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With a significant increase in the obesity epidemic in China, addressing adolescent obesity should be highlighted as a priority. The current qualitative study aims to explore the perspectives of key stakeholders regarding adolescent obesity, providing guidance for developing effective obesity interventions for Chinese adolescents. A total of 12 focus group discussions were convened with a range of representative stakeholders including adolescents (n = 37), parents (n = 28), and school staff (n = 21) from sample schools. Semi-structured topic guides were used for data collection. All data were transcribed verbatim and analyzed thematically. From multiple stakeholder perspectives, we finally identified 3 overarching themes (Understanding adolescent obesity, Key healthy lifestyles, and Barriers to obesity prevention practices) and 8 sub-themes. While participants had mixed perceptions of status and prevalence of adolescent obesity, all acknowledged the serious health consequences associated with it. As significant modifiable risk factors, unhealthy diet and physical activity were identified to be prevalent among Chinese teenagers and lead to excessive weight gain. However, a variety of individual, environmental and sociocultural factors hindered the implementation of healthy lifestyles, affecting adolescent obesity prevention and control. Given adolescent obesity is a complex, multifactorial and multilevel public issue, comprehensive lifestyle interventions are recommended that synergistically engage multiple stakeholders across key communities to fight the ongoing obesity epidemic.
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Grupos Focais , Obesidade Infantil , Pesquisa Qualitativa , Humanos , Adolescente , Masculino , China/epidemiologia , Feminino , Obesidade Infantil/prevenção & controle , Obesidade Infantil/epidemiologia , Exercício Físico , Pais/psicologia , Fatores de Risco , Estilo de Vida Saudável , Participação dos Interessados , DietaRESUMO
The emerging prefabricated decoration (PD) sector in China offers a compelling avenue for revolutionizing the construction industry, aligning with the imperatives of sustainability and industrialization. However, the outlook for the diffusion of PD in China's construction industry is less than promising. The development of PD is closely related to its value creation and the intricate interplay of stakeholder strategies and their ramifications on PD's value co-creation necessitates thorough exploration. Based on evolutionary game theory, this study elucidates the dynamic interactions among local governments, developers, and decoration contractors in China's evolving PD landscape. A tripartite evolutionary game model was established, investigating the evolutionary stable equilibriums and the corresponding strategies. Then, an empirical analysis in Chongqing City validates the game models and primary conclusions. Scrutinizing subsidy thresholds, local subsidy biases, PD proportion in prefabrication, and binary innovation allocation, the research unveils nuanced insights pertinent to boosting PD's value co-creation. Findings advocate an assembly rate threshold of subsidy (65%-70 %) and a shift towards incentivizing decoration contractors to catalyze PD adoption. Additionally, excessive PD proportion and immature product investments may hinder industry development, prompting stakeholders to recalibrate strategies dynamically. These findings characterize the mechanisms of stakeholder value co-creation during the PD diffusion, enriching the implications of value co-creation theory in the emerging industry of the construction sector. They also furnish stakeholders committed to promoting the diffusion of PD in the domestic and international construction sectors with practical strategic guidance, particularly tailored for cities in the early stages of PD development.
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One of the key issues embedded in the 2030 Agenda for Sustainable Development is the need for disaggregated data. Given the nature of the Coronavirus disease 2019 (COVID-19), studies on such should respond to this call. This paper investigates gendered and other perspectives on COVID-19 vaccination status in South Africa's Limpopo Province. The work utilises a household survey (n = 4,571), data from Our World in Data and Johns Hopkins University, as well as policy documents and academic literature. The findings are that the government moved away from a goal to attain 67% herd immunity, to the containment strategy. While the country attained 35% of population fully vaccinated, the current study reveals 72.84% of the respondents fully vaccinated in Limpopo (including those receiving a booster). Noteworthy findings include 7.1% of the respondents reporting partial vaccination and 19.8% expressing vaccine hesitancy. Gender differences were significant, with females exhibiting higher vaccination rates than males, and age-related variations were observed, particularly among the youngest participants. Further analysis stratified by gender and age groups unveiled substantial disparities, emphasizing the need for targeted interventions. Additionally, the study highlights patterns in COVID-19 vaccine uptake based on education levels, with higher education associating with increased vaccination rates. Significant gender-based differences in vaccine uptake across education levels indicate potential areas for focused public health efforts. The findings emphasise the complexity of factors influencing vaccination behaviour, providing valuable insights for policymakers, public health practitioners, and researchers aiming to enhance vaccine uptake and address disparities in diverse demographic groups.
