Title- Design thinking for a patient-centered innovation in the nursing industry: How hospitals can use the design thinking tool for processes, services and infrastructure around the patient

Speaker Abstract

The market-focused willingness for innovation ensures the success of the clinics. Hospitals need the ability to recognize customer needs, develop solutions and advertise accordingly. The current hospital structures imply only a little willingness for innovation in nursing care, while the demands are changing. The clinics need to adapt to the ever changing needs of patient as the average innovation development process is not efficient enough due to traditional project management. The transformation method “Design Thinking” offers a holistic identification of customer’s ideas and needs through a user-oriented and systematic approach to complex problems. Creative solutions are sought and tested in the form of a prototype. In addition, ongoing feedback is provided by the end-user in order to develop or improve user-oriented concepts. At the Health Forum, the basics of Design Thinking are being presented. Qualitative and quantitative research results are introduced in regards to the opportunities and risks of Design Thinking in nursing and in addition, the possible uses of Design Thinking in nursing are reported and the projects that have been accomplished are presented. In the RoMed clinics, various topics have already been established using Design Thinking like the successful implementation of attractive learning areas for trainees, the decrease of patient accidents, the integration of nursing assistants in every nursing department, the work-life-balance, an innovative application tracking system, improved patient care for cognitively impaired patients and optimized discharge management with a rehabilitation clinic. Helpful recommendations for a successful implementation of Design Thinking is given at the end of the presentation and an open discussion around is promoted.

Speaker Biography

Judith Hantl-Merget B.B. A., M.A.: Director of Nursing in the RoMed clinicsThe ideal case of an executive manager combines leadership and management. This principle is a daily reminder for my operative work as a member of the management and director of nursing. In this role, I intensively explore the culture of New Work and apply these elements to drive the cultural change at the RoMed clinics for the last four years. Especially helpful was my advanced training in Future and Digital Leadership at SGMI. With this background, I enabled frontline staff to independently solve a multitude of problems with the innovation framework Design Thinking.

Title- Making decision-making visible- teaching the process of evaluating interventions

Speaker Abstract

Significant educational efforts to increase evidence-based practice have emphasized increasing knowledge, however these efforts have had minimal effect on sustained engagement of working healthcare professionals. Critically, many new interventions with limited evidence of effectiveness continue are readily adopted-indicating that openness to change is not the problem. The selection of an intervention is the outcome of an elaborate and complex process, which is shaped with how they represent the problem and their knowledge. This process is mostly invisible to others. An alternative strategy for increasing EBP use is to teach healthcare professionals to make visible to themselves, explicitly teaching how to develop an evidence-informed cognitive model, and explicitly teach the thinking process of deciding how to assess and provide a specific intervention with clients (See figure 1: the simple view of intervention selection). This complex thinking process has many places where errors in thinking can lead to adverse decisions. However, it also identifies where specific EBP activities are implemented to be able to make quality decisions and not just when confronted with a clinical dilemma. The objective of this presentation is to: a) explain why teaching how students develop richer cognitive model increases their implementation of EBP activities; b) explain how developing an evidence-informed cognitive model of client problems improves heuristic reasoning, and c) describe the criteria which can be used to understand and integrate new interventions with previous strategies. Making the process visible to clinicians/students increases the skills required to judiciously select one intervention over others.

Speaker Biography

Angela Benfield is an occupational therapist who has over 23 years of clinical experience with children. She currently teaches in an entry-level master’s degree occupational therapy program. She has spoken on clinical reasoning, measuring outcomes and EBP internationally. Her research interest explores the skills required to be a competent allied health professional and the development of expertise. She has developed an interprofessional model of evidence-informed professional thinking which identifies activities which support the development of expertise. She has also operationalized the model through the development of the measure of evidence-informed professional thinking using Rasch analysis.

Title- Design thinking for a patient-centered innovation in the nursing industry: How hospitals can use the design thinking tool for processes, services and infrastructure around the patient

Speaker Abstract

The market-focused willingness for innovation ensures the success of the clinics. Hospitals need the ability to recognize customer needs, develop solutions and advertise accordingly. The current hospital structures imply only a little willingness for innovation in nursing care, while the demands are changing. The clinics need to adapt to the ever changing needs of patient as the average innovation development process is not efficient enough due to traditional project management. The transformation method “Design Thinking” offers a holistic identification of customer’s ideas and needs through a user-oriented and systematic approach to complex problems. Creative solutions are sought and tested in the form of a prototype. In addition, ongoing feedback is provided by the end-user in order to develop or improve user-oriented concepts. At the Health Forum, the basics of Design Thinking are being presented. Qualitative and quantitative research results are introduced in regards to the opportunities and risks of Design Thinking in nursing and in addition, the possible uses of Design Thinking in nursing are reported and the projects that have been accomplished are presented. In the RoMed clinics, various topics have already been established using Design Thinking like the successful implementation of attractive learning areas for trainees, the decrease of patient accidents, the integration of nursing assistants in every nursing department, the work-life-balance, an innovative application tracking system, improved patient care for cognitively impaired patients and optimized discharge management with a rehabilitation clinic. Helpful recommendations for a successful implementation of Design Thinking is given at the end of the presentation and an open discussion around is promoted.

Speaker Biography

He works intensively in the innovation and development of nursing care. Matthias Scherm is a Surgical Assistant, Health Manager, Design Thinking Facilitator, Bachelor of Science in Public Health and currently a part-time student enrolled in a Master of Arts, Business Psychology. He is fascinated by the challenges in healthcare and likes to change the processes around the patient with new tools. Further, he has successfully established the first robot support in the RoMed clinics.

Title- Building a peer group community

Speaker Abstract

Aim: To build a network of professional communities that engage, participate and facilitate in supporting each other with the key shared principles to promote a safe space for well-being, sharing good clinical practice, identifying quality improvement projects and working together to support each other in order to support compassionate care giving. Background: Nursing as a profession has for many years struggled with the retention of nurses in the NHS, the period of restoration and recovery following the Covid 19 pandemic is required to ensure that nurses are supported and wellbeing is central to the recovery to promote retention of a compassionate nursing workforce. Nursing by nature undertakes clinically complex work that can stimulate many emotional responses that can be hard to process and understand, leading to the inner critic take over a phenomenon that encourages self-blame, self dis-trust and compassion burnout. Methodology: Using Clinical Supervision to build resilience and restoration within a work based community, promoting a tool kit that can be used to pro-actively enhance a community of peer support, check in skills, mindfulness and a safe space to reflect, learn and promote self-care as well as compassionate care. Implementing a clinical supervision cycle as well as building support networks in multiple clinical settings and with multiple peer groups. Clinical supervision has been implemented as group clinical supervision within the preceptorship groups and individual supervision for ward based nurses. Alongside building peer support communities as a tool to support and promote quality and compassionate care. Outcome measured by qualitative feedback and engagement. Results: Qualitative feedback revealed positive themes and identified engagement in the process to promote well-being and maintaining compassionate care to avoid burnout and promote improvement projects. Conclusion: The nature of clinical supervision and building peer group communities facilitated with an element of mindfulness and positive reframing gives nurses the time, space and skills to recognise the importance of their own wellbeing and that of their peers, in turn encouraging the identification and development of projects to promote working and caring as a team to build on and demonstrate that clinical supervision can increase peer group support and in turn compassionate care giving as well as leadership.

