Mone Lapao’o works with the Waste Management & Pollution Control Division within Tonga’s Department of Environment
He is leading work to reduce plastic waste impacting the coasts and waters of Tonga through education
and all-hands-on-deck efforts to clean up trash
In Tonga we are very proud of our oceans – we are after all an Island nation – and the ocean and our waters hold great significance for us
This is the biggest reason why we need to look after our oceans
It starts with keeping them clean and healthy
The main sources of waste here are littering and illegal dumping
Any plastic waste that enters our waterways ultimately flows to the ocean
where it breaks down and enters the food chain as microplastic are consumed by marine life
Recent reports have exposed the threat of plastic waste from domestic and international sources
it’s clear that the fight begins at home – tackling the sources of plastic pollution within our own borders
When did you first get involved in trying to address this issue / make a change
I first got involved in waste management in 2011
as a member of the team leading a community-level program supported through the Japan International Cooperation Agency (JICA)
I joined the Department of Environment under a similar program but one with a broader national reach
What impact do you hope your work/project can achieve
I hope we can start by eliminating the sources of plastic waste within our borders
Most of the waste we find in Tonga’s waterways and oceans is shown to come from Tonga itself
The majority of this waste is junk and takeaway food packaging
We are working to better enforce the <a target='_blank' href="http://www.wasteauthority.to/content/legislation">Waste Management Act</a>, by restricting dumping and ensuring no plastic is incinerated. We are also engaged in direct clean-up exercises to remove physical waste from waterways and coastal areas, like the <a target='_blank' href="https://www.environment.gov.to/2019/05/29/beat-pollution-and-keep-our-environment-clean/">Beat Pollution Trash Challenge</a>
I know that through a greater focus on awareness – why we need to stem the flow of plastic waste – we can solve this critical issue
Healthy oceans are critical for the health and beauty of Tonga – this country of which I am very proud
This is probably my biggest motivator for the work I am undertaking
It also motivates me to plan ahead for the future
or consider areas that require further attention
like waste in the shipping sector: where is it going now
and how should we manage it when ships dock in our waters
People need to be responsible for their own actions
including around littering and illegal dumping
We are trying to help increase this awareness and sense of responsibility through education – there’s much more to be done
If there’s one change you’d like to see every person in Tonga make to reduce plastic pollution
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<a href="/articles/10.1186/s12877-024-05120-z/metrics" data-track="click" data-track-action="view metrics" data-track-label="link" rel="nofollow">Metrics details</a>
A <a href="/articles/10.1186/s12877-024-05280-y" class="relation-link" data-track="click" data-track-action="view linked article" data-track-label="link">Correction</a> to this article was published on 08 August 2024
This article has been <a href="#change-history">updated</a>
Population aging is forcing the transformation of health care
Long-term care in the home is complex and involves complex communication with primary care services
the expansion of digital health has the potential to improve access to home-based primary care; however
the use of technologies can increase inequalities in access to health for an important part of the population
The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults
This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)
The quantitative data were analyzed through descriptive statistics
and the qualitative data were analyzed through basic qualitative content analysis
interpersonal and technical dimensions of care
The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations
as well as potential forms of socialization
The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region
Older adults have benefited from the use of different digital health strategies; however
this review also addresses limitations and challenges
such as the need for digital literacy and technological infrastructure
In addition to the impacts of technologies on the quality of health care
The review gathered priority themes for the equitable implementation of digital health
such as access to home caregivers and digital tools
importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies
which must be prioritized to overcome limitations and challenges
shorter hospitalization time and autonomy of older adults
results can be measured by the 7 pillars of quality: effectiveness (ensuring that digital technologies produce desirable results)
These include: effectiveness (ensuring that digital care achieves the same results in day-to-day practice); efficiency (use of available resources; optimization with the search for improvements in processes and results); acceptability (adaptation and acceptance of technologies by older people and health professionals); legitimacy of the ethical and legal compliance of digital care; and equity
(equal access and quality in digital health services for all older people
regardless of their individual characteristics)
This scoping study is relevant for its originality in mapping the use and types of digital health interventions and evaluating their impact on the quality of health care for the elderly from Donabedian's theoretical perspective
adapting his framework to evaluate the quality of technology-mediated health care
It has theoretical robustness as it is based on a theory of quality assessment that is widely recognized in the field
and one of the differential aspects of the methodology is the inclusion of stakeholder consultation as a way of consulting the applicability of the review's results so that they can be accessible to other researchers
Seeking to contribute to improving the quality of primary health care
this review aim to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults
The following research questions were developed according to the PCC (population—older adults
concept—digital health interventions and context- home-based primary care):
Which countries use digital health interventions in home-based primary care for older adults
What kind of digital health interventions (methods
human resources and technology) are used in home-based primary care for older adults
What is the impact of digital health interventions on the quality of home-based primary care for older people
We chose to include publications that addressed the use of digital health interventions in home-based primary care for older adults
