Roles, Responsibilities, and Functions of Village Health, Sanitation, and Nutrition Committees in India: A Qualitative Evidence Synthesis.

National Health Mission instituted the Village Health, Sanitation, and Nutrition Committees (VHSNCs) in 2005, with an aim of ensuring health and well-being for local communities in India. There is a lack of concrete evidence on the functioning of VHSNCs at a national level. Thus, this study was undertaken to outline the roles, responsibilities, and functions of VHSNCs in India. We conducted a comprehensive data search in Medline, Cochrane Library, ScienceDirect, EMBASE, and Google Scholar between 2005 and August 2021. All peer-reviewed qualitative studies that reported the roles, responsibilities, functions, and good practices of VHSNCs from India were included in our review. Critical Appraisal Skills Programme checklist was used to assess the quality of individual studies. In total, we included 15 studies (including 1100+ VHSNCs) from various states of India. Our review highlighted that the majority of the VHSNCs functioned without a clear-cut definition of roles and responsibilities had irregular meetings and workforce shortage. There was a lack of inclusivity, accountability, and delay in the processing of untied funds. The included studies have showed that VHSNCs were involved health promotional activities such as formulation and implementation of village health plans, delivery of services through public distribution systems, ensuring safe drinking water and sanitary supervision, and identification and referral of malnourished children. Our review highlights the crucial role that VHSNCs play in improving the health outcomes of rural populations and underscores the need for continued support and capacity-building efforts to ensure their effectiveness.

Culture circle in primary care: dialogues with managers on health promotion.

OBJECTIVE: To identify health promotion strategies used by managers in primary health care. METHOD: Qualitative research, of a participant action nature, which adopted the Culture Circle proposed by Paulo Freire as its methodological reference. Eleven primary health care managers from a medium-sized municipality in southern Brazil took part. RESULTS: Nine generative themes emerged, categorized into four themes that highlight the interconnection between health promotion, social determinants and primary health care. These themes highlight preventive approaches, healthy habits and underline the need for a multidisciplinary approach to health care, recognizing the complexity of the dimensions involved, the influence of social determinants, environmental and health issues. These aspects call for intersectoral policies and actions, demonstrating the viability of health promotion in line with the principles of the Unified Health System. FINAL CONSIDERATIONS: The autonomy of professionals working in primary health care services is highlighted, especially that of nurses, who play a central role in connecting and organizing health promotion actions.

Inuit youth health and wellbeing programming in Canada.

Inuit youth face challenges in maintaining their wellbeing, stemming from continued impacts of colonisation. Recent work documented that urban centres, such as Winnipeg Canada, have large Inuit populations comprised of a high proportion of youth. However, youth lack culturally appropriate health and wellbeing services. This review aimed to scan peer-reviewed and grey literature on Inuit youth health and wellbeing programming in Canada. This review is to serve as an initial phase in the development of Inuit-centric youth programming for the Qanuinngitsiarutiksait program of research. Findings will support further work of this program of research, including the development of culturally congruent Inuit-youth centric programming in Winnipeg. We conducted an environmental scan and used an assessment criteria to assess the effectiveness of the identified programs. Results showed that identified programs had Inuit involvement in creation framing programming through Inuit knowledge and mostly informed by the culture as treatment approach. Evaluation of programs was diffcult to locate, and it was hard to discren between programming, pilots or explorative studies. Despite the growing urban population, more non-urban programming was found. Overall, research contributes to the development of effective strategies to enhance the health and wellbeing of Inuit youth living in Canada.

A community case detection tool to promote help-seeking for mental health care among children and adolescents in Ugandan refugee settlements: a stepped wedge cluster randomised trial.

BACKGROUND: Strategies to promote mental health care help-seeking among children are needed, especially in low-income and middle-income countries and in complex settings. The aim of this trial was to compare a vignette-based, community-level, proactive case detection tool (CCDT) against standard awareness raising for promoting mental health help-seeking among children and adolescents. METHODS: This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780. FINDINGS: 28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use. INTERPRETATION: The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services. FUNDING: Sint Antonius Stichting Projects. TRANSLATIONS: For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.

Perspectives of primary school teachers on the capacity of schools to support post-pandemic health needs emerging among school-age children.