Speaker Biography

Angela Cole is a Clinical Nurse Specialist for Children with Intestinal Failure at The Royal London Hospital. During the Covid 19 Pandemic Angela developed and facilitated a peer support group for paediatric nurses redeployed to adult ITU areas, this experience has developed a passion for Clinical Supervision and the positive outcome this toolkit holds in keeping steady in the midst of chaos. Building peer group communities to really fulfil the term resilience to promote restoration is a forever aim. Well-being and compassionate care at the heart of nursing care.

Title- Bereavement needs of critical care nurses: A qualitative study

Speaker Abstract

Background/Introduction: Bereavement and grief in critical care nurses remain an under studied phenomenon. As a way of self-protection, nurses may compartmentalize their own feelings and need assistance and support in processing feelings of bereavement. Nurses spend much of their time caring for patients and their family members, while guiding them through the dying process, however they may not take adequate time to address their own bereavement needs. Objective/Aims: To explore the bereavement needs of critical care nurses after experiencing the expected or unexpected death of a patient. From their lived experiences, gain insight as to how nurses perceive, process and cope with the death of a patient. Methodology: A qualitative, phenomenological focus group was conducted with critical care nurses (N = 10) after gaining Internal Review Board (IRB) approval. The group discussion was audio-recorded and transcribed. Content analysis was performed to identify common themes. Results: Seven themes emerged a) Emotional Distress, leading to compassion fatigue, burnout, moral distress, b) Empathy, c) Resurfacing Personal Loss leading to secondary traumatic stress in the workplace, d) Unrealistic Expectations placed on the nurse, e) Detachment leading to compartmentalization, f) Lack of Formal Education, and g) Selfcare and Available Resources. (See Table 1 and 2) Discussion/Conclusion: More education for nurses in undergraduate and continuing education programs is needed to assist nurses in the bereavement process. More interventional studies are needed to explore programs of nurses’ selfcare both in the workplace and in nurses’ personal lives to more effectively support their emotional needs.

Speaker Biography

Taline Omran, Vanguard University; MSN, Point Loma Nazarene University; BSN, PHN (Public Health Nursing). Certifications and Competencies include: BLS, ACLS, NIH stroke certification. Relief charge nurse, sepsis nurse, rapid response nurse. She has passionately been working in critical care nursing for 15 years. Her love of nursing has allowed her to travel all over the world participating in humanitarian relief aid. The topic for this article was prompted by witnessing co-workers having a difficult time processing and coping with personal and work- related losses.

Title- Direct to consumer genetic and genomic testing with associated implications for advanced nursing practice

Speaker Abstract

Direct-to-consumer genetic and genomic testing (DTCGT) has paved the way for consumers to gain information about their genetic makeup. Consumers may seek DTCGT to estimate ethnic background, identify genetic relations, or obtain raw DNA information that can be used for other purposes, such as testing for paternity and identifying genetically linked illnesses. Despite robust progress in genetic and genomic testing, most people have a low exposure threshold to DTCGT. Patient consumers may unnecessarily experience anxiety if they do not have a health care provider (HCP) to consult and review their results. Presently, there is a knowledge gap in how accurately HCPs can interpret and communicate genetic test results to patients compared with genetic specialists who may be inaccessible to underserved populations. Genetic and genomic information is rapidly progressing in health care and can identify patients at increased risk for certain diseases and improve patient care and outcomes. Appropriate use of genetic and genomic testing and knowing the limitations and difficulties of current testing available are integral to the success of HCPs in using these results in health promotion and improving quality of life. Health care providers should be aware of DTCGT recommendations and implications for patients, be prepared to counsel patients who present with testing results in hand, seeking advisement, and be competent in determining the need for further diagnostic testing or referral to a specialist genetic counselor.

Speaker Biography

Dr. Ashley Kate Hughes has been an employee of the Department of Veterans Affairs for over 14 years. Additionally, she selflessly serves as a reservist in the United States Air Force, holding the rank of Major. She has a dynamic background in the nursing field. She has held many nursing positions, including medical-surgical nurse, assistant nurse manager, nurse manager, nurse supervisor, nurse practitioner, clinical faculty nurse, academic faculty nurse, and military nurse. Dr. Hughes has experience in inpatient, outpatient, and deployed treatment settings. Her research includes opioids, ethics, genomics, genetics, access to healthcare, employee satisfaction, quality improvements, and program evaluations. Dr. Hughes is an expert Family Nurse Practitioner with outstanding professional organizational involvement at the local, state, and national levels. She drives innovative, visionary leadership, developing nurse practitioner-led inclusive and diverse interprofessional teams to produce impactful quality health care outcomes, particularly for vulnerable and underserved populations.

Title- Impact of waterpipe educational program on university students' who are active waterpipe smokers

Speaker Abstract

Background: Water-pipe smoking (WPS) is considered as one of the most dangerous patterns of tobacco smoking. It is expected by the end of this century to kill a billion people or more unless urgent action is taken. Jordan is ranked as the fourth highest Arab country in regards to smoking rates. It aims to investigate Jordanian university students' knowledge and beliefs towards WPS; explore factors that are associated with being a WPS smoker; and evaluate the effectiveness of a WPS cessation program. Method: A randomized clinical trial design was used to evaluate the effectiveness of a WPS cessation educational program. The sample included 400 students. Ethical approval was obtained from the target universities before data collection, and each participant was asked to sign a written consent form. Invitations was posted through internet websites and announcement boards in the universities. Results: The difference in the educational program posttest total score (dependent variables) were statistically significant: motivation (F {1, 257}=1365, p = 0.000), attitudes (F{1,257}= 276, p = 0.000), knowledge of health effects (F{1, 257}= 307, p = 0.000), health risks (F{1,257}= 329, p = 0.000), and intention to quit smoking shisha (F{1,257}= 318, p = 0.000). Conclusion: It was found to be effective in promoting students' knowledge and attitudes towards WPS and intention to quit WPS. Therefore, health faculties have the obligation to conduct frequent educational sessions using various teaching approaches as part of the campaigns to fight against the epidemic of the WPS within this age group.

Speaker Biography

Dr. Mahmoud Al-Hussami, a professor of epidemiology and leadership at the University of Jordan, School of Nursing. His teaching has a wide range of undergraduate and graduate modules in the school of nursing and school of medicine. His research includes leadership in healthcare and infectious disease epidemiology. He published over 52 research articles in distinguished and prestigious journals. Al-Hussami has been awarded his PhD (2007) from Barry University, for his research in leadership. Also, he received his DSc. in Health Science, specialized in Epidemiology, from Nova Southeastern University in 2005 and MPH in Epidemiology from Florida International University. As a faculty member at the university of Jordan Dr. Al-Hussami has some hopes and plans to improve the ultimate goal for his school beside his personal long life learning goals, which represent a more advanced stage of renewal and build the sense of self-esteem by enhancing the store of knowledge, thus promoting on increased level of competence and efficacy in approaching work related problems.