and responded to the PCC of the research; included primary studies
theoretical communications; and included gray literature
No time or language filters will be applied to the searches
as the search strategies have been designed to reach a wide range of publications
Duplicate publications (Duplicate publications are those retrieved more than 1 × during the literature search process)
and studies with patients under 60 years of age were included as exclusion criteria
so studies that included patients under the age of 60 were excluded to avoid biasing the results
considering that the health needs and challenges faced by older people are different
Studies that included caregivers and health professionals under the age of 60 were not excluded
A search strategy adapted to the different bases was used; it was refined by a librarian to improve sensitivity and assertiveness based on the objective of the study
and the standard search strategy is available in Additional file 1
The study selection process was guided by the steps proposed in the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA-ScR)
The identified studies were grouped according to the Endnote® reference manager
Rayyan software® was used to assist in blinding the reviewers
who independently performed the double-blind selection
conflicts were resolved by a third reviewer
The studies selected by title and abstract were moved to the full-text reading phase
After reading the full texts and validating the final sample
4 researchers evaluated the compatibility and relevance of the evidence with the objective of the review
The evidence was extracted and organized in an Excel® spreadsheet
and the data were extracted according to the extraction form available in Additional file 2 (for which the form was updated)
A summary of the results was preliminarily shared with stakeholders
who were considered to be a mechanism for knowledge transfer and exchange
as well as for developing effective dissemination strategies and ideas for future studies
A summary of the stakeholder comments is available after the discussion
the study was approved by the Research Ethics Committee of the authors' institute under CAEE 54853921.0.0000.5292
</a>Selection of sources of evidence—PRISMA-ScR
</a>Distribution of the number of publications according to year
</a>Distribution of the number of publications according to country
The mapping of countries reveals nations with different levels of socioeconomic development
The group of countries considered socioeconomically developed is responsible for the largest number of studies mapped
With the intention of knowing the main health conditions of people who use digital health strategies, Fig. <a data-track="click" data-track-label="link" data-track-action="figure anchor" href="/articles/10.1186/s12877-024-05120-z#Fig4">4</a> presents a word cloud.
</a>Health conditions addressed by digital means in the HBPC for older people
In the case of positive impacts, presented in Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/articles/10.1186/s12877-024-05120-z#Tab1">1</a>
the organizational dimension was reported in two subcategories
The first subcategory addresses the contributions of technologies to facilitating access and accessibility to health care
The second subcategory includes the results focused on the use of digital health technologies
The Relational Dimension and Interpersonal dimension portray the use of technologies to improve communication between patients
The technical dimension was the most expressive among the positive impacts because 57.97% of the analyzed documents reported some positive outcomes from the use of digital health services covering health care directed at older adults
There are challenges and limitations when using digital health interventions for the health care of older adults. Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/articles/10.1186/s12877-024-05120-z#Tab2">2</a> summarizes how this issue relates to the quality of care
The organizational dimension is organized into three sub-dimensions
access to technologies and to technological infrastructure
challenges related to the management of people and teams and challenges linked to economic impacts
limitations related to the communication of people mediated by technologies
challenges in using digital tools and how this communication affects the relationship between older adults and caregivers are discussed
limitations related to clinical outcomes were found
such as patients reporting no significant improvement in quality of life
The evidence also indicates that digital technologies do not yet have an impact on health care or quality of life
</a>Strategies for improving the quality of care mediated by digital health
The results presented in this study provide a comprehensive overview of the use of digital health interventions in primary home care for older adults
Sweden and Canada have published the most studies on the subject
A wide range of digital interventions were used in home-based primary care for the elderly
health monitoring and assistive technologies
The main health conditions addressed were chronic non-communicable diseases
and the digital interventions showed significant improvements in the quality of life and mental health of the elderly
such as limited access to technologies and communication problems
Several points for discussion emerge from these results
with emphasis on the evaluation of the impacts of digital health on the quality of HBPC for older adults
digital technologies in health can contribute to the Sustainable Development Goals of Health and Well-Being
helping individuals collaborate to achieve universal health coverage and expand access to health services
digital health has impacts on the relational dimension with regard to the feasibility of communication
proximity and improvement of human interactions
this approach can provide updated information in real time and optimize care
social inequities are responsible for dividing those who can use technologies to improve health care from those who could have their access to health improved by technologies but do not have access to adequate infrastructure
it is early to conclude that digital interventions can interfere with the cost-effectiveness of health care
The findings of this study will assist public health policymakers in their decision-making
presenting the difficulties to be faced and the main benefits of digital health
Mapping the digital tools used in the HBPC of older people contributes to choosing the most appropriate digital interventions for each patient
When making the choice to include digital tools in the home care of older people
caregivers and patients should be aware of the strengths and limitations of these strategies
