Preventive Consultation Research Articles

Bioetics Issues of Artificial Placenta and Artificial Womb Technology.

The worldwide infertility crisis and the increase in mortality and morbidity among infants, due to preterm births and associated complications, have stimulated research into artificial placenta (AP) and artificial womb (AW) technology as novel solutions. These technologies mimic the natural environment provided in the mother's womb, using chambers that ensure the supply of nutrients to the fetus and disposal of waste substances through an appropriate mechanism. This review aims to highlight the background of AP and AW technologies, revisit their historical development and proposed applications, and discuss challenges and bioethical and moral issues. Further research is required to investigate any negative effects of these new technologies, and ethical concerns pertaining to the structure and operation of this newly developed technology must be addressed and resolved prior to its introduction to the public sphere.

Family wellbeing in general practice: a study protocol for a cluster-randomised trial of the web-based resilience programme on early child development

BackgroundSocial, emotional and behavioural problems in early childhood are associated with increased risk for a wide range of poor outcomes associated with substantial cost and impact on society as a whole. Some of these problems are rooted in the early mother-infant relationship and might be prevented. In Denmark, primary health care has a central role in preventive care during pregnancy and the first years of the child’s life and general practice provides opportunities to promote a healthy mother-infant relationship in early parenthood.ObjectiveIn the context of standardised antenatal and child development assessments focused on psychosocial wellbeing, we examine the impact of a complex intervention designed to improve maternal mentalisation skills, involving training of general practice clinicians and signposting towards a web-based resource. Joint main outcomes are child socio-emotional and language development at age 30 months measured by parentally reported questionnaires (Communicative Development Inventory and Strengths and Difficulties Questionnaire).MethodsThe study is a cluster-randomised controlled trial based in general practices in the Capital Region and the Zealand Region of Denmark. Seventy practices were included. Practices were randomised by a computer algorithm in a ratio of 1:1 to intervention or control groups. Each practice was asked to recruit up to 30 women consecutively at their first scheduled antenatal assessment. Clinicians in both groups received one day of training in preventive antenatal and child development consultations with added focus on parental psychosocial well-being, social support, and parent–child interaction. These preventive consultations delivered in both trial arms require enhanced data recording about psychosocial factors. In intervention clinics, clinicians were asked to signpost a web page at three scheduled antenatal consultations and at four scheduled consultations when the child is 5 weeks, 5 months, 1 and 2 years.DiscussionWe hypothesise that the intervention will increase mothers’ ability to be sensitive to their child’s mental state to an extent that improves the child’s language and mental state at 30 months of age measured by parent-reported questionnaires.Trial registrationClinicalTrials.gov NCT04129359. Registered on Oct 16 2019.

Improving Primary Healthcare Access for Asylum Seekers and Refugees: A Qualitative Study From a Swiss Family Physician Perspective.

Since 2015 the need for evidence-based guidance in primary health care management of refugees, asylum seekers, and immigrants has dramatically increased. The aims of this study were to identify the challenges met by primary care physicians in Switzerland, by performing semi-structured interviews and to identify possible approaches and interventions. Between January 2019 and January 2020, 20 GPs in 3 Swiss cantons were interviewed. The interviews were transcribed, coded with MAXQDA 18, and analyzed using the framework methodology. Following relevant findings were highlighted; (i) problems relating to health insurance companies among (health-insured) asylum seekers and refugees were negligible; (ii) there is a high acceptance for vaccination by refugees, asylum seekers, and immigrants; (iii) limitations in time for consultations and adequate reimbursement for practitioners pose a serious challenge; (iv) the majority of consultations are complaint-oriented, preventive consultations are rare; and (v) the language barrier is a major challenge for psychosocial consultations, whereas this appears less relevant for somatic complaints. The following issues were identified as high priority needs by the study participants; (i) increased networking between GPs, that is, establishing bridging services with asylum centers, (ii) improved training opportunities for GPs in Migration Medicine with regular updates of current guidelines, and (iii) a standardisation of health documentation facilitating exchange of medical data, that is, digital/paper-based "health booklet" or "health pass."