Title- Waterpipe smoking and the coronavirus syndemic

Speaker Abstract

smokers among the participants. In Jordan, an online survey conducted in March 2021 by Al-Tammemi and colleagues (2021) included 2424 participants. Among the findings related to waterpipe smoking, respondents recorded their opinions on the relationship between smoking and domains of COVID-19 such as risk and spread of infection, safety concerns of smoking in public places and the home, clinical outcome and the belief in the protective effective of nicotine. Approximately 38.2%, 72.9% and 44.6% of respondents believed that cigarette smoking, waterpipe smoking and e-cigarette smoking respectively were related to the risk of contracting COVID-19. Clearly, participants considered that waterpipe smoking constituted a much higher risk. About 74% also considered that severity of COVID-19 would be worse for waterpipe smokers, ans almost 80% believed that waterpipe smoking in public places was unsafe during the syndemic. Conclusion: All the evidence suggests that waterpipe smoking poses its own unique set of risks and hazards during the COVID-19 syndemic. When combined with the well-established dangers of tobacco use in causing mortality and morbidity, contributing to a wide range of illnesses, the particular features of waterpipe smoking – the social setting, the apparatus used, the perceptions of waterpipe smokers themselves – all present a cause for concern. This review has concentrated on the research conducted in the Middle East region, both before and during the COVID-19 syndemic. While this region constitutes the highest use of waterpipe smoking, it is necessary to emphasise again that current research has alerted health authorities on the growing widespread use of waterpipes as a global problem, along with e-cigarettes and even e-hookah innovative products promoted by the tobacco industry. Misinformation disseminated by the industry has aided in influencing perceptions and endangering lives. More information is now required on motivation specifically to quit waterpipe smoking since the start of the syndemic, along with an appraisal of the effect of bans on waterpipe cafes in those countries where such bans have been applied.

Speaker Biography

M. Phil., University of Huddersfield, 2014: The perceptions of smokers and health care professionals on the smoking cessation program in Saudi Arabia. M.A. University of Bradford, 2006: Strengthening the relationship between the social worker and drug addicts. 1996-2005: various senior administrative positions in the Northern Area Armed Forces Hospital, Saudi Arabia, relating to logistics and patient affairs. 2007-2012 and 2015-2018: senior administrative roles within the Prince Sultan Military Medical City, Riyadh, Saudi Arabia. 2019- present: attached to the Saudi Arabian Embassy, London.

Title- Efficacy and cost‐feasibility of the timely chest compression training (T‐CCT): A contextualized cardiopulmonary resuscitation training for personal support workers participating during in‐hospital cardiac arrests

Speaker Abstract

Objectives: The Timely Chest Compression Training (T-CCT) was created to promote more frequent training in chest compressions for personal support workers. This study aims to assess the efficacy of the T-CCT on the chest compression performance and to examine costs related to this intervention. Methods: A prospective single group, before after study was conducted at a university affiliated hospital. The T-CCT is adapted for support workers and lasts 20 min during working hours. Guided by peer trainers, live feedback devices and mannikins, the T-CCT targets chest compression training. Using an algorithm, chest compression performance scores were gathered before and after the intervention. Results: Of 875 employed support workers, 573 were trained in 5 days. Prior to the intervention, the median performance score was 72%. Participants significantly improved after the intervention (p < 0.001) and the median of the differences was 32% (95% CI 28.5–36.0). Support workers in critical care units and those with an active basic life support (BLS) certification performed better at baseline and were less inclined to have large changes in performance scores after the intervention. When compared to basic life support training, the T-CCT is over three times less expensive. Conclusions: The T-CCT was an effective and low-cost initiative that allowed to train a large group of support workers in a short amount of time. Since they are actively involved in resuscitation efforts in Quebec (Canada), it may promote the delivery of high-quality compressions during in-hospital cardiac arrests. Our inquiry can incite and guide other organizations in the implementation of similar interventions.

Speaker Biography

Catalina Sokoloff is an Emergency and Intensive Care Physician working at the CHUM, a tertiary academic hospital in Montreal, Canada. She has completed a 1-year Fellowship program in Clinical Simulation and Medical Education in Sydney, Australia, and is now in charge of the In Situ Simulation Committees of both services at her institution. She shares her clinical practice between the Emergency Room and the Intensive Care Unit, and she fills the rest of her time developing training programs for healthcare workers to improve patient care and cardio-pulmonary resuscitation performance. Her academic and research interests lie in the fields of Crisis Resource Management, teamwork efficiency, and optimal teaching methods.

Title- Using mobile phones in health behaviour change: Perceptions among adolescents

Speaker Abstract

Health promotion interventions delivered via mobile phones (mHealth) need to be carefully tailored to end-users to optimize engagement and effects on health outcomes. However, tailoring requires an in-depth understanding of the users’ context and under which circumstances end-users are willing to engage. The aim of this study was to identify and describe how high school students perceive health behaviour change and how mobile phones are used in the process of change. Thematic analysis was used to analyse data collected through 6 focus groups with 21 Swedish high school students (16–19 years). The results showed that behaviour change among adolescents were promoted by having an open approach, being able to be independent, and self-accepting. Mobile phones can provide resilience in long-term behaviour change. These findings may be useful in the development of mHealth interventions, but also for professionals in promoting healthy behaviours among adolescents.

Speaker Biography

I am a PhD-student with an interest in health behaviours among adolescents and in promotion of healthy behaviours through interventions delivered via mobile phones (mHealth). My research interest involves qualitative as well as quantitative methods. Before my PhD-studies, I worked as a school nurse and that was why I became interested in the public health area of reaching many individuals at a time, and at any place, and across socio economic strata, by use of digital tools to support healthy behaviours. My first manuscript was accepted and published in June 2021. Orcid: 0000-0002-7780-8417.

Title- Assessing understanding of caregivers on immunization and COVID-19 vaccines using a survey instrument

Speaker Abstract

Background: Preventive medicine and immuniation are crucial to preserve public health. In this study, it was aimed to determine the perspectives of the caregivers against the immunization services and awareness of the vaccine for the Covid-19 pandemic, which is the most critical challenge in nowadays. Methods: In this cross-sectional descriptive study, parents who applied to the pediatric outpatient clinic of our hospital for any reason during one-week period were evaluated. A questionnaire was administered to 205 parents about their knowledge and perceived on immunization and Covid-19 vaccines. Demographic characteristics of families, income and education levels, number of children and presence of Covid-19 vaccination of the parents were sought. The questionnaires were filled in by face-to-face interview method after informing the participants about the study and obtaining consent from the participants. SPSS software was used for analysis. Content analysis method was used to evaluate the data at qualitative stage. Result: In the study, 205 questionnaires were included. Of the parents who participated, 174 were mothers, 42.4% (n:87) were between the ages of 30-39, 48,8% (n:100) were housewives and 21,0% (n:43) were primary school graduates and 21% were unvaccinated. Majority of the parents (42%) believe that there are other ways to prevent diseases which can be prevented by a vaccine and 37% of them assume to get not enough information on vaccines. Thirty eight percent of parents presume the vaccine causes the diseases. It was found 70% of the parents assume that not be vaccinated is an individual right. It was observed that as the level of education of the parents increased, the rate of being aware of vaccines and getting them increased. Conclusion: It was concluded that majority of the parents believed that not getting vaccinated is an individual right. A significant number of parents were found to lack information about vaccines. Getting vaccinated is not an individual decision. To increase awareness of caregivers about vaccines can be achieved by providing accurate and appropriate information by health professionals and extended immunization programs to the public.

