Implementation Of Program Research Articles

Evidence-Informed Provision of Doxycycline Post-Exposure Prophylaxis for Prevention of Bacterial Sexually Transmitted Infections.

Doxycycline post-exposure prophylaxis (doxy-PEP) reduces the risk of bacterial sexually transmitted infections (STIs) among men who have sex with men and transgender women. In the United States, doxy-PEP is in an early stage of integration into clinical practice, and national guidelines for its use were recently released. The goal of this manuscript is to provide practical guidance for clinicians who are considering or currently prescribing doxy-PEP. We address five clinical questions using post hoc analyses of data from the DoxyPEP randomized controlled trial and discuss the potential implications and limitations of each question with the goal of informing clinical practice and implementation of doxy-PEP programs. The questions address patient eligibility criteria for doxy-PEP, the expected benefit and associated doxy-PEP doses for the average patient, the initial number of doses prescribed, and laboratory monitoring of persons taking doxy-PEP.

Analysis of Strengthening Youth Organizations in Lolowua Village, Hiliserangkai District Nias Regency, Indonesia

The purpose of this study is to analyze the strengthening of youth organization activities in Lolowua Village, Hiliserangkai District, Nias Regency, to analyze how obstacles to strengthening youth organizations in lolowua village and to analyze how efforts are made in strengthening youth organizations in lolowua village. This type of research is qualitative. Data analysis techniques use data reduction, data presentation and conclusion drawn. The result of this study is that the Capacity Strengthening of the Youth Organization in Lolowua village has not run optimally, this is because there are still several obstacles to indicators that are not yet effective, The main factors that become obstacles are lack of budget that limits the implementation of programs and activities, lack of adequate human resources, ineffective communication, and limited facilities, Lack of training and mentoring for member capacity, low participation from members and the community. The efforts made in strengthening the Youth Organization in Lolowua Village pay special attention to the youth organization, monitoring, evaluation of management and programs, involving the youth organization in the planning to strengthen human resources, improve communication, provide better facilities, and increase participation and training for all members of the Youth Organization.

Pemberdayaan Masyarakat di Bidang Pertanian melalui Pembuatan Pupuk Organik

Organic fertilizer is defined as fertilizer that is partly or wholly derived from plants and/or animals that has gone through an engineering process, can be in solid or liquid form which is used to supply organic material to improve the physical, chemical and biological properties of the soil. The aim of this activity is to empower the community through making organic fertilizer in the agricultural sector. The activity steps include: 1) Preparation stage. The preparation stage is very important as a form of more mature planning to achieve better things. This preparation stage includes observations and interviews with partners and the community, checking the implementation location, in this case I used Sumbek Hamlet, Wajageseng Village, Kopang District, Central Lombok Regency, establishing collaboration with youth and the entire community, preparing tools and materials for the main program which includes everything needed in this training; and 2) Program implementation stage. The program implementation stages are described as follows: the process of collecting cow dung which is processed into fertilizer, the process of mixing cow dung with straw, and the fermentation process for up to ± 30 days to make it into soil to be used as fertilizer. The results achieved in this training activity were the acquisition of knowledge by the community and youth about how to make organic fertilizer using existing materials. The community is able to minimize expenditure on purchasing fertilizer and reduce the use of chemical fertilizers. Through this activity, the public also understands more about the negative impacts caused by the use of chemical or inorganic fertilizers if used over a long period of time. This community empowerment can also support various village activities in organizing training in the agricultural sector, because the community is able to create their own fertilizer from materials that are easily obtained.

Effect of video-based exercise on premenstrual symptoms: a randomized controlled trial.

This study aims to investigate the impact of Pilates exercises on premenstrual syndrome (PMS) symptoms, perceived stress levels, and pain intensity. Forty-six women with PMS participated in this study and were assigned to the intervention and control groups based on their willingness to participate. The intervention group undertook Pilates practices via video recording twice a week for 8 weeks, while the control group did not engage in regular exercise during the same period. PMS symptoms were assessed using the Premenstrual Syndrome Scale (PMSS), premenstrual stress levels were evaluated using the Perceived Stress Scale (PSS), and premenstrual pain levels were assessed using the McGill Melzack Pain Questionnaire (MPQ) at both the beginning and end of the study. There was a significant difference observed in the PMSS, PSS and MPQ evaluations of the intervention group following their participation in Pilates practices (p < 0.05). Conversely, no significant difference was observed in the PMSS, PSS and MPQ evaluations of the control group at the end of the study (p > 0.05). There was no statistically significant difference between the two groups in PMSS evaluation (p > 0.05) at the end of the study. However, a statistically significant difference was detected in PSS and MPQ evaluations (p < 0.05). Pilates exercise can affectively decrease the perceived stress level and pain severity in PMS affected women. This study highlights the efficacy of Pilates for physiotherapists in PMS symptom reduction. Moreover, the implementation of a self-guided video-based home exercise program could provide patients with practical and time-efficient alternatives.

