Engagement Of Multiple Stakeholders Research Articles

Brazilian primary dental care in a universal health system: Challenges for training and practice

ObjectivesTo report the challenges for training and practice for the Brazilian primary dental care in a universal health system. MethodsHealth, education and protection rights against poverty are guaranteed by the 1988 Brazilian Constitution and public health in Brazil is provided by the Unified Health System (SUS), one of the largest public health systems in the world. According to SUS, every Brazilian citizen has the right to free primary oral health care as secondary and tertiary care, offering a unique opportunity to integrate oral care within general health care. ResultsThe Brazilian undergraduate Dental curriculum was updated in 2021 aiming to graduate general practitioners with a major in comprehensive health care in primary health care, integrated with public and general health. This curriculum update requires at least 20% of the academic hours to be exercised outside the university walls (extramural or community work), preferably within the SUS. ConclusionsConsidering the World Health Organization (WHO) agenda, Brazil needs to advance the innovative oral health workforce, the integration of oral health into primary care, the population access to essential dental medicines and optimal fluorides for caries control. Clinical significanceIt is necessary political action and the engagement of multiple stakeholders, mainly from the health and education sectors, to improve primary health care

Bridging the Gap: Oral Health-care Delivery Plan in Tribal Belt of Western India

Abstract Background: India has launched many initiatives to achieve Universal Health Coverage, despite there exist gaps in oral health-care need and service delivery. Especially in tribal areas, due to the prevalence of risk factors as well as the lack of accessibility and affordability for health-care services, oral diseases remain unidentified and untreated. Therefore, the present study aims to assess the needs and design an implementation plan for sustainable and culturally acceptable oral health-care delivery in one of the tribal blocks of Mokhada in the state of Maharashtra, Western India. Methodology: The study included participants above 18 years of age and adopted a co-design approach. Data collection methods consisted of a short-form survey and focused group discussion. Convenient and purposive sampling methods were used to select participants for quantitative and qualitative data collection, respectively. Quantitative data analysis was performed using the STATA 16 tool, whereas thematic analysis was performed for the qualitative data. Need assessment led to the design of implementation by engaging multiple stakeholders. Results: A total of 2008 adults participated in the survey with a mean age being 37.7 years. 52.4% of participants were male. Out of 2008 screened, 83.2% were found to have at least one oral disease and a high prevalence of tobacco consumption (42%). Barriers of oral healthcare-seeking behaviour were addressed in the proposed model of care. Accordingly, a twice-a-week functional comprehensive oral care health-care model was integrated into the already existing health center of a community led development organization and portable mobile dental unit were planned with the support of multiple stakeholders. Conclusion: The study demonstrates the feasibility of delivering oral healthcare through integration into primary healthcare and multiple stakeholder engagement.

9.H. Workshop: Applying the Supersetting-approach to tackle health inequities in disadvantaged settings

Abstract Inequity in health remains a major urgent global public health challenge, not least concerning noncommunicable diseases (NCDs) including type 2 diabetes (T2D). Peoples’ abilities to live long healthy lives is linked to their social and economic situation and living in disadvantaged neighbourhoods is associated with increased health risk across the life course and increased risk of T2D in adulthood. The risk of ill health is thus deeply rooted in the complex social contexts of people's everyday lives. Thus, addressing the social determinants of health by incorporating a variety of strategies and interventions in the settings where people live is imperative to tackle health inequities. Evidence suggests that multilevel-multicomponent interventions can have a positive impact on a range of health and behavioural outcomes. Moreover, studies show that bottom-up approaches in community interventions constitute important drivers of collaborative action and sustainable solutions to inequity in health at a community level. This workshop presents the Supersetting approach - an intervention strategy for comprehensive community interventions - as one solution to tackle growing health inequities in disadvantaged urban settings focusing on T2D. The approach strives to attain synergistic effects through coordinated engagement of multiple stakeholders in multiple settings to mobilize local resources and strengthen social networks for collective community action. The Supersetting approach has recently gained international recognition as a “a whole-of-society endeavor” approach to health promotion by welcoming complexity at all levels of the intervention. The workshop uses Tingbjerg Changing Diabetes (TCD) a long-term community-based initiative, as a case to unfold the complexity and width of the Supersetting approach (www.tingbjergchangingdiabetes.dk). Beginning with an introduction and conceptualization of the Supersetting approach and characterization of the urban area of Tingbjerg focusing on T2D, we hereafter present three integrated TCD initiatives. These illustrate how the Supersetting approach can be applied in practice as well as how to explore and measure its different impacts through different methodological approaches. The workshop aims to present and discuss the potentials and challenges of using a Supersetting approach to tackle inequalities in health in disadvantaged urban settings. Key messages • The rising challenge of inequity in health calls for complex systems approaches. • The Supersetting approach is presented as a sustainable complex systems approach to tackle growing health inequities in disadvantaged neighborhoods.