BACKGROUND: This study aimed to explore the impact of the COVID-19 pandemic on capacity building for health promotion in primary schools from the perspectives of primary school teachers. METHODS: A cross-sectional observational study was conducted via an anonymous online survey between February and May 2022. Three-quarters (n2460) of all schools in the Republic of Ireland were invited to participate. Demographics such as gender, teaching experience, school type and delivering equality of opportunity in schools (DEIS) designation were collected. Perceived capacity for health promotion was measured on a 10-point Likert scale. Facilitators and barriers related to health promotion and aspects of child health prioritised for health promotion in the 2 years after restrictions eased were explored via closed- and open-ended questions. RESULTS: Of the 595 responses, 493 were eligible for analysis. Participants were based in schools in every county in the Republic of Ireland, with most (85.4%, n421) being female. Almost a third (30.5%, n150) were 11-20 years post-qualification, and a quarter (25.2%, n124) had over 30 years' teaching experience. Mean capacity for school-based health promotion pre-pandemic was moderate, at 6.6 ± 2.2 on a 10-point scale. Mean capacity in spring 2022 decreased significantly (p < 0.001) to 4.1 ± 2.4, indicating poor capacity. Capacity ratings did not significantly differ by school type (p = 0.31), socioeconomic designation (p = 0.27) or years post-qualification (p = 0.08). Capacity decrements were most frequently (49.7%, n245) attributed to organisational factors, while individual and community-level factors were cited by 27.6% (n136) and 21.5% (n106) of respondents, respectively. Healthy eating significantly (p < 0.001) decreased as a priority for health promotion between pre-pandemic times (76.3%, n376) and spring 2022 (23.1%, n114). Mental health significantly (p < 0.01) increased as a priority, being listed by 38.1% (n188) as a priority pre-pandemic and doubling to 72.6% (n358) in spring 2022. CONCLUSIONS: Fostering a holistic approach to health promotion in schools remains a challenge. Further efforts are needed to support schools to implement sustainable and balanced systems of health promotion.

A review of oral health promotion programmes in Eastern Mediterranean Region.

Background: Oral health conditions, such as dental caries, periodontal disease, tooth loss, dental fluorosis, dental trauma, and oral cancer, are prevalent in the WHO Eastern Mediterranean Region. However, there has been no systematic review of oral health promotion interventions in the region. Aims: To review existing literature on oral health promotion programmes in the Eastern Mediterranean Region and recommend improvements for the future. Method: We reviewed on PubMed and Google Scholar 61 articles published in the Eastern Mediterranean Region between 2010 and 2023. Quality assessment of included studies was performed using established criteria. We used the content analysis approach to create appropriate themes from the studies and to document meaningful conclusions about oral health promotion. Results: Majority of the studies were cross-sectional, a few were randomized controlled, quasi-experimental, longitudinal studies, or reviews. Oral health problems identified included poor oral health knowledge, dental caries, periodontal disease, tooth loss, dental fluorosis, and oral cancer. Although oral disorders were common in most of the countries, very few have implemented oral health promotion programmes. Conclusion: We recommend prioritization of oral health promotion programmes in the Eastern Mediterranean Region to tackle the diverse oral health challenges. To be effective, such programmes should be region- and context-specific. More studies on oral health promotion are needed in the region.

A community of practice intervention to increase education-focused mental health promotion actions among interdisciplinary professionals: a qualitative study.

Introduction Through a unique, inter-sectoral and interprofessional initiative, practitioners from education, health and social service sectors were invited to participate in communities of practice, facilitated online. The focus was on building workforce capacity to address the mental health needs of children and youth. Aim This paper explores interprofessional workforce development by translating knowledge from a mental health promotion initiative developed overseas into the Aotearoa New Zealand context. Methods Over a 6-month period, practitioners engaged in an iterative, capacity-building process, where they had access to the initiative materials and resources, shared practice stories, networked, and discussed barriers and facilitators for implementation. Qualitative thematic analysis was used to interpret data. Results Members of the communities of practice engaged in storytelling and made sense of the initiative in relation to their previous knowledge and experiences: practice and thinking were validated. Mental health promotion was positioned as the responsibility of all sectors and the need for effective interprofessional collaboration was deemed essential. Furthermore, translation of the initiative into the bicultural context of Aotearoa New Zealand demanded and deserved sustained attention. Discussion This study contributes interprofessional and inter-sectoral evidence for building workforce capacity to address the mental health needs of children and youth. Further research is warranted to investigate the outcomes for the children and youth served. Interprofessional communities of practice were shown to provide a sustainable mechanism by which knowledge can be received, transformed and translated into practice.

Young peoples' reflections about using a chatbot to promote their mental wellbeing in northern periphery areas - a qualitative study.

