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In light of the increasing life expectancy of Europe’s population and the rising significance of active and healthy ageing relating thereto, an integrated approach of nutritional care within primary health care is gaining importance. The aim of the review was to summarize evidence on the effectiveness of nutritional interventions in primary health care. The scoping review is based upon a comprehensive literature search of relevant literature published between January 2010 and August 2021 in PubMed, CINAHL, Cochrane Database of Systematic Reviews, Embase and Medline databases. Overall, 15 studies were included for evidence synthesis and interventions were basically clustered according to their type, into 1) eHealth and tele-medical interventions; 2) targeted single interventions; and 3) comprehensive, multi-faceted interventions. The review presents diverging evidence regarding the efficacy and effectiveness of interventions for nutritional care in primary health care, however, demonstrates encouraging outcomes. eHealth and tele-medical interventions partly show a careful positive tendency. Likewise, manifold single interventions on patient level present significant improvements in patient health outcomes. Multifaceted and comprehensive interventions found in the literature also partly demonstrate significant changes in intervention groups. Primary health care represents a critical setting for the care of older citizens and patients with complex health needs. This scoping review provides an overview of current nutrition care practices in primary health care and results reinforce the need to strengthen implementation of multi-faceted interventions carried out by the inter-disciplinary primary care team for advanced nutritional care.

Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy rarely relieves bothersome symptoms for all patients. The objective of this study was to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. A qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the "Blueprint on Digital Transformation in Health and Care in an Ageing Society" persona methodology. A Survey was administered to a group of patients in anonymous form. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Three main needs were identified to be met to improve IBS patient's lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and homebased digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. KEY WORDS: Digital Health, Irritable bowel syndrome, mHealth, Nutrition, Physical activity, Psychological support.La sindrome dell’intestino irritabile (IBS) è una condizione multifattoriale comune che colpisce l’intestino crasso ed è caratterizzata da dolore addominale cronico e recidivante e alterazione delle abitudini intestinali. L’IBS è dovuta a una combinazione di fattori genetici, ambientali e dietetici. Di solito è un problema che permane per tutta la vita, molto frustrante per conviverci e può avere un grande impatto negativo sulla qualità della vita, poiché la terapia con un solo farmaco raramente allevia i sintomi fastidiosi per tutti i pazienti. L’obiettivo di questo studio era di analizzare gli approcci e le soluzioni che affrontano i bisogni sociali e sanitari insoddisfatti dei pazienti con IBS. Nel presente studio è stato adottato un approccio qualitativo per identificare e specificare la soluzione digitale chiave e gli scenari utente ad alto impatto applicati ai pazienti con IBS, attraverso un adattamento al singolo della metodologia “Blueprint on Digital Transformation in Health and Care in an Aging Society”. Un sondaggio è stato somministrato a un gruppo di pazienti in forma anonima. L’elaborazione teorica IBS personale è stata sviluppata attraverso un Focus Group interdisciplinare, che ha anche tracciato il percorso per la gestione del paziente. Sono state identificate tre esigenze principali da soddisfare per migliorare lo stile di vita dei pazienti affetti da IBS: accesso al supporto psicologico, soluzioni di mHealth a supporto della dieta e dell’attività fisica adattata e supporto sanitario digitale domiciliare. L’intervento mHealth è stato identificato per l’aderenza alla dieta, l’esercizio fisico e il benessere psicologico. Il processo è stato mappato e adattato per integrare le nuove soluzioni nel percorso assistenziale. Sono necessarie ulteriori ricerche per valutare in che modo i servizi di mHealth consentano ai pazienti con IBS di gestire le loro condizioni e migliorare la loro qualità di vita.

Background Although the burden of influenza infection is the highest in older adults, vaccination coverage remains low, despite this age group being more vulnerable than others. Aims Given the current pandemic of SARS-CoV-2, it was the aim of this scope review to update knowledge on factors affecting seasonal influenza vaccine uptake among older adults to strengthen prevention approaches in the context of an overall burden of infectious diseases. Methods We searched bibliographic databases from 2012 to 2019. All studies reviewed one or more social determinant of health listed by WHO, or factors affecting the decision-making process whether to accept influenza vaccine or not. Results Overall, 44 studies were included, 41 determinants were extracted and summarized into six categories. Older age and constitutional factors including multiple chronic diseases as well as preventive lifestyle and frequent routine healthcare utilization positively affected vaccination uptake (VU). Living and working conditions are also researched determinants of influenza vaccine uptake. A small number of studies explored the role of social inclusion and system-based interventions. Discussion and conclusions This scope review provides a comprehensive overview on factors affecting seasonal influenza vaccination uptake among older citizens. The review also clearly shows gaps for evidence on system-based level or political strategies to improve vaccination uptake.

