http://hdl.handle.net/10993/101 Search this channel search https://orbilu.uni.lu/simple-search http://hdl.handle.net/10993/43852 Title: L’agénésie de membre <br/> <br/>Author, co-author: Derian, Maxime; Kleinpeter, Édouard; Donzeau-Gouge, Véronique; Savvaki, Véra <br/> <br/>Abstract: leafleat destinated to families http://hdl.handle.net/10993/43587 Title: The D²Rwanda mixed-methods study including a cluster-randomised controlled clinical trial <br/> <br/>Author, co-author: Lygidakis, Charilaos <br/> <br/>Abstract: 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. The first study aimed at describing the protocol of the research project, reporting the research questions, inclusion and exclusion criteria, primary and secondary outcomes, measurements, power calculation, randomisation methods, data collection, analysis plan, implementation fidelity and ethical considerations. The aim of the second study was to report on the translation and cultural adaptation of the Problem Areas in Diabetes (PAID) questionnaire and the evaluation of its psychometric properties. First, the questionnaire was translated following a standard protocol. Second, 29 participants were interviewed before producing a final version. Third, we examined a sample of 266 adult patients living with diabetes to determine the psychometric characteristics of the questionnaire. The full scale showed good internal reliability (Cronbach’s α = 0.88). A four-factor model with subdimensions of emotional, treatment, food-related and social-support problems was found to be an adequately approximate fit (RMSEA = 0.056; CFI = 0.951; TLI = 0.943). The mean total PAID score of the sample was high (48.21). Important cultural and contextual differences were noted, urging a more thorough examination of conceptual equivalence with other cultures. The third study aimed at reporting on the disease-related quality of life of patients living with diabetes mellitus in a non-representative sample in Rwanda and to identify potential predictors. This cross-sectional study was part of the baseline assessment of the clinical controlled trial. Between January and August 2019, 206 adult patients living with diabetes were recruited. Disease-specific quality of life was measured using the Kinyarwanda version of the Diabetes-39 (D-39) questionnaire, which was translated and cross-culturally adapted beforehand by the same group of researchers. A haemoglobin A1c (HbA1c) test was performed on all patients. Socio-demographic and clinical data were collected, including medical history, disease-related complications and comorbidities. “Anxiety and worry” and “sexual functioning” were the two most affected dimensions. Hypertension was the most frequent comorbidity (49.0% of participants). The duration of the disease and HbA1c values were not correlated with any of the D-39 dimensions. The five dimensions of quality of life were predicted differentially by gender, age, years of education, marital status, achieving a HbA1c of 7%, hypertension, presence of complications and hypoglycaemic episodes. A moderating effect was identified between use of insulin and achieving a target HbA1c of 7% in the “diabetes control” scale. Further prospective studies are needed to determine causal relationships. http://hdl.handle.net/10993/38530 Title: A17044 Community health workers for non-communicable disease interventions in the digital age <br/> <br/>Author, co-author: Mishra, Shiva Raj; Lygidakis, Charilaos; Neupane, Dinesh; Gyawali, Bishal; Virani, Salim S; Kallestrup, Per; Miranda, J. Jaime <br/> <br/>Abstract: 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. http://hdl.handle.net/10993/38528 Title: Combating non-communicable diseases: potentials and challenges for community health workers in a digital age, a narrative review of the literature <br/> <br/>Author, co-author: Mishra, Shiva Raj; Lygidakis, Charilaos; Neupane, Dinesh; Gyawali, Bishal; Uwizihiwe, Jean Paul; Virani, Salim S; Kallestrup, Per; J. Jaime, Miranda <br/> <br/>Abstract: The use of community health workers (CHWs) has been explored as a viable option to provide home health education, counselling and basic health care, notwithstanding their challenges in training and retention. In this manuscript, we review the evidence and discuss how the digitalization affects the CHWs programmes for tackling non-communicable diseases (NCDs) in low- and middle-income countries (LMICs). 