An international research collaboration with researchers from northern Sweden, Finland, Ireland, Northern Ireland, Scotland and developed the ChatPal chatbot to explore the possibility of a multilingual chatbot to promote mental wellbeing in people of all ages. In Sweden the end users were young people. The aim of the current study was to explore and discuss Swedish young peoples' experiences of using a chatbot designed to promote their mental wellbeing. Young people aged 15-19 filled out an open-ended survey giving feedback on the ChatPal chatbot and their suggestions on improvements. A total of 122 survey responses were analysed. The qualitative content analysis of the survey responses resulted in three themes each containing two to three sub-themes. Theme 1, feeling as if someone is there when needed, which highlighted positive aspects regarding availability and accessibility. Theme 2, human-robot interaction has its limitations, which included aspects such as unnatural and impersonal conversations and limited content availability. Theme 3, usability can be improved, given technical errors due to lack of internet connection and difficulty navigating the chatbot were brought up as issues. The findings are discussed, and potential implications are offered for those designing and developing digital mental health technologies for young people.

[Maisons sport-santé: A tool for promoting an active lifestyle]. / Maisons sport-santé : outil de promotion d'un mode de vie actif.

The Paris 2024 Olympic Games promise not only world-class sporting competition, but also a legacy of sustainable sport that extends far beyond the stadiums. At the heart of this legacy are the Healthy Sports Houses, innovative projects designed to promote an active lifestyle and improve public health in the long term.

Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022-2023 UK mpox outbreak.

BACKGROUND: Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak. METHODS: Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. RESULTS: Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. CONCLUSIONS: The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

[Towards a disruptive preventive approach for sustainable healthcare systems]. / Vers une approche préventive disruptive pour «soigner¼ durablement nos systèmes de santé.

Faced with the multiple challenges impacting the Belgian healthcare system - notably the aging of the population, the increase in chronic diseases and growing social inequalities in health - the development of a disruptive preventive approach rooted in health promotion is essential to address the population's health problems in a cross-sectional and intersectoral way. However, the scant attention paid to prevention and promotion in the Belgian political landscape (only 3 % of healthcare expenditure), accentuated by the fragmentation of its deployment between the various political-institutional entities (Federal Authority, Communities and Regions), represents a significant limitation. New opportunities, supported in particular by "4P medicine", are paving the way for a modernization of preventive approaches. However, this new way of conceiving prevention will only be beneficial to the community, in all its diversity and complexity, if it re-engages with the fundamentals of health promotion.

Devant les multiples défis auxquels est confronté le système de santé belge - notamment le vieillissement de la population, la progression des maladies chroniques, l'accroissement des inégalités sociales de santé - le développement d'une approche préventive disruptive, qui trouve ses fondements dans la promotion de la santé, est essentiel pour aborder, de façon transversale et intersectorielle, les problèmes de santé de la population. Toutefois, la faible place accordée à la prévention et à la promotion dans le paysage politique belge (seulement 3 % des dépenses de santé), accentuée par un éclatement de son déploiement entre les différentes entités politico-institutionnelles (Autorité fédérale, Communautés et Régions), représente des limites non négligeables. De nouvelles opportunités, notamment soutenues par une «médecine des 4P¼, ouvrent la voie à une modernisation des approches préventives. Toutefois, cette nouvelle façon de concevoir la prévention ne sera profitable à la collectivité, prise dans sa diversité et sa complexité, qu'à la condition de se réancrer dans les fondamentaux inhérents à la promotion de la santé.

History and Current Status of Well-being Among Organizations (Impact of Wellness on a Section, Division, Institution and Profession, ACGME Requirements, Policies).

The authors provide an overview of cultural adjustments and policy changes to support wellness in medicine. Subsequently, the data around wellness in cardiothoracic surgery, as well as policies and interventions that have been put into place to address wellness concerns in cardiothoracic surgery is discussed. The authors focus on both trainees and attendings and provide both a list of actions to address deficits in wellness management in the field, as well as resources available to promote well-being among cardiothoracic surgeons.

A Multicomponent Workplace Environmental Intervention to Promote Physical Activity among the Staff of Universiti Malaysia Sarawak.