Barriers and facilitators to implementing geriatric assessment in daily oncology practice in Japan: A qualitative study using an implementation framework

IntroductionVarious guidelines recommend geriatric assessment (GA) for older adults with cancer, but it is not widely implemented in daily practice. This study uses an implementation framework to comprehensively and systematically identify multi-level barriers and facilitators to implementing GA in daily oncology practice. Materials and MethodsWe conducted 16 semi-structured interviews with healthcare providers in 10 designated cancer hospitals in Japan, using purposive and convenience sampling. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection and analysis of interview data following a deductive content analysis approach with consensual qualitative research methods. After coding the interview data, ratings were assigned to each CFIR construct for each case, reflecting the valence and strength of each construct relative to implementation success. Then, those constructs that appeared to distinguish between high-implementation hospitals (HI) where GA is routinely performed in daily practice and low-implementation hospitals (LI) where GA is performed only for research purposes or not at all were explored. ResultsOf the 24 CFIR constructs assessed in the interviews, 15 strongly distinguished between HI and LI. In HI, GA was self-administered (Adaptability), or administered via a mobile app with interpretation (Design Quality and Packaging). In HI, healthcare providers were strongly aware of the urgent need to change practice for older adults (Tension for Change) and recognized that GA was compatible with existing workflow as part of their jobs (Compatibility), whereas in LI, they did not realize the need to change practice, and dismissed GA as an extra burden on their heavy workload. In HI, usefulness of GA was widely recognized by healthcare providers (Knowledge & Beliefs about the Intervention), GA had a high priority (Relative Priority) and had strong support from hospital directors, managers, and nursing chiefs (Leadership Engagement), and multiple stakeholders were successfully engaged, including nurses (Key Stakeholders), peer doctors (Opinion Leaders), and those who drive implementation of GA (Champions). DiscussionThese findings suggest that successful implementation of GA should focus on not only individual beliefs about the usefulness of GA and the complexity of GA itself, but also organizational factors related to hospitals and the engagement of multiple stakeholders.

Exploring emergent collaborations for digital transformation in local governments: The engagement of public libraries in the development of smart cities

Collaboration is increasingly perceived as essential for digital transformation in the public sector. Transforming services and internal operations through the use of information and communication technologies frequently requires the engagement of multiple stakeholders beyond government agencies. This is particularly important in the specific case of smart city initiatives, which intend to leverage technologies to address complex socio-economic and sustainability challenges in local jurisdictions. In addition, emergent research asserts that community organizations such as public libraries can be strategic partners in these multi-actor efforts but does not adequately assess the determinants of these collaborations for developing smart cities, which may result in significant digital transformation at the local level. Based on public management literature on collaboration, this article contributes to digital transformation research by quantitively testing the antecedents of existing collaborations between public libraries and other stakeholders to develop smart cities. Overall, our findings suggest that leadership, preexisting relationships, and agreement on initial aims significantly impact the extent and effectiveness of public libraries' collaborations in developing smart cities.