A holistic approach to supporting death in the home: Implementation of a home hospice program in a northern community–A study protocol

Introduction To enhance support for individuals at end of life to die at home, a new community-driven home-based hospice program was developed–Home Hospice. This wholistic hospice care program, co-designed by hospice care staff, community end-of-life care providers, researchers, and health systems decision-makers, will provide around the clock care to clients and their families. Methods and analysis This mixed methods study, guided by a process evaluation framework, will use secondary client and caregiver data collected as part of regular Home Hospice program processes, as well as primary interview data collected from caregivers at least three months post-death of the client and from hospice staff and volunteers involved in the Home Hospice program. Analysis will include descriptive statistical analysis of quantitative data and thematic analysis employing an inductive and a deductive qualitative analysis approach. Ethics Ethics approval has been received from the University of Northern British Columbia (File No: 6009117). All individuals and caregivers who enroll in the Home Hospice program will be invited to participate in this study. At three months post-death of the client, hospice staff will contact caregivers to ask if they would like to participate in a one-on-one interview with a research team member. Staff and volunteers will also be eligible to participate in one-on-one interviews with research team members. De-identified participant data will be provided by hospice staff to the research team. All participants will provide informed consent prior to participation in the study. Dissemination This study will use an integrated Knowledge Translation/Knowledge Mobilization (iKTKM) lens wherein the research team will work closely and meaningfully with knowledge users and community partners at all stages. Evidence-based and targeted iKTKM products will be created, including community event presentations and social media posts to share findings with participant and community audiences. Further, findings will be disseminated at conferences, workshops, and policy rounds with academic and decision-making audiences. Preliminary and full project findings will be published in high-quality open access journals. Strengths and limitations of this study Co-design of Home Hospice program and evaluation metrics involves researchers, hospice staff, health systems decision-makers, and community members. Evaluation metrics involve prospective collection of service utilization from client, family, hospice, and health systems perspectives. Integrated knowledge translation approach which frames the knowledge dissemination plan for the study findings focuses on a range of audiences, including local citizens, hospice and community end-of-life care providers, health systems decision-makers, and academic professionals. As a one-year pilot study, the number of clients who may be able to participate in this program will be approximately 50 persons.

Understanding caregivers' needs: supporting families of autistic children

Parenting a child with autism spectrum disorder (ASD) poses significant emotional, financial, and social challenges to caregivers. This paper examines the experiences of caregivers, highlighting their increased stress, burnout, and mental health concerns. The importance of accessible information resources, respite care services, emotional support networks, and financial assistance programs is emphasized. Effective strategies for supporting caregivers include educating them about ASD symptoms, treatments, and therapies, teaching coping mechanisms for managing challenging behaviors, and promoting collaboration between healthcare providers and caregivers. Policy implications are discussed, including advocating for legislative modifications that prioritize caregiver needs, promoting inclusionary practices within educational systems, and increasing funding for early intervention programs and caregiver support services. The implementation of parent training programs, collaborative relationships between educators and caregivers, and professional development opportunities for educators are also recommended. This study aims to inform policymakers, healthcare professionals, and educators about the critical role of caregiver support in improving outcomes for children with ASD. By addressing caregiver needs and providing comprehensive support, we can enhance the well-being of both caregivers and children with ASD.

E-EARLY TOGETHER Intervention for Infants at High Risk of Cerebral Palsy: Randomized Controlled Trial Protocol.

The purpose of this study is to evaluate the effectiveness of an early intervention program, e-EARLY TOGETHER, that combines goal-oriented training, parental coaching, environmental enrichment in a telehealth approach in a low- and middle-income country. Protocol for a randomized controlled clinical trial to evaluate the effectiveness of e-EARLY TOGETHER intervention compared to standard guidelines on outcomes related to development and performance in infants at high risk of cerebral palsy. This protocol will inform and enrich clinical practice related to early intervention in low- and middle-income countries. It is expected that the data obtained will contribute to the implementation of effective early intervention programs with positive and lasting results for the child, their family, and the community. Brazilian Registry of Clinical Trials: RBR-7WWJRQ3, registered May 10, 2023; WHO Trial Registration UTN Code U-1111-1286-4639.