BACKGROUND: Physical inactivity is a significant public health issue affecting working adults because it can increase the risk of noncommunicable diseases. OBJECTIVES: The objective is to determine the outcomes of a multi-component workplace environmental intervention that incorporated physical activity self-regulation (PASR) to promote physical activity (PA) among employees. MATERIALS AND METHODS: This was a 6-month intervention with a two-group, parallel, quasi-experimental study. A total of 11 workplaces were randomly assigned to intervention group (IG) or control group (CG) using a 1:1 allocation ratio. In each group, 84 eligible participants were recruited. The IG was exposed to the organizational support and the PA support components throughout the study. The PASR Scale, International PA Questionnaire, and pedometer were used to measure the outcome at the baseline, 3rd-month, and 6th-month follow-ups, respectively. The repeated measures-analysis of variance analysis was used to determine the changes in the PASR skills, MET-min/week, and step/week over time. RESULTS: The IG had 75 participants (51 females and 24 males) and the CG had 73 participants (52 females and 21 males) at the 6th-month follow-up. Despite there was no statistically significant difference in the outcomes between groups over time, the IG showed significant improvements in total PASR (ηp2 = 0.021), goal setting (ηp2 = 0.024), total MET-min/week (ηp2 = 0.031), housework-related PA (ηp2 = 0.101), and step/week (ηp2 = 0.827) throughout this intervention. CONCLUSION: This intervention was found to be effective in improving the PASR skills, MET-min/week, and step/week of IG participants. Meanwhile, because some effect sizes were small, these findings should be interpreted with caution.

An upstream approach to addressing the childhood obesity epidemic in New Zealand-a call to action.

Childhood obesity is a critical issue in New Zealand that we can no longer afford to ignore. Currently, one in three children is overweight or obese, putting the health of an entire generation at risk if we continue to delay taking action. This issue highlights a significant matter of equity. Maori and Pacific children and those from socio-economically deprived backgrounds are disproportionately affected, reminding us of the systemic barriers rooted in historical factors that exist within our society. Efforts focussed on changing individual behaviour have achieved limited success in reducing childhood obesity rates. Therefore, it is necessary to shift our focus upstream and address the root causes of this issue. This viewpoint piece underscores the role of the obesogenic environment as the primary driver of childhood obesity, advocating for an upstream approach to enact broader changes in the food environment. Within this framework, this piece puts forward three policy measures that could be essential in addressing the childhood obesity epidemic: implementing a tax on sugary beverages, restricting unhealthy food marketing and ensuring access to healthy food in schools. These policies are backed by substantial evidence of their efficacy, cost-effectiveness and potential to improve health equity, including contextual evidence from successful international models. However, despite ample evidence and support, New Zealand has fallen behind international standards in adopting these measures, partly due to resistance from the food industry and the need for stronger political leadership. Thus, a "call to action" is needed to overcome these challenges, mobilise against the current policy inertia and make addressing childhood obesity a priority.

Social prescribing in Canada: health promotion in action, 50 years after the Lalonde report. / La prescription sociale au Canada : la promotion de la santé en action, 50 ans après le rapport Lalonde.

The Lalonde report, published in 1974 by the Canadian Minister of National Health and Welfare, broke ground for public health in Canada by acknowledging that the determinants of health are much broader than health care services. Fifty years later, this special issue of Health Promotion and Chronic Disease Prevention in Canada charts a clear path towards addressing upstream determinants of health through an emerging intervention called "social prescribing." Social prescribing connects patients with community resources tailored to their individual priorities, fostering a paradigm shift from a deficitbased to a strengths-based approach in health promotion. Part 1 of this issue covers the rapid growth and diverse applications of social prescribing across Canada, with targeted initiatives for various populations and interventions ranging from nature and arts to physical activity and social connectivity. Contributions from a wide range of partners, including researchers, health professionals and community members, explore the adaptability of social prescribing for different groups, underscore the role of community and lived experiences in research, and call for more studies on social prescribing's effectiveness and outcomes. Highlighted case studies demonstrate tangible benefits in health equity and access to social services. This issue not only reflects the current scope and impact of social prescribing in Canada but also sets the stage for its future development and integration into broader health practices.

Social prescribing connects patients with nonmedical resources, shifting the focus from deficits to a strengths-based approach in health. Growing initiatives target diverse populations including caregivers, youth, racialized peoples and Indigenous communities. Case studies demonstrate social prescribing's benefits in health equity and expanding access to essential services.

La prescription sociale oriente les patients vers des ressources non médicales, selon une approche de la santé qui se concentre sur les forces plutôt que sur les déficits. Les initiatives se multiplient à l'intention de populations particulières comme les aidants naturels, les jeunes, les personnes racisées ou les collectivités autochtones. Des études de cas montrent que la prescription sociale favorise l'équité en santé et un accès élargi aux services essentiels.

