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The COVID-19 pandemic has demonstrated the urgency of better chronic disease management and the importance of making it an integral part of the recovery agenda in Europe. This paper aims to explore the shift towards digital and integrated care systems in Europe.

In this viewpoint paper the Expert Group for Integrated Care and Digital Health Europe (EGIDE) group argues that an orchestrated shift towards integrated care holds the solution to the chronic disease pandemic.

The development of integrated care cannot happen without shifting towards a digitalised healthcare system via large-scale initiatives like the European Health Data Space (EHDS) and the involvement of all stakeholders.

The EGIDE group has identified some foundational principles, which can guide the way to realise the full potential of the EHDS for integrated care and can support the involved stakeholders’ thinking.

The purpose of this study is to identify best practices for innovative primary care models and to describe a potential future primary care (PC) model for Texas to address the burden of chronic disease in a population-based approach.

A systematic literature review was conducted and identified 1,880 published records through PubMed using 26 search terms. After abstract and full-text review, 70 articles remained as potential models.

Although there is already a severe shortage of physicians in Texas, emerging practice patterns and choices among physicians are likely to erode access to primary care services in the state. Health-care leaders are encouraged to consider models such as complex adaptive systems for team-based care, pharmacist hypertension care management program and combined nurse-led care management with group visit structure.

As with any study, this research has its limitations; for example, models that might work in one state, or under a unique state-funded academic medical center, might not be “do-able” in another state within the nuances of a different funding mechanism.

Results of this research provide a model for implementing IPCM for the state of Texas first and will guide IPCM planning and implementation in other states.

This study is “land grant-centric” and focused on carrying out the mission of a major, top-tier research university with an emerging college of medicine at an academic medical center.

A global trend of type 2 diabetes prevalence is rising. Preventing and managing of systemic and dental complications is crucial to decrease negative effects on glycemic control. The purpose of this paper is to estimate the efficacy of Brief Lifestyle Change in conjunction with Dental Care (Brief-LCDC) Programs to decrease glycemic level and improve periodontal status in patients with type 2 diabetes.

Health Center 54 conducted randomized controlled trial among 192 patients (96 intervention and 96 control) from February to August 2018. Group education for lifestyle modification, individual oral hygiene instruction and lifestyle counseling by motivational interviewing was provided to the intervention group at baseline. Motivation of lifestyle modification every month by multimedia was also provided to the intervention group. The usual program was provided to the control group. At baseline and a six-month follow-up, glycemic level and periodontal status were assessed from participants. Data were analyzed by descriptive statistic, t-test, χ² test, Fisher’s exact test, Repeated measure ANOVA and multiple linear regression.

Glycemic level and periodontal status were lower in the intervention group than the control group at the sixth-month followed up with statistical significances. Glycemic level and periodontal status had negatively correlated to intervention group with statistically significant.

Brief-LCDC Program which incorporated lifestyle modification and oral health care had efficacious to decrease glycemic level and improve periodontal status in patients with type 2 diabetes. Early prevention program by Brief-LCDC Program is crucial to prevent dental complications.

Healthy Together (HT) is an innovative family education program focused on bringing families together to promote physical activity and healthy eating. The HT program was implemented in 10 community-based organizations across Canada offering services to immigrant and refugee families. The purpose of this study was to explore the feasibility and acceptability of HT when offered to these families.

A cross-sectional, non-comparative design was used. Caregiver participants were invited to complete a survey at the end of 15, 30 or 24 HT sessions. Trained program facilitators and directors of community-based organizations also provided feedback on the program.

Among the 203 caregiver participants, 135 (64%) were born outside of Canada. These caregivers were more likely to attend 50% or more of the HT sessions than Canadian-born caregivers. Survey responses show that the HT program was acceptable to immigrant and refugee caregivers and held important benefits for families including positive changes in healthy eating and physical activity, strengthening social connections and learning about community services and resources. Areas for enhancing the HT program for immigrant and refugee families were identified by participant caregivers and community organizations delivering the program.

The HT program demonstrates the value of family-centered program models in supporting immigrant and refugee families in establishing healthy lifestyles and building social connections in ways that hold promise for long-term impact.

The HT program model demonstrates strong potential to fill gaps in community programming for immigrant and refugee families. Although focused on promoting healthy lifestyles, the program extends additional benefits that can positively influence resettlement trajectories. The findings contribute to the growing field of implementation studies that are focused on expanding the reach and impact of community health interventions in a real-world setting while reaching multiple target populations.

The purpose of this paper is to examine the effect of mindfulness practice on health behaviors and quality of life (QOL) among hypertensive patients.

A quasi-experimental research was designed by before, after and a follow-up phase (i.e. on the 0th, 6th and 12th weeks). Two primary health care units (PCU) were selected as control and experiment groups. Samples included patients 35–59 years old who had been diagnosed with stage I hypertension. Both groups received treatment according to standard hypertension guidelines. The experimental group was added as a drill for the purpose of a mindfulness-based health education (MBHE) practice that would emphasize behavior skills (in diet, exercise and mental function) and instill a feeling of adaptation to everyday life.

The total mean score of the prevention and promotional hypertension behaviors (PPHB), QOL, perceived in mindfulness (MF) and self-efficacy (SE) in the experiment group showed a significant statistical difference when compared to the control group in the 6th week in PPHB and SE (p<0.001), QOL and MF (p=0.001). Similar results were found in the 12th week in PPHB, QOL, SE (p<0.001) and MF (p=0.023), respectively.

However, finished implementation in experiment group, during the follow-up phase on the 12th week, ten participants in the control group were excluded (Figure 1). It may be no active intervention or as usual in the control group. Thus, the authors controlled missing data using intention-to-treat analysis comparison and the data distribution was successfully tested by a normality plot before the use of statistical data. Based on the results of this study, the following recommendations can be made: patients should practice in mindfulness in lifestyle modification continued for intensive skill practice over the long term in order to promote sustainability in behavior and in QOL.

