Specific approaches are needed to reach and support people with a lower socioeconomic position (SEP) to achieve healthier eating behaviours. There is a growing body of evidence suggesting that digital health tools exhibit potential to address these needs because of its specific features that enable application of various behaviour change techniques (BCTs). The aim of this scoping review is to identify the BCTs that are used in diet-related digital interventions targeted at people with a low SEP, and which of these BCTs coincide with improved eating behaviour. The systematic search was performed in 3 databases, using terms related to e/m-health, diet quality and socioeconomic position. A total of 17 full text papers were included. The average number of BCTs per intervention was 6.9 (ranged 3–15). BCTs from the cluster ‘Goals and planning’ were applied most often (25x), followed by the clusters ‘Shaping knowledge’ (18x) and ‘Natural consequences’ (18x). Other frequently applied BCT clusters were ‘Feedback and monitoring’ (15x) and ‘Comparison of behaviour’ (13x). Whereas some BCTs were frequently applied, such as goal setting, others were rarely used, such as social support. Most studies (n = 13) observed a positive effect of the intervention on eating behaviour (e.g. having breakfast) in the low SEP group, but this was not clearly associated with the number or type of applied BCTs. In conclusion, more intervention studies focused on people with a low SEP are needed to draw firm conclusions as to which BCTs are effective in improving their diet quality. Also, further research should investigate combinations of BCTs, the intervention design and context, and the use of multicomponent approaches. We encourage intervention developers and researchers to describe interventions more thoroughly, following the systematics of a behaviour change taxonomy, and to select BCTs knowingly.
Introduction: Awake proning may result in lower intubation and mortality rates in COVID-19 patients with hypoxemia refractory to simple oxygen therapy. Aims. To summarize available evidence for benefit and develop a set of pragmaticrecommendations for awake proning in COVID-19 patients.Methods. An international group of 43 healthcare professionals searched MEDLINE for articles on awake proning, and formulated recommendations for its use.Results. The professionals reached consensus regarding indications and contraindications, feasibility and safety; they recommended applying awake proning if SpO2/FiO2 < 315, or SpO2 < 93% under supplementary oxygen, and if patient is able to follow instructions. Severe hypoxemia (SpO2/FiO2 < 140) and hemodynamic instability are absolute contraindications in the ward, but relative contraindications in the ICU. Morbid obesity was also seen as a relative contraindication, depending on assistance needed to help turn the patient. Pregnancy was not seen as a contraindication, but extra monitoring in the last trimester was seen as mandatory, and extra pillows for stabilization and prevention of aortocaval compression are necessary. Five steps may improve safety: i. adequate patient information; ii. help in positioning; iii. ensuring oxygen supply and placing of tubing free at sight; iv. optimized position to prevent harm; and v. monitor oxygen saturation and respiratory rate. Dissensus remained regarding duration, and number of sessions per day, and use of sedation during prone positioning.Conclusion. Awake proning is an attractive, simple and safe way to improve oxygenation in hypoxemic COVID–19 patients. Studies remain needed to see if it effects intubation and mortality rates.
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IntroductionIt is unknown how awake prone positioning was practiced in patients with COVID–19 in the second wave of the national outbreak in the Netherlands.ObjectivesWe studied the practice of awake prone positioning in COVID–19 patients admitted to the ICU because of acute hypoxemic respiratory failure, and determined associations with demographics and outcomes.MethodsInvestigator–initiated, national, multicenter study in 16 hospitals in the Netherlands. Patients that received awake prone positioning were compared to patients that did not receive this intervention. The primary endpoint was a composite of various aspects of awake prone positioning practice. The secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors.ResultsIn 546 non–intubated patients, awake prone positioning was used in 88 (16.1%) patients, within median 1 [0 to 2] days after ICU admission, for median 1.0 [0.8–1.4] days and median 12.0 [8.4–14.5] hours per day. High–flow oxygen therapy was the most often used oxygen interface at start of awake prone positioning. Patients in the awake prone positioning group less often had a history of cardiovascular disease. In unmatched analysis, treatment failure occurred more often in patients that received awake prone positioning (HR, 1.80 [1.41–2.31]; P<0.001); in matched analysis, differences remained present, but did no longer reach statistical significance (HR, 1.17 [0.87-1.59]; P=0.30). ConclusionsIn this national cohort of COVID–19 patients in the second wave of the national outbreak, awake prone positioning was used in one in six patients. Awake prone positioning started early, but was often discontinued because of need for intubation. Patients that received awake prone positioning had higher risk for treatment failure.
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