as the implementation of digital health without proper monitoring of the quality of care can increase inequities
Technology developers must pay attention to the results presented when developing digital interventions that meet the health needs of older people
intuitive and improve their quality of life
seeking to overcome possible difficulties and limitations
so that the use of technologies does not become a burden in the HBPC of older people
Further research should be carried out to understand the local reality in different countries
motivators for professionals to use digital health
and the satisfaction of older people and their caregivers with health technologies
In order to assess the maturity and quality of digital health in HBPC
especially in emerging countries and universal health systems
The strong point is that this was the first scoping review
with methodological rigor and broad analysis of the evidence
to identify the types of digital intervention used in home-based health care for older people in the context of primary care and to assess the quality of care at the same time
The results allow us to visualize the regions that published their results in the literature to determine the most commonly used tools and the main health conditions of the patients in the context of interest in the study
we can mention the lack of reach of countries that use digital health tools in the home environment for older people but did not publicize their results
This study included the place of interest in the family home; this cut excluded publications that included the place of research community residences
hospitals and long-stay institutions for older adults
A new study focusing on these modalities of residence should be considered
Twenty potential stakeholders were invited via e-mail; among them
eight had confirmed participation and answered questions of interest via Google forms
The stakeholder consultation strengthened the discussion
pointing out the most relevant results and weaknesses in the presentation of these results that were corrected at the preparation stage of the article
Regarding strategies for the dissemination and sharing of results
stakeholders suggested scientific socialization in national/international journals
The technical sharing of the results (science translation) among managers with decision-making power was suggested to enable the implementation
monitoring and evaluation of interventions in digital health
The results of this consultation indicate that the authors should be concerned with promoting the participation of professionals
managers and other stakeholders in the formulation and implementation of guidelines and policies for the implementation of digital health to reduce health inequities
articulating with figures of political influence and social representatives is relevant
Stakeholders encouraged dissemination at health events in the form of banners
and sharing on social networks and official websites of the institutions to which the researchers are linked
It was suggested that the theme of this research be expanded in the training spaces of future health professionals
The present scoping review mapped and identified the uses and types of digital health interventions and their impacts on the quality of primary home care for older adults
The findings presented here will be useful for researchers
managers and users to understand the current landscape and the actions needed to improve technology-mediated health care
the results point to the relevance of the use of digital health and the types of technologies most commonly used in clinical situations that can be mediated by digital health
Digital health is playing an increasingly important role in improving the quality of home-based health care for older people through the use of a multidisciplinary approach
it is crucial to address the challenges identified and ensure that interventions are tailored to the individual needs of patients
as well as to investment in digital literacy
age-appropriate technologies and policies for equitable deployment of digital health
This approach can help promote healthy aging
and provide high-quality care to older adults worldwide
it is possible to establish priority themes that should be addressed and researched
such as the challenges for equitable implementation of digital health in emerging countries
the sustainability of universal health systems and home care
policies for assessing the quality and safety of digital health technologies used in the HBPC
new business models of digital services and the financing of digital health in the context of PHC
Advances in the health area must be distributed according to the concept of equity
Data is provided within the manuscript or supplementary information files
A Correction to this paper has been published: <a href="https://doi.org/10.1186/s12877-024-05280-y">https://doi.org/10.1186/s12877-024-05280-y</a>
Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews
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This study was partly financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001
Ísis de Siqueira Silva &amp; Aguinaldo José de Araújo
Vilani Medeiros de Araújo Nunes &amp; Severina Alice da Costa Uchôa
WHO Collaborating Center on Health Workforce Policy and Planning
Department of Mechanical and Industrial Engineering
Laboratório Associado de Sistemas Inteligentes
Escola de Engenharia Universidade do Minho
All authors read and approved the final manuscript
The authors include six women and five men
specialists in the field of public health and with extensive experience of the SUS
One of the authors is Portuguese and a WHO consultant with experience in evaluating public health policies
All the authors have experience in qualitative research and in the area of health evaluation and digital health
seven of the authors have expertise in the methodology of scoping reviews and previous publications
The study was approved by the Research Ethics Committee of the authors' institute under CAEE 54853921.0.0000.5292
The authors declare no competing interests
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
The original online version of this article was revised: The authors reported that the affiliations of author Luís Velez Lapão was incorrect
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DOI: https://doi.org/10.1186/s12877-024-05120-z
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The Movement for the Catalan Language in the 'Franja' promoted a Manifesto denouncing the “lamentable situation” of Catalan and Aragonese, languages spoken in the “Franja”, the name given to the Aragonese territories next to the border between Catalonia and Aragon. The Movement is protesting against the removal of the last law that recognised both languages in Aragon by its autonomic Parliament led by the People’s Party (PP) and the Regionalist Aragonese Party (PAR).
