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Viszerale Hypersensitivität wird als zentraler Mechanismus bei chronisch-entzündlichen Darmerkrankungen (CED) und Reizdarmsyndrom (RDS) diskutiert, welche beide mit einer erheblichen Einschränkung der Lebensqualität einhergehen. Bisherige Studien verwenden zumeist invasive Verfahren, die jedoch typischerweise mit der Messung viszeraler Wahrnehmung interferieren. Diese Studie untersucht daher, ob CED und RDS mit einer veränderten Wahrnehmung „natürlicher“ (nicht-invasiver) gastrischer Dehnungen assoziiert sind („Interozeption“). Zwanzig CED-Patienten in Remission (13 Morbus Crohn, 7 Colitis Ulcerosa), 12 RDS-Patienten, sowie 20/12 parallelisierte gesunde Kontrollprobanden absolvierten den 2-stufigen Water-Load-Test, bei dem eine beliebige Menge Wasser getrunken wird, bis die subjektiven Schwelle der Sättigung (Stufe 1) und des Völlegefühls (Stufe 2) erreicht sind. Gastrische Motilität wurde mittels Elektrogastrographie untersucht. CED-Patienten tranken signifikant mehr Wasser bis zur Sättigungsschwelle als RDS-Patienten, während es keine Unterschiede zu den Kontrollgruppen gab. Die getrunkene Wassermenge bis zur Schwelle des Völlegefühls unterschied sich nicht zwischen den Gruppen. Die elektrogastrographischen Muster zeigten ebenfalls keine Gruppenunterschiede, was impliziert, dass es keine Pathologien in der gastrischen Motilität gab. Die getrunkene Wassermenge bis zur Sättigung korrelierte negativ mit darmbezogener Lebensqualität bei CED-Patienten, aber positiv mit emotionalem Wohlbefinden bei RDS-Patienten. Diese Ergebnisse legen eine relative gastrische Hypersensitivität bei RDS und eine relative gastrische Hyposensitivität bei CED nahe, was jeweils mit spezifischen Facetten der wahrgenommenen Lebensqualität assoziiert ist.

Objectives To report on the disease-related quality of life of patients living with diabetes mellitus in Rwanda and identify its predictors. Design Cross-sectional study, part of the baseline assessment of a cluster-randomised controlled trial. Setting Outpatient clinics for non-communicable diseases of nine hospitals across Rwanda. Participants Between January and August 2019, 206 patients were recruited as part of the clinical trial. Eligible participants were those aged 21–80 years and with a diagnosis of diabetes mellitus for at least 6 months. Illiterate patients, those with severe hearing or visual impairments, those with severe mental health conditions, terminally ill, and those pregnant or in the postpartum period were excluded Primary and secondary outcome measures Disease-specific quality of life was measured with the Kinyarwanda version of the Diabetes-39 (D-39) questionnaire. A glycated haemoglobin (HbA1c) test was performed on all patients. Sociodemographic and clinical data were collected, including medical history, disease-related complications and comorbidities. Results The worst affected dimensions of the D-39 were ‘anxiety and worry’ (mean=51.63, SD=25.51), ‘sexual functioning’ (mean=44.58, SD=37.02), and ‘energy and mobility’ (mean=42.71, SD=20.69). Duration of the disease and HbA1c values were not correlated with any of the D-39 dimensions. A moderating effect was identified between use of insulin and achieving a target HbA1c of 7% in the ‘diabetes control’ scale. The most frequent comorbidity was hypertension (49.0% of participants), which had a greater negative effect on the ‘diabetes control’ and ‘social burden’ scales in women. Higher education was a predictor of less impact on the ‘social burden’ and ‘energy and mobility’ scales. Conclusions Several variables were identified as predictors for the five dimensions of quality of life that were studied, providing opportunities for tailored preventive programmes. Further prospective studies are n