Assessing the influence of variation in forage availability on spatial patterns of beehive migration using a hybrid modelling approach – B-Agent

Bees and beekeeping are increasingly recognised as important contributors to sustainable development. Beekeeping is a landscape-scale process that involves complex interconnectivities between beekeepers, beehives and bee forage. Yet, accounting for these interactions within beekeeping system models is challenging as interactions are dynamic and often influenced by human behaviour and decision making. To this end, this research describes a spatially explicit modelling approach B-Agent, which draws upon multiple stakeholder engagement, a machine-learning algorithm and an agent-based model to simulate beehive migration processes. The Western Australian beekeeping sector provides a case study for model development and testing, to examine changes in (i) distances travelled by beekeepers, (ii) the frequency of beehive migration, and (iii) the spatial distribution of harvest locations resulting from climate related impacts on forage availability. The results indicate an increase in travel distance and frequency of hive migrations for commercial beekeepers under a moderate emissions climate scenario and indicated an eastward shift in the spatial distribution of harvest locations. The approach provides an evidence-base for better-informed management decisions in order to improve the long-term sustainability of beekeeping systems in Western Australia and beyond.

Target Aortic Stenosis: A National Initiative to Improve Quality of Care and Outcomes for Patients With Aortic Stenosis.

Target Aortic Stenosis: A National Initiative to Improve Quality of Care and Outcomes for Patients With Aortic Stenosis.

Exploring Mental health Barriers in Emergency Rooms (EMBER)

Background: Mental illness stigma is a complex public health issue that creates barriers for clients seeking services. For many clients, an ED visit may be their first point of contact with the health-care system for a mental illness/addiction crisis – but it often results in poor outcomes and negative experiences due to discriminatory and structural inequities. Calgary Health Foundation has funded a five-year multiphase study (EMBER) to explore stigma holistically through patients, families, physicians, psychiatrists, nurses, and protective services in FMC ED. The goal is to explore, address, understand, and evaluate interventions that mitigate stigma at both the individual and organizational levels. Methods: The EMBER research team is working collaboratively with AHS Policy Services team to examine mental health and addiction-related policies that may be connected to institutional stigma and practices that create barriers to access, help-seeking and the provision of mental health and addiction services. The ORBIT model is being used as a conceptual framework to support the cross-disciplinary approaches used by the research team to explore clinical and public health policy needs (phases 1 & 2); multiple intervention strategies (phase 3); targeted changes in health behaviors related to mental health stigma; and the potential of behavioral treatments to affect health outcomes (phases 4 & 5). Intervention implementation considerations include: (1) the perceived fit between proposed training and identified learning needs; (2) the suitability of intervention content for different learner groups; (3) intervention length; (4) format of delivery; (5) size of training groups; (6) mix of professionals within groups; (7) incentives for participation; (8) sustainability; (9) support for reinforcement of training over time; (10) anticipated implementation challenges and how to address them; and (11) expected or desired outcomes. Evaluation Methods: Addressing structural and resource inequities in the delivery of mental health/addiction care is a focal point of our study and an evidenced based pathway to ensure improved health outcomes for all Albertans. We are employing a mixed-method approach to capture quantitative and qualitative findings related to the experiences of patients/families, health care providers, and protective services as well as the policies that inform the delivery of care in ED settings. Evaluation throughout Phases 1/2 included thematic analysis of interview and focus group transcripts. In Phase 1, baseline surveys were used to collect demographics of participants and current levels of stigma amongst ED staff. Phase 2a, includes policy review through a human rights lens. In Phase 3, quantitative and qualitative surveys will be used pre- and post-intervention, and at follow up points (TBD). In Phases 4/5, the intervention data will be synthesized and used to inform recommendations for scale and spread. Results: Based on in-depth 60–90-minute focus groups or interviews with patients/families, health care providers, and protective services in phase one, the following results were captured using thematic analysis. Structural Stigma · Mental health rooms in the ED feel like “jail cells” · Staffing and other resource inequities for mental health care · Lack of training and role confusion Interpersonal Stigma · Patients/families: perceived lack of mental health training and resources, leading to unsatisfactory experiences, including in many cases, experiences of harm · Staff: inadequate mental illness training and occupational distress contribute to staff burnout and compassion fatigue Intrapersonal Stigma · Patients/families: lack of communication and dehumanizing interactions with staff contributing to feelings of isolation, shame, and hopelessness · Staff: vulnerability in disclosing personal mental health struggles Advice and Lessons Learned: Including a patient research partner in this study ensures that the voices of patients/families are heard, respected, and represented, and that a focus on patient-identified priorities and outcomes is maintained. Our PRP is an active and important member of our research team who acts as a liaison and role model during focus group discussions with patients and families. She assists with stigma reduction by using her lived experience and voice to educate others. More recently, we have identified professional silos within the healthcare system that have become the catalyst for promoting collaboration between EMBER researchers, AHS AMH clinical and operational leaders, and the Calgary Health Foundation (funder). Prioritizing the engagement of multiple stakeholders who have a direct interest in the process and outcomes of this study and how it is translated back into structural, policy and practice changes, is an important pathway to achieving sustained positive impact.