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 26 are included in the analysis. Existing theories were used to construct a conceptual framework for understanding how digitalization affects the prospects of CHW programmes for NCDs. The results are divided into two themes: (1) the benefits of digitalization and (2) the challenges to the prospects of digitalization. We also conducted supplemental search in non-peer reviewed literature to identify and map the digital platforms currently in use in CHW programmes. 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. Several dozens of digital platforms were mapped, including mobile-based networking devices (used for behavioural 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). The digitalization efforts of CHW programmes 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 when applied at the right place and time. http://hdl.handle.net/10993/35242 Title: The D²Rwanda Study: March 2018 Report <br/> <br/>Author, co-author: Kallestrup, Per; Vögele, Claus; Uwizihiwe, JeanPaul; Lygidakis, Charilaos <br/> <br/>Abstract: 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. http://hdl.handle.net/10993/34130 Title: One consensual depression diagnosis tool to serve many countries: a challenge! A RAND/UCLA methodology <br/> <br/>Author, co-author: Nabbe, P.; Le Reste, J. Y.; Guillou-Landreat, M.; Beck-Robert, E.; Assenova, R.; Lazic, D.; Czachowski, S.; Stojanovi -\vSpehar, S.; Hasanagic, M.; Lingner, H.; Clavería, A.; Fernandez San Martin, M. I.; Sowinska, A.; Argyriadou, S.; Lygidakis, Charilaos; Le Floch, B.; Doerr, C.; Montier, T.; Van Marwijk, H.; Van Royen, P. <br/> <br/>Abstract: 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. http://hdl.handle.net/10993/32932 Title: Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis <br/> <br/>Author, co-author: Hunter, Rachael; Wallace, Paul; Struzzo, Pierluigi; Vedova, Roberto Della; Scafuri, Francesca; Tersar, Costanza; Lygidakis, Charilaos; McGregor, Richard; Scafato, Emanuele; Freemantle, Nick <br/> <br/>Abstract: Objectives To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI). Design Randomised 1:1 non-inferiority trial. Setting Practices of 58 general practitioners (GPs) in Italy. Participants Of 9080 patients (>18 years old) approached to take part in the trial, 4529 (49·9%) logged on to the website and 3841 (84.8%) undertook online screening for hazardous drinking. 822 (21.4%) screened positive and 763 (19.9%) were recruited to the trial. Interventions Patients were randomised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website (facilitated access). Primary and secondary outcome measures The primary outcome is the cost per QALY gained of facilitated access compared with face-to-face. A secondary analysis includes total costs and benefits per 100 patients, including number of hazardous drinkers prevented at 12 months. Results The average time required for the face-to-face BI was 8 min (95% CI 7.5 min to 8.6 min). Given the maximum time taken for facilitated access of 5 min, face-to-face is an additional 3 min: equivalent to having time for another GP appointment for every three patients referred to the website. Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient (95% CI −0.007 to 0.011). Conclusions Facilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes. The lower cost of facilitated access, particularly in regards to investment of time, may facilitate the increase in provision of BIs for hazardous drinking. Trial registration number NCT01638338;Post-results. http://hdl.handle.net/10993/32917 Title: Universal health coverage: an urgent need for collaborative learning and technology in primary care <br/> <br/>Author, co-author: Patel, Kunal D.; Mcloughlin, Clodagh; Lygidakis, Charilaos; Bollinger, Robert; Reeves, Scott <br/> <br/>Abstract: 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. http://hdl.handle.net/10993/32881 Title: Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website <br/> <br/>Author, co-author: Wallace, Paul; Struzzo, Pierliugi; Della Vedova, Roberto; Scafuri, Francesca; Tersar, Costanza; Lygidakis, Charilaos; McGregor, Richard; Scafato, Emanuele; Hunter, Rachael; Freemantle, Nick <br/> <br/>Abstract: Background: Brief interventions (BIs) delivered in primary care have been shown to be effective in reducing risky drinking, but implementation is limited. Facilitated access to a digital application offers a novel alternative to face-to-face intervention, but its relative effectiveness is unknown.Methods: Primary care-based, non-inferiority, randomised controlled trial comparing general practitioner (GP) facilitated access to an interactive alcohol reduction website (FA) with face-to-face BI for risky drinking. Patients screening positive on the short Alcohol Use Disorders Identification Test (AUDIT-C) were invited to participate in the trial. Assessment at baseline, 3 months and 12 months was carried out using AUDIT and EQ-5D-5L questionnaires. Findings: 58 participating GPs approached 9080 patients of whom 4529 (49.9%) logged on, 3841 (84.8%) undertook screening, 822 (21.4%) screened positive and 763 (19.9%) were recruited. 