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Background The Family Adoption Programme (FAP) has been introduced under the competency-based medical education curriculum wherein each medical student adopts families. The objective of this study was to determine the stakeholders' perspective and to suggest measures to make it relevant for Indian medical graduates. Methodology A mixed-method study was conducted among the faculty, undergraduate students, and community using prestructured, validated instruments. The quantitative data were entered into Microsoft Excel (Microsoft Corp., Redmond, WA) and analysed, while the qualitative data were coded and analysed thematically. Results All faculty members (12, 100%), the majority of students (49, 44.30%), and the community members strongly agreed that the policy decision to introduce the FAP was 'right'. The benefits mentioned were that FAP helps improve knowledge, psychomotor skills, attitudes and communication, attitude and behaviour skills, understanding of the social structures, health status of the community, and health-seeking behaviour of the families and provides an appropriate early clinical exposure. The challenges mentioned were selecting a site, gaining cooperation from family, communication, arrangement of logistics and transportation, getting support from teachers, difficulties in managing students in the community and coordinating among faculty, staff and students. Most faculty members recommended that the FAP should be started later in the curriculum and there should be restrictions on the number of families to be adopted. The students suggested that adequate logistics be provided as well as a reduction in the number of family visits. Conclusion The programme has been welcomed by most stakeholders. It requires the necessary support from the institution authorities, prior planning of visits, judicious utilization of social media, and coordination with government field-level health workers e.g. Accreditated Social Health Activists (ASHA). A comprehensive program evaluation and formulation of a standard operating module will further strengthen the programme.
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Domestic violence (DV) is a significant concern within China. Currently, there are few standardized measurement tools to gauge Chinese stakeholders' perceptions and beliefs concerning DV. This research sought to validate tools to be used with such stakeholders. Factor analyses were utilized on cross-sectional, survey data from a purposive sample of 683 Chinese DV professionals working in four institutions in Guangdong. Analyses developed three scales for measuring DV Definitions, DV Attitudes, and DV Policing. The development of these scales is beneficial to advance the already growing research related to DV in China in ways that are relevant to the Chinese context.
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Background: The need for rehabilitation in South Africa has doubled between 1990 and 2017 and is expected to increase in the coming years. However, the rehabilitation needs of South Africans (and globally) remain largely unmet. Establishing a common understanding of the value of rehabilitation can inform clinical practice and policymaking to achieve Universal Health Coverage (UHC). Objectives: This study aims to explore the value of rehabilitation services in South Africa's public healthcare sector by gathering perspectives from stakeholders. The goal is to inform policy decisions related to the implementation of National Health Insurance (NHI) in South Africa. Method: The study used a phenomenological approach and interpretivist paradigm. Semi-structured interviews were conducted face-to-face, online, or telephonically with 12 stakeholders from various rehabilitation sectors. The value of rehabilitation was analysed and categorised into five main categories: context, service delivery, patient outcomes, economic and financial components, and collaboration within and between sectors. Results: The value of rehabilitation was found to be multifaceted, because of the varying health, economic, and social challenges faced by many South Africans. Conclusion: The study identified components of value-based rehabilitation that should be prioritised in the proposed NHI of South Africa. Future research should explore all stakeholder perspectives, including patients, and provide empirical evidence of rehabilitation's economic and societal value. Contribution: We highlight priority areas that are central to the value of rehabilitation in South Africa and other low- and middle-income countries (LMICs). Tailoring rehabilitation services to patient and community needs is crucial for achieving value-based care. Given South Africa's commitment to the United Nations Convention on the Rights of Persons with Disabilities, prioritising rehabilitation remains essential.