Development levels of stakeholder relationships in collaborative projects: challenges and preconditions

PurposeThis article aims to address the confusion related to the meanings of interorganisational cooperation, control, coordination and collaboration in collaborative projects by developing a conceptual framework. From this, the authors aim to describe the links among these concepts in terms of development levels of stakeholder relationships. In addition, the authors aim to identify challenges and preconditions in relation to developing relationships at different levels.Design/methodology/approachThe authors have adopted the directed approach of qualitative content analysis method to validate and extend the conceptual framework of this study. The context of this study is a large hospital construction project located in northern Finland.FindingsThe findings of this study suggest that collaboration is a multilevel process of active engagement of multiple stakeholders. These stakeholders must have a high degree of shared understanding in terms of cooperation, control and coordination to achieve the mutually desired outcomes. This study also identifies the challenges that project stakeholders could face in developing collaborative relationships and propose preconditions for the same.Practical implicationsThis study provides a better understanding for project managers to manage interorganisational collaborative construction projects successfully. The outcome of this research would be beneficial to project management team to deliver dispute-free construction projects.Originality/valueExisting practical research on the development of relationships at different levels in collaborative construction projects is limited. This study offers a framework for the same which is validated in a real-life project.

Building capacity to use legal tools to address climate change through a public health lens

Abstract Background EPH Conferences have an increased focus on the health impacts of climate change. However, until 2021 EPHC abstracts did not address opportunities to challenge government inaction in national and international courts. ASPHER’s European List of Core Competences for the Public Health Professional (2018) only mentions NCDs and data protection law. Yet litigation to address environmental degradation and climate change is well-developed in Europe and beyond. International environmental law was presciently framed as part of global health law by Joaquin Cayon in Laaser U. and Beluli F. A Global Public Health Curriculum. South Eastern European Journal of Public Health (2016). Objectives 1. Clarify the role of litigation in achieving environmental and climate goals 2. Highlight the role of public health practitioners (PHP) in documenting evidence of harms 3. Propose ways to build PHP capacity to use litigation to address related public health challenges Results In 2021 EUPHA-LAW, EUPHA-ENV, the Faculty of Public Health (FPH) (UK) and partners co-hosted a multi-stakeholder, interdisciplinary, open-access webinar on public health, climate change and litigation with experts from WHO, Greenpeace, ClientEarth, Lancet Countdown and the Groningen Centre for Health Law (GCHL). A related workshop was held at the 14th EPHC. In March 2022, EUPHA-LAW, FPH, GCHL and the University of Liverpool hosted a webinar on climate action in the European Court of Human Rights. [Patterson et al, Post COP26: legal action now part of public health’s environment and climate change toolbox, EJPH 31/5/2022.] EUPHA-LAW is preparing a toolkit for public health practitioners and a conference on public health litigation in 2023. Conclusions There is keen interest in the public health community to better understand how litigation can address public health challenges including climate change and environmental degradation. Capacity building is needed. Key messages • Climate litigation supported by interdisciplinary collaboration can strengthen government resolve and accountability for action to address environmental and climate commitments. • Litigation can advance public health objectives even without a favourable court decision. Its value also includes the publicity and awareness generated and engagement of multiple stakeholders.