1220. Public Health Investigations of Water-Related Organisms in Neonatal Intensive Care Units—United States, 2014–2022

Abstract Background Preterm and critically ill infants cared for in neonatal intensive care units (NICUs) are vulnerable to a wide variety of infections. Water use in healthcare settings is a known risk factor for opportunistic pathogen transmission due to the ability of such pathogens to persist in premise plumbing, though facility water risk assessments may also not account for practices within NICUs. We describe Centers for Disease Control and Prevention (CDC) consultations involving NICU patients and water-related organisms to help inform infection prevention and control response. Methods We searched internal CDC records from January 1, 2014, through December 31, 2021, to identify consultations involving investigations of potential or confirmed transmission of water-related organisms in NICU settings. We used available information to determine number of consultations and patients affected, most common organisms implicated, and potential exposure pathways and transmission routes. Results Of 92 consultations involving NICUs in the United States during the study period, we identified 30 consultations (33%) of water-related organism infections or outbreaks; combined, water-related organisms were isolated from 178 patients during these investigations. Serratia marcescens was the organism reported in the greatest number of investigations (n=10, 33%), followed by Pseudomonas spp. and Burkholderia cepacia complex (each n=4, 13%). Definitive transmission routes were not determined for all consultations, though investigations frequently identified concerns with water use in infant activities of daily living, such as bathing or feeding (n=14, 47%). Examples of such exposures unique to the NICU setting included the use of tap water to remove disinfectant residue from humidified isolettes and storage of supplies rinsed in water in infant bath basins to dry. Conclusion Consultations involving water-related organisms are common in the NICU. While clear sources of transmission are not always found, investigations often identified water exposures that may pose infection risks. To protect critically ill infants, hospitals should account for the extensive and unique characteristics of water use in NICUs when developing water management programs. Disclosures All Authors: No reported disclosures.

1222. Summary of CDC consultations related to non-traditional medical therapies, 2016─2021

Abstract Background Non-traditional medical therapies, which include invasive or parenteral therapies for unapproved conditions, such as stem cell joint injections and certain cosmetic procedures may lack regulatory oversight and pose infectious risks to patients. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving outbreaks or infection control lapses that involved non-traditional medical therapies to identify areas for prevention efforts. Methods We reviewed internal CDC records from January 1, 2016, through December 31, 2021, to identify consultations that involved investigations of disease transmission and infection control lapses involving non-traditional medical therapies in U.S. settings. We included consultations involving therapies and procedures such as facials, fillers, microneedling, intravenous hydration, vitamin infusions, platelet-rich plasma (PRP), and stem cell injections. We determined number of consultations and patients infected or exposed to infection control lapses, infection types, types of procedures implicated, pathogen of concern, and whether at-risk patients were notified. Results We identified 25 consultations that met inclusion criteria; 22 involved 65 infected patients and 3 involved infection control lapses without identified infections. Infection types included joint (n=8, 32%), skin and soft tissue (5, 20%), and bloodstream (3, 12%). The most common pathogens implicated included nontuberculous mycobacteria (3, 12%), hepatitis C virus (3, 12%), and several Enterobacterales (6, 24%). Therapies most frequently involved included PRP or stem cell joint injections (9, 36%), vitamin infusions/injections (4, 16%), and aesthetic treatments (6, 24%). Settings most commonly involved chiropractic clinics (3, 12%), pain clinics (3, 12%), medical spas (2, 8%), orthopedic clinics (2, 8%), and aesthetics clinics (2, 8%). Conclusion Lapses in infection control practices involving non-traditional medical therapies have the potential to place patients at significant risk of infection. Targeting infection control education and oversight to settings where these procedures commonly take place may help reduce patient risk. Disclosures All Authors: No reported disclosures.

Veterinary services during the COVID-19 pandemic: less stressful for cats and their carers?

