Background: COVID-19 is a global challenge to healthcare. Obesity is common in patients with COVID-19 and seems to aggravate disease prognosis. In this review we explore the link between obesity, chronic disease, lifestyle factors and the immune system, and propose societal interventions to enhance global immunity.Search Strategy and Selection Criteria: We performed three literature searches using the keywords (1) coronavirus AND comorbidities, (2) comorbidities AND immune system, and (3) lifestyle factors AND immune system. Results were screened for relevance by the main author and a total of 215 articles were thoroughly analyzed.Results: The relationship between obesity and unfavorable COVID-19 prognosis is discussed in light of the impact of chronic disease and lifestyle on the immune system. Several modifiable lifestyle factors render us susceptible to viral infections. In this context, we make a case for fostering a healthy lifestyle on a global scale.Conclusions: Obesity, additional chronic disease and an unhealthy lifestyle interactively impair immune function and increase the risk of severe infectious disease. In adverse metabolic and endocrine conditions, the immune system is geared toward inflammation. Collective effort is needed to ameliorate modifiable risk factors for obesity and chronic disease on a global scale and increase resistance to viruses like SARS-CoV-2.

BackgroundHealthcare professionals (HPs) can play a substantial role in smoking cessation counseling (SCC) but in practice often skip this task due to time constraints. This study evaluates the implementation of the rapid Ask-Advise-Connect (AAC) method in a University hospital setting.MethodsThis mixed methods pre-post interventional study was performed at the Cardiology department of a University hospital and consisted of (1) a quantitative assessment of patient smoking registration and HP connection rates to external SCC from the Electronic Medical Record, (2) semi-structured interviews with 10 HPs to assess their attitudes toward AAC, and (3) a blended intervention aimed to implement AAC. The blended intervention consisted of face-to-face and online AAC psychoeducation for HPs followed-up with motivational messages on their smart pagers over a period of 6 weeks.ResultsIn total, 48,321 patient registrations and 67 HPs were included. Before AAC implementation, HPs assessed smoking status in 74.0% of patients and connected 9.3% of identified smokers with SCC. Post intervention, these percentages did not increase (73.2%, p = 0.20; and 10.9%, p = 0.18, respectively). Nonetheless, the vast majority (90%) of HPs feel it is important to discuss patient smoking, and view it as their duty to do so. Main barriers to AAC reported by HPs were forgetfulness and time pressure.ConclusionThis study shows that this AAC intervention does not increase Asking after smoking status or Connection of patients to SCC in a University Hospital. However, HPs hold positive attitudes toward AAC. A better understanding of the mechanisms required for optimizing HPs practice behavior is needed.

No abstract

BACKGROUND Type 2 diabetes (T2D) tremendously affects patient health and healthcare globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioural, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change health behaviour and improve glucose regulation. Digital tools are effective in areas of self-mangement and have great potential to support patient self-management due to low costs, 24/7 availability and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and to use a structured approach to guide the development team in planning, coordinating and executing the development process. OBJECTIVE Taking this into account, we aimed to develop an integrated, eHealth-supported, educational care pathway for people with T2D. METHODS The educational care pathway was developed using the first three phases of the CeHRes Roadmap; the contextual inquiry, the value specification and the design phase. Following this roadmap we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with healthcare professionals and a patient panel, to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box and consisted of personalized education, online educational material, self-measurements of glucose, blood pressure, activity and sleep, and a smartphone application to bring it all together. RESULTS The scoping review highlights the importance of self-management education, and the potential of telemonitoring and mobile apps for blood glucose regulation in T2D patients. Focus groups with healthcare professionals revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualisation and that insulin use should be incorporated into the app. Both patients and healthcare professionals stressed the importance of direct automated feedback in the Diabetes Box. CONCLUSIONS After developing the Diabetes Box prototype using the CeHReS Roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible, and that direct automated feedback and education on stress and sleep are essential. To assess feasibility, acceptability and usefulness in more detail, a pilot study is planned.

No abstract