Luxembourg Institute of Health

Cancer treatment decision making (CTDM) presents important challenges among older adults due to variation in health and functional status, presence of comorbidities, differing goals/values, quality and quantity of life considerations, and limited inclusion in clinical trials. Nursing standards and guidelines call for competence in supporting CTDM and nurses advocate for greater involvement. However, clear understanding of the existing evidence to inform nursing practice is lacking. We aimed to map and synthesize evidence that provides insight into nursing practice in CTDM among older adults, with attention to nursing roles, required skills and competencies, potential barriers and facilitators, and outcomes studied. Following JBI (formerly Joanna Briggs Institute) methodology for scoping reviews, we included empirical articles that describe nursing contribution, individually or as part of a multidisciplinary team (MDT), related to CTDM for active (curative or non-curative) treatment among adults aged ≥60years diagnosed with cancer. Nine databases were searched systematically from inception to January 2024, no limits applied. Two independent reviewers screened identified records and full texts, then systematically extracted data from included articles. Basic qualitative content analysis was conducted on charted data. Of the 9582 records screened, 980 full texts were assessed for eligibility; 84 reports describing 78 studies were included. Conducted primarily in the United States or United Kingdom, studies described nursing interventions, nursing involvement in geriatric assessment and MDT meetings/clinics, and the perspectives of patients, family, and/or healthcare professionals. Although seldom the primary focus, researchers have highlighted the important roles of nurses in the CTDM process, before, during, and after consultations with physicians and MDT meetings, which require disease-specific knowledge and relational skills. MDT collaboration, training, dedicated time and space, adequate resources, and support from leadership are critical to promoting involvement, with potential impact on decision satisfaction and optimal treatment decisions. The value of nurses' involvement is endorsed by patients, family, and other healthcare professionals. Nurses play a vital role in CTDM among older adults, particularly in the MDT context. However, rigorous studies demonstrating the impact of nursing practice on CTDM outcomes among older adults are lacking. Further research is needed to inform nursing practice and interventions.

Cardiac arrest (CA) is a leading cause of mortality and neurological disability. Prediction of post-CA outcomes is challenging. Epitranscriptomic (RNA) modifications are emerging as potential biomarkers due to their regulatory roles in RNA metabolism and disease progression. However, their relevance in CA remains unexplored. This study aimed to investigate the association between N1-methyladenosine (m¹A) RNA modification and outcome after CA. Total RNA was extracted from whole blood samples of 211 patients collected 48 h after return of spontaneous circulation (ROSC). M¹A and adenosine (A) blood levels were quantified using liquid chromatography coupled to mass spectrometry (LC-MS), and the ratio m¹A/A was calculated. Neurological outcome assessed using the cerebral performance category (CPC) score and survival at 6 months were used as end-points. Patients with moderate to severe neurological outcome or death within 6 months after CA (CPC 2–5) exhibited elevated m¹A/A ratio compared to survivors without neurological sequelae (CPC 1) (p = 0.03). In multivariable logistic regression, higher m1A/A levels were associated with an increased risk of moderate to severe neurological outcome or death at 6 months compared to survivors without neurological sequelae (odds ratio [95% confidence interval] 1.50 [1.04–2.19]), after adjustment for age, time between CA and return of spontaneous circulation, lactate and neuron-specific enolase levels. In Kaplan-Meier survival analysis, patients with elevated m¹A/A levels showed a lower probability of survival at 6 months (p = 0.003). This study provides the first evidence that m1A RNA methylation, reflected by the m1A/A ratio, is associated with neurological outcome and death at 6 months after CA. Although these findings require validation, they raise the possibility that m¹A RNA methylation could help to improve prognostication after CA.

Non-specific low back pain (NSLBP) is the leading cause of global disability, and self-management is considered a key component of care. However, physiotherapists' approaches to supporting self-management can be improved. To explore how Italian physiotherapists conceptualize and enact self-management support for non-specific low back pain, and to describe perceived barriers and enablers to its implementation in routine practice. An online SurveyMonkey questionnaire was administered in February 2024 to assess Italian physiotherapists' knowledge and experience with self-management strategies for NSLBP. The survey consisted of 15 open-ended questions adapted from a Dutch study. Responses were analysed using inductive thematic analysis. Thirty physiotherapists (21 female, mean age 30.4±8.7 years) participated. Four themes emerged: (1) Therapeutic interaction style: active, passive, or multimodal?; (2) The patient as the main actor; (3) Self-management as more than a single tool; and (4) The physiotherapist's role in the self-management journey. Most participants viewed self-management support as essential and commonly used education as their primary strategy, while recognising its limitations. Although a variety of treatment approaches was reported, many remained grounded in biomechanical reasoning. A majority expressed the need for further knowledge and skills to better support self-management. Most participants recognised the importance of self-management in treating NSLBP but did not fully align with its core principles. Although they emphasised patient-focused, person-centred care, it remains unclear whether these principles are truly applied. Over half indicated a need for additional skills, consistent with broader challenges physiotherapists face in integrating self-management strategies.