The COVID-19 pandemic saw major changes to small animal veterinary practice, many of which may have had an impact on stress in cats presented to the clinic. The aim of this study was to examine the nature of feline outpatient visits before and during the pandemic, and examine signs of stress noted in cats before, during and after these visits. A questionnaire was used to gather data on cat owner experiences of visits to the veterinary clinic. Data were gathered on the owner's most recent experience of a consultation, with consultations occurring in February 2020 or earlier coded as a standard consultation, and consultations occurring in March 2020 or later coded as COVID-19 consultations. A total of 371 responses were received, with 210 coded as standard consultations and 161 coded as COVID-19 consultations. Consultation type varied significantly between standard and COVID-19 consultations (P <0.001), with emergency consultations more frequent and preventive healthcare consultations less frequent during the COVID-19 pandemic. The area in which the owner and their cat waited also varied significantly between standard and COVID-19 consultations (P <0.001), with standard consultations more likely to involve time in a waiting room while COVID-19 consultations were often called straight in or waited outside the practice. Most owners notedbehaviours associated with stress in their cats, regardless of consultation type, although trying to hide or escape were noted more frequently for cats seen prior to the COVID-19 pandemic. The findings suggest that outpatient visits to the veterinary clinic were stressful for cats both prior to and during the COVID-19 pandemic, but some measures taken during the pandemic, for example less use of waiting rooms, could be used alongside existing cat friendly measures to help to reduce stress in feline patients.

Onset of sexuality is impaired in young men with a persistent congenital phimosis.

Phimosis is a narrowing of the preputial orifice that hinders complete and painless foreskin retraction onto the glans. It is physiological in children but should be resolved at puberty. Some men reach adulthood with a persistent congenital phimosis (PCP) that can impair their sexuality. The literature is abundant on circumcision, but little attention is paid to phimosis. We aimed to evaluate the impact of PCP on sexuality in early adulthood. Inclusion criterae: men over 18 years of age who reached adulthood with PCP. Methods: Descriptive study based on an online questionnaire (37 questions), exploring medical history, emotional experience and sexual function (including a personal adaptation of the Sexual Complaint Screener for Males). 435 men were contacted, 80 completed the questionnaire, 67 were included. 79% had impaired sexual onset, 69% had significant anxiety, 66% avoided sex, and 46% avoided a romantic relationship. Desire and arousal were impaired in only 20% and 15%. Sexual function was more impaired during penetration than during masturbation, in the domains of arousal (erectile dysfunction 36% vs 13%) and orgasm (rapid ejaculation 28% vs 20%, delayed ejaculation 18% vs 3%). 67% were dyspareunic. 60% realized they had a problem before 18 years, but 82% did not seek medical advice until after 20, half of them after 25. The mode of revelation was comparison with others (porn and peers) (36%), self-observation (33%), sexual encounter (28%).There was no traumatic experience of foreskin retraction in childhood, and 55% recommended prevention in adolescents. Biases: descriptive study, heterogeneity of the population, declarative nature of the data, absence of a control population. Nevertheless, this study is the first to show that unresolved PCP in adolescence alters penetrative but not masturbatory sexuality, leads to avoidance of romance and penetration, with delay in seeking treatment. Preventive systematic andrological consultation should be proposed to adolescents. The authors declare no conflict of interest

A Teleconsultation Device, Consult Station, for Remote Primary Care: Multisite Prospective Cohort Study.