This movement is also critical of everyday situations where Catalan and Aragonese are discriminated against, such as when in a school from Aragon the subject “Catalan Language” was called “Oriental Language”. So, the Franja’s Movement for Catalan Language is gathering signatures for its Manifesto so that Catalan has a more dignified status and the Government can implement linguistic policies for its normalisation in schools, institutions and public spaces.&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;
According to the promoters of the Manifesto, these facts are not coincidental, but rather respond to a “calculated operation of discrediting and negation of the original language of the “Franja”, which is Catalan, and has the objective of pushing Catalan aside in schools and society”. At the moment, several civil and political associations have signed the Manifesto to change this situation.&nbsp;&nbsp;
The sociolinguist Natxo Sorolla, expert in Catalan and Aragonese language in Aragon, has recently criticised the new law passed by the regional parliament. Sorolla highlights that this reform replaces the terms “Catalan” and “Aragonese” to acronyms referring to “Aragonese languages with its linguistic modalities predominantly used in northern and eastern areas of the Autonomous Community”.
Sorolla warns that the current law could lead to confusion because it does not specify if these “Aragonese languages” are one, two, or more. Furthermore, the sociolinguist also remarks that the new legislation does not recognise Catalan and Aragonese as minority languages, but as “original and historical” on the same level as Spanish, which does not need any protection and promotion. &nbsp;&nbsp;&nbsp;&nbsp;
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Police are still facing a blank wall over the alleged &#39;mass grave&rsquo; in Sapad
Residents have dug out seven bodies buried in a shallow grave at Sitio Lapao in Barangay Karkum morning on Sunday
Authorities have already identified three of the seven bodies
The cadavers were brought to a funeral homes for the post mortem examination
which happened in a remote area where communication signal is very challenging
Investigation on the reported &lsquo;mass grave&rsquo; is still ongoing
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ILIGAN CITY (MindaNews / 8 January) – Authorities revealed Monday the identities of the seven dead persons exhumed altogether from a shallow grave Sunday afternoon at Sitio Lapao, Barangay Karkum, in Sapad town, Lanao del Norte.
In his report, Police Major Alibsar Daraba, Sapad police chief, said all the victims had multiple gunshot wounds in the different parts of their bodies.
He identified them as Joselito Gaviola,  Marly Gaviola, Elvie Gaviola  Lenara, Epifanio Lenara, Jopay Lenara, Jomar Lenara and Epifanio Lenara Jr., all residents of Purok Dama de Noche, Sitio Lugimit, Poblacion Margosatubig, Zamboanga del Sur.
Four of the victims were males and three were females.
The supposed &#8220;salvage&#8221; victims or victims of summary execution were buried in a small shallow grave, which authorities uncovered following a report from a concerned civilian. The area is about 30 kilometers southwest of Sapad town.
A team from the 51st Armor Company of the 5th Mechanized Infantry Battalion helped the Sapad police in exhuming the cadavers.
Their remains were brought to a funeral home in Kapatagan, Lanao del Norte, Daraba said.
Police Colonel Sandy Valles,&nbsp;Zamboanga del Sur police director, said they are still investigating the possibility that the victims were abducted and killed somewhere in Zamboanga del Sur, and buried in Sapad town.
The immediate families were expected to arrive in Kapatagan today, January 8, &nbsp;to claim the dead bodies and to provide information to authorities. (Richel V. Umel / MindaNews)
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&mdash; The neologism introduced by the new law poses a worrying question about its future consequences. It constitutes the clearest declaration of a narrow conception of Aragonʼs linguistic and cultural richness.
— The neologism introduced by the new law poses a worrying question about its future consequences. It constitutes the clearest declaration of a narrow conception of Aragonʼs linguistic and cultural richness.
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This progressive advance of the language as a whole coincides with “regional unbalance” as underlined by the Catalan Language Observatory in their 2011 report
are accentuated “by the political offensive against the Catalan language and the legislative siege” it is victim of.&nbsp;   A constant growth in spite of a political “offensive” against Catalan
At European Union level, Catalan ranked 16th in its number of speakers