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OBJECTIVES: To assess the potential number of EU PICOs based on EUnetHTA 21 guidance and to explore further evidence-based opportunities to produce more predictable and workable EU PICOs. METHODS: The consolidated EU PICOs of two future hypothetical medicines in first line non small cell lung cancer (1L NSCLC) and third line multiple myeloma (3L MM) were derived using published HTA reports of two recent medicines in similar indications based on EUnetHTA 21 proposed guidance. Sensitivity analysis assessed the impact of additional PICO requests. The number of analyses requested was estimated. RESULTS: In 1L NSCLC and 3L MM, six and nine EU Member States (MS), respectively, had published HTA reports. PICO consolidation resulted in 10 PICOs for 1L NSCLC and 16 PICOs for 3L MM, increasing to 14 and 18 PICOs respectively when England's NICE scope was included to proxy remaining MS. A minimum of 280 and 720 analyses would be requested, exponentially increasing as additional outcome measures and subgroups are requested. CONCLUSIONS: The PICO approach outlined by EUnetHTA 21 results in a significant number of analysis requests and substantial resources. Use of complementary analyses alongside evidence-based methods to derive PICOs and engaging with the health technology developer throughout the process, would create a workable EU PICO that is predictable and most impactful for the EU, resulting in a timely and high-quality assessment report that is more usable at a MS level.
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The COVID-19 pandemic shed light on systemic issues plaguing care (nursing) homes, from staff shortages to substandard healthcare. Artificial Intelligence (AI) technologies, including robots and chatbots, have been proposed as solutions to such issues. Yet, socio-ethical concerns about the implications of AI for health and care practices have also been growing among researchers and practitioners. At a time of AI promise and concern, it is critical to understand how those who develop and implement these technologies perceive their use and impact in care homes. Combining a sociological approach to trust with Annemarie Mol's logic of care and Jeanette Pol's concept of fitting, we draw on 18 semi-structured interviews with care staff, advocates, and AI developers to explore notions of human-AI care. Our findings show positive perceptions and experiences of AI in care homes, but also ambivalence. While integrative care incorporating humans and technology was salient across interviewees, we also identified experiential, contextual, and knowledge divides between AI developers and care staff. For example, developers lacked experiential knowledge of care homes' daily functioning and constraints, influencing how they designed AI. Care staff demonstrated limited experiential knowledge of AI or more critical views about contexts of use, affecting their trust in these technologies. Different understandings of 'good care' were evident, too: 'warm' care was sometimes linked to human care and 'cold' care to technology. In conclusion, understandings and experiences of AI are marked by different logics of sociotechnical care and related levels of trust in these sensitive settings.
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OBJECTIVES: Mpox continues to spread in China, and stakeholders' experiences may help inform prevention and control strategies. STUDY DESIGN: Qualitative study. METHODS: A qualitative study across 14 Chinese cities recruited stakeholders from Centers for Disease Control and Prevention (CDCs), community-based organizations (CBOs), and hospitals involved in curbing mpox. Semi-structured interviews were conducted by telephone and analyzed using Colaizzi's phenomenological method. RESULTS: 15 CBOs workers, 14 CDCs staff, and 13 healthcare workers were recruited. Three theme categories were identified: "Efforts to curb mpox epidemic", including CDCs' epidemic management and health education, hospitals' diagnosis, treatment, and care, CBOs' counseling, publicity, and referrals. "Challenges to curb mpox epidemic", including negative impacts of hospital-based quarantine, lack of specific antiviral drugs, gay identity disclosure concerns, psychological problems, contact tracing difficulties, and inadequate communication and collaboration. "Recommendations for curbing mpox epidemic", including prioritizing supervised home-based quarantine, incorporating HIV-related indicators into hospital quarantine criteria, reducing the cost of hospital quarantine, accelerating the development of vaccines and drugs, enhancing patient privacy protection, psychological training for stakeholders, establishing a task force that comprises personnel who are experienced in contact tracing and strengthening communication and collaboration. CONCLUSIONS: Effective control of mpox spread requires strengthening collaboration with CBOs and community healthcare centers (CHCs) and working out a flexible and contextualized mechanism. It also needs to reinforce patient privacy protection and integrate stigma reduction into strategies. Additionally, it is important to include HIV-related indicators in the quarantine evaluation and provide psychological training for stakeholders to help them manage their mental health and improve counseling skills.