BackgroundTelemedicine technology is a growing field, especially in the context of the COVID-19 pandemic. Consult Station (Health for Development) is the first telemedicine device enabling completely remote medical consultations, including the concurrent collection of clinical parameters and videos.ObjectiveOur aim was to collect data on the multisite urban and suburban implementation of the Consult Station for primary care and assess its contribution to health care pathways in areas with a low density of medical services.MethodsIn a proof-of-concept multisite prospective cohort study, 2134 consecutive patients had teleconsultations. Consultation characteristics were analyzed from both the patient and practitioner perspective.ResultsIn this study, the main users of Consult Station were younger women consulting for low-severity seasonal infections. Interestingly, hypertension, diabetes, and preventive medical consultations were almost absent, while they accounted for almost 50% of consultations with a general practitioner (GP). We showed that for all regions where the Consult Station was implemented, the number of consultations increased as GP density decreased. The study of practitioner characteristics showed GPs from metropolitan areas are motivated to work with this device remotely, with a high level of technology acceptability.ConclusionsThe multisite implementation of Consult Station booths is suitable for primary care and could also address the challenge of “medical deserts.” In addition, further studies should be performed to evaluate the possible contribution of Consult Station booths to limiting work absenteeism.

Improving veterinarian-client communication in companion animal preventive healthcare consultations.

Improving veterinarian-client communication in companion animal preventive healthcare consultations.

The evaluation of oral and dental health and behavioural risk among ultra-endurance athletes: a cross-sectional epidemiological study

ABSTRACT This study assessed for the first time the oral and dental health of ultra-trail athletes. We also confirmed and quantified the scale of their exposure to oral health risk factors. This was a cross-sectional study using data from a survey among runners who enlisted in the 2020 edition of the UT4M races (Ultra-Trail des 4 Massifs). The dental health of 84% of the participants was “good” or “very good”. The nutritional intake during effort comprised foods liable to induce tooth decay (energy bars (55%), sugar-rich gels and fruit confectionary (40%)) and snacking was frequent (39%). More than 3/5 of runners saw a dentist for preventive check-ups. The more runners participate in races the more likely they are to have oral hygiene strategies during competitions (aOR = 1.85, p ≤ 0.05). The oral health of ultra-trail runners is better than that of the average French adult population. Regular dental hygiene and preventive dental consultations appear to counterbalance the risks that we evidenced.

Validity of data collection methods for time spent, professional involvement and treatment volume for the purpose of cost-effectiveness studies in dentistry

Objectives Economic evaluations can support provision of adequate and affordable oral care, requiring valid information on costs. The aim was to assess the validity of (a) patients’ self-report (PS) and routine electronic patient records (EPR) regarding time spent per visit and (b) PS regarding types of treatment and type of dental professionals involved. Methods Data were collected in four dental clinics regarding time spent using PS and EPR, on types of treatment and dental professionals involved using PS. As reference standard for time spent, independent research assistants (RA) collected data on time per visit using stopwatches. As reference standard for types of treatment and of dental professionals involved, we used the dental clinic’s Electronic Patient Files (DEPF). The two one-sided tests (TOST) equivalence procedure for the difference between paired means for time and kappa statistics for treatment and professional were used to assess agreement of data collection methods with the reference standards. Results Equivalence and agreement was good between (a) PS and RA registration concerning waiting time, appointment time and total time spent and (b) EPR and DEPF concerning appointment time. Agreement between PS and DEPF concerning types of treatment was moderate to fair (kappa values between 0.49 and 0.56 for preventive consultation, restoration, radiographs and extractions and between 0.15 and 0.26 for fluoride applications and sealants). Agreement between PS and DEPF for dental professional involved was fair (kappa = 0.41). Conclusions Data collection regarding time using PS and EPR was valid. Data collection via PS on treatment and professionals involved were not sufficiently valid and should occur via DEPF.

Explanatory factors of the psychomotor development of infants aged 1-24 months in N'Djamena (Chad)

