Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations.

BACKGROUND: The COVID-19 pandemic outbreak has dramatically disrupted healthcare systems. Two rapid WHO pulse surveys studied disruptions in mental health services, but did not particularly focus on neurology. Here, a global survey was conducted and addresses the impact of the pandemic on neurology services. METHODS: A cross-sectional study was carried out in which 34 international neurological associations were asked to distribute the survey to national associations. The responses represented the national situation, in November-December 2020, with regard to the main disrupted neurological services, reasons and the mitigation strategies implemented as well as the disruption on training of residents and on neurological research. A comparison with the situation in February-April 2020, first pandemic wave, was also requested. FINDINGS: 54 completed surveys came from 43 countries covering all the 6 WHO regions. Overall, neurological services disruption was reported as mild by 26%, moderate by 30%, complete by 13% of associations. The most affected services were cross-sectoral neurological services (57%) and neurorehabilitation (56%). The second wave of the pandemic, however, was associated with the improvement of service provision for diagnostics services (44%) and for neurorehabilitation (41%). Governmental directives were the major cause of services' disruption (56%). Mitigation strategies were mostly established through telemedicine (48%). Almost half of respondents reported a significant impact on neurological research (48%) and educational activities (60%). Most associations (67%) were not involved in decision making for neurological patients' issues by their national government. INTERPRETATION: The COVID-19 pandemic affects neurological services and raises the universal need for the development of neurological health care at the policy, systems and services levels. A global national plan on mitigation strategies for disruption of neurological services during pandemic situations should be established and neurological scientific and patients associations should get involved in decision making.

The design of health promotion strategies for seafarers.

Health promoting interventions among seafarers have, to date, been limited in scope and their effectiveness is questionable. There is good knowledge base from a wide range of onshore settings that indicates how best to structure health promotion initiatives in ways that are accepted by those affected by them and where their effectiveness has been fully evaluated. Here we identify the main lessons to be learnt from experience in other sectors and note the special features of the settings in which seafarers live and work as the basis for strategic development. The history of health promoting initiatives in seafarers is also summarised. The aim of this review is to foster debate about the best means to formulate seafarer health promotion initiatives and to introduce them in such ways that their effectiveness can be evaluated. The review has its origins as a scoping document for a strategic review of seafarer health promotion supported by the Seafarers' Trust.