Background : Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy ra: Objective to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. Design: A quantitative-qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the “Blueprint on Digital Transformation in Health and Care in an Ageing Society” persona methodology. Settings: Digital health solutions bring the potential of supporting health interventions through mobile apps, wearable devices, telemedicine. Patients: A Survey was administered to a group of patients in an anonymous form, and no need for Medical Ethical Committee approval was identified. Interventions. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Main Outcome : Three main needs were identified to be met to improve IBS patient’s lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and home-based digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Limitation: Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. Conclusion The person-centered approach was implemented through a multidisciplinary Focus group that enabled the identification of the need for a mHealth intervention

The meeting of the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) action group A3 together with members of the Reference site collaborative network (RSCN) in December 2019 in Rome focused on integration of evidence-based approaches on health and care delivery for older citizens at different levels of needs with expertise coming from stakeholder across Europe. It was the final aim of the group to co-create culturally sensitive pathways and facilitate co-ownership for further implementation of the pathways in different care systems across Europe. The study design is a mixed method approach. Based on data analysis from a cohort of community-dwelling over-65 citizens in the framework of a longitudinal observational study in Rome, which included health, social and functional capacity data, three personas profiles were developed: the pre-frail, the frail and the very frail personas. Based on these data, experts were asked to co-create care pathways due to evidence and eminence during a workshop and included into a final report. All working groups agreed on a common understanding that integration of care means person-centered integration of health and social care, longitudinally provided across primary and secondary health care including citizens' individual social, economic and human resources. Elements for consideration during care for pre-frail people are loneliness and social isolation, which, lead to limitation of physical autonomy in the light of reduced access to social support. Frail people need adaption of environmental structures and, again, social resource allocation to maintain at home. Very frail are generally vulnerable patients with complex needs. Most of them remain at home because of a strong individual social support and integrated health care delivery. The approach described in this publication may represent a first approach to scaling-up care delivery in a person-centered approach.

In view of ongoing demographic developments resulting in a longer life expectancy of the European population, the creation of &ldquo, age-friendly&rdquo, environments represents an initiative picked up by the European Union and its Member States to enable active and healthy ageing. The present study aims at the co-creation of a cross-border framework model to deploy a healthy ageing region linking Austria and Slovenia, building on previous work dealing with the development of an integrated regional ecosystem for active and healthy ageing. A qualitative, community-based action research method based on focus group discussions allowed the development of an exemplary framework model for active and healthy ageing building on cross-border collaboration in the region of Promura. Within the project group, twelve cross-border regional key assets were identified. In the course of further open discussions, an exemplary model for the deployment of a cross-border healthy ageing region was developed, comprising underlying fundamental environmental aspects, regional structures in the field of health and care as well as crosscutting features spreading across all levels. This article presents a promising, strategic co-creation approach on how to span a model on active and healthy ageing across two cross-border regions with similar characteristics and assets.

VAD-Systeme sind heutzutage bei steigender Pravalenz der Herzinsuffizienz sowie sinkenden Transplantationszahlen ein wichtiges Therapiekonzept. Mittlerweile gehort zum Konzept eines erfolgreichen Herzzentrums der Aufbau von Herzinsuffizienzambulanzen, Transplantationszentren und VAD-Ambulanzen. Die Implantation von VAD-Systemen optimiert die Behandlung bestimmter Herzinsuffizienz-Patienten und offnet neue Therapiedimensionen. Hierfur ermoglichen VAD-Ambulanzen eine ganzheitliche Betreuung von Patienten. Dieser Aufbau neuer Strukturen bewirkt eine Entlastung der Arzte und ermoglicht ein innovatives und autarkes Arbeitsfeld fur die Pflegekraft. Sie erhalt die Moglichkeit, sich beruflich zu engagieren und an einem neuen Konzept mitzuwirken. Das aktive Gestalten neuer Strukturen schafft unter anderem Arbeitszufriedenheit. Die Pflege schreitet voran und geht neue Wege.