Introduction: Psychomotor development (PMD) reflects the cerebral maturation through sensory, motor and psychological acquisitions of an individual. Its evaluation allows an early diagnosis of delays in order to take care of them. The objective of this study was to determine the profile and explanatory factors of PMD of infants in N'Djamena. Methods: This was a cross-sectional study conducted at the “Notre Dame des Apôtres” Hospital in N'Djamena. It involved 428 infants aged 1 to 24 months received in preventive consultation between October 2017 and June 2018. The Denver II scale was used for the assessment of PMD. Data were analyzed with SPSS 21.0 software. Results: the sex ratio was 1.06. The most represented age group was under 3 months (35.5%). The items of gross motor skills were 95% completed, fine motor skills 93.8%, language 84.6% and sociability 68.8% at the 90th percentile. Development was advanced in 56.8% normal in 32.1% and delayed in 2.1%. Statistically significant differences in PMD were observed according to age group (p= 0.000), vaccination status (p= 0.002), feeding mode (p= 0.000), maternal exchange (p= 0.000) and pregnancy follow-up (p= 0.03). Conclusion: The psychomotor development of N'Djamenese infants is similar to that of other African children, although some variations are noted. It is influenced by certain factors related to the infant and the mother.

Provider-perceived barriers to patient adherence to colorectal cancer screening

BackgroundAverage-risk colorectal cancer (CRC) screening remains underutilized in the US. Provider recommendation is strongly associated with CRC screening completion. To inform interventions aimed at improving screening uptake, we examined providers’ perspectives on patient and health system barriers to CRC screening adherence, along with associated system-level interventions to improve uptake. MethodsWe conducted an online survey between November and December 2019 with a sample of primary care clinicians (PCCs) and gastroenterologists (GIs) from a validated panel of US clinicians (814 PCCs, 159 GIs; completion rates: 25.3% for PCCs, 29.6% for GIs). Clinicians rated the extent to which each patient and health system factor interferes with patient adherence with CRC screening recommendations and the availability of practice interventions to improve screening rates. ResultsProvider-reported top barriers to CRC screening included patient discomfort with offered screening method (66%), cost (62–64%), and perceived low importance of screening (62%). Additional barriers included providers prioritizing urgent health concerns over screening (45–48%), not offering a choice of screening options (42–48%), lacking time to educate patients about screening (38–45%), and lacking education about available screening options (37–40%). Most frequently reported system-level interventions to improve CRC screening rates included patient education materials (57–62%) and point of care prompts (56–61%). Other interventions were less frequently reported, although variations existed by clinical specialty regarding barriers and interventions. ConclusionsAddressing barriers to CRC screening requires system-level interventions, including provider training on shared decision-making, automated scheduling and reminder processes, and policies to increase clinician time for preventive screening consultations.

Novel instrument to guide nurse-led consultations with parents of three-year-olds in school health services in Flanders: A feasibility study of SPARK36

BackgroundIn the framework of new legislation on School Health Services (SHS) in Flanders (Belgium), nurses lead a preventive consultation with every three-year-old child and its parent(s), with the aim of assessing risks in child development and potential parenting problems. This study assesses the feasibility of the “Structured Problem Analysis of Raising kids aged 36 months” (SPARK36), a broad-scope structured interview to facilitate such consultations. Design and methodsA feasibility study was conducted with SHS nurses across Flanders, to determine need for this instrument, acceptability and practical feasibility of SPARK36 with both parents and professionals. Nurses were trained to use the instrument. Mixed methods (i.e., questionnaires for both parents and nurses, and a focus group interview with nurses) were used to evaluate the feasibility of using SPARK36. ResultsParents were satisfied (97.0%) with what was discussed during the consultation and with the consultation's structure (98.8%). After the training, all 20 nurses felt strengthened in performing the consultation and in making a risk assessment. The interview was feasible in 20–30 min. During 561 interviews nurses gave parenting support in 88.2% of cases. ConclusionsSPARK36 is acceptable, practically feasible for parents and nurses, and it meets needs of both parties. The instrument supports nurses during their consultation. More research is needed to evaluate the instrument and to prepare its implementation in daily practice. Practice implicationsSPARK36 is a promising instrument for nurse-led consultations in the SHS setting.

ImmunoStart: preparing patients for immunosuppression.