Climate-sensitive training for sustainable business in Dickson County with global applications

Purpose This paper aims to examine the implementation and impact of climate-sensitive training programs tailored to the specific climate risks and business needs of Dickson County, Tennessee. It aims to emphasize the importance of integrating climate adaptation strategies into business training and to propose a replicable model that can be adapted to regions facing similar challenges, contributing to global sustainability efforts. Design/methodology/approach The research uses Dickson County’s climate profile as a case study, analyzing its impact on local businesses in sectors such as agriculture, manufacturing and tourism. This paper integrates theoretical frameworks, including organizational learning and adaptive capacity, to provide practical strategies for climate-sensitive training. It further incorporates insights from local institutions, industry partnerships and public data, using a qualitative approach to analyze key themes related to training effectiveness and sustainability. Findings The findings demonstrate that climate-sensitive training significantly enhances the resilience and sustainability of businesses by preparing them to address local climate challenges. Critical factors for successful implementation include stakeholder engagement, industry-specific customization and the continuous evaluation of training outcomes. The model presented shows promise for broader applicability in other regions, especially when localized climate data and collaborative efforts are integrated. Originality/value This paper provides a novel, region-specific approach to climate-sensitive training, distinguishing itself by combining theoretical insights with practical strategies for businesses. By focusing on localized adaptation and stakeholder collaboration, the model addresses an existing gap in the literature on climate adaptation training for smaller, climate-vulnerable regions. This work offers a replicable and scalable framework that contributes to the global discourse on sustainable development and climate resilience in business practices.

Optimization of Acacia auriculiformis A. Cunn. Ex Benth. Seed Germination Using Pretreatment Analysis

Agroforestry resources play a crucial role in conserving biodiversity, stabilizing soils and improving the livelihoods of rural populations. This study investigates the impact of different treatments on the germination of Acacia auriculiformis, an important tree species for soil restoration in Côte d'Ivoire. The work was carried out at the University Jean Lorougnon GUEDE in Daloa. The seeds used for this work were subjected to four treatments, including a control (T0); those soaked for 3 days in ordinary water (T1); a hot water treatment at 60°C (T3); a boiling water treatment at 100°C and a flame treatment (T4). A randomized block design consisting of four treatments in three blocks. The results showed that seed treatment in hot water at 100°C until cooling gave the best germination percentages and germination speed. The results also showed that soaking the seeds in water for three days produced seedlings with the shortest germination time. The study underlines the importance of pregermination for the selection of better-performing varieties and the implementation of effective reforestation programs. It also highlights the need for further research into the impacts of climate change on tree germination and growth. However, for a better policy of extension, production and improvement of this endangered forest species of socio-economic interest, mastery of the requirements of this species while maintaining optimal conditions for its germination in the nursery is more necessary.

Transbronchial lung cryobiopsy for interstitial lung disease: early experience, learning curve, and the impact of sedation on complication rates at a single centre in Japan

BackgroundTransbronchial lung cryobiopsy (TBLC) has emerged as a promising diagnostic tool for interstitial lung disease (ILD). This study aimed to assess the initial experience, procedural learning curve, and influence of sedative medications on complication rates, particularly bleeding and pneumothorax, in the implementation of a TBLC program for ILD diagnosis.MethodsIn this retrospective cohort study, we analysed 119 patients who underwent TBLC at Nippon Medical School Hospital from April 2021 to March 2024. Procedural times, complication rates, and histopathological outcomes were evaluated. The learning curve was assessed using cumulative sum (CUSUM) analysis, focusing on procedure time and biopsy yield. The association between sedative medication dosages and bleeding risk was also examined.ResultsThe overall diagnostic yield was high, with alveolar tissue obtained in 97.5% of cases and a definitive pathological diagnosis achieved in 81.5% of patients. CUSUM analysis revealed a proficiency threshold at approximately 56 cases, with improved efficiency and biopsy yield in the consolidation phase. Fentanyl dosage was significantly associated with reduced bleeding complications (odds ratio 0.51, 95% confidence interval 0.27–0.97, p = 0.041).ConclusionsTBLC is a safe and effective diagnostic tool for ILDs, with a manageable learning curve for procedural efficiency. Sedation, particularly fentanyl dosage, may plays a crucial role in minimizing complications, but further research is needed to clarify this relationship. These findings support the adoption of TBLC as a standard diagnostic approach for ILD and highlight the importance of adequate training and optimized sedation protocols to ensure safety and efficacy in clinical practice.