Ethics and regulatory complexities posed by a pragmatic clinical trial: a case study from Lilongwe, Malawi.

Pragmatic clinical trials generally rely on real world data and have the potential to generate real world evidence. This approach arose from concerns that many trial results did not adequately inform real world practice. However, maintaining the real world setting during the conduct of a trial and ensuring adequate protection for research participants can be challenging. Best practices in research oversight for pragmatic clinical trials are nascent and underdeveloped, especially in developing countries. We use the PRECIS-2 tool to present a case study from Lilongwe in Malawi to describe ethical and regulatory challenges encountered during the conduct of a pragmatic trial and suggest possible solutions. In this article, we highlight the following six issues: (1) one public facility hosting several pragmatic trials within the same period; (2) research participants refusing financial incentives; (3) inadequate infrastructure and high workload to conduct research; (4) silos among partner organisations involved in delivery of health care; (5) individuals influencing the implementation of revised national guidelines; (6) difficulties with access to electronic medical records. Multiple stakeholder engagement is critical to the conduct of pragmatic trials, and even with careful stakeholder engagement, continuous monitoring by gatekeepers is essential. In the Malawian context, active engagement of the district research committees can complement the work of the research ethics committees (RECs).

Bovine tuberculosis control in Fiji: Retrospective study findings for 2015 to 2020.

Control of bovine tuberculosis (bTB) is a priority for animal health, biosecurity, and human health authorities in Fiji as evident from the long-term funding of the Bovine Brucellosis and Tuberculosis Eradication and Control program (BTEC) and notable improvements to the program described in this paper. To evaluate the performance of the Fiji BTEC program from 2015 to 2020, all available bTB data for cattle were analyzed. Data sources included BTEC bTB testing records, abattoir records and laboratory records. We integrated all information to quantify the bTB tests applied, bTB positive farms and animals, meat inspection and laboratory findings. Test coverage was highest among dairy cattle in Central Division (~73%), where bTB was highly prevalent with 7.8% of dairy cattle and 61.7% of dairy farms found to be positive between 2015 and 2020. There was no visible downward trend in the apparent prevalence of bTB over the 6-year period. During 2019 and 2020, only 21.3% (51/239) of the tested dairy farms maintained their clear status, another 8.4% (20/239) reverted to infected status after 1 year or more of being bTB clear, and most farms remained infected during these 2 years. Factors observed to be contributing to this situation were persistent infections, related in part to the significant number of untested animals, uncontrolled animal movements, and larger farm size. Similar to other developing countries, bTB remains a serious concern and further strengthening of the program targeting the main contributors to bTB persistence, along with maintenance of a comprehensive reporting and traceability system, industry awareness and government support are needed. Control of bTB in Fiji is a long-term objective that must have multiple stakeholder engagement and regular review to measure success.