Speaker Biography

Title- Estimating nickel exposure in respirable dust from nickel in inhalable dust

Speaker Abstract

At different workplaces, the dust exposure and associated metal constituents, e. g. nickel, can be immense, and can cause occupational diseases. They range from allergic reactions to different forms of cancer. From early years of exposure measurement, only data of nickel in one dust fraction (mainly inhalable instead of respirable and inhalable) were measured. For retrospective evaluations of exposure levels or of occupational diseases, this is problematic. For this purpose, it is desirable to convert nickel concentrations from inhalable to respirable dust. Therefore, a total of 234 202 respirable fraction measurements, 123 118 inhalable fraction measurements and 32 882 nickel measurements in total were extracted from the exposure database MEGA. After several parameters and restrictions (e.g. same industrial sector, working activity and sampling duration or type of sampling) were considered, 551 parallel measurements of nickel concentrations in inhalable (c_I(Ni) ) and respirable dust (c_R(Ni) ) fractions from 2011 to 2020 could be determined and investigated by linear regression analysis. Inhalable dust is the most important predictor variable, showing an adj. R² of 0.767. To refine the conversion of nickel concentrations, the total dataset was divided into working activity groups ‘high temperature processing’, ’filling/ transport/storage’, and ‘machining/abrasive techniques’. From these groups, more task-specific subgroups were formed: ‘welding (grinding time fraction [GTF] < 5 %)’, ‘welding (GTF > 5 %)’, ‘high temperature cutting’ and ‘grinding’. The nickel concentrations were transformed using the natural logarithm. For each group an individual conversion function with its relating confidence interval could be calculated. All conversion functions (except for ‘welding GTF < 5 %’) are power functions with adj. R² between 0.628 and 0.924: cR(Ni) =c(I(Nik*ec0 ), where k and C0 are regression coefficients. Thus, there is no linear correlation between cI(Ni)and cR(Ni) , no single conversion factor and the conversion must always refer to the individual workplace.

Speaker Biography

Cornelia Wippich graduated in 2016 with a master’s degree in analytical chemistry and quality assurance at the University of Applied Sciences Bonn-Rhein-Sieg, Germany. As a part of her doctoral thesis, she conducted research on the conversion of inhalable and respirable dust and metal dust constituents in different industry sectors. Since 2019 Ms. Wippich is working as a scientific employee in the section metal analysis at the Institute for Occupational Safety and Health of the German Social Accident Insurance.

Title- Covered-stent treatment of an extracranial internal carotid artery pseudoaneurysm in a 3 years-old child with 12-years follow-up: A case report

Speaker Abstract

Introduction: Extracranial internal carotid artery (ICA) pseudoaneurysms in children, although uncommon, are life-threatening. Covered stents are a good alternative treatment, as they avoid the risk of open surgery and preserve the internal carotid artery. Long- term outcomes were unknown until recently. Report: In August 2008, a 3-years-old child was treated with a covered stent for a pseudoaneurysm in the extracranial ICA. A long-term follow up is presented. Results: The child was discharged with full recovery and without neurological sequelae. He has been followed-up and has remained asymptomatic for 12 years, with CTA-confirmed internal carotid artery patency, without deformation or evidence of significant re- stenosis. Conclusion: This the first report of the long-term outcome of a covered stent in a child treated at 3 years of age, with a 12-year follow-up. The good performance of the covered stent in this case reinforces its adoption as a first-line option in the treatment of extracranial ICA pseudoaneurysms in children.

Speaker Biography

Prof. Roberto Sánchez, MD Professor of Surgery Faculty of Medicine- University of Concepción- CHILE Fellow of the American College of Surgeons Ancien Resident Etranger des Hopitaux de Paris Membre Asociee Etranger Société de Chirurgie Vasculaire et Endovasculaire de Langue Francaise (SCVE) Non-european Membership European Society of Vascular and Endovascular Surgery (ESVS).

Title- Can you train the neck to help prevent concussion?

Speaker Abstract

Over the past 20 years there has been a significant increase in the awareness of the devastating impact concussions can have on athletes, military personnel and our youth. There is a lot of discussion around the problem, but very little progress has been made on prevention. Fortunately, mother nature has already found the solution and provided us with our very own shock-absorption system. This is the role of the neck muscles. In fact, research in high school athletes has shown that every one pound of increased neck strength leads to a 5% decreased risk in concussion. However, best evidence does not recommend traditional neck strengthening as an effective means to lower concussion risk. Why is that? Because muscles respond very specifically to the type of training they are exposed to. Traditional neck strengthening involves taking a heavy weight and pushing the head against it. This will improve the neck’s ability to take a heavy weight and push against it. However, it will not necessarily improve the neck muscles’ ability to respond and react quickly to stabilize the head against a potentially concussive blow. This presentation will provide a scoping review of the current evidence around the role the neck muscles play in mitigating concussion risk. It will examine whether these neck muscles can be trained to help decrease an individual’s concussion risk. With an understanding of muscle physiology, it will outline the six key training principles that must be incorporated into a training program aimed at providing the best opportunity for the neck muscles to help protect against concussion.

Speaker Biography

Dr. Theo Versteegh is a physiotherapist with over 20 years’ experience in sports medicine. During his undergraduate training in physiotherapy at Western University, he was a member of the National championship Mustang football team. He has worked clinically across Canada and internationally in the United Kingdom and Saudi Arabia. In 2010, he completed his Master of Science in Physiotherapy researching the effects of dynamic warm up in older golfers. In 2016 he completed his PhD in Physiotherapy at Western University exploring the role neck muscles play in protecting the head from concussion. He has been conducting primary research in the field of neck training and injury prevention ever since.