Purpose: This symposium will present evidence, expertise, and experiences from different European countries on the implementation and effectiveness of Physical Activity Referral Schemes (PARS) and the development of relevant guidelines and implementation standards for physical activity promotion. Description: Promoting physical activity through healthcare professionals is a key strategy for improving population activity levels, as highlighted in the WHO’s Global Action Plan on Physical Activity (GAPPA) and the Physical Activity Strategy for the WHO European Region 2016–2025. PARS are considered a promising approach to integrating physical activity promotion into routine clinical practice. However, although PARS aim to support sustained behaviour change, evidence of their effectiveness remains mixed, probably due to differences in programme content and delivery, as well as the lack of standardised guidelines. This symposium examines five initiatives that address these challenges. Evidence from Belgium and Germany highlights the potential of PARS to promote long-term physical activity improvements, with additional gains in psychosocial determinants such as motivation, self-efficacy, and health competences. In the Netherlands, the launch of an online consultation guideline (“Bewust Bewegen”) enables healthcare professionals to integrate brief, evidence-based physical activity advice into daily practice. Another German initiative focuses on developing practical, interdisciplinary guidelines for the promotion of physical activity in rehabilitation settings, ensuring alignment with real-world clinical needs. Finally, Scotland’s national evaluation of its PARS standards shows high adoption of behaviour change principles, but also identifies barriers to routine data collection that limit robust outcome evaluation. Conclusion: These contributions demonstrate that PARS and related guidelines can effectively support the promotion of physical activity within healthcare systems. However, their long-term success depends on sustained implementation efforts, professional support, and standardised approaches to monitoring and evaluation. By sharing lessons learned across countries, this symposium offers valuable insights into how healthcare systems can better embed physical activity promotion into practice to improve patient outcomes and public health.

Purpose: To date, no study has examined the dose–response association between daily step count and the incidence of Multiple Sclerosis (MS), and no specific step-based guidelines exist for MS prevention. This study aimed to investigate the association between accelerometer-derived daily step count and MS incidence in a large population-based cohort from the United Kingdom (UK). Methods: We used data from the UK Biobank cohort, including participants aged 40–79 years at baseline (2013–2015) who agreed to wear a wrist-worn triaxial accelerometer (Axivity AX3) for seven days. Daily step counts were estimated using the Verisense step-count algorithm implemented via the GGIR R-package. Incident MS cases were ascertained based on primary care and hospital inpatient data, as well as self-reported data. Cox proportional hazards models, with age as the timescale, were used to examine the association between step count and MS risk, adjusting for potential confounders. Daily step counts were analysed as a continuous variable (per 1,000 steps/day), in categories (<7,000; 7,000–10,000; ≥10,000), and using restricted cubic splines to assess potential non-linearity. Results: Among 96,253 participants (mean age = 62.4 ± 7.8 years), 67 developed MS over a mean follow-up of 8.1 (±1.0) years. Participants recorded an average of 10,937 (±3,427) steps/day. A linear association was observed between daily steps and MS incidence (hazard ratio (HR) per 1,000 steps/day = 0.92; 95% confidence interval (CI) = 0.85, 0.99; p = 0.029). Participants in the highest category had a 62% lower incidence of MS compared to those in the lowest (HR = 0.38; 95% CI = 0.19, 0.74; p = 0.004). While the inclusion of splines did not statistically improve the model fit (p-non-linearity = 0.097), a plateau in the dose–response curve was observed around 12,000 steps/day when using three knots. Conclusion: In this large prospective cohort study, higher daily step counts were associated with a reduced incidence of MS. The dose–response relationship also suggests that even a modest increase in daily activity (1,000 steps) may confer substantial benefits among individuals with less than 10,000 steps/day. These findings support the integration of step-based physical activity targets into public health strategies for MS prevention. Future guidelines may build upon this evidence to develop practical, step-oriented recommendations aimed at promoting neurological health. Support/Funding Source: Luxembourg Institute of Health funding.

Important questions remain regarding differences in geographical and age-specific mortality patterns as the COVID-19 pandemic evolved in consecutive waves, and how COVID-19 mortality compares to seasonal influenza. In a pandemic situation, excess all-cause mortality provides a more complete and robust measure than cause-specific mortality. Data submitted by 26 countries participating in the European Mortality Monitoring (EuroMOMO) network between 2020 and 2023 was analysed to quantify excess all-cause mortality during the COVID-19 pandemic. Excess mortality from this period was compared to previous influenza seasons from 2014 to 2019. Pooled estimates of excess mortality showed four main waves during the COVID-19 pandemic period, most markedly in people aged 65 years and above, with timing and magnitude that varied between countries. Here we show that prior to implementation of control measures and COVID-19 vaccination, excess mortality greatly exceeded typical seasonal influenza mortality, but later during the pandemic was at levels comparable to influenza.