Dispensing of antibiotics in community pharmacies before, during, and after the COVID-19 pandemic

Abstract Background Antibiotic resistance threatens our capability to successfully treat bacteriological infections, becoming a major threat to public health. Therefore, measures must be taken to minimize de incidence of multi-drug resistant bacterial infections. Antimicrobial Stewardship is a systemic healthcare approach devised to foster, enhance, oversee, and assess the judicious application of antimicrobials, aiming to safeguard their efficacy in the future, whilst advocating and safeguarding public health. In the initial phase, a correct diagnosis of antimicrobial utilization is pivotal for the proper implementation of an Antimicrobial Stewardship Program. Methods A cross-sectional study encompassing the Alentejo region, Portugal, with a specific focus on central Alentejo, was conducted to analyze the dispensing of antimicrobials in community pharmacies, alongside the examination of the prescribing locations, before, during, and after the COVID-19 pandemic, from 2019 to 2023. Results The number of antibiotic packages dispensed decreased, as expected, during the COVID-19 pandemic, but returned to pre-pandemic levels after its conclusion. In several prescribing locations, the proportion of cephalosporins and quinolones exceeded the maximum expected value. Conclusions The implementation of an appropriate Antimicrobial Stewardship Program in this region is necessary to ensure the correct prescription of antimicrobials, decreasing the risk that antibiotic resistance pose to public health. Emphasis on the application of the Clinical Practice Guidelines issued by the Portuguese Directorate-General of Health regarding the proper approach to bacterial infections should be intensified so that all prescribing locations exhibit proportions of cephalosporins and quinolones below the maximum expected value. Key messages • Antimicrobial resistance poses a threat to public health. • Stewardship is crucial for appropriately safeguarding public health by reducing antimicrobial resistance emergence.

Framework for Implementation of Building Automation Control Programs for Industrial Heating and Cooling Systems

This article proposes a novel framework for the rapid implementation of automation programs in industrial heating and cooling systems. The global push for sustainability necessitates significant infrastructural transformations within these systems, which currently rely heavily on fossil fuels and are responsible for 75% of industrial final energy consumption. Our research highlights the critical role of design patterns and object-oriented programming principles to address the complex integration of additional energy converters and storage into automation programs. By leveraging design patterns, our framework encapsulates the intricacies of various components, such as actuators, sensors, and storage, within a comprehensive object-oriented model that also allows the integration of different control strategies. Qualitatively, this approach enhances the reusability, scalability, and adaptability of automation programs. Therefore, quantitatively, our framework enables a more resilient and efficient energy system. The framework is validated through its application to a complex, cross-linked industrial heating and cooling system at the ETA Research Factory of the Technical University of Darmstadt. Using the developed framework reduces implementation effort significantly due to its consistent and modular structure resulting from the reusable design patterns.

Cost per kilogram weight-lost - Lifestyle change program at the Public Health Institute in Croatia

Abstract According to the 2019 European Health Survey, 42% and 23% of the Croatian adult population were affected by overweight or obesity, respectively. Counselling services are available in some Public Health Institutes for free or paid out-of-pocket. The estimated cost per kilogram lost in programs in Europe and the USA ranges from 100-340€, with a justifiable cost estimation for a weight loss intervention being 120-210€. Aim was to demonstrate the cost of losing one kilogram by analysing necessary initial material and human resources, including equipping counselling centres, and estimating the cost of continuous implementation. In the year 2023, 47 participants (31F,10M) with a BMI higher than 30 kg/m2 enrolled in the three-month free Program in the County Public Health Institute in Pozega. The program consisted of personalized assessment, habit change plan, education, counselling and follow-up. An analysis of the minimal required equipment and working hours of physician and a nurse (contracted gross hourly wage rates) was conducted. The main outcome measure was the cost of one kilogram lost by participants at the end of the Program. Program was completed by 41 (22F, 9M) participants (87.2%). Their initial BMI ranged from 30.3 to 47.4 kg/m2. Collectively, they lost 323.2 kg (1.3-24.4kg), with an average of 7.9 kg or 7.4% (1.7-19.8%) of their initial weight lost. The estimated total cost of medical, IT and office equipment, was 9363€. The human resources cost was 9509€, with a specialist and nurse spending 249 and 116 hours, respectively (27.6€/hour and 13€/hour). The initial cost per kilogram lost, including the prerequisites for the work of the counselling centre, was 58.4€. The continuous program cost with equipment already in place is estimated at 27.9€ per kilogram lost. We have shown that the lifestyle management program in the Croatia without extra cost to patients delivers results with a cost of 27.9€ per kilogram weight-lost in continuous implementation. Key messages • The significant impact of obesity on premature mortality and healthcare systems calls for the systematic implementation of effective weight management programs that are available to patients for free. • It is possible to implement effective weight management program in Croatia without extra cost to patients for 27.9 € per kilogram weight-lost.