Title- The acceptability and use of mind-body interventions among African American cancer survivors: An integrative review

Speaker Abstract

Mind-body interventions have been shown to improve physical and mental health outcomes among cancer survivors, and African Americans have one of the highest cancer mortality rates of all racial/ ethnic groups, while often facing considerable barriers to quality healthcare. African American cancer survivorsreport difficulty accessing mind-body practices, and few studies have focusedexclusively on African American populations. The purpose of this integrative review is to explore the acceptability and use of mind-body interventions among African American cancer survivors. This review seeks to determine if current research indicates that mind-body interventions may be helpful in improving outcomes for African American cancer survivors. Search terms included: “African American,” “intervention,” “cancer,” “survivor,” “mind-body,” “focus group,” “complimentary medicine,” “integrative medicine,” “meditation,” “yoga,” and “mindfulness." The literature search resulted in 118 studies, of which 10 met the inclusion criteria. Inclusion critera were articles published in or after 2011 and written in the English language. Other reviews, meta-analyses, or studies without results were excluded. Results indicate that African American cancer survivors have expressed receptiveness to interventions incorporating mindfulness, meditation, yoga, Tai Chi, and other mind-body or complimentary/ alternative medicine interventions, but few studies have offered such interventions exclusively to African American breast cancer survivors. This review indicated that African American cancer survivors across demographic backgrounds are interested in and view mind-body practices as an acceptable way to improve quality of life, pain interference, fatigue, anxiety, depression, and physical health; however, the interventions should be culturally appropriate and accessible. In conclusion, despite a growing interest in mind-body interventions, African American communities are often unaware of opportunities to engage in these practices in their communities, andmind-body practices are inaccessible due to cost or geographical location. Additional research that offers such interventions specific to African American cancer survivors is warranted.

Speaker Biography

My research and scholarly career focuses on the multi-disciplinary evaluation of integrative medicine with a focus on mind-body exercise interventions, objective and subjective measures of symptom outcomes, and health disparities, all within a bio-behavioral approach to cancer survivorship. I currently serve as an Assistant Professor of Nursing at the University of Houston, College of Nursing, where I conduct research on the effectiveness of mind-body interventions to improve the quality of life of those affected by cancer. I have over 13 years of experience in the development and implementation of interventions focusing on mind- body interventions and symptom outcome assessment. My leadership in the field of health disparities and mind-body exercise research has been recognized internationally, and my commitment to translating my research to educate my peers is reflected through my position as Research Consultant for new research proposals for Houston Methodist West Hospital.

Title- Multithreaded variant calling elPrep 5 and future developments in genomics analysis

Speaker Abstract

We present elPrep 5, the latest release of our software framework for analyzing sequencing data. The main new feature of elPrep 5 is the introduction of variant calling. This allows elPrep 5 to execute the full pipeline described by the GATK best practices for variant calling, which consists of PCR and optical duplicate marking, sorting by coordinate order, base quality score recalibration, and variant calling using the haplotype caller algorithm. elPrep 5 produces identical BAM and VCF outputs as GATK 4, while parallelizing and merging the computation of the different pipeline steps to significantly speed up the runtime. Concretely, elPrep speeds up the variant calling pipeline by a factor 8-16x compared to GATK on both whole-exome and whole-genome data without requiring specialized or proprietary accelerator hardware. elPrep 5 is developed as an open source project on Github and is designed for use with community-defined standards and file formats for NGS analysis. While computational performance is a main focus of elPrep, we also strive to improve the user experience with the software. elPrep is distributed as a single stand-alone binary, making it easy to install, and has a simple user interface where a full variant calling pipeline can be expressed as a singled command-line invocation. elPrep has an active user community, mainly at hospitals, research facilities, but also companies. This community actively supports elPrep by making it available on platforms such as Bioconda (over 15k downloads) and Seven Bridges genomics who have independently validated elPrep. In this talk, we present an overview of the elPrep software, as well as future developments for our sequencing software. We will in particular address the challenges we see with further optimizations and privacy preservation for supporting population genomics.

Speaker Biography

Roel Wuyts leads imec’s ExaScience Life Lab, a lab focused on scaling software solutions for data-intensive high-performance computing problems, primarily in the life sciences domain. The lab has extensive experience with high performance computing technologies (distributed computing, parallel computing, concurrent computing, vectorization, NUMA optimizations), programming languages (Go, C++, Python, Lua, Rust, and many more), and usage of hardware accelerators (GPU, TPU, FPGA). By leveraging their high performance computing skills. imec’s ExaScience Life Lab frequently helps companies in developing prototype software solutions for complex problems involving multiple disciplines. The lab has successfully done this for large-scale machine learning for pharmaceutical companies, DNA sequencing software for hospitals and pharmaceutical companies, large scale image feature extraction from high throughput screening, or advanced biostatistics and data analytics. With privacy and protection of IP becoming paramount when doing AI on health data, the lab is proposing innovative privacy-preserving amalgamated machine learning techniques to reason across data silos. Roel is also part-time professor at KU Leuven. His academic achievements include publications in PLOS One, IEEE Software, TOPLAS, ECOOP, OOPSLA or AOSD.

Title- Reproductive health counseling in CKD

Speaker Abstract

Reproductive health issues are an important aspect of caring for patients with chronic kidney disease; however, it is unclear how frequent these conversations take place during a clinic visit. Discussions about pregnancy, fertility, and contraception will shape family planning and impact renal disease management. The goal of this study was to determine the frequency of contraception and pregnancy counseling in nephrology clinic visit using chart review of the electronic medical records. Sixty percent of the 125 female patients ( n=74) seen in a general nephrology clinic received reproductive health counseling. Of the 125 patient charts reviewed, 30 received comprehensive counseling (24%), 44 received intermediate counseling (35.2%), and 51 received no counseling (40.8%). Patient factors including age, race, and severity of renal disease did not impact of counseling in this study. Dialysis patients were disproportionately not counseled. Continued discussions about women’s health issues continue to be a pivotal part of caring for patients with chronic kidney disease.

Speaker Biography

Dr. Okundaye is a native from Wisconsin, born in Chicago IL to immigrant parents from Nigeria. She attended Wake Forest University in Winston-Salem, NC under the "Joseph G. Gordon" Scholarship", where she studied Biology and Chemistry. She earned her medical degree from University of Wisconsin School of Medicine and Public Health in 2015 and then completed her internal medicine residency training at Loyola University, Chicago, IL where she was appointed a research scholar and developed a curriculum for medical student education. This year Dr. Okundaye finished her nephrology fellowship at Stanford University for advanced clinical and research training in kidney disease. Her area of interest is women's health with focus on fertility, pregnancy, and contraception. She has authored research manuscripts, case reports, book chapter and presented her research at numerous conferences including at the International Society of Nephrology Frontiers Meeting in Tokyo, Japan. Dr. Okundaye has hosted and produced a health radio show and a community health podcast in order to expand her outreach to those seeking answers to health problems. In 2019, she developed the Ivie O. Appiah Medical Arts Institute that produced a short film about the kidney patient experience. The Institute is currently developing future projects in film and media. Dr. Okundaye was also featured on the cover of Women magazine where her story was showcased in the article "Queen for a Day" in the October 2019 issue. For. Ultimately, she hopes to empower people to be their own health advocates.

