A stepwise implementation of the Slovenian National Diabetic Retinopathy Screening Program - evaluation of the first 4.5 years.

BACKGROUND: This retrospective cohort study aimed to assess the characteristics of patients enrolled in the national diabetic retinopathy (DR) screening program and evaluate the selected program's quality elements in the first five years after implementation. METHODS: Patients who underwent DR screening between February 2018 and June 2022 at the University Medical Centre Ljubljana were included. General patient characteristics (age, sex, type and therapy of diabetes mellitus (DM), duration of DM, blood HbA1c levels), best corrected visual acuity, stage of DR, presence of sight-threatening diabetic retinopathy (STDR), and selected quality indicators (quality of photographs, re-screening interval, time to treatment) were recorded and evaluated. RESULTS: A total of 34 654 screening examinations were performed on 13 513 patients with diabetes. The majority (77.3%) had Type 2 diabetes, with a mean DM duration of 9.74 ± 9.87 years. In 55.9% of patients, DM duration was less than ten years, and the mean HbA1c was 7.33% ± 1.49. DR signs were noted in 29.1% of patients and 0.89% of patients exhibited STDR. After establishing the diagnosis of STDR, treatment was initiated in 3.43 ± 1.98 months. CONCLUSION: Implementing the DR screening program provides valuable insights into managing diabetic retinopathy nationwide. It allows for the early detection of sight-threatening DR and facilitates timely and effective treatment, which could help prevent severe visual impairment.

Tackling the challenge of cardiovascular diseases and diabetes across Europe: a joint action by more than 300 public health professionals. Commentary.

Cardiovascular diseases (CVD) and diabetes pose significant health challenges in Europe, affecting millions and burdening healthcare systems. The recent EU4Health Programme places reducing the burden of non-communicable diseases (NCD) at the forefront, through a Joint Action focused on CVD and diabetes (JACARDI, Joint Action on CARdiovascular diseases and DIabetes). This initiative unites 21 European countries, including Ukraine, and over 300 experts. Employing an innovative approach and standardised methodology, JACARDI implements 142 pilot projects covering the entire "patient" journey. Particular focus will be given to improvement of data availability and quality. Additionally, JACARDI will emphasise transversal and intersectional aspects, such as health equity, determinants of health, and social, cultural, and ethnic diversity, while pioneering gender-transformative leadership. Committed to evidence-based interventions, JACARDI aims to harmonise strategies and disseminate knowledge for enhanced CVD and diabetes prevention and management. The goal is to identify effective strategies for wider implementation, fostering cross-national collaboration and fortifying Europe's health resilience.

Creation of a Different Landscape for Cardiovascular Diseases and Diabetes in Europe Through JACARDI Joint Action.

The Joint Action on CARdiovascular diseases and DIabetes (JACARDI) aims to reduce the burden of cardiovascular disease and diabetes in European countries, both at the individual and societal levels. The initiative covers the entire patient journey, from improving health literacy and awareness of cardiovascular diseases and diabetes, travelling through primary prevention among high-risk populations and screenings, reaching people living with cardiovascular diseases and diabetes, improving service pathways, self-management, and labour participation. The project involves 21 European countries, 76 partners and plans to implement 142 pilot interventions, ensuring diversity in terms of cultural backgrounds, public health priorities, and healthcare systems. In Slovenia, interventions will be developed and tested to improve screening for diabetes through community involvement, the involvement of people with diabetes in education programmes in health centres, and the involvement of people with diabetes in a screening programme for diabetic retinopathy. A set of unified, comprehensive and integrated health education materials and approaches will be developed for both healthcare providers and patients referred to the outpatient cardiovascular rehabilitation programme. The effectiveness of the upgraded health education intervention will be tested in a randomized trial. Furthermore, Slovenian experts are involved in developing a harmonized implementation methodology across all 142 pilot interventions, including contextual analysis at the country and pilot levels, multidimensional assessment and evaluation. JACARDI will enhance cross-national collaboration, maximizing the exploitation of lessons learned through a clear strategy, promoting the integration and sustainability of approaches to achieve high-level impact, including the implementation of effective interaction, cooperation and co-creation between science and policy.

National plans and awareness campaigns as priorities for achieving global brain health.

Neurological conditions are the leading cause of death and disability combined. This public health crisis has become a global priority with the introduction of WHO's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 (IGAP). 18 months after this plan was adopted, global neurology stakeholders, including representatives of the OneNeurology Partnership (a consortium uniting global neurology organisations), take stock and advocate for urgent acceleration of IGAP implementation. Drawing on lessons from relevant global health contexts, this Health Policy identifies two priority IGAP targets to expedite national delivery of the entire 10-year plan: namely, to update national policies and plans, and to create awareness campaigns and advocacy programmes for neurological conditions and brain health. To ensure rapid attainment of the identified priority targets, six strategic drivers are proposed: universal community awareness, integrated neurology approaches, intersectoral governance, regionally coordinated IGAP domestication, lived experience-informed policy making, and neurological mainstreaming (advocating to embed brain health into broader policy agendas). Contextualised with globally emerging IGAP-directed efforts and key considerations for intersectoral policy design, this novel framework provides actionable recommendations for policy makers and IGAP implementation partners. Timely, synergistic pursuit of the six drivers might aid WHO member states in cultivating public awareness and policy structures required for successful intersectoral roll-out of IGAP by 2031, paving the way towards brain health for all.