Upon continuous stress exposure, plants display attenuated metabolic stress responses due to regulatory feedback loops. Here, we have tested the hypothesis that pulsed stress exposure with intervening recovery periods should affect these feedback loops, thereby causing increased accumulation of stress-induced metabolites. The response of Arabidopsis plantlets to continuous UV-B exposure (Cuv ) was compared with that of pulsed UV-B exposure (Puv ). The differential responses to Puv versus Cuv were monitored at the level of gene expression and metabolite accumulation, using wild type (WT) and different mutant lines. In comparison with Cuv , Puv increased sinapyl and flavonol (S + F) content, whereas adaptive growth attenuation was reduced. Furthermore, in a myb4 mutant (AtMYB4, repressor-type R2R3-MYB transcription factor), the S + F content was increased only for Cuv , but not beyond the level for Puv observed in WT. These observations and the ability of AtMYB4 to repress AtMYB12/AtMYB111-mediated activation of target gene promoters (pCHS and pFLS) indicate that the increase of S + F content after Puv observed in WT plants results from reduced feedback inhibition by AtMYB4. The results support the notion that stress-induced metabolic changes not necessarily cause a growth penalty. Furthermore, the observed Puv -induced increase in flavonol accumulation may stimulate reevaluation of commercial plant production practices.

The current demographic shift raises the demand for provision of health care tailored to the complex care needs for older adults. Given the growing number of national care plans and best practice models there is an urgent need to build evidence for inter- and multiprofessional care provision for older people when offered an integrated care approach. The aim of this study was to determine whether an inter-professional or multi-professional care intervention, can improve geriatric patients’ health determinants. A systematic review was performed according to PRISMA Guidelines. Databases were searched for clinical trials which compare inter-professional or multi-professional complex care interventions with usual care among people aged ≥60 years, in hospital or emergency care settings. Based on nine studies, inter-professional or multi-professional intervention has no impact on mortality rate but either positive or neutral effects on physical health, psychosocial wellbeing and utilization of health care service. It shows that these inter-professional or multi-professional interventions were feasible. This systematic review highlights the scarcity of evidence showing either positive or neutral impact of intervention based on inter-professional or multi-professional teamwork across care settings on the health determinants among geriatric patients. International harmonization of assessment tools may allow direct comparisons for future interventions.

In 2013, the European Commission founded the platform European Innovation Partnership on Active and Healthy Aging as a communication and innovation network in this domain. The goal of the current study was the development of an integrated regional ecosystem for active and healthy aging for the region of Styria via a step-by-step co-creation process. A mixed model approach was used to establish an ecosystem for active and healthy aging, which includes macro-, meso- and micro-level stakeholders in the province of Styria, Austria. Based on the results, eight recommendations for the deployment of a healthy aging region were developed. The visibility and accessibility of healthy aging products and services were evaluated as key factors for innovation in active and healthy aging in the region. Health professionals were identified as major drivers of innovation related to active and healthy aging in Styria. The study presented in this article assessed the capacities for healthy aging in the Styria region and identified the need to improve communication pathways between all levels of the public health system and market.

Due to the demographic shift complex care management of older multimorbid patients with changing functional capacities has become core clinical business for many stakeholders in western health care systems. It is the aim of the mini-review to summarise evidence to be translated into clinical practice for pharmacists and medical doctors and interested readers. The review is based upon a comprehensive literature review in PubMed and EMBASE from 2000 to 2018 and grey literature. Interprofessional exchange and discussion among stakeholders from geriatric medicine and the International Association for Pharmaceutical Technology during a meeting in Graz, Austria 2018, led to the narrowing of the review addressing complex care needs of geriatric patients. In this mini-review, attention is drawn to a comprehensive therapeutic goal setting according to evidence-based guidelines: clinical, disease-related care aspects, functional capacities, evaluated by comprehensive geriatric assessment, and patient's wishes and perspectives as main drivers for personalised complex care of geriatric patients.