Title- Citizen participation and new practices and meanings for the development of healthy public policies

Speaker Abstract

Background: From 1994 to 1999, the Ministry of Health, together with the Pan American Health Organization and supported by the leadership of the mayors, promoted the project "Municipalities Towards Health" in Venezuela, whose main objectives focused on the implementation of healthy public policies that sought to reduce and mitigate the consequences of social inequalities; through the interaction of governmental and non-governmental sectors such as agriculture, commerce, education, sport, industry, among others; and in this way, establish a local culture of governance for health and wellbeing through community projects, for which a methodology was designed. This effort, which had been advanced in 75% of the country's federal regions, was interrupted due to a change in government and project management; however, thanks to iteration in inclusive citizen participation, health promotion activities became sustainable over time. Among the facilitating factors that marked these processes, the strengthening and consolidation of social capital stands out. Methodology: In this qualitative research, we attempt to demonstrate the importance of social capital in this process. The knowledge emerged from the focus groups conducted in the five municipalities with the greatest unsatisfied basic needs at the beginning of the project and involved a total of 200 actors, who recounted their inter-subjective relationships experienced between 1994 and 2013. This evidence was systematized into four constructs that characterize social capital as a determinant of health: sense of community, collective efficacy, community capacity and community competence. We also compared the results in relation to its impact on life expectancy and infant mortality. Results: Psychological sense of community or sense of community. Solidarity and social responsibility were the cardinal principles that facilitated the organization of communities through the union of networks that privileged the promotion of health. From this emerged a group identity to generate their own political culture, promoting social roles, customs and ethical norms such as co-responsibility, freedom with shared social objectives, commitment or the capacity to promise, critical capacity based on trust and the constant will to practice justice; in this framework, they built a participatory agenda through dialogue and agreement with all social, political and economic forces. Collective efficacy. Through a series of acquired values and behaviours such as mutual trust, an inclusive higher identity that allows social identities to overlap, and cooperation for the common good, organised communities gained greater access to decisions, driving negotiated projects that guaranteed their citizenship rights. In this perspective, the government committed itself to facilitating technical and political decision-making through deliberative actions leading to negotiated proposals. To consolidate this process, a number of joint mechanisms for monitoring targets were formalised in different types of collective spaces to inform communities of progress over time. Community capacity. Participants built and coalesced around networks through which they acquired new competencies and skills, and various advocacy mechanisms and technical procedures were established to assist in the implementation of these initiatives. In this way, communities, local government teams and government agencies consolidated their leadership style. Community competences. In these initiatives, the community acquired the competencies to articulate with the government and various public and private institutions. This organisation, a product of the balance between solidarity, social justice and the rights of communities, allowed for targeted, planned and constructive behaviour that provided the triggers and political legitimacy for the elaboration of the social contract that privileged the promotion of health and well-being. Health impact. Life expectancy at birth increased between 0.6 and 4.5 years. The infant mortality rate decreased between 4% and 44%. In this sense, the municipalities with the greatest basic needs satisfied made impressive progress, as evidenced by the fact that the interactions carried out in populations with greater social capital provide greater possibilities of intervening on avoidable and unfair factors that condition differences in life opportunities. Conclusion: The research highlights the need for early recognition of the role that community networks and other citizen activities can play in promoting positive health and wellbeing outcomes through participation An active and resilient citizenship was able to build participatory agendas to interact on the social determinants of health, whose fundamental political objectives were the satisfaction of basic needs in vulnerable populations; The effective development of these agendas was associated with an accelerated process of building social capital to achieve positive health/quality of life outcomes in various sectors through the implementation of healthy public policies; The empowered and effective citizens who helped bring about these democratic gains and benefits did not automatically achieve their goals. New forms of governance and the mobilization of extraordinary public and private resources were also very important; Strengthening these citizen participation processes along with political will and supporting mechanisms, such as interactive methodologies and broader legal instruments, created opportunities to improve government responsiveness; andIt is from the sustainability of these events that citizen participation took on a new cultural significance for the governance of health and well-being. Recommendations: These findings have a number of implications for community associations and policy makers as well as donors and development agencies, which in turn can contribute as a resource for political negotiation in building responsive governments towards health-in-all-policies approaches: A long-term social pact that consolidates political support from the highest authority at each level of government is needed to develop different legal, social and economic structures that engage organised communities; The conceptual and methodological capacity of the different actors involved needs to be strengthened in order to systematically preserve the model in the context of conflicts of interest exacerbated by strictly sectoral judgements in public institutions and the community in general; and Financial sustainability needs to be ensured to maintain structures and processes in the presence of economic uncertainty and the discretionary will of the government of the moment.

Speaker Biography

Venezuelan/German doctor with a PhD in Political Science and a Masters in Public Health Administration; with courses in Local Development and Social Management in Health and in Management Design of Social Policies and Programmes. He has held various positions in the Venezuelan Ministry of Health at local, state and federal level. He has also represented Venezuela as Temporary Advisor to PAHO/WHO in several countries. He is currently Advisor to the National Academy of Medicine of Venezuela and the Venezuelan Society of Public Health.iedad Venezolana de Salud Pública.

Title- Ethical aspects of AI in healthcare

Speaker Abstract

A recent survey in Germany found that people increasingly would like to see AI deployed in a variety of application fields, and in particular in healthcare-related sectors. This is most probably due to the multiple opportunities AI can offer. However, serious, especially ethical, issues arise with its use. Not least the Covid-19 pandemic has taught us how technologies which could help solve demanding challenges, however need to be carefully reflected on and designed to foster trust and well-being of society. To address and manage the risks arising from such ethical concerns, researchers have developed recommendations, such as the Ethics Guidelines for Trustworthy Artificial Intelligence by the European Commission, or the Ethical Framework for a Good AI Society by the AI4People Committee. However, these frameworks tend to be rather broad and need to be adapted to the specific application contexts. One of the current challenges for AI ethics research, and even more so for responsible AI use in sensitive areas such as healthcare, is therefore to develop concrete and applicable guidelines that can be used and implemented directly on specific AI systems. Examples will be given.

Speaker Biography

Christoph Lütge is Full Professor of Business Ethics at TU Munich and the Director of the Institute for Ethics in Artificial Intelligence (IEAI). He is Distinguished Visiting Professor of Tokyo University and has held further visiting positions at Harvard, Stockholm, Taipei and Kyoto. His most recent book is “Business Ethics: An Economically Informed Perspective” (Oxford University Press, 2021, with Matthias Uhl). He is a member of the European AI Ethics initiative AI4People and of the German Ethics Commission on Automated and Connected Driving.