347 (45.5%) were allocated to FA and 416 (54.5%) to BI. At 3 months, subjects in FA group with an AUDIT score of ≥8 reduced from 95 (27.5%) to 85 (26.8%) while those in BI group increased from 123 (20.6%) to 141 (37%). Differences between groups were principally due to responses to AUDIT question 10. Analysis of primary outcome indicated non-inferiority of FA compared with BI, and prespecified subgroup analysis indicated benefits for older patients and those with higher levels of computer literacy and lower baseline severity. Additional analyses undertaken to take account of bias in response to AUDIT question 10 failed to support non-inferiority within the prespecified 10% boundary.Interpretation: Prespecified protocol-driven analyses of the trial indicate that FA is non-inferior to BI; however, identified bias in the outcome measure and further supportive analyses question the robustness of this finding. It is therefore not possible to draw firm conclusions from this trial, and further research is needed to determine whether the findings can be replicated using more robust outcome measures.Trial registration number NCT01638338; Results. http://hdl.handle.net/10993/32746 Title: Digital health: navigating towards meaningful and sustainable solutions <br/> <br/>Author, co-author: Lygidakis, Charilaos http://hdl.handle.net/10993/32741 Title: Embracing diversity in the digital transformation of primary healthcare <br/> <br/>Author, co-author: Lygidakis, Charilaos <br/> <br/>Abstract: 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. http://hdl.handle.net/10993/32740 Title: Community- and mHealth-based integrated management of diabetes in primary healthcare in Rwanda (D²Rwanda): The study protocol <br/> <br/>Author, co-author: Uwizihiwe, Jean Paul; Lygidakis, Charilaos; Vögele, Claus; Condo, Jeanine; D'Ambrosio, Conchita; Kallestrup, Per <br/> <br/>Abstract: 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. http://hdl.handle.net/10993/29204 Title: Comorbid depression in elderly with type 2 diabetes <br/> <br/>Author, co-author: Lygidakis, Charilaos; Altini, Chiara; Rigon, Sara; Spezia, Carlo; Luppi, Davide; Alice, Stefano <br/> <br/>Abstract: Aim: To evaluate the potential correlation between depression and type 2 diabetes mellitus (DM2) in patients aged 65 years and over accessing primary health care (PHC) units. Methods: During the last semester of 2008, 109 elderly patients with DM2 (mean age 74.86, sd = 5.72) were examined by GP trainees in PHC practices. Demographics, BMI, waist circumference, fasting blood glucose (FBG), HbA1c and medicine treatment were queried. Dietary and drug therapy compliance and weekly physical activity in recreational time were investigated; expended energy was measured using Metabolic Equivalents (METs). Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15) and mental health was evaluated with the General Health Questionnaire – 12 (GHQ-12). For comparison purposes, a short interview comprising the GDS-15 and GHQ-12 was performed in 52 non diabetic, randomly selected patients. The two groups were properly adjusted for sex and age. Results: Moderate (GDS-15 scores 6–8) and severe depression (GDS-15 >9) were found in 33.9% and 17.4% of the diabetics respectively. Female patients seemed to have better FBG values (r = 0.33, p = 0.006) and more controlled HbA1c (<7%, r = 0.37, p = 0.003). However, only males with regular HbA1c showed significantly lower BMI (Mdn = 27.72, U = 128.00, p <0.001) and waist circumference (Mean = 91.84 cm, t = 3.32, p = 0.002). Diabetics without depression signs were triply likely to do moderate weekly exercise compared with depressed ones (OR = 3.01, 95%CI = 1.36–6.57). Lower GDS-15 and GHQ-12 scores were correlated with more scarce therapy compliance (r = 0.46, p <0.001; r = 0.43, p <0.001 respectively). Diabetics seemed to be 2.83 times more likely to suffer