Assessing the Potential for Private Sector Engagement in Integrated Landscape Approaches: Insights from Value-Chain Analyses in Southern Zambia

Agricultural and forested landscapes in Africa are changing rapidly in response to socio-economic and environmental pressures. Integrated landscape approaches provide an opportunity for a more holistic and coordinated resource management strategy through the engagement of multiple stakeholders. Despite their influence as landscape actors, participation of private businesses in such initiatives has thus far been limited. This study focuses on the Kalomo District in southern Zambia, which provides an example of a rural landscape characterized by high levels of poverty, low agricultural productivity, and widespread deforestation and forest degradation. The study applied a value-chain analysis approach to better understand how the production of four locally important commodities (maize, tobacco, cattle, and charcoal) impacts land use, local livelihoods, and environmental objectives in this landscape, focusing on the role and influence of private sector actors. Data were collected through focus group discussions and key informant semi-structured interviews. Qualitative content analysis was employed to analyze the data and contextualize the findings. Results indicate three key potential entry points for increased private sector engagement: (1) improving water security for smallholders; (2) empowering small and medium-sized enterprises (SMEs) as private sector actors; and (3) collective planning for sustainable landscape activities with deliberate measures to involve private sector actors. We discuss options for optimizing benefits from the identified entry points.

Opportunities, challenges and solutions for black soldier fly larvae-based animal feed production

Increasing global demand for animal protein combined with an urgent need to advance towards global sustainability, as enshrined within the Sustainable Development Goals (SDGs), has spurred the development of insects as a protein source in animal and fish feed. The acceptance and feasibility of these advances are nevertheless poorly understood. This study aimed to identify opportunities, challenges and solutions for black soldier fly larvae-based animal feed production, through stakeholder interviews in Malaysia, analysed using thematic analysis and the analytic hierarchy process. The data identified 17 challenges, alongside 19 potential solutions, which we analysed under political, economic and resourcing, institutional and legal, and social and cultural categories. The need to establish a black soldier fly larvae-based feed sector has become important, but for black soldier fly larvae feed to make a substantive contribution to the animal feed sector, a more enabling environment is required. This includes improved support from the government, ensuring cost-effective investment and low operational costs, better coordination between regulatory authorities and improved consumer acceptance. Tackling these challenges from multiple entry points within each of the categories we identified could help to advance policies that advance progress towards the SDGs through the development of black soldier fly larvae-based animal feed production, supported by the engagement of multiple stakeholders. Policy recommendations emerging from this study offer important inputs to inform black soldier fly larvae-based animal feed production both in Malaysia and globally.

Challenges and Opportunities With Routinely Collected Data on the Utilization of Cancer Medicines. Perspectives From Health Authority Personnel Across 18 European Countries.

Background: Rising expenditure for new cancer medicines is accelerating concerns that their costs will become unsustainable for universal healthcare access. Moreover, early market access of new oncology medicines lacking appropriate clinical evaluation generates uncertainty over their cost-effectiveness and increases expenditure for unknown health gain. Patient-level data can complement clinical trials and generate better evidence on the effectiveness, safety and outcomes of these new medicines in routine care. This can support policy decisions including funding. Consequently, there is a need for improving datasets for establishing real-world outcomes of newly launched oncology medicines. Aim: To outline the types of available datasets for collecting patient-level data for oncology among different European countries. Additionally, to highlight concerns regarding the use and availability of such data from a health authority perspective as well as possibilities for cross-national collaboration to improve data collection and inform decision-making. Methods: A mixed methods approach was undertaken through a cross-sectional questionnaire followed-up by a focus group discussion. Participants were selected by purposive sampling to represent stakeholders across different European countries and healthcare settings. Descriptive statistics were used to analyze quantifiable questions, whilst content analysis was employed for open-ended questions. Results: 25 respondents across 18 European countries provided their insights on the types of datasets collecting oncology data, including hospital records, cancer, prescription and medicine registers. The most available is expenditure data whilst data concerning effectiveness, safety and outcomes is less available, and there are concerns with data validity. A major constraint to data collection is the lack of comprehensive registries and limited data on effectiveness, safety and outcomes of new medicines. Data ownership limits data accessibility as well as possibilities for linkage, and data collection is time-consuming, necessitating dedicated staff and better systems to facilitate the process. Cross-national collaboration is challenging but the engagement of multiple stakeholders is a key step to reach common goals through research. Conclusion: This study acts as a starting point for future research on patient-level databases for oncology across Europe. Future recommendations will require continued engagement in research, building on current initiatives and involving multiple stakeholders to establish guidelines and commitments for transparency and data sharing.