Advancing Public Health Equity through Expanded Vaccination Services in prison: case studies from Italy and France

Abstract In Montpellier prison in France and San Vittore remand house in Italy, the provision of expanded, age-appropriate, coercion-free, and tailored vaccination services to PLP has emerged as a cornerstone in improving health outcomes within prison settings. The implementation of life course vaccination programs required the full integration of prison health into public health systems building on existing vaccination services covering HBV, flu and COVID-19. In San Vittore, a vaccination clinic aimed at people living in prison was set-up. Universal vaccination status assessment and vaccination catch-up was introduced targeting people admitted into prison. The vaccination clinic-related activities included information and awareness sessions on vaccination and health literacy offered regularly to PLP: increased vaccination knowledge is effective to enhance uptake. The vaccination clinic team consisted of infectious diseases physicians and a health assistant with an anthropological background, who ran the information and awareness sessions combining and adapting core content on vaccination with individual and community social and cultural contexts. Besides seasonal flu vaccination and anti-SARS-CoV-2 immunisation campaigns, vaccinations against pneumococcal pneumonia and herpes zoster were also offered to older and fragile individuals as per national immunization plan. One of the priority objectives of the vaccination clinic was the increase in vaccination coverage against HBV and HPV, not only as a tool for the prevention of infectious diseases, but as an innovative and effective tool of cancer prevention. As part of a more ambitious program to protect sexual health in prison and related to updated screening tools for the early diagnosis of lesions due to HPV infection, vaccination against HPV was also offered as part of a health empowerment project tailored to women in detention, with the aim of building self-awareness of their own health needs.

The Impact of a 12-Week Workplace Physical Activity Program on the Quality of Life of Sedentary Workers: A Pilot Study

Office workers frequently display behavioral patterns marked by extended periods of sedentary and seated work. In this context, the implementation of a workplace exercise program has been shown to be effective in mitigating health-related risk factors. This study aimed to evaluate the impact of a 12-week workplace exercise program on the quality of life of employees whose primary occupational duties involve prolonged sitting. The final sample comprised 19 participants (6 females and 13 males), aged between 21 and 48 years (M = 32.26; SD = 9.03). Among these participants, 78.9% reported engaging in a hybrid work arrangement, 15.8% followed an on-site work regimen, and 5.3% worked remotely. Furthermore, 84.2% of participants reported sitting for 6 to 8 h per day, while 15.8% reported sitting for between 9 and 12 h daily. The quality of life of participants was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey. A paired samples t-test was employed to examine differences between dependent variables. The results revealed a statistically significant improvement in general health (p &lt; 0.01), vitality (p &lt; 0.01), social functioning (p &lt; 0.05), and the mental health summary measure (p &lt; 0.04). Promoting physical activity through workplace exercise programs offers substantial benefits for workers’ health and quality of life, contributing to the prevention of occupational diseases.

Direct annual healthcare costs in survivors of acute pulmonary embolism: estimates based on a prospective multicentre cohort study