Title- Waterpipe smoking and the coronavirus syndemic

Speaker Abstract

This paper aims to provide a background to the phenomenon of waterpipe smoking during the present COVID-19 syndemic. In the context of a syndemic, it seeks to summarise what research findings have revealed to date of the specific dangers of this form of tobacco use in the current situation, in terms of the particular dangers of the use of the apparatus itself, social settings in which waterpipes are smoked, and the perceptions of smokers themselves on the potential harms at this time. A narrative review, based on a focused search of electronic databases, was conducted, which resulted in a final list of 49 articles which were selected for inclusion in the paper. The results obtained from this review provided strong confirmatory evidence of the specific dangers both of transmitting infection via the waterpipe apparatus, whatever its regional variation, and the social milieu in which transmission of the COVID-19 virus was likely to be increased. The discussion of the results of the research was then widened to include what is known about the beliefs of smokers in general, and waterpipe smokers in particular, on the health risks of waterpipe smoking and the likely transmission and severity of the COVID-19 virus. Introduction: A number of published studies have investigated diverse aspects of the impact of COVID-19 on various aspects of the behaviour of individuals during lockdowns. These include a survey conducted in Italy into eating habits and lifestyle changes (Di Renzo et al, 2020), sedentary time and behaviour (Runacres et al, 2021). cannabis use in Spain (Fernandez-Artamendi et al, 2021) and smoking. It is those studies relevant to waterpipe (hookah) smoking behaviour during the present COVID-19 syndemic which form the basis of the discussion in this paper. First, however, the choice of the term syndemic rather than pandemic should be explained (Horton, 2020; Medenhall, 2020; Courtin and Vineis, 2021). What drives the coronavirus to spread through the population of a specific region or country is an interaction of particular political, social, economic and cultural factors. Patterns of social inequality exacerbate the adverse effects of the disease. Recognising these determinants of health is central to the concept of a syndemic., rather than the narrower perception of the COVID-19 outbreak as a biomedical issue. Synergistic failures cannot be omitted from the discussion of forms of tobacco use or a wide range of causes of ill-health, including viral diseases, and how to combat them in the future. For example, Gaiha and colleagues (2020) conducted an online national survey of over 4000 adolescents and young adults (aged 13-24) in the USA in May 2020, investigating a possible association between cigarette and e-cigarette use and COVID-19. One finding This paper aims to provide a background to the phenomenon of waterpipe smoking during the present COVID-19 syndemic. In the context of a syndemic, it seeks to summarise what research findings have revealed to date of the specific dangers of this form of tobacco use in the current situation, in terms of the particular dangers of the use of the apparatus itself, social settings in which waterpipes are smoked, and the perceptions of smokers themselves on the potential harms at this time. A narrative review, based on a focused search of electronic databases, was conducted, which resulted in a final list of 49 articles which were selected for inclusion in the paper. The results obtained from this review provided strong confirmatory evidence of the specific dangers both of transmitting infection via the waterpipe apparatus, whatever its regional variation, and the social milieu in which transmission of the COVID-19 virus was likely to be increased. The discussion of the results of the research was then widened to include what is known about the beliefs of smokers in general, and waterpipe smokers in particular, on the health risks of waterpipe smoking and the likely transmission and severity of the COVID-19 virus. Introduction: A number of published studies have investigated diverse aspects of the impact of COVID-19 on various aspects of the behaviour of individuals during lockdowns. These include a survey conducted in Italy into eating habits and lifestyle changes (Di Renzo et al, 2020), sedentary time and behaviour (Runacres et al, 2021). cannabis use in Spain (Fernandez-Artamendi et al, 2021) and smoking. It is those studies relevant to waterpipe (hookah) smoking behaviour during the present COVID-19 syndemic which form the basis of the discussion in this paper. First, however, the choice of the term syndemic rather than pandemic should be explained (Horton, 2020; Medenhall, 2020; Courtin and Vineis, 2021). What drives the coronavirus to spread through the population of a specific region or country is an interaction of particular political, social, economic and cultural factors. Patterns of social inequality exacerbate the adverse effects of the disease. Recognising these determinants of health is central to the concept of a syndemic., rather than the narrower perception of the COVID-19 outbreak as a biomedical issue. Synergistic failures cannot be omitted from the discussion of forms of tobacco use or a wide range of causes of ill-health, including viral diseases, and how to combat them in the future. For example, Gaiha and colleagues (2020) conducted an online national survey of over 4000 adolescents and young adults (aged 13-24) in the USA in May 2020, investigating a possible association between cigarette and e-cigarette use and COVID-19. One finding Firstly, the smoking of waterpipes in cafes presupposes communal use – the sharing of a single mouthpiece and hose, and the impossibility of physical distancing in this social environment. Secondly, in waterpipe cafes Alagaili and colleagues (2019) noted the lack of routine cleaning of the waterpipes after each smoking session, further increasing the risk of transmission of infectious microbial agents. In addition, these cafes throughout the world tend to be densely occupied and badly ventilated (Kalan et al, 2020). Daniels and Roman (2013) note that sharing a waterpipe contributes to a range of tuberculosis, viral and bacterial infections when an infected user shares a mouthpiece with non-infected individuals through the transmission of oral secretions. The contention of Daniels and Roman, of course, precedes the COVID-19 syndemic. Corroborative evidence is provided, in the context of COVID-19, in a study by Sinclair and colleagues (2021). This was a convenience sampling study conducted in the Lao People’s Democratic Republic in July 2011 where, although the waterpipe has a simple bamboo construction, the parts still perform the same function as the Eastern Mediterranean waterpipe. In this study, samples were taken from the water bowl of the waterpipe, and the field assessment of water quality indicators showed that the water inside the Lao waterpipes had the potential to be contaminated by various types of micro-organisms. In addition to microbial mechanisms, infectious disease exposure – such as to the COVID-19 virus – was identified as a potential risk. The virus thrives in dark, humid environments and will be spread through communal use in the smoking process. In Turkey, Altindis and colleagues (2020) analysed culture samples from 182 waterpipes used in public places. The inside and outside of the mouthpiece were sampled, along with water from the waterpipe bowl. The mouthpiece – inside and outside – and the handle were found to be the most affected parts in terms of bacterial contamination. The role played by hand contact is evident in the results found from analysis both of the handle and the outside of the mouthpiece. The significance of the findings – that microbiological growth in the waterpipe samples collected from the public establishments was very high – is that they indicate that waterpipe smoking increases the likelihood of the transmission of respiratory pathogens, including viruses as well as tuberculosis (Sinclair et al, 2021), fungi and a range of other bacteria. The study did not analyse samples from the interior of the hoses, although the authors cite other earlier research which tends to confirm their findings (Safizadeh el al, 2014; Alaidarous et al, 2017; Shakhatreh et al, 2018). Although the majority of these studies, therefore, pre-date the outbreak of the COVID-19 syndemic, they clearly underpin the concerns expressed by Shekhar and Hannah-Shmouni and the WHO about the potential risks of waterpipe smoking for increased transmission of the virus. A summary is provided in Table 1 below. Discussion: Evidence for the many harms resulting from cigarette smoking has been furnished by innumerable studies, to the effect that the best efforts of the tobacco industry have been unable to contest the findings, which are now universally acknowledged. In terms of cigarette smoking and health risk beliefs during the COVID-19 syndemic, Brown (2021) has published a useful review of the findings to date. As he indicates, some studies have concluded that current or former cigarette smokers