Making the case for the governance of (digital public) health futures

Digital and data tools are fundamentally changing approaches to health and the design of health systems, but governance models have neither followed nor kept up with the pace of innovation. In response to this challenge, The Lancet & Financial Times Commission on Governing health futures 2030: Growing up in a digital world explores the convergence of digital health, artificial intelligence, and other frontier technologies with universal health coverage to support attaining the SDG 3. Children and young people are crucial groups requiring particular attention to ensure that no one is left behind in achieving universal health coverage and SDG 3 amidst the digital transformation in health. Today, there are 1.8 billion people between the ages of 10 and 24 - the largest youth population in history - 90 percent of whom live in developing countries. This cohort represents an unprecedented powerhouse of human potential and digital engagement that could transform health to reach sustainable development goals. This presentation introduces several key findings from the Commission's report which pertain to the governance of (digital public) health futures amidst digital transformations in health. It will highlight how human-centred approaches to health are vital to navigating the digital transformations and maximising their benefits for population health and well-being. Further, it will provide an action plan for meaningful youth engagement in the design, development, implementation, and evaluation of digital public health policies, programmes, and services.

Preparing the public health workforce for digital health futures: the case for digital Health training & capacity building

Digital technologies are rapidly being integrated into a wide range of health fields, public health in particular. While ‘digital health' has the potential to significantly improve population health and well-being outcomes, its effective implementation and responsible use are contingent on building a public health workforce with a sufficient level of knowledge and skills to effectively navigate the digital transformations in health. In particular, the next generation of public health professionals-namely youth-must be adequately prepared to maximise the potential of these digital transformations. This presentation will highlight three key priority areas which should be prioritised in digital health education in public health to fully harness the potential benefits of digital health: capacity building, opportunities for youth, and an ethics-driven approach. It will also present applications of digital health (technologies) and best practices for public health education.

The critical role of Digital Health in Public Health

Digitalization in itself is not simply a means to an end but involves an operational change in workflows that is on the critical-path to the digital transformation of public health. The COVID-19 pandemic has been a unique opportunity to put a shining light on all the different technologies that were available and also consider a large number of new and innovative technologies that were developed in a breath-taking place over a period of one year. These different initiatives also brought relevant advances in public health needs such as epidemiological surveillance, rapid case identification, interruption of community transmission and communication with different audiences. Moreover, social media channels, blogs and websites confirmed to be a fertile ground to find data for research, but also to spread misinformation - and public health professionals should be ready to counter that threat effectively. This presentation aims to provide a comprehensive background on digital tools and strategies that can be used in national and local public health services and how stakeholder alignment across different sectors could propel forward the implementation of digital solutions.

Pulmonary granulomas in a patient with positive ANCA and history of tuberculosis: case report

BACKGROUND

Granulomatous polyangiitis (GPA) is a rare multisystem autoimmune disease of unknown aetiology that is pathologically characterised by necrotising vasculitis, tissue necrosis and granulomatous inflammation, typically in the presence of anti-neutrophil cytoplasmic antibodies (ANCA). However infectious diseases may induce high titre ANCA and mimic vasculitis. Tuberculosis may share many clinical features with GPA including fever, arthralgia, granulomatous inflammation and pulmonary lesions and patients.

CASE PRESENTATION

A 39 year old patient was admitted with ocular irritation and redness, arthralgia and multiple new pulmonary lesions. The past medical history was significant for two episodes of tuberculosis previously requiring prolonged treatment. ANCA antibodies were positive and CT showed multiple pulmonary lesions including cavitatory lesions. After extensive investigation, the patient was treated for GPA with high dose immune suppression with good clinical response.

CONCLUSIONS

Here we review the diagnostic considerations between differentiating GPA and tuberculosis in patients from endemic regions. It is recommended that biopsies of lung lesions, sputum microscopy and multidisciplinary team input are sought as part of the workup when these two differentials are being considered.

0550 Insomnia is Associated with Greater Arterial Stiffness and Cardiac Dysfunction

Introduction

Insomnia is a novel and modifiable risk factor for incident cardiovascular disease (CVD). However, identification of early markers of subclinical CVD in diagnosed insomnia is understudied. Our aim for this ongoing study is to contrast markers of cardiovascular structure and function between people with insomnia and good-sleeping controls.

Methods

Persons with insomnia (met ICSD-III criteria) and good sleeping controls (<8 Insomnia Severity Index, mean 8-night SOL and WASO<31min) were recruited from the community. Twenty-two adults (21-39y; 55% women) with no history of CVD, diabetes, inflammatory conditions, significant hypertension, or current sleep-disordered breathing (WatchPat200, Itamar Medical) were enrolled and underwent fasting cardiovascular testing. Testing included: Central augmented aortic pressure (AP) and carotid-femoral pulse wave velocity (cfPWV) for vascular stiffness; brachial artery flow mediated dilation (FMD) to assess endothelial function; and 2D echocardiography to assess ejection fraction (EF%), left ventricular global longitudinal strain (LVGLS), left atrial volume index (LAVI), mitral valve E/e’ ratio (E/e’), and lateral e’. ANCOVA models, adjusting for age, comparing persons with insomnia (n=6) to good sleeping controls (n=16) on each cardiovascular measure were conducted.

Results

AP (range:-5,10mmHg), cfPWV (range: 4.8-7.6m/s), EF% (range:55.0-72.0%), LVGLS (range:-26,-19%) LAVI (range:14.1-26.7mL/m2), E/e’ (range:3.2-7.8), and lateral e’ (range:0.09-0.22cm/sec) were all within normal ranges according to age and sex normative standards. Mean FMD was 8.8% (SD=4.3, range:4.3-19.8%). Age adjusted ANCOVA models indicated that the insomnia group had significantly worse cardiovascular function than good sleeping controls on cfPWV (M=6.8±0.3 vs. M=5.7±0.2; p=0.004), EF% (M=60.0±1.7 vs. M=65.2±1.0; p=0.017), LVGLS (M=-21.6±0.6 vs. M=-24.3±0.4; p=0.001), and lateral e’ (M=0.12±0.01 vs. M=0.18±0.01; p=0.003). No group differences were found for AP, FMD, LAVI, and E/e’.

Conclusion

Among relatively healthy young adults, people with insomnia had greater arterial stiffness and worse left ventricular systolic and diastolic functioning.

Support

American Academy of Sleep Medicine Foundation Focused Projects Award for Junior Investigators 179-FP-18

Comparison of sporadic and familial behavioral variant frontotemporal dementia (FTD) in a North American cohort

INTRODUCTION

Behavioral variant frontotemporal dementia (bvFTD) may present sporadically or due to an autosomal dominant mutation. Characterization of both forms will improve understanding of the generalizability of assessments and treatments.

METHODS

A total of 135 sporadic (s-bvFTD; mean age 63.3 years; 34% female) and 99 familial (f-bvFTD; mean age 59.9; 48% female) bvFTD participants were identified. f-bvFTD cases included 43 with known or presumed chromosome 9 open reading frame 72 (C9orf72) gene expansions, 28 with known or presumed microtubule-associated protein tau (MAPT) mutations, 14 with known progranulin (GRN) mutations, and 14 with a strong family history of FTD but no identified mutation.

RESULTS

Participants with f-bvFTD were younger and had earlier age at onset. s-bvFTD had higher total Neuropsychiatric Inventory Questionnaire (NPI-Q) scores due to more frequent endorsement of depression and irritability.

DISCUSSION

f-bvFTD and s-bvFTD cases are clinically similar, suggesting the generalizability of novel biomarkers, therapies, and clinical tools developed in either form to the other.