Mindfulness trainer should drill and faith in the value of mindfulness corporation owner with patients learning all of the times; and for health practitioner, it should add MBHE for patients.

Education institution should add mindfulness in educational programs all of graduates.

The mindfulness practice-based health education training should be in counterpart with modern medicine in order to promote sound health behaviors and an improved QOL for stage I hypertensive patients and to forestall cardiovascular and blood-pressure diseases.

Previous dynamic prediction models rarely handle multi-period data with different intervals, and the large-scale patient hospital records are not effectively used to improve the prediction performance. This paper aims to focus on the prediction of cardiovascular disease using the improved long short-term memory (LSTM) model.

A new model based on the traditional LSTM was proposed to predict cardiovascular disease. The irregular time interval is smoothed to obtain the time parameter vector, and it is used as the input of the forgetting gate of LSTM to overcome the prediction obstacle caused by the irregular time interval.

The experimental results show that the dynamic prediction model proposed in this paper obtained a significant better classification performance compared with the traditional LSTM model.

In this paper, the authors improved the LSTM by smoothing the irregular time between different medical stages of the patient to obtain the temporal feature vector.

This study aims to elucidate the health care organization, management and policy barriers and facilitators associated with implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain.

Seven focus groups were conducted with 49 health professionals from six primary care centers participating in the Prescribing Healthy Life program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management and policy.

The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow and (3) available resources to carry out the program. Specific barriers in these areas related to lack of financial and political support, consultation time constraints and difficulty managing competing day-to-day demands. Other barriers and facilitators were related to the constructs networks and communication, culture, relative priority and leadership engagement. A set of six specific barrier-facilitator pairs emerged.

Implementation science and, specifically, the CFIR constructs were used as a guide. Barriers and facilitators related to the implementation of a health promotion program in primary care were identified. Healthcare managers and policy makers can modify these factors to foster a more propitious implementation environment. These factors should be appropriately monitored, both in pre-implementation phases and during the implementation process, in order to ensure effective integration of health promotion into the primary care setting.

This paper aims to overview the need for tobacco harm reduction, the consumer products that facilitate tobacco harm reduction and the barriers to its implementation. The worldwide endemic of tobacco smoking results in the death of over seven million smokers a year. Cigarette quit rates are very low, from 3%–12%, and relapse rates are high, from 75%–80% in the first six months and 30%–40% even after one year of abstinence. In addition, some smokers do not desire to quit. Cigarette substitution in tobacco harm reduction is one strategy that may reduce the burden of morbidity and mortality.

This review examines the displacement of smoking through substitution of non-combustible low-risk products such as snus, heated tobacco products and e-cigarettes.

Toxicological testing, population studies, clinical trials and randomized controlled trials demonstrate the potential reductions in exposures for smokers. Many barriers impede the implementation of product substitution in tobacco harm reduction. These products have been subjected to regulatory bans and heavy taxation and are rejected by smokers and society based on misperceptions about nicotine, sensational media headlines and unsubstantiated fears of youth addiction. These barriers will need to be addressed if tobacco harm reduction is to make the maximum impact on the tobacco endemic.

This review provides the rationale for tobacco harm reduction, evaluates the current products available and identifies the barriers to implementation.

How to improve healthcare for the ageing population is attracting academia attention. Emerging technologies (i.e. robots and intelligent agents) look relevant. This paper aims to analyze the role of cognitive assistants as boundary objects in value co-creation practices. We include the perceptions of the main actors – patients, (in)formal caregivers, healthcare professionals – for a fuller network perspective to understand the potential overlap between boundary work and value co-creation practices.

We adopted a grounded approach to gain a contextual understanding design to effectively interpret context and meanings related to human–robot interactions. The study context concerns 21 health solutions that had embedded the Watson cognitive platform and its adoption by the youngest cohort (50–64-year-olds) of the ageing population.

The cognitive assistant acts as a boundary object by bridging actors, resources and activities. It enacts the boundary work of actors (both ageing and professional, caregivers, families) consisting of four main actions (automated dialoguing, augmented sharing, connected learning and multilayered trusting) that elicit two ageing value co-creation practices: empowering ageing actors in medical care and engaging ageing actors in a healthy lifestyle.

We frame the role of cognitive assistants as boundary objects enabling the boundary work of ageing actors for value co-creation. A cognitive assistant is an “object of activity” that mediates in actors' boundary work by offering novel resource interfaces and widening resource access and resourceness. The boundary work of ageing actors lies in a smarter resource integration that yields broader applications for augmented agency.

This study aims to examine the different effects that the fear and humor appeals in anti-smoking advertisements for children have on their affective reactions to the advertisements, on their beliefs about smoking and on their behavioral intentions to smoke.

This paper presents the findings of a qualitative research study conducted in Italy with children aged from 8 to 11 years.

The results indicated that the humor appeal is a useful method for conveying a social theme in a pleasant way and creating a likable character that becomes an example for children to imitate; however, it is necessary to employ the fear appeal to make children reflect carefully about the negative consequences of smoking.

This study examined only children's behavioral intentions derived from anti-smoking advertisements, but future research should also examine their real behaviors after a period following repeated viewing of public service announcements about smoking prevention or other social issues.

Understanding how different types of appeals can influence children represents an important result for the prevention of youth smoking and the promotion of healthy lifestyle habits during childhood.

Understanding how different types of appeals can influence children represents an important result for the prevention of youth smoking and the promotion of healthy lifestyle habits during childhood.

Few studies have examined the impact of social advertisements on children, and particularly little is known about the effectiveness of fear appeals on this group.