are at higher risk of contracting more severe symptoms of COVID-19, or even mortality, than never-smokers. The proponents of the opposing case argue that nicotine may have a protective role in those who contract COVID-19 (Simons et al, 2021, Lippi and Henry, 2020: Rossato et al, 2020). Several articles have considered the evidence for both claims, including Cattaruzza et al (2020), Samet (2020) and Shastri et al (2021). The survey results obtained by Brown (2021) indicate that – in the UK, at least - that the perceived probability of contracting COVID-19 correlated with motivation to quit cigarette smoking. Having reviewed the findings of studies on the dangers of cigareete smoking in relation to COVID-19, it remains to discuss the perceptions of waterpipe smokers on the risks posed by the syndemic. As in the case of cigarette smoking, the evidence for the harms occasioned by waterpipe smoking is overwhelming. These harms include significant association with lung cancer, respiratory illness, bladder and oral cancers, and heart disease among its many serious risks (Akl et al, 2011; El-Zaatari et al, 2015; Waziry et al, 2017). A full and recent appraisal of these harms may be found in Darawshy et al (2021). The waterpipe smoke – a mixture of tobacco and molasses known as ‘maasel’ - is cooled as it passes through the base of the waterpipe, enabling smokers to inhale it deeper into their lungs. However, despite such evidence, waterpipe smoking is widely considered to be less harmful than cigarette smoking (Jaam et al, 2016). There is a misconception that passing smoke through the water acts as a cleaning process to remove toxins (El-Zaatari et al, 2015) along with the view that the intermittent practice of waterpipe smoking is less harmful compared with the constant use of cigarettes (Qasim et al, 2019; Maziak, 2008). A single waterpipe smoking session typically lasts for 30-90 minutes, during which time a large volume of smoke is produced. This contains the equivalent of 80 times more toxicants than those found in the smoke of a single cigarette (Al Ali et al, 2020). The effect on smokers, and second-hand smokers, in cafes, homes or meeting places has serious health implications. The tobacco industry has played a role in promoting this confusion (Ahmad & Dutra, 2019; Maziak, 2008). In fact, waterpipe users are exposed to many of the same toxic compounds as cigarette users, although at levels which are much higher (Qasim et al, 2019; Rezk-Hanna & Benowitz, 2019) While there are estimates of 100 million waterpipe smokers globally (Al Ali et al, 2020; Ward et al, 2005), these are less useful than national and regional studies in identifying trends. The WHO Tobacco Atlas (2015) adopts such a national approach to the prevalence of waterpipe use, for example to identify trends in Syria, 1955-2000. Jawad et al (2018) adopt the same approach for the Middle East and Europe. Maziak (2008) summarises the principal trends. Although prevalence is highest in the Middle East and North Africa, waterpipe use is growing rapidly in Europe and the Americas (Babaie et al, 2021; Akl et al, 2011). The practice declined during most of the 20th century, but waterpipe smoking saw a rapid increase in popularity in the 1990s coinciding with the introduction of sweetened waterpipe tobacco (‘maasel’). The tobacco industry commercialised and glamourised the practice on the internet and mass media, especially targeting the youth market. Studies of waterpipe smoking indicate increases since that time in most countries both for daily use and ever-use, with the greatest increases among the youth, both boys and girls (Maziak et al, 2014). A growing number of national studies confirm this trend and Jawad et al (2016) provide confirmatory evidence from the Global Youth Tobacco Surveys. In their systematic review, Babaie et al (2021) draw attention to the management and prevention of waterpipe tobacco use, noting that waterpipe products are still tax exempt, but although taxation has been effective in controlling cigarette smoking, this may not be the case with waterpipe use (Jaam et al, 2016; Maziak et al, 2014). In the present situation of the presence of COVID-19, the association of waterpipe smoking with the restaurant and cafe culture – an influential factor in its growth and popularity – has induced some authorities to institute bans on these places. The Eastern Mediterranean Regional Office (EMRO) of the WHO has reminded its 19 member states that, as signatories to the Framework Convention on Tobacco Control, they have a legal obligation to ban smoking in all indoor public places. 17 of the member countries have banned waterpipe use temporarily in public places (WHO, 2022 (i)), though full implementation of the legislation is necessary to put this into effect. The WHO EMRO has publicised the measures taken in Iran to ban waterpipe use in public places to limit the spread of COVID-19 (WHO, 2022 (ii)) as an instance of what can be achieved through determined policy implementation. The Eastern Mediterranean Region still has the highest prevalence of waterpipe smoking in the world (Shihadeh et al, 2004). Two recent studies from this region investigated the relationship between beliefs and tobacco use behaviours and the risk of COVID-19 infection among samples of smokers and never-smokers. Both studies included waterpipe smoking in their surveys. Firstly, in Iran, Kalan and colleagues (2020) included 89 waterpipe smokers among respondents in their online national survey. From the responses, 38.2% of waterpipe smokers considered that waterpipe smoking was related with spreading infection of COVID-19, compared with 14.6% of cigarette smokers who believed that cigarette smoking was related with spreading infection of COVID-19. Of all the 944 study participants as a whole, 29.1% thought that cigarette smoking was related with spreading COVID-19 infection, compared with 49.4% who believed that waterpipe smoking and spreading COVID-19 were related. The survey also found that waterpipe smokers (approximately 1 in 4) were more likely than cigarette smokers and never-smokers to believe that smoking waterpipe at home was safe during the syndemic, and that smoking waterpipe would have a protective effect and lead to more rapid recovery if they were to be infected with COVID-19. This is all the more concerning, since in Iran waterpipe-home delivery services have become popular with the closure of cafes due to government bans (Kalan et al, 2021). Such perceptions of the safety of waterpipe smoking will increase risk for the smokers themselves and those – such as the family in the home – with whom they interact. A second study into health beliefs and tobacco use during the syndemic also included waterpipe smokers among the participants. In Jordan, an online survey conducted in March 2021 by Al-Tammemi and colleagues (2021) included 2424 participants. Among the findings related to waterpipe smoking, respondents recorded their opinions on the relationship between smoking and domains of COVID-19 such as risk and spread of infection, safety concerns of smoking in public places and the home, clinical outcome and the belief in the protective effective of nicotine. Approximately 38.2%, 72.9% and 44.6% of respondents believed that cigarette smoking, waterpipe smoking and e-cigarette smoking respectively were related to the risk of contracting COVID-19. Clearly, participants considered that waterpipe smoking constituted a much higher risk. About 74% also considered that severity of COVID-19 would be worse for waterpipe smokers, ans almost 80% believed that waterpipe smoking in public places was unsafe during the syndemic. Conclusion: All the evidence suggests that waterpipe smoking poses its own unique set of risks and hazards during the COVID-19 syndemic. When combined with the well-established dangers of tobacco use in causing mortality and morbidity, contributing to a wide range of illnesses, the particular features of waterpipe smoking – the social setting, the apparatus used, the perceptions of waterpipe smokers themselves – all present a cause for concern. This review has concentrated on the research conducted in the Middle East region, both before and during the COVID-19 syndemic. While this region constitutes the highest use of waterpipe smoking, it is necessary to emphasise again that current research has alerted health authorities on the growing widespread use of waterpipes as a global problem, along with e-cigarettes and even e-hookah innovative products promoted by the tobacco industry. Misinformation disseminated by the industry has aided in influencing perceptions and endangering lives. More information is now required on motivation specifically to quit waterpipe smoking since the start of the syndemic, along with an appraisal of the effect of bans on waterpipe cafes in those countries where such bans have been applied.

Speaker Biography

M.A. Honours History, University of Edinburgh, 1969. M.A. Latin America Studies, University of London, 1970. 1972-present: teacher of English as a Foreign Language (EFL) in schools and colleges in Chile, Portugal and the UK. Online contributor to international EFL websites.