Hrev_master Veins and Lymphatics 2018; volume 7:7631 [page 74] [Veins and Lymphatics 2018; 7:7631] Increasing public venous awareness, graduated compression stockings compli- ance and scientific data collection through open events on golf courses: A feasibility study Sergio Gianesini,1,2 Steve Zimmet,3 Oscar Bottini,4 Diana Neuhardt,5 Mark Meissner,6 Kate Gibson,7 Eva Kalodiki,8 Christopher R. Lattimer,8,9 Paolo Spath,10 Lorenzo Tessari,11 Mirko Tessari,1 Yung Wei Chi,12 Maria Grazia Sibilla,1 Erica Menegatti1 1Translational Surgery Unit, University of Ferrara, Italy;2USUHS University, Bethesda, MD, USA; 3Zimmet Vein & Dermatology Center, Austin, TX, USA; 4Vascular Surgery Department, University of Buenos Aires, Argentina; 5Compudiagnostics, Inc., Scottsdale, AZ, USA; 6Vascular Surgery Department, University of Washington, Seattle, WA, USA; 7Lake Washington Vascular Labs, Bellevue, WA, USA; 8Josef Pflug Vascular Lab, Imperial College, West London Vascular & Interventional Centre, London, UK; 9Thrombosis & Hemostasis Lab, Loyola Medical Centre, Maywood, IL, USA; 10Vascular Surgery Department, University of Bologna, Italy; 11Bassi Foundation, Trieste, Italy; 12University of California, Davis, CA, USA Introduction On an international level, public venous awareness is still low.1 Campaigns to increase it are needed in order to reduce the clinical and economic burden of venous dis- ease,2,3 and in particular of venous throm- boembolism, a leading cause of preventable death in industrialized countries.4 The cen- ter for disease control and prevention declared how adequate communication ini- tiatives represent fundamental opportunities to improving health around the world.5 Nevertheless, the rapid growth of countless initiatives has led to the need for a deeper analysis in order to determine the real effi- cacy of these activities.6,7 The aim of the present paper is to evaluate the feasibility of a new format in venous awareness promo- tion. Materials and Methods Seven international public venous awareness events were developed. These events were twinned with top quality Phlebology meetings of the International Union of Phlebology, American College of Phlebology and Latin American Venous Forum. This social project was called Game Over to Leg Failure, as the acronym GOLF and was endorsed by the Italian Olympics Committee and by the Italian Golf Federation. The vision of the project is the promotion of public venous awareness by means of golf and other pleasant activities at the golf course. All events were open to the public. The same field was transformed into an educational pathway. All the participants, before walking onto the field, received a venous awareness questionnaire with 18 true/false questions about chronic venous disease issues. This questionnaire was aimed at testing the actu- al knowledge on venous disease and gradu- ated compression stockings (GCS). After having walked through the 18 holes and having read all the answers on the banners, golfers and non-golfers were asked to fill out the same questionnaire again, in order to detect the final improvement in their knowledge on the topic. Each right answer to the 18 questions scored one point, wrong answers and not reported answers were scored 0. At the field, another set of data collection was related to the effect of an 18-hole walk on lower limb drainage and perceived fatigue following the use of different levels of GCS. A putting green area of 9 holes was ded- icated to venous awareness messages too. These educational messages were on the scorecard of all the players, so that they could take home the educational messages. The following services were offered complimentary: i) venous ultrasound scan- ning; ii) cardiology consultation; iii) nutri- tional consultation; iv) sport-medicine con- sultation; v) physiatry consultation; vi) physiotheray; vii) postural evaluation; viii) adapted physical activity on the treadmill; ix) adapted physical activity with an inno- vative Jacket for electrical muscle stimula- tion training and muscular rehabilitation (miha bodytecTM); x) capacitive and resis- tive energy transfer (TECAR) therapy. A workshop about correct prescribing and use of GCS was offered. All the con- cepts delivered during the day were associ- ated with scientific paper references. A sur- vey was performed to detect an eventual improvement in terms of compliance to GCS 6 months after the event. Results Among the 7 events, 1684 participants attended the events. Three hundred thirty- four (334) players filled in the venous awareness questionnaire before starting to play the 18-hole course, thus before reading all the banners. Among these players, 305 participants filled in the questionnaire also at the completion of the course: the average score improved from 11±2.1 to 16±1.3 (P<0.0001). In 71% of the questionnaires the attendees answered that there is no dif- ference among GCS defined in mmHg or denars. Sixty-two (62) lower limb venous ultrasound scans were performed among the participants. Seven-hundred-thirtyseven (737) attendees stopped at the educational corner dedicated to GCS. Three-hundred- fortyfive (345; 46.8%) subjects among the ones who stopped at the GCS corner were already GCS users, nevertheless 35.9% (124/345) of them presented with a previ- ous wrong GCS prescription in terms of size, 20.9% (72/345) with a wrong class of compression (Figure 1). At 6 months, 227 subjects of the 345 (65.8%) who were already GCS users replied to the survey about the compliance change after the event attendance: 41.8% (95/227) of them reported an improvement after the change in the prescription. Of the remaining 392/737 (53.2%) attendees who have never used GCS before, 37.8% (148/392) begun to use them. The reason for beginning using GCS was prolonged standing work in 70.9% (105/148), and chronic venous disease detected just during one of the screenings offered at the venous awareness event in 29.1% (43/148) (Figure 2). In the study population in which lower limb volume was assessed and related to perceived exertion (40 subjects), the use of no hosiery led to a 5% increase in leg vol- ume (P<0.0001), 18-mmHg led to a non- Correspondence: Sergio Gianesini, University of Ferrara, via Aldo Moro 8, 44128 Cona (FE), Italy. E-mail: sergiogianesini@hotmail.com Conference presentation: International Compression Club (ICC) Meeting, Paris, 2017. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright S. Gianesini et al., 2018 Licensee PAGEPress, Italy Veins and Lymphatics 2018; 7:7631 doi:10.4081/vl.2018.7631 No n- co mm er cia l u se on ly Conference Presentation significant 1% volume reduction, 23- mmHg to a significantly reduction by 4%. A significant fatigue reduction was reported only using 23-mmHg GCS.8 Conclusions The present investigation reports an innovative format of public venous aware- ness. In the United States alone, almost 200-health awareness days, weeks and months are reported on the US national health observances calendar. Nevertheless, the real impact on the global health status of these noble activities is still questionable, due to limiting factors that can influence the final outcome.5This study potentially solves some of the most common weak points of public health awareness initia- tives: adequate attendance, attraction of the public, setting feasibility, knowledge improvement assessment and reliability of the educational message. Educational gadg- ets significantly contributed to continue the health message delivery. An extreme lack of knowledge in the discrimination about Figure 1. Attendees stopping at the dedicated graduated compression stockings (GCS) workshop. Figure 2. New graduated compression stockings users after the dedicated workshop. [Veins and Lymphatics 2018; 7:7631] [page 75] No n- co mm er cia l u se on ly Conference Presentation [page 76] [Veins and Lymphatics 2018; 7:7631] every day stockings, self-claimed graduated stockings and certified GCS stockings was reported. This finding is in accordance with a previous analysis by Lim, reporting how addressing patients’ concerns, providing adequate information and reassurance can positively impact compliance toward GCS.9,10 Another major point in public aware- ness is the promotion of physical activity, in particular for the elderly.11,12 The present format involved the general public, older ages included, not only on the health topic, but also on the sport practice. A wider data collection is ongoing, in order to precisely depict the socio-econom- ic characteristics of the participants. References 1. Wendelboe AM. Global public aware- ness of venous thromboembolism. J Thromb Haemost 2015;13:1365-71. 2. Lefebvre P, Laliberté F, Nutescu EA, et al. All-cause and potentially disease- related health care costs associated with venous thromboembolism in commer- cial, Medicare, and Medicaid benefici- aries. J Manag Care Pharm 2012;18:363-74. 3. Wakefield T. Call to action to prevent venous thromboembolism J Vasc Surg 2009;49:1620-3. 4. Editorial. Thromboembolism: an under appreciated cause of death. Lancet Hematol 2015;2:e393. 5. Bernhardt JM. Communication at the core of effective public health. Am J Public Health 2004;94:2051-53. 6. Purtle J, Roman LA. Health awareness days: sufficient evidence to support the craze? Am J Public Health 2015;105:1061-5. 7. Ayers JW, Westmaas JL, Leas EC, et al. Leveraging big data to improve health awareness campaigns: a novel evalua- tion of the great american smokeout. JMIR Public Health Surveill 2016;2:e16. 8. Gianesini S, Tessari M, Menegatti E, et al. Comparison among 18 mmHg and 23 mmHg elastic stockings effect on leg volume and tiredness after golf. Int Angiol 2017;36:129-35. 9. Lim CS, Davies AH. Graduated com- pression stockings. CMAJ 2014;186:E391-8. 10. Carpentier P, Auvert J-F, Bensedrine S, et al. Compression therapy in everyday life: let the patients have the floor. Veins and Lymphatics 2017;6:6625. 11. King AC, Rejeski WJ, Buchner DM. Physical activity interventions targeting older adults. A critical review and rec- ommendations. Am J Prev Med 1998; 15:316-33. 12. Blair SN, Franklin BA, Jakicic JM, Kibler WB. New vision for health pro- motion within sports medicine. Am J Health Promot 2003;18:182-5. No n- co mm er cia l u se on ly