ObjectivesPatients with immune-mediated inflammatory disease (IMID) present an increased risk of infection. Here, we present the concept of a preventive consultation called ImmunoStart and the first results of its implementation in the care pathway of patients with IMID.MethodsRelevant information about vaccination history, tuberculosis exposure and other infectious risks were collected through blood sampling, complete anamnesis, chest X-ray and Mantoux test. During the ImmunoStart consultation, vaccination schedules, specific treatments and risk considerations were discussed.ResultsBetween October 2016 and February 2020, 437 patients were seen at an ImmunoStart consultation, mainly referred by rheumatologists (56%), dermatologists (25%) and gastroenterologists (18%). A total of 421 (96%) patients needed at least one vaccine (a mean of 3.3 vaccines per patient). Live attenuated vaccine was indicated for 45 patients (10%), requiring them to reduce or interrupt their immunosuppressive drug(s). Ninety-two patients (21%) were treated for latent tuberculosis infection.ConclusionThis preventive consultation provides a centralized and systematic setting for the direct management of patients with IMID in need of vaccination, treatment of latent disease and specific advice regarding their immunomodulating treatments.

The impact of the COVID-19 pandemic on professional practice and patient volume in medical practices: A survey among German physicians and psychotherapists

IntroductionThis study examines the consequences of the COVID-19 pandemic on outpatient care in the German federal state of Brandenburg during the first ‘lockdown’ between 22 March and 4 May 2020, focusing on the burden for physicians and psychotherapists in outpatient practices and on alternative ways to provide care, in particular telehealth. MethodsWe conducted an online cross-sectional survey among outpatient health care professionals. The responses of n=277 physicians and n=87 psychotherapists were included in the analysis. Frequencies are shown; the relationship between categorical variables was examined using the χ2 test; we used a qualitative content analysis for free text answers. ResultsAlmost all (96 %) physicians and 59 % of the psychotherapists reported a patient volume reduction since the COVID-19 outbreak. Cancellations were most often initiated by patients rather than physician offices. Among the physicians, routine check-ups and preventive care consultations were cancelled most frequently, and patients also appeared less frequently in open consultations. 72 % of the physicians and 29 % of the psychotherapists reported economic losses. While personal patient-physician contact was reduced, the use of telehealth has increased since the COVID-19 outbreak: during the first ‘lockdown’, two thirds of the psychotherapists (66 %) and 14 % of the physicians used telehealth for the first time. The COVID-19 pandemic contributed to a positive change in attitudes towards telehealth; this trend was significantly stronger among psychotherapists than among physicians. DiscussionThe reduction in patient volume shown in this study is confirmed by outpatient billing data analyses. Clinical routines changed due to COVID-19 and led to a growth in telehealth usage. By facilitating formal billing options, the increased use of telehealth can also be promoted after the pandemic. ConclusionShortly after the COVID-19 outbreak, outpatient physicians and psychotherapists were faced with various challenges: Through their spontaneous and flexible response to the COVD-19 pandemic, outpatient providers were able to maintain their work despite high stress levels. Telehealth is becoming more important as a result of COVID-19.

Inconsistencies in Overdose Suicide Death Investigation Practice and Potential Remedies Using Technology: A Centers for Disease Control and Prevention Consultation Meeting Summary.

It is widely accepted that suicides-which account for more than 47 500 deaths per year in the United States-are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as accidents or undetermined intent. Virtual and in-person meetings were held with suicidologists and DSI experts from five states (Spring-Summer 2017) to explore how features of a hypothetical electronic DSI tool may help address these challenges. Participants envisioned a mobile DSI application for cell phones, tablets, or laptop computers. Features for systematic information collection, scene description, and guiding key informant interviews were perceived as useful for less-experienced investigators. Wide adoption may be challenging due to differences in DSI standards, practices, costs, data privacy and security, and system integration needs. However, technological tools that support consistent and complete DSIs could strengthen the information needed to accurately identify overdose suicides.

Is the quality of skin cancer screening in Germany related to the specialization of the physician who performs it?: Results of a nationwide survey among participants of skin cancer screening.