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Efficient information management is pivotal for the effective execution of spatial planning projects, yet many encounter hurdles stemming from disjointed information systems and processes. In this article, authors consider the intricacies of information management within the realm of spatial planning, leveraging insights from the multifaceted MAKING-CITY project to elucidate common challenges and propose innovative solutions. The proposed conceptual model for an integrated information management system offers a holistic approach, aiming to eliminate weaknesses inherent in existing information landscapes by seamlessly integrating diverse information components into a unified framework. By facilitating robust communication channels and synchronizing the actions of all project participants and stakeholders, this model enhances collaboration, streamlines workflows, and fosters informed decision-making. Importantly, the adaptability and versatility of developed model ensure its applicability across various spatial planning initiatives, offering a scalable solution to address the evolving demands of urban development projects. Through a meticulous examination of real-world challenges and practical solutions, this article contributes to the advancement of information management practices in spatial planning, laying the groundwork for more efficient, sustainable, and inclusive urban development processes in today's dynamic landscape.
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The American Association of Colleges of Pharmacy has long emphasized the value of strategic engagement, recognizing that it is critical to the success of pharmacy education, contributing to the expansion of pharmacy and public health practice, the fulfillment of institutional missions, and the meeting of programmatic needs. The 2023-2024 Strategic Engagement Committee was charged with operationalizing advocacy champions, creating an advocacy resource guide to support advocacy champions in their engagement with diverse public and private stakeholders, offering formal training to advocacy champions in the form of a new connect community and webinar series, and conducting focus groups at the 2024 Annual Meeting to determine strengths of the advocacy guide and opportunities to support advocacy champions further.
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Educação em Farmácia , Educação em Farmácia/organização & administração , Humanos , Sociedades Farmacêuticas/organização & administração , Faculdades de Farmácia/organização & administração , Estados Unidos , Comitês Consultivos , Grupos FocaisRESUMO
Small ruminant (sheep and goat) production of meat and milk is undertaken in diverse topographical and climatic environments and the systems range from extensive to intensive. This could lead to different types of welfare compromise, which need to be managed. Implementing Precision Livestock Farming (PLF) and other new or innovative technologies could help to manage or monitor animal welfare. This paper explores such opportunities, seeking to identify promising aspects of PLF that may allow improved management of welfare for small ruminants using literature search (two reviews), workshops in nine countries (France, Greece, Ireland, Israel, Italy, Norway, Romania, Spain, and the United Kingdom) with 254 stakeholders, and panels with 52 experts. An investigation of the main welfare challenges that may affect sheep and goats across the different management systems in Europe was undertaken, followed by a prioritisation of animal welfare issues obtained in the nine countries. This suggested that disease and health issues, feed access and undernutrition/malnutrition, maternal behaviour/offspring losses, environmental stressors and issues with agonistic behavioural interactions were important welfare concerns. These welfare issues and their indicators (37 for sheep, 25 for goats) were categorised into four broad welfare indicator categories: weight loss or change in body state (BWC), behavioural change (BC), milk yield and quality (MY), and environmental indicators (Evt). In parallel, 24 potential PLF and innovative technologies (8 for BWC; 10 for BC; 4 for MY; 6 for Evt) that could be relevant to monitor these broad welfare indicator categories and provide novel approaches to manage and monitor welfare have been identified. Some technologies had the capacity to monitor more than one broad indicator. Out of the 24 technologies, only 12 were animal-based sensors, or that could monitor the animal individually. One alternative could be to incorporate a risk management approach to welfare, using aspects of environmental stress. This could provide an early warning system for the potential risks of animal welfare compromise and alert farmers to the need to implement mitigation actions.