Abstract Background Patients surviving acute pulmonary embolism (PE) necessitate long-term care and follow-up. However, the economic impact of PE on healthcare systems after the acute event remains largely unknown. Purpose To estimate the direct cost of PE during the first year after discharge from hospital for the index event, focusing on rehospitalizations, anticoagulant medication, and outpatient follow-up. Methods We analyzed the data from a multicentre cohort study of 1017 unselected patients with confirmed acute symptomatic PE in Germany. After the index episode, the costs of which were not considered, patients prospectively followed an outpatient visit plan at 3, 12 and 24 months. All rehospitalisations were documented with the main and accompanying diagnoses; hospital costs were calculated based on current reimbursement in the German Diagnosis Research Groups (G-DRG) system. The duration and type (central unique drug identifier) of anticoagulant treatment was documented at each visit. Per-patient costs of ambulatory follow-up visits and tests were calculated by multiplying (i) the costs of each visit/test (German ambulatory healthcare services reimbursement catalogue) by (ii) the probability π (0.0≤π≤1.0) of needing that specific service, based on the PE follow-up algorithm of the ESC Guidelines which we populated with the actual results per step in the present study (Figure). The primary analysis was conducted in all patients with ≥3-month follow-up. An additional sensitivity analysis included only the patients completing ≥12-month follow-up. We additionally identified the baseline predictors for the number of rehospitalizations and costs using multivariable zero-inflated Poisson and hurdle regression and accounting for censored data. Results Of 1017 enrolled patients, 958 (94%) were included in the primary analysis. Of them, 24% were rehospitalized, for a marginal mean of 0.34 (bootstrapped 95% CI: 0.30-0.39) readmissions per PE survivor. Age, coronary artery, pulmonary and kidney disease, diabetes, and (in the sensitivity analysis) cancer, emerged as independent cost predictors by multivariable hurdle gamma regression (Table). Estimated overall rehospitalisation costs were €1138 (95% CI 896-1420) per patient (€1171 [908-1479] in the sensitivity analysis). Mean anticoagulation duration was 330 days, with estimated per-patient costs of €1050 (€1190 in the sensitivity analysis). Per-patient costs of ambulatory follow-up visits and tests were estimated at €182, yielding a total cost of illness per PE survivor of €2370-2543. For the entire country, the annual direct costs after acute PE would thus amount to €202-217 million. Conclusions By estimating per-patient costs and identifying major cost drivers of post-PE care, the present study may inform decisions concerning implementation and reimbursement of follow-up programmes aiming at improved overall cardiovascular prevention.TableFigure

Adult Immunization Board: A platform to provide guidelines for implementation of adult immunization

Abstract Background Several organizations, including governments, (inter)national public health organizations and vaccine manufactures are currently considering how adult immunization can be further improved to increase health impact and promote a lifelong approach to vaccination. Despite many organizations thinking about ways to improve adult immunization, there is currently no multidisciplinary discussion platform focusing on this topic at the European level. Therefore, a group of experts in the field of adult immunization established the Adult Immunization Board (AIB). Methods AIB is established with the aim of contributing to the reduction of the impact of vaccine-preventable infections and diseases in European adults. AIB works by organizing 2 meetings per year: 1) a technical meeting to discuss specific technical aspects on adult immunization with subject-matter experts, and 2) a country meeting to discuss country specific aspects of adult immunization together with local experts. Results In April 2023 and 2024 the AIB organized its first technical meetings on “Assessing the health burden of vaccine-preventable infections in European Adults (2023)” and “Strategies for introducing and implementing vaccines for adults into National Immunization Programs in Europe (2024)”. In December 2023, the AIB organized its first country meeting in Italy with local experts to learn out best practices in adult immunization and address aspects to improve. Conclusions AIB is a platform that brings together the different key European stakeholders in adult immunization to effectively contribute towards the implementation and optimization of adult immunization programs in Europe. Key messages • Continued efforts to promote research, implementation, awareness, accessibility, and vaccine uptake are crucial to mitigate the burden of (future) infectious diseases in the adult population. • The AIB represents a significant step towards bolstering adult immunization efforts in the EU.

Training for outbreak response through the Global Outbreak Alert and Response Network

Abstract The WHO designated the Information Centre for International Health Protection (INIG/ZIG 1) at the Robert Koch Institute as the first WHO Collaborating Centre for Global Outbreak Alert and Response (WHO CC GOARN). Its mandate is to aid WHO’s efforts in improving the detection of public health events and enhancing preparedness, readiness, and capabilities for alerts and rapid responses. The main focus of WHO CC GOARN at RKI include supporting WHO in the development and implementation of the GOARN training programme on international outbreak alert and response, as well as facilitating knowledge exchange and information dissemination. GOARN’s extensive engagement in international public health response underscores the need to complement technical expertise with human-centred competencies like effective communication and teamwork, while respecting diversity. On 18 -22 September 2023, WHO CC GOARN at RKI hosted the first “GOARN Outbreak Response Leadership Training Programme”, inviting 24 public health leaders plus highly experienced mentors from all WHO. The training was designed to enhance leadership mind-sets and practices, including advanced interpersonal and situational awareness, managing polarised tension, establishing trusted relationships with stakeholders, and influencing collective decision-making. Alongside expert facilitators and experienced mentors from various fields, participants engaged in open discussion, shared experiences and reflected on lessons from the COVID-19 pandemic and other recent outbreaks. This course provided an opportunity to engage with diverse, experienced and highly regarded leaders, sharing their views and personal experiences on what it means to practise leadership in health emergency response. This training also aimed to build a network of diverse, well-trained and interconnected public health leaders, upholding the principles of diversity, equity and inclusion to ensure that our response efforts resonate with the communities we serve.