Newborn screening research sponsored by the NIH: From diagnostic paradigms to precision therapeutics.

Newborn screening (NBS) is a successful public health initiative that effectively identifies pre-symptomatic neonates so that treatment can be initiated before the onset of irreversible morbidity and mortality. Legislation passed in 2008 has supported a system of state screening programs, educational resources, and an evidence-based review process to add conditions to a recommended universal newborn screening panel (RUSP). The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, has promoted NBS research to advance legislative goals by supporting research that will uncover fundamental mechanisms of disease, develop treatments for NBS disorders, and promote pilot studies to test implementation of new conditions. NICHD's partnerships with other federal agencies have contributed to activities that support nominations of new conditions to the RUSP. The NIH's Newborn Sequencing In Genomic Medicine and Public Health (NSIGHT) initiative funded research projects that considered how genomic sequencing could be integrated into NBS and its ethical ramifications. Recently, the workshop, "Gene Targeted Therapies: Early Diagnosis and Equitable Delivery," has explored the possibility of expanding NBS to include genetic diagnosis and precision, gene-based therapies. Although hurdles remain to realize such a vision, broad engagement of multiple stakeholders is essential to advance genomic medicine within NBS.

Country profile: Australia, New South Wales. From validation to implementation: Progressing tobacco smoking cessation among people with cancer and beyond via relevant authorities

This paper delineates how a program of tobacco smoking cessation after a cancer diagnosis was achieved by engagement of multiple stakeholders, government, and non-government authorities in one jurisdiction in Australia, New South Wales. While it had become increasingly obvious that smoking cessation imparts benefits akin to other known treatment modalities, knowledge of this generalisation is without benefit unless this information is delivered in a trusted context and means to quit are made available. Against a backdrop of little enthusiasm among clinicians, the Cancer Institute NSW, charged with implementing tobacco control strategies, decided to focus its 2017 annual colloquium on the topic. While the evidence was unequivocal, better clarity was needed that this was indeed a clinical responsibility, and on the resources needed. The Clinical Oncology Society of Australia, (COSA) a non-governmental peak national body representing cancer care professionals, addressed this challenge. The society’s governing body resolved to develop a position statement indicating how smoking cessation might be integrated within hospital-based cancer care. The position statement, endorsed by nineteen other cancer and non-cancer organisations, provided reassurance to the Institute to improve record capture of hospital smoking information; upskill all clinical staff and develop an automatic “patient opt out” referral to existing resources such as the Quitline. Early pilot work shows that people newly diagnosed with cancer who smoke and who were advised at that time to quit increased from 55% in 2016 to 72% in 2019.

Primary school children's responses to food waste at school

PurposeThis paper seeks to understand children’s responses to food waste in school by exploring children’s views on food waste and empowering them to discuss and develop their own solutions.Design/methodology/approachUsing creative problem-solving approach and photovoice technique, the authors conducted focus group discussions with 28 primary school children in the UK.FindingsChildren have a clear understanding of the consequences of food waste for individuals, society and the environment. They displayed negative emotions concerning food waste and responded positively to the possibility of food recycling. Their solutions to reduce food waste will require multiple stakeholder engagement, including self-regulation, peer-monitoring, teacher supervision and family support. However, rather than relying on intervention schemes that require significant adult involvement, children placed a heavy emphasis on self-regulation, playing an active role in addressing food waste in school.Originality/valueThis research extends previous understanding, by showing children as agentic consumers who can shape food waste solutions in school. These findings are of use to primary teachers and local education authorities, to aid children in developing their own solutions to reduce food waste in their own schools.