Building the social prescribing student movement in Canada. / Mouvement étudiant pour la prescription sociale au Canada.

INTRODUCTION: Social prescribing is defined as "a means for trusted individuals in clinical and community settings to identify that a person has nonmedical, health-related social needs and to subsequently connect them to nonclinical supports and services within the community by co-producing a social prescription-a nonmedical prescription, to improve health and well-being and to strengthen community connections." Globally, there is growing interest in social prescribing as a holistic approach to health and well-being, with almost 30 countries involved in the social prescribing movement. In Canada, great strides are being made in social prescribing research, policy and practice, with all of this work being supported by the Canadian Institute for Social Prescribing.

A global network of student champions has emerged to build the social prescribing student movement, with student groups in seven countries, including Canada. The Canadian Social Prescribing Student Collective was established in 2022. Much progress has been made in building the social prescribing student movement in Canada, but there is a lot of work to be done, which calls for action by students, staff in health care and community organizations, and faculty and administration at postsecondary institutions. Collective efforts to build the social prescribing student movement in this country will not only shape the wider social prescribing movement, but also the future of our health system.

Un réseau mondial de champions étudiants a vu le jour dans sept pays, dont le Canada, dans le but de créer un mouvement étudiant pour la prescription sociale. Le Collectif étudiant canadien de prescription sociale a été créé en 2022. De grands progrès ont été réalisés dans la création d'un mouvement étudiant pour la prescription sociale au Canada, mais il reste encore beaucoup de travail à faire. Les étudiants, le personnel des organismes de santé et des organismes communautaires, ainsi que le corps professoral et le personnel administratif des établissements d'enseignement postsecondaire doivent agir en ce sens. Les efforts collectifs visant à créer un mouvement étudiant pour la prescription sociale au Canada façonneront non seulement le mouvement pour la prescription sociale en général, mais aussi l'avenir de notre système de santé.

Stakeholders' perceptions of value of nature-based interventions in promoting health in people with stress-related illness: a qualitative study.

Stress-related illness is a common and increasing cause for sick leave in Sweden. Spending time in nature reduces stress and promotes health and well-being. Accordingly, nature-based interventions (NBI) for people with stress-related illness have been developed and implemented in southern Scandinavia; however, such interventions are uncommon in the Circumpolar North. Previous studies have examined the effects and experiences of participating in NBI, but research about different stakeholders' perspectives on NBI is lacking. The aim of this study was to explore different key stakeholders' perceptions of the value of NBI in promoting health in people with stress-related illness. Data were collected through semi-structured interviews with 11 persons with stress-related illness experience, 14 healthcare professionals, and 11 entrepreneurs offering NBI. Qualitative content analysis resulted in four categories: Providing opportunity for recovery, Offering new perspectives and opportunity for reflection, Empowering balance and control in life, and Enabling one to overcome barriers. Although the study was conducted in a region where NBI is not widely implemented, the different stakeholders expressed similar perceptions of the value of NBI, indicating that NBI may be a valuable complement to health care which reaches people with stress-related illness needs and promotes their health.

[Maisons sportsanté to promote physical activity]. / Maisons sport-santé pour la promotion de l'activité physique.

MAISONS SPORT-SANTÉ TO PROMOTE PHYSICAL ACTIVITY. Maisons sport-santé are an organizational innovation proposed by the government in 2019. Responding to the concept of a "one-stop shop", these 500 or so structures with no legal status of their own have a highly variable composition, ranging from sports associations to health services, local authorities and private companies, or even digital platforms. Their vocation is to help any citizen who feels the need to be supported in taking charge through physical activity, whether for primary, secondary or tertiary prevention of chronic diseases, or because of a loss of autonomy, with or without a medical prescription. Welcomed and supervised by an adapted physical activity or sport-health professional, users are given a fitness and motivational assessment, before being referred to a structure offering physical activity (sports club, gym, individual coach). If necessary, they are offered "bridge" sessions for initial reconditioning. The cost of this program is still largely borne by the participants themselves, as the financing of the maisons sport-santé relies largely on public subsidies, which are still insufficient to ensure their sustainability. French health insurance coverage of physical activity programs on medical prescription could considerably help the operation of maisons sport-santé, but this, hoped for by 2024, is no longer envisaged for the time being. These funding difficulties threaten the survival of a highly promising concept.