from moderate depression compared with the control patients (95%CI = 1.19–6.68). Conclusions: The findings of our study suggest that moderate depression is a common underlying comorbidity in DM2, affecting aspects of its management such as the physical activity and compliance of medical therapy. http://hdl.handle.net/10993/29195 Title: Arrhythmias in primary care: Common treatment failures that could be adjusted <br/> <br/>Author, co-author: Lygidakis, Charilaos; Argyriadou, S.; Lygera, A.; Georgiadou, T.; Makris, T.; Chatzikosma, G.; Chatzijiannakos, I. http://hdl.handle.net/10993/29194 Title: Estimating partner abuse in primary care <br/> <br/>Author, co-author: Lygidakis, Charilaos; Argyriadou, Stella; Lygera, Anastasia; Anyfantakis, Jannis http://hdl.handle.net/10993/29193 Title: Screening for cognitive impairments in primary health care using the 6 item cognitive impairment test: a collaborative study between Italy and Greece <br/> <br/>Author, co-author: Lygidakis, Charilaos; Marzo, Carla; Argyriadou, Stella; Lygera, Anastasia; Tritto, G.; Fabbri, F.; Carnesalli, F.; Calderino, Pm; Vitas, A.; Papatheodosiou, L. http://hdl.handle.net/10993/29185 Title: Influenza del fumo di tabacco sui trattamenti farmacologici <br/> <br/>Author, co-author: Zagà, Vincenzo; Lygidakis, Charilaos; Pozzi, Paolo; Boffi, Roberto <br/> <br/>Abstract: Cigarette smoke, that contains more than 4.000 substances, may directly or indirectly influences the efficacy and the tolerability of many medications through complex pharmacokinetic and pharmacodinamic interactions. In fact, cigarette smoke, and in particular polycyclic aromatic hydrocarbons, nicotine, carbon monoxide and heavy metals, powerful enzymatic inducers, determines modifications of the sistemic and local bioavailability of several drugs. Therefore, in patients who are currently assuming any therapy, the clinicians should consider adjustments of dosages either when a smoker patient starts a new drug or when he quits smoking. The purpose of this review is to examine the main drug interactions with tobacco smoke clinically relevant that can be of particular importance especially in patients with multiple comorbidities, with a closer look on those who developed respiratory, cardiovascular, oncologic or psychiatric diseases. http://hdl.handle.net/10993/29180 Title: A randomized controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR-FVG): preliminary results <br/> <br/>Author, co-author: Struzzo, Pierluigi; Vedova, Roberto; Ferrante, Donatella; Freemantle, Nicholas; Lygidakis, Charilaos; Marcatto, Francesco; Scafato, Emanuele; Scafuri, Francesca; Tersar, Costanza; Wallace, Paul <br/> <br/>Abstract: Background The effectiveness of brief interventions for risky drinkers by GPs is well documented.[1] However, implementation levels remain low. Facilitated access to an alcohol reduction website offers an alternative to standard face-to-face intervention, but it is unclear whether it is as effective.[2] This study evaluates whether online brief intervention, through GP facilitated access to an alcohol reduction website for risky drinkers, is not inferior to the face-to-face brief intervention conducted by GPs. Material and methods In a northern Italy region participating GPs actively encouraged all patients age 18 attending their practice, to access an online screening website based on AUDIT-C.[3] Those screening positive underwent a baseline assessment with the AUDIT-10[4] and EQ-5D[5] questionnaires and subsequently, were randomly assigned to receive either online counselling on the alcohol reduction website (intervention) or face-to-face intervention based on the brief motivational interview[6] by their GP (control). Follow-up took place at 3 and 12 months and the outcome was calculated on the basis of the proportion of risky drinkers in each group according to the AUDIT-10. Results More than 50% (n= 3974) of the patients who received facilitated access logged-on to the website and completed the AUDIT-C. Just under 20% (n = 718) screened positive and 94% (n= 674) of them completed the baseline questionnaires and were randomized. Of the 310 patients randomized to the experimental Internet intervention, 90% (n = 278) logged-on to the site. Of the 364 patients of the control group, 72% (263) were seen by their GP. A follow-up rate of 94% was achieved at 3 months. Conclusions The offer of GP facilitated access to an alcohol reduction website appears to be an effective way of identifying risky