Skin cancer screening (SCS) is an important measure for secondary prevention of skin cancer, which is the most common cancer type worldwide. This study aimed to describe patient-reported quality of SCS in Germany according to the specialization of the performing physician and different patient characteristics. Data from 1260 participants 35-65years of age (54.4% female) who underwent SCS and participated in National Cancer Aid Monitoring in 2019 were evaluated using chi-squared tests. Waiting times for SCS from a dermatologist were significantly longer than those for other physicians (31.1 versus [vs.] 15.7days; P<.001). Each body area examined during the standardized inspection was examined significantly more frequently by dermatologists than by other physicians (eg, upper body, 96.6% vs. 91.7%; P<.001). Dermatologists more often offered consultation for skin cancer prevention (74.0% vs. 67.6%; P=.026) and provided written information (47.8% vs. 34.8%; P<.001). Patients with statutory insurance had to pay more frequently for additional services during SCS from a dermatologist than from other physicians (24.7% vs. 17.1%, P=.012). Results of this study revealed differences in the provision of preventive information and the quality of visual examination during SCS between dermatologists and other physicians. These results highlight the need for quality assurance measures.

MEDICAL AND SOCIAL JUSTIFICATION OF MULTI-FACTOR PREVENTION OF MAJOR NONCOMMUNICABLE DISEASES

Purpose – to substantiate and propose a model of multi-factor prevention of majornoncommunicable diseases (NCDs) at the level of primary health care (PHC).Material and methods. The analysis of the results of a cross-sectional sociologicalstudy (N=1252); copying from the medical documentation of inpatients (n=1543) andtheir survey data (n=57) were the materials and basis for the development of the model.Content analysis, conceptual modelling method, and statistical methods (PIVOT, χ2test,step-by-step logistic regression analysis) were used.Results. The prevalence of combined pathology of NCDs was determined on the exampleof hospitalized patients. The importance of taking into account the age and results ofthe primary screening in the formation of the COPD risk group and the possibility ofsupplementing it with an assessment of the risk of fatal complications of cardiovasculardiseases on the SCORE scale is proved. Features of prevalence and combination ofrisk factors (RF) and the major NCDs among the economically active population arerevealed. It was found that with the same targeted preventive consultation of patients byPHC and specialized medical care doctors, the effectiveness of interventions significantlyincreases. The key to the high effectiveness of prevention is proved to be coordinatedcooperation between medical professionals at different levels of medical care and patientand their families.Conclusions. The proposed model of multi-factor prevention of major NCDs is based ona patient-oriented approach, taking into account the combined RF and major NCDs. Theprinciple of an integrated approach and the complexity of interventions is ensured bylayering all types of prevention provided by PHC in cooperation with specialized medicalcare and the public health service.

Supporting Occupational Physicians in the Implementation of Workers' Health Surveillance: Development of an Intervention Using the Behavior Change Wheel Framework.

Workers’ health surveillance (WHS) is an important preventive activity aimed at prevention of work-related diseases. However, WHS is not regularly implemented in some EU-countries. As occupational physicians (OPs) have to play an important role in implementation of WHS, this study aimed to develop an intervention to support OPs in implementation of WHS. The behavior change wheel framework (BCW) was used to develop the intervention. First, the problem was defined, and target behavior was selected by using results from a survey study among OPs. Subsequently, change objectives in target behavior were specified. Finally, appropriate intervention functions, behavior change techniques, and modes of delivery were identified to develop the intervention. Target behaviors were (1) OPs initiate WHS, and (2) OPs conduct preventive consultations with workers. OPs’ capabilities, and experienced opportunities were identified as change objectives. Intervention functions (education, training, enablement) and behavior change techniques (information about consequences, demonstration, instructions, behavioral practice, feedback on behavior, goal setting, action planning, reviewing goals) were selected to develop the intervention, delivered by face-to-face group training and e-learning. The proposed intervention consists of training and e-learning to support OPs in implementing WHS. Feasibility and effect of the intervention will be evaluated in future studies.