Evidence-Based Programs in France: Insights and Strategies for Implementation Support

Abstract Issue In France, both regional and national health institutions increasingly support and fund the implementation of evidence-based programs (EBP), promoted at the national level by the French Public Health agency. Description of the problem practitioners who implement EBP face several operational questions: scaling issues, implementation in specific and varying contexts, integration and adjustment to daily regional practices. Results/effects In 2023, the French Society for Public Health initiated a collaborative effort to create a platform for discussion among practitioners, researchers, and decision-makers involved in EBP implementation. The first step was to assess EPB implementation experiences, using 3 types of data: an analysis of 6 documented EBP (capitalization works), an online questionnaire answered by 29 stakeholders, and four focus groups with funders, researchers, practitioners, and institutions. Data analysis was based on thematic content analysis and structural data analysis. Lessons Different ways to implement EBP were identified through a typology. The results highlight favorable conditions and levers for EPB implementation in France: • Facilitate access and adoption of EBP by concerned stakeholders, including through clear communication and knowledge sharing; • Strengthen and value support for implementation support (i.e., providing necessary resources and continuous monitoring); • A ‘favorable environment’ is also required (i.e. regional context acceptability and information on program themes or topics); • Breadthen perspectives and promote mutual learning through sharing and comparing implementation experiences across regions; • Value transferability and adaptation studies, which are key to enable EBP adaptations to account for context specificities while maintaining effectiveness. The platform’s next steps are to develop deployment tools and structure an advocacy strategy to mobilize stakeholders around the issue. Key messages • Achieving wide-scale implementation of EBP requires to tackle key implementation issues such as scaling, context adaptation, etc. and to give support to implementing stakeholders. • A collaborative assessment helped identify levers and barriers to EBP implementation in France. Involvement in EBP fosters an evidence-based mindset among practitioners.

The cost-effectiveness of a digitally enabled telerehabilitation program delivered nationally to patients in Australia

Abstract Introduction Traditionally delivered cardiac rehabilitation (CR) programs have considerable benefits, yet access and participation remains low. Emerging digital health models offer promise in healthcare delivery, but their benefits and impact on healthcare utilization and cost-effectiveness are uncertain. We conducted a cost-effectiveness analysis of a telehealth program with a CR mobile app for post-hospitalization coronary heart disease (CHD) patients. Purpose To assess whether a digitally enabled CR program is cost-effective compared with a propensity matched usual care control group in the Australian health system. Methods Patients were recruited nationally, through a health insurer, following hospitalization for CHD. Participants received weekly telehealth consultations for up to 8 weeks, supplemented by use of an mHealth app. Using administrative private health insurance claims data, we assessed differences in hospital costs, mortality rates and bed days at 12-months post discharge. Incremental cost effectiveness ratios (ICERS) were calculated to determine the cost per deaths prevented and cost per bed days saved for the digital-CR group (n=133) compared with usual care (n=266). Results Among the cohort, 36% lived in regional/rural areas, 70% were male and the mean age was 68 years. The mean total hospital all cause readmission costs at 12-months were $1,488 AUD less in the digital-CR group ($16,411) compared to the usual care group ($17,899). Digital-CR had fewer total hospital days relative to the usual care group (median of 2 vs 3 days) and patients in the digital-CR group had a significantly lower mortality rate at 12-months post discharge. The ICERs were -$337 per 100 patient deaths prevented and -$3,033 per median bed days saved. Conclusion The implementation of a digital-CR program demonstrates cost-effectiveness for patients with CHD when compared to usual care. Thus, advocating for the widespread availability of digital-CR programs as an option for CHD patients following hospital discharge is warranted.