Diabetes mellitus prevalence has been estimated at 5.1% in Rwanda. Several factors, including an increase in screening and diagnosis programmes, the urbanization of the population, and changes in lifestyle are likely to contribute to a sharp increase in the prevalence of diabetes mellitus in the next decade. Patients with low health literacy levels are often unable to recognise the signs and symptoms of diabetes mellitus, and may access their health provider late, hence presenting with more complications. The Rwandan health care system is facing a severe shortage in human resources. In response to the need for a better management of non-communicable diseases at primary health care level, a new type of community health workers was introduced: the home-based care practitioners (HBCPs). Approximately 200 HBCPs were trained and deployed in selected areas (“cells”) in nine hospitals across the country. There is growing evidence for the efficacy of interventions using mobile devices in low- and middle-income countries. In Rwanda, there is an urgent call to using mobile health interventions for the prevention and management of non-communicable diseases. The D²Rwanda (Digital Diabetes in Rwanda) research project aims at responding to this call. The overall objectives of the D²Rwanda project are: a) to determine the efficacy of an integrated programme for the management of diabetes in Rwanda, which would include monthly patient assessments by HBCPs and an educational and self-management mobile health patient tool, and; b) to qualitatively explore the ways these interventions would be enacted, their challenges and effects, and changes in the patients’ health behaviours and HBCPs’ work satisfaction. The project employed a mixed-methods sequential explanatory design consisting of a one-year cluster randomised controlled trial with two interventions and followed by focus group discussions with patients and HBCPs. The dissertation presents three studies from the D²Rwanda project.

According to WHO, violence against women tend to increase during any type of emergency, such as the COVID19 outbreak, impacting not just women but also children and their families health . Although data on family violence during crisis is scarce, existing reports from China, UK and USA already suggest an increase of intimate partner violence. As social distancing measures are taken and people forced or encourage to stay at home, we could expect that the increase of tension at many homes will unfortunately end up in new cases of family violence or exacerbations of existing ones. Such context of an overloaded health system facing the crisis may imply in extra challenges for victims to seek help. This article aims to summarize the existing evidence regarding family violence during crisis and the resources available that can help to mitigate the impact of violence.

The Sars-CoV-2 pandemic puts an extreme strain on health care professionals, who are at a high risk of psychological distress and other mental health problems. Contributing factors include facing uncertainty, the often unbearable workload, shortages in personal protective equipment and treatments, an overwhelming flow of information, and changes in habitual roles and tasks. Existing studies show that in similar situations, they also experience stigmatization, as well as fear of infection for themselves and their families. This article summarizes the existing research on the mental health issues in health care professionals in this context, including risk factors, and interventions that can be implemented to promote mental well-being in front line professionals.

Background: Social media have been used exponentially and globally, providing a means for billions of users to connect, interact, share opinions and criticise, becoming one of the main channels of communication for users around the world. One of the most popular free social media networks is Twitter, with more than 100 million active users per day worldwide. Purpose: The aim of this study was to analyse a sample of the public conversations generated, using the hashtag #MeToo, around the topic of sexual abuse on Twitter. Methods: Using social media marketing software, the use of the #MeToo hashtag was analysed over a period of 60 days (14 September 2017 to 13 November of 2017). Results: The #MeToo conversation was mainly in English (79.3%), located in the United States (48.2% of cases), but with global repercussions. The volume of mentions of the #MeToo hashtag was far greater (97.7%), compared with other hashtags related to violence over this period of time, using mostly Twitter (96.2%). Conclusions: These results suggest that it is possible to describe different groups using the social media, and analyse their conversations to identify opportunities for successful public health interventions. If the topic is relevant for the general public, it will generate interest and conversations at the global level, supported by a universal and borderless channel such as Twitter.