drinkers and enabling them to receive brief intervention. <br/> <br/>Commentary: 10.1186/1940-0640-10-S2-O29 http://hdl.handle.net/10993/29179 Title: Randomised controlled non-inferiority trial of primary care based facilitated access to an alcohol reduction website (EFAR-FVG) <br/> <br/>Author, co-author: Wallace, Paul; Struzzo, Piero; della Vedova, Roberto; Tersar, Costanza; Verbano, Lisa; Lygidakis, Charilaos; MacGregor, Richard; Freemantle, Nick; Scafato, Emanuele <br/> <br/>Abstract: Introduction There is a strong body of evidence demonstrating effectiveness of brief interventions by primary care professionals for risky drinkers but implementation levels remain low. Facilitated access to an alcohol reduction website constitutes an innovative approach to brief intervention, offering a time-saving alternative to face to face intervention, but it is not known whether it is as effective. Objective To determine whether facilitated access to an alcohol reduction website is equivalent to face to face intervention. Methods Randomised controlled non-inferiority trial for risky drinkers comparing facilitated access to a dedicated website with face to face brief intervention conducted in primary care settings in the Region of Friuli Venezia-Giulia, Italy. Adult patients are given a leaflet inviting them to log on to a website to complete the AUDIT-C alcohol screening questionnaire. Screen positives are requested to complete an online trial module including consent, baseline assessment and randomisation to either standard intervention by the practitioner or facilitated access to an alcohol reduction website. Follow up assessment of risky drinking is undertaken online at 1 month, 3 months and 1 year using the full AUDIT questionnaire. Proportions of risky drinkers in each group will be calculated and non-inferiority assessed against a specified margin of 10%. The trial is being undertaken as an initial pilot and a subsequent main trial. Results 12 practices have participated in the pilot, and more than 1300 leaflets have been distributed. 89 patients have been recruited to the trial with a one month follow-up rate of 79%. Discussion The findings of the pilot study suggest that the trial design is feasible, though modifications will be made to optimize performance in the main trial which will commence in January 2014. Plans are concurrently underway to replicate the trial in Australia, and potentially in the UK and Spain. <br/> <br/>Commentary: 8 Addiction Science \& Clinical Practice 1 1940-0640 http://hdl.handle.net/10993/29177 Title: Cross-Cultural Validation of the Definition of Multimorbidity in the Bulgarian Language. <br/> <br/>Author, co-author: Assenova, Radost S.; Le Reste, Jean Yves; Foreva, Gergana H.; Mileva, Daniela S.; Czachowski, Slawomir; Sowinska, Agnieszka; Nabbe, Patrice; Argyriadou, Stella; Lazic, Djurdjica; Hasaganic, Melida; Lingner, Heidrun; Lygidakis, Charilaos; Munoz, Miguel-Angel; Claveria, Ana; Doerr, Chista; Van Marwijk, Harm; Van Royen, Paul; Lietard, Claire <br/> <br/>Abstract: INTRODUCTION: Multimorbidity is a health issue with growing importance. During the last few decades the populations of most countries in the world have been ageing rapidly. Bulgaria is affected by the issue because of the high prevalence of ageing population in the country with multiple chronic conditions. The AIM of the present study was to validate the translated definition of multimorbidity from English into the Bulgarian language. MATERIALS AND METHODS: The present study is part of an international project involving 8 national groups. We performed a forward and backward translation of the original English definition of multimorbidity using a Delphi consensus procedure. RESULTS: The physicians involved accepted the definition with a high percentage of agreement in the first round. The backward translation was accepted by the scientific committee using the Nominal group technique. DISCUSSION: Some of the GPs provided comments on the linguistic expressions which arose in order to improve understanding in Bulgarian. The remarks were not relevant to the content. The conclusion of the discussion, using a meta-ethnographic approach, was that the differences were acceptable and no further changes were required. CONCLUSIONS: A native version of the published English multimorbidity definition has been finalized. This definition is a prerequisite for better management of multimorbidity by clinicians, researchers and policy makers.