme is exploring how fitness is assessed in such patients across the UK, the extent to which prehabilitation is available and used and how other radical treatment options, especially Stereotactic Body Radiotherapy (SBRT), are considered. Methodology: In collaboration with the Society of Cardiothoracic Surgeons, a questionnaire was sent to trusts in November 2020 that specialise in thoracic surgery, focusing on: their access to, and management of, a prehabilitation programme;methods used to assess fitness for surgery;access to a clinical oncologist with expertise in SBRT Results: To date, a total of 20/32 units responded. Findings include: 15/20 offer a prehabilitation programme mostly available within 2 weeks. The programmes typically last 1-2 weeks. 10 respondents are running virtual sessions due to COVID-19;standard pulmonary function tests are available to all units and 17/20 units have access to cardiopulmonary exercise testing and echocardiogram;complex case MDTs are run by 14/20 units, 13 including attendance from anaesthetists;an oncologist with SBRT expertise is available to all MDTs;a 2nd opinion is obtained in 17/20 units, of these 9/17 were following patient request Conclusion: It is encouraging to see wider application of prehabilitation programmes for borderline fitness patients in the UK. Such enhanced management of these patients could reduce variation in treatment rates and improve outcomes. The ACE Programme plans to use this preliminary work to develop examples of best practice and support implementation to achieve these aims. Disclosure: No significant relationships.