Introduction. Family violence (FV) is a widespread public health problem of epidemic proportions and serious consequences. Doctors may be the first or only point of contact for victims who may be hesitant or unable to seek other sources of assistance, and they tend not to disclose abuse to doctors if not specifically asked. A comprehensive healthcare response is key to a coordinated community-wide approach to FV, but most of the practising physicians have received either no or insufficient education or training in any aspect of FV. Training of medical students concerning FV is often delivered in an inconsistent or ad hoc manner. The main aim of this project, Family Violence Curricula in Europe (FAVICUE), is to (1) describe current FV education delivery in European medical universities (undergraduate period) and during the specialist training in general practice (GP)/family medicine (FM) (postgraduate residency programme), and (2) compare it with WHO recommendations for FV curriculum. Methods and analysis. This is the protocol of a cross-sectional descriptive study consisting of two self-report online surveys (for undergraduate and postgraduate training, respectively) with 40 questions each. For both surveys, general practitioners, residents, medical students and professionals involved in their education from countries of the European region will be identified through the European Regional Branch of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) and will be invited to provide information regarding the training on FV. Descriptive tests will be carried out and a thematic analysis will be conducted on the open-ended questions. Ethics and dissemination Ethics approval has been obtained by the University of Luxembourg (ERP 17–015 FAVICUE). The results will provide important information concerning current curricula on FV, and can be used for mapping the educational needs and plannin

The Community- and MHealth-Based Integrated Management of Diabetes in Primary Healthcare in Rwanda: the D²Rwanda Study (which stands for Digital Diabetes Study in Rwanda) is a twin PhD project, developed in collaboration with Aarhus University (AU) and the University of Luxembourg (UL), and under the auspices of the University of Rwanda and Rwanda Biomedical Centre. The project involves two PhD students, Jean Paul Uwizihiwe (enrolled at AU) and Charilaos Lygidakis (enrolled at UL), and is kindly sponsored by the Karen Elise Jensens Foundation, alongside AU and UL. In this report we wished to narrate what we had been working on for the past two years: from the first steps to understanding better the context and mapping the territory; from obtaining the necessary authorisations to developing the app and translating the questionnaires.

Objectives: In this study, we review the evidence and discuss how the digitalization affects the CHWs programs for tackling non-communicable diseases (NCDs) in low-and-middle income countries (LMICs). Methods: We conducted a review of literature covering two databases: PubMED and Embase. A total of 97 articles were abstracted for full text review of which 21 are included in the analysis. Existing theories were used to construct a conceptual framework for understanding how digitalization affects the prospects of CHW programs for NCDs. Results: We identified three benefits and three challenges of digitalization. Firstly, it will help improve the access and quality of services, notwithstanding its higher establishment and maintenance costs. Secondly, it will add efficiency in training and personnel management. Thirdly, it will leverage the use of data generated across grass-roots platforms to further research and evaluation. The challenges posed are related to funding, health literacy of CHWs, and systemic challenges related to motivating CHWs. More than 60 digital platforms were identified, including mobile based networking devices (used for behavioral change communication), Web-applications (used for contact tracking, reminder system, adherence tracing, data collection, and decision support), videoconference (used for decision support) and mobile applications (used for reminder system, supervision, patients’ management, hearing screening, and tele-consultation). Conclusion: The digitalization efforts of CHW programs are afflicted by many challenges, yet the rapid technological penetration and acceptability coupled with the gradual fall in costs constitute encouraging signals for the LMICs. Both CHWs interventions and digital technologies are not inexpensive, but they may provide better value for the money.

From a systematic literature review (SLR), it became clear that a consensually validated tool was needed by European General Practitioner (GP) researchers in order to allow multi-centred collaborative research, in daily practice, throughout Europe. Which diagnostic tool for depression, validated against psychiatric examination according to the DSM, would GPs select as the best for use in clinical research, taking into account the combination of effectiveness, reliability and ergonomics? A RAND/UCLA, which combines the qualities of the Delphi process and of the nominal group, was used. GP researchers from different European countries were selected. The SLR extracted tools were validated against the DSM. The Youden index was used as an effectiveness criterion and Cronbach's alpha as a reliability criterion. Ergonomics data were extracted from the literature. Ergonomics were tested face-to-face.