The SHOnet learning health system: Infrastructure for continuous learning in pediatric rehabilitation.

To describe the development and implementation of learning health system (LHS) infrastructure for a pediatric specialty care health system to support LHS research in pediatric rehabilitation settings. An existing pediatric common data model (eg, PEDSnet) of standardized medical terminologies for research was expanded and leveraged for this stud, and applied to SHOnet, a clinical research data resource consisting of deidentified data extracted from the electronic health record (EHR) from the Shriners Hospitals for Children speacialty pediatric health care system. We mapped EHR data for laboratory, procedures, drugs, and conditions to standardized vocabularies including ICD-10, CPT, RxNorm, and LOINC to the common data model using an established extraction-transformation-loading process. Rigorous quality checks were conducted to ensure a high degree of data conformance, completeness, and plausibility. SHOnet data elements from all sources are de-identified and the server is managed by the SHC Information Systems Department. SHOnet data are refreshed monthly and data elements are continually expanded based on new research endeavors. Not applicable. The Shriners Health Outcomes Network (SHOnet) includes data for over 10 000 distinct observational data elements based on over two million patient encounters between 2011 and present. The systematic process to develop SHOnet is replicable and flexible for other pediatric rehabilitation research settings interested in building out their LHS capabilities. Challenges and facilitators may arise for building such LHS infrastructure for rehabilitation in areas of (a) data capture, curation, query, and governance, (b) generating knowledge from data, and (c) dissemination and implementation of new institutional knowledge. Further research studies are needed to evaluate these data resources for scalable system-learning endeavors.SHOnet is an exemplar of an LHS for rehabilitation and specialty care settings. The success of an LHS is dependent on engagement of multiple stakeholders, shared governance, effective knowledge translation, and deep commitment to long-term strategies for engaging clinicians, administration, and families in leveraging knowledge to improve clinical outcomes.

Transitions to Legume-Based Agrifood Systems – Stakeholders' Views from Hungary

The pressing need for the radical transformation towards more sustainable agricultural and food systems, which only recently gained substantially more acknowledgement, staged several underutilised crops in new roles. Legumes have become the primary focus of research and analytical attention first in agroecology, and lately in international policy communities and the social sciences. With their effortless talent to fix nitrogen into the soil, substitute animal protein, reduce greenhouse gas emissions, legumes are now recognised as forgotten stars, that could help both agriculture and the food industry become more ecological. However, legume production and consumption, albeit multiple advantages, remain still marginal in Europe for several reasons. This article adopts an interpretative policy framework to address the legume paradox, that is our legume-dependent agri-food systems relying on imports and simultaneously maintaining deficient production and consumption of legumes. We reviewed the state of the art of legume-based food systems in Hungary by analysing conceptual frameworks and data from exploratory mixed-method research. In a case study research, we analysed the root causes of this state-of-the-art through mapping the understanding of challenges and potentialities of legume value chains in Hungary by critical stakeholders. Our primary research question is what is at play behind and how Hungarian stakeholders make meaning of this paradox. We also explore how the current trends could still open pathways for more legumes in production and consumption. Drawing on insights from the literature and stakeholder interviews in Hungary, we show an extremely locked-in agri-food system. Our results indicate that especially small scale producers face difficulties to tackle with shallow yield stability of legumes. Their struggle is further aggravated by the dumping of cheap import of plant-based protein food and feed and inorganic nitrogen fertilisers, virtually absent small-scale processing, consumers' unawareness of legumes' benefits and preoccupation with their gut discomfort and food services' unwillingness to experiment with tasty plant-based protein food. We suggest several future research topics and pathways to promote more sustainable legume-based food systems. In conclusion, we argue that any transition towards legume-based food and feed systems would initially require the mutual engagement of multiple stakeholders in the value chains, strong policy support orchestrated by public institutions.