MAISONS SPORT-SANTÉ POUR LA PROMOTION DE L'ACTIVITÉ PHYSIQUE. Les maisons sport-santé représentent une innovation organisationnelle proposée par le gouvernement depuis 2019. Répondant au concept de « guichet unique ¼, ces quelque 500 structures sans statut juridique propre ont une composition très variable, allant de l'association sportive au service de santé, en passant par les collectivités locales et les sociétés privées, ou encore les plateformes numériques. Elles ont pour vocation d'aider chaque citoyen qui en éprouve le besoin à se faire accompagner dans une prise en charge par l'activité physique, que ce soit en prévention primaire, secondaire ou tertiaire des maladies chroniques, ou en raison d'une perte d'autonomie, sur prescription médicale ou non. Accueillis et encadrés par un professionnel de l'activité physique adaptée ou du sport-santé, les usagers bénéficient d'un bilan de condition physique et motivationnel, avant d'être orientés vers une structure proposant de la pratique (club sportif, salle de sport, coach individuel). Si nécessaire, ils se voient proposer des séances passerelles pour un reconditionnement initial. La prise en charge financière de ce parcours reste encore largement à la charge des pratiquants, le financement des maisons sport-santé reposant en grande partie sur des subventions publiques, encore insuffisantes pour en assurer la pérennité. La prise en charge par l'Assurance Maladie des programmes d'activité physique sur prescription médicale pourrait aider considérablement le fonctionnement des maisons sport- santé, mais celle-ci, espérée pour l'année 2024, n'est, pour le moment, plus envisagée. Ces difficultés de financement menacent la survie d'un concept pourtant très prometteur.

A multisectoral approach to medication safety in Kuwait using the take-back campaign.

Background: The take-back campaign, which focuses on enhancing public awareness, safe medication disposal practices, stakeholder engagement and patient participation was used to promote medication safety in Kuwait. Aim: To evaluate the effectiveness of the take-back campaign in promoting medication safety in Kuwait. Methods: The campaign was implemented systematically through several stages of planning, communication and coordination among several stakeholders. This social media campaign encouraged individuals from the participating healthy cities to bring unwanted medications to designated collection centres. Returned medications were categorized based on the British National Formulary and data analysis was conducted using Excel. Consultations were held at the collection sites to increase patient confidence in medication compliance and safety. The medications were sorted and disposed safely. Results: The take-back campaign lasted 56 hours over a period of one month. It successfully engaged 405 households and collected 1005 kg of medication, comprising 7648 items, over a period 6 working days. Fifty-seven percent of the medications collected through the campaign originated from the Ministry of Health and 43% from the private sector. Fifty-two percent had expired and 59% were in solid dosage form. Painkillers comprised the largest group (18%) among the returned medications. Conclusion: The take-back campaign effectively raised awareness about medication safety and provided a safe disposal mechanism for unused and expired medications. This campaign has provided a foundation for future initiatives and contributed significantly to improving medication safety and public health outcomes in Kuwait.

Rethinking organizational culture in intersectoral coordination: the perspective of boundary work.

PURPOSE: The purpose of this paper is to rethink the concept of organizational culture as something that emerges bottom-up by using the sociological concepts of boundary object and boundary work as an analytical lens and to show how this approach can help understand and facilitate intersectoral coordination. DESIGN/METHODOLOGY/APPROACH: We used observations and qualitative interviews to develop "deep" knowledge about processes of intersectoral coordination. The study draws on a conceptual framework of "boundary work" and "boundary objects" to show how a bottom-up perspective on organizational culture can produce better understanding of and pave the way for intersectoral coordination. We use a case of health professionals engaged in two Danish intersectoral programs developing and providing health promotion services for women with gestational diabetes mellitus (GDM). FINDINGS: The study showed how boundary work revolves around negotiations on how to define, understand and act on the diagnosis of GDM. This diagnosis has the characteristics of a "boundary object", being more loosely structured in general terms, but strongly structured in local settings. Boundary objects help connect different professionals and facilitate coordination. The analysis showed how the introduction of time and the concept of "lifelong health promotion" helped to transgress existing organizational and professional boundaries. RESEARCH LIMITATIONS/IMPLICATIONS: The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination and collaboration. While the theoretical implications will be general applicable when studying organizational culture, the implications for practice are sensitive to context and the processes we have described as the outcomes of boundary work are generated from cases that were most likely to provide deep insight into our research topic. PRACTICAL IMPLICATIONS: For practice this can build bridges between organizational and professional boundaries. ORIGINALITY/VALUE: The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination. This may build bridges between organizational and professional boundaries in practice settings.