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Criação de Animais Domésticos , Bem-Estar do Animal , Cabras , Animais , Criação de Animais Domésticos/métodos , Ovinos , Europa (Continente) , GadoRESUMO
In the field of violence against women (VAW) prevention, one of the current questions at stake is how to address men's role and masculinities, but it is still an emerging field in Spain. The aim of this study was to analyze the up-to-date discourses on masculinity among stakeholders in the field of VAW prevention and gender equity in Spain. We used a qualitative methodology with semi-structured interviews, conducted between October 2019 and February 2020 in Madrid and Alicante (Spain), with 23 key stakeholders from different areas: in governmental (public health and VAW prevention/intervention, and institutional and policy positioning) and nongovernmental organizations (anti-violence masculinities workers, youth education workers, and feminist and LGBT associations). A discourse analysis was performed with the data collected. Our findings showed that discourses around masculinities among Spanish stakeholders in VAW prevention and gender equity were diverse and presented different layers of critique. Despite a general agreement on the importance of transforming sexist men's practices toward more gender equitable relations, three main interpretive repertoires were identified: "Constructing positive/new masculinities" discourse, focused on promoting men's engagement and egalitarian practices; "Deconstructing hegemonic masculinity" discourse, intended to critically identify and question harmful masculinities norms; and "Abolishing gender" discourse, which aims at dismantling masculinity, and gender in general, as a social structure that generates oppression in itself, advocating for its abolition. Those interpretive repertoires were not mutually exclusive and sometimes stakeholders incorporate in their work more than one approach. The study findings shed light on this current emerging and urgent debate and contributes more broadly to the critical assessment of the concepts used and their implications for VAW prevention.
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The international authorities, such as the Food and Agriculture Organization of the United Nations, World Health Organization, World Organization for Animal Health, United Nations Environment Programme, and World Bank, have endorsed the One Health concept as an effective approach to optimize the health of people, animals, and the environment. The One Health concept is considered as an integrated and unifying approach with the objective of sustainably balancing and optimizing the health of people, animals, and ecosystems. Despite variations in its definitions, the underlying principle remains consistent - recognizing the interconnected and interdependent health of humans, animals, and the environment, necessitating interdisciplinary collaboration to optimize health outcomes. The One Health approach has been applied in numerous countries for detecting, managing, and controlling diseases. Moreover, the concept has found application in various areas, including antimicrobial resistance, food safety, and ecotoxicology, with a growing demand. There is a growing consensus that the One Health concept and the United Nations Sustainable Development Goals mutually reinforce each other. The World Bank has recommended five domains as foundational building blocks for operationalising the One Health approach, which includes: i) One Health stakeholders, roles, and responsibilities; ii) financial and personal resources; iii) communication and information; iv) technical infrastructure; and v) governance. The domains provide a generalised overview of the One Health concept and guide to its application. We conducted a scoping review following the five-staged Arksey and O'Malley's framework. The objective of the review was to map and synthesise available evidence of application of the One Health approach to five major zoonotic diseases using the World Bank domains. Publications from the year 2004, marking the inception of the term 'One Health,' to 2022 were included. Information was charted and categorised against the World Bank domains identified as a priori. We included 1132 records obtained from three databases: Embase, Medline, and Global Health; as well as other sources. After excluding duplicates, screening for titles and abstracts, and full text screening, 20 articles that contained descriptions of 29 studies that implemented the One Health approach were selected for the review. We found that included studies varied in the extent to which the five domains were utilised. Less than half the total studies (45%) used all the five domains and none of the studies used all the sub-domains. The environmental sector showed an underrepresentation in the application of the One Health approach to zoonotic diseases as 14 (48%) studies in 10 articles did not mention it as a stakeholder. Sixty two percent of the studies mentioned receiving support from international partners in implementing the One Health approach and 76% of the studies were supported by international donors to conduct the studies. The review identified disparate funding mechanisms employed in the implementation of the One Health approach. However, there were limited discussions on plans for continuity and viability of these funding mechanisms in the future.
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Objective: To describe two main pillars of the Maryland Maternal Health Innovation Program (MDMOM): (1) centering equity and (2) fostering broad stakeholder collaboration and trust. Methods: We summarized MDMOM's key activities and used severe maternal morbidity (SMM) surveillance and program monitoring data to quantify MDMOM's work on the two pillars. We developed measures of hospital engagement with MDMOM (participation in quality improvement [QI] activities, participation in check-in meetings, staff involvement) and with other partners (participation in QI activities, representation in state-level groups). We examined Bonferroni-adjusted correlations between these hospital engagement measures and with key hospital characteristics: level of maternity care, annual delivery volume, and SMM rate. Results: Over 100 national and state organizations and individual stakeholders contributed to our building the MDMOM program and implementing key activities centering equity: hospital-based SMM surveillance in 20 of Maryland's 32 hospitals; almost 5,000 trainings offered to perinatal health care providers; two telemedicine/telehealth interventions; training of home visitors and community-based organization staff. Birthing hospitals represent MDMOM's main implementation partners. The strength of their participation in MDMOM QI activities is positively correlated to their participation in check-in meetings and with the degree of involvement by physicians in such activities. Higher engagement in MDMOM QI activities is also positively correlated to hospitals' participation in other state-level maternal health initiatives or groups. Conclusion: Our experience with the MDMOM program demonstrates that an equity focus and broad stakeholder collaboration building strong relationships and providing implementation support can lead to high levels of engagement in innovative maternal health interventions.