Social media offers great potential in primary care research. Online platforms can be used to conduct experimental studies, facilitating the recruitment and retention of participants, as well as the delivery of the intervention. As patients are increasingly able to use information technology to help make informed decisions about their health care, reports show that the use of social media for health-information seeking is not limited to the younger demographics anymore. Notably, patients seem to be willing to share their health data in communities of peers, such as PatientsLikeMe, and actively engage with researchers. Additionally, publicly available social media data can be used for secondary analysis purposes, potentially contributing to the monitoring of health topics and disease surveillance. Finally, social media tools can be used to streamline the management of research projects and facilitate team collaboration.

Social media are a powerful means of communication among health-care professionals, patients and the public. Their use has been increasing steadily globally, transforming the way that people exchange information, interact and collaborate. Physicians are using more and more social networks to connect with broader audiences, communicate with their patients and their colleagues and build a network of trustworthy peers. Researchers are also leveraging social media, capitalising on the velocity with which the messages can spread and the ability to disseminate their messages to the general public in addition to research communities, thus attracting more attention and increasing the influence and impact of their work.

Introduction: The diabetes mellitus (DM) prevalence in Rwanda is estimated at 3.5%. In 2013, there were only one medical doctor and one nurse per 15,000 and 1,200 people respectively in Rwanda. A new programme employing frontline workers (Home-Based Community Practitioners (HBCPs)) is currently piloted, aiming at following-up patients with non-communicable diseases in their communities. We hypothesise that the management of DM at community level will improve following the introduction of a HBCP programme with regular monthly assessments and disease management, coupled with integration of a mobile health (mHealth) application with patient diaries, notifications and educational material. Objective: The aim of the study is to determine the efficacy of such an integrated programme in Rwanda. Methods: The study is designed as a one-year, open-label cluster trial of two interventions (arm1: HBCP programme, arm2: HBCP programme + mHealth application) and usual care (control). The primary outcomes will be changes in glycated haemoglobin levels and health-related quality of life. Mortality, complications, health literacy, mental well-being and treatment adherence will be assessed as secondary outcomes. Measurements will be conducted at baseline, 6 and 12 months. An intention-to-treat approach will be used to evaluate outcomes. Before trial onset, ethical approval will be sought in Rwanda, Luxembourg and Denmark, and a cross-cultural adaptation of questionnaires and a pilot will be carried out. Relevance: The project will provide evidence on the efficacy of innovative approaches for integrated management of DM and may spur the development of similar solutions for other chronic diseases in low-resource settings.

The use of information and communication technologies for health constitutes a strategic ally to the sustainable development goals and attaining universal health coverage through enabling equitable access to high quality and affordable health care services. The omnipresence of mobile devices and sensors, the increasing availability of data and computational power, and the breakthroughs in imaging and genomics, are creating a perfect storm that is bound to transform health care profoundly. At the population level, the coordination of disease control and prevention programmes is facilitated, cost-effective interventions are implemented, and ultimately the quality of life of our communities is enhanced. EHealth also plays a significant role in the delivery of people-centred and integrated health services, empowers individuals to make informed decisions and self-manage their health needs. For the first time in history, the individual is placed at the centre, has timely and affordable access to data, knowledge and tools, and health care is tailored for his/her diverse background, context and needs. A second perspective to the digital revolution is how our own discipline is transformed. As technology is a catalyst for sustainable, large scale social change, health care has the opportunity to invest in inter-professional collaboration, and leverage a diverse range of expertise, stakeholders and resources to expand its horizons and tackle old and future challenges.

Universal health coverage is an achievable goal for all health professionals globally. However, for it to be implemented technology and collaboration are essential. This letter focuses on recently published recommendations for technology in primary care education in respect to Universal Health Coverage.