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BACKGROUND: WHO postulates the application of adaptive design features in the global clinical trial ecosystem. However, the adaptive platform trial (APT) methodology has not been widely adopted in clinical research on vaccines. METHODS: The VACCELERATE Consortium organized a two-day workshop to discuss the applicability of APT methodology in vaccine trials under non-pandemic as well as pandemic conditions. Core aspects of the discussions are summarized in this article. RESULTS: An "ever-warm" APT appears ideally suited to improve efficiency and speed of vaccine research. Continuous learning based on accumulating APT trial data allows for pre-planned adaptations during its course. Given the relative design complexity, alignment of all stakeholders at all stages of an APT is central. Vaccine trial modelling is crucial, both before and in a pandemic emergency. Various inferential paradigms are possible (frequentist, likelihood, or Bayesian). The focus in the interpandemic interval may be on research gaps left by industry trials. For activation in emergency, template Disease X protocols of syndromal design for pathogens yet unknown need to be stockpiled and updated regularly. Governance of a vaccine APT should be fully integrated into supranational pandemic response mechanisms. DISCUSSION: A broad range of adaptive features can be applied in platform trials on vaccines. Faster knowledge generation comes with increased complexity of trial design. Design complexity should not preclude simple execution at trial sites. Continuously generated evidence represents a return on investment that will garner societal support for sustainable funding. Adaptive design features will naturally find their way into platform trials on vaccines.
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In many European countries, responsibilities for social care have been shifted to municipalities to enhance accessibility and stimulate integration of care and social services, and to cut costs. Multidisciplinary local Social Community Teams (SCTs) have become increasingly responsible for the provision of these integrated services, requiring them to collaborate with local health and societal organisations. To collaborate and to integrate services the SCTs must work across their own and stakeholders' boundaries (e.g., domain specific boundaries). We investigated how boundary work in SCTs' practices contributes to service integration in a dynamic multi-stakeholder context. In our embedded case study, for 18 months, we followed three SCTs in their efforts to integrate services, and used data from multiple sources, including bi-weekly questionnaires in which SCT members reflect on their stakeholder-directed goal achievements. The case analysis yielded four takeaways. First, it demonstrates how SCTs' bottom-up formulation of a long-term service integration vision brought internal coherence (boundary reinforcement), while the short-term action-goals increased collaboration with stakeholders (boundary spanning). Second, only SCTs that managed to incorporate constraints into their action-goals and practices, and to span and play with boundaries, continued with integrating services just-by-doing. Third, two stakeholder characteristics facilitated the SCTs' boundary spanning: well-organized stakeholders and prior familiarity with the stakeholder. Fourth, a new boundary work type emerged, "boundary play", consisting of informal, experimental collaboration efforts with stakeholders contributing to emergent service integration.
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Marine ecosystems are facing a dramatic loss of biodiversity worldwide, together with a widespread collapse of habitats and their functionality. In this context, Marine Citizen Science (MCS) can be a powerful tool to monitor these changes over time. The flowering of very well-structured international projects is strengthening the scientific credibility of MCS data, especially when data are collected after specifically designed training programs and shared in public user-friendly repositories. Here we present a new perspective on the use of MCS in the Mediterranean area, along with the main benefits for the stakeholders (i.e., diving centers, trainers, and policymakers) and the users (i.e., divers), resumed in three pillars: Pillar I - MCS as a tool for the site valorization; Pillar II - MCS as a new career opportunity for graduated students; Pillar III - MCS as a business opportunity for diving centers. In the frame of the Quintuple Helix Approach, for which there is a strong need of a socioecological transition of the society and economy, we show how MCS can be a win-win-win solution for all the actors involved, providing the vision for new and highly qualified job and business opportunities for the diving sector.