Local Practitioners Research Articles

Clinician experiences of a hybrid virtual medical service supporting rural and remote hospitals: a qualitative study.

To explore the experiences of clinicians delivering, facilitating, and potentially affected by a hybrid virtual medical model servicing rural and remote hospitals in western New South Wales. Qualitative study using semi-structured focus groups and individual interviews, conducted between 7 April 2022 and 16 March 2023, with rural generalist doctors delivering the Virtual Rural Generalist Service (VRGS) within the Western NSW Local Health District, local site staff, and local general practitioner visiting medical officers (GP VMOs). Key themes in clinician experience of the model and recommendations for improved experience, based on qualitative content analysis. We interviewed 12 VRGS doctors, 25 site nursing staff and nine GP VMOs. Clinicians were overwhelmingly positive about the VRGS, seeing it as providing good quality care and being an innovative and translatable solution to rural workforce challenges. In-person site visits by VRGS doctors were highly valued, especially by local site staff, for team building, skill building and increasing VRGS doctors' understanding of the local context. The VRGS model relies on nursing availability and skill, and creates additional workload for nurses. Nurses in isolated sites valued the clinical support provided by the VRGS. Overall, most GP VMOs valued the fatigue relief offered by the VRGS; however, some viewed the VRGS as diminishing local doctors' autonomy and the viability of their positions. The hybrid VRGS model is widely accepted by clinicians as providing good quality care for patients and high job satisfaction for providers. The service supports the local health workforce and makes rural medical positions more attractive and sustainable. The in-person shift requirement is central to the model's effectiveness and acceptability. Further investment is needed to train and resource local nurses who play an integral role in providing virtual medical care.

Reconfiguring “Heritage hip-hop” From the scenes: Rightful youth rebellion and localised authenticity in the Huxiang Flow

This study builds upon the established frameworks of popular music heritage, scene theory, and Chinese hip-hop politics and authenticity, highlighting the intricate relationship between cultural heritage and hip-hop. Focusing on the localised genre the “Huxiang Flow” from Hunan province, it conducts critical discourse analysis of 98 song lyrics, music videos, and performances, alongside interviews with 20 local hip-hop audiences and practitioners. The research reconfigures “heritage hip-hop,” suggesting that artists leverage their cultural heritage as a strategic resource in their creative processes, thereby achieving nuanced self and local identities, articulating ideological expressions, and fostering emotional dialogues with audiences. Operating on the fringes of legitimate cultural channels, Huxiang flow artists employ elements like revolutionary historical figures and significant sites to enact legitimate resistance. They also utilise everyday environments to critique internal social divisions, shaping forms of everyday resistance through hip-hop, which resonates with local audiences and fosters collective consciousness. This study demonstrates heritage as dynamic to construct legitimate resistance in hip-hop music under Chinese cultural politics. Hip-hop artists are not merely representatives of marginalised groups but are influenced by localised cultural education, which underpins their creative work and informs their use of sophisticated rhetorical strategies to achieve legitimate resistance and promote social cohesion.

Ethno-Medicinal Uses of Dongoria Kandha of Niyamgiri Hill, Odisha, India

Background: In the current study, the Ethnomedicinal data have been collected from tribal people of Niyamgiri hill region of Kalahandi district, Odisha, India. The tribals of this region have been using the medicinal plants to treat various diseases since the time immemorial. Objective: The main objective is to find out the mostly used plant parts and their Ethnomedicinal values used to cure different diseases by tribal people of Niyamgiri hill region of Kalahandi district, Odisha, India. Methods: It includes to record the information on medicinal uses of plant by leading healers by taking interviews and recording the comprehensive knowledge about the medicinal properties of different plants with the snow ball technique and sampling method. Plants are recognized by the local practitioner also known as Kabiraja or Vaidya in forest floor and were classified botanically. Results: The present study records the use of different parts of 50 plant species which belongs to 47 genera of 35 families, against 48 human diseases, with special reference to diarrhoea, dysentery, cold, cough, piles and fever. The practitioners use these plants to treat kinds of ailments like asthma, skin diseases, constipation, diabetes, toothache, wound healing, headache, infertility in women, mouth ulcer, insect bites, ring worms, thirst and eczema. All these medicinal plants are used as healing sources as there is not modern medical facilities available nearby. The collected data are analysed through use value (UV). Bacopa monnieri (UV of 1.50), Bryonia laciniosa (UV of 1.33), Andrographis paniculata (UV of 1.0), Bryophyllum pinnatum (UV of 0.83) and Celastrus paniculalus (UV of 0.83) are the most frequently and popularly used medicinal plant species in the study area. Conclusion: 50 plant species that were collected from Niyamgiri hill region. It is found that still a large number of tribal people use their traditional knowledge and culture and have adopted herbal therapy for most of the diseases because of the strong belief of the local practitioners.

Assessing The Capability of Disaster Risk Reduction and Management in Marikina City

This study assesses the capability of disaster risk reduction and man-agement (DRRM) in Marikina City, Philippines, aiming to enhance disas-ter resilience through effective implementation of Republic Act 10121 the Philippine Disaster Risk Reduction and Management (DRRM) Act of 2010. The research assesses Marikina City's implementation and chal-lenges across disaster prevention and mitigation, disaster preparedness, disaster response, and disaster recovery and rehabilitation. Utilizing a quantitative methodology, data were collected from Marikina City Disas-ter Risk Reduction and Management Office (MCDRRMO) personnel, ba-rangay officials, and residents to evaluate implementation levels and identify challenges. This research contributes significantly to under-standing local government DRRM capabilities in urban disaster-prone areas. It provides valuable insights for policymakers and practitioners, highlighting effective practices and areas for further improvement. The study found that continuous capacity building, community engagement, and inter-agency collaboration are critical for strengthening Marikina City's resilience. It offers valuable recommendations for local policy-makers and practitioners to address identified challenges and improve DRRM implementation."

Pengembangan Ekonomi Lokal melalui Budidaya Rumput Laut dalam Meningkatkan Perekonomian Masyarakat Pesisir

Pontap Village in Palopo City is one of the seaweed cultivation locations. The focus of developing this cultivation is to overcome the unemployment rate and increase community income. This study aims to provide an overview of the development of seaweed cultivation in improving the economy of coastal communities, especially around Pontap Village, Palopo City. The technical aspects of seaweed cultivation businesses make seaweed cultivation activities very popular with coastal communities, which are relatively easy with a short maintenance time. In contrast, from an economic aspect, this business is not just profitable but highly lucrative because the investment and production costs are relatively cheap. The type of seaweed that has economic value that is developed in Palopo City is the Gracilaria sp. type. So it can be concluded from the results of this study that seaweed cultivation efforts positively impact local communities' welfare. However, challenges related to the management of natural resources and environmental impacts need to be considered to maintain the sustainability of seaweed cultivation. This can be seen from the community's behavior in managing seaweed, which still ignores environmental factors. This certainly contradicts the concept of integrated coastal area conservation. These findings provide important insights for local stakeholders, government, and development practitioners.

Between International Policy and Local Practice: Nepali Service Providers' Constructions of Domestic Violence in Context.

The conceptualization of social problems is an important site for examining the extent to which the knowledge and priorities of local practitioners are reflected in international policy. This study employed critical discourse analysis to examine the constructions of domestic violence (DV) used by service providers in Pokhara, Nepal, as compared with two major international women's human rights policy documents. Both constructed DV as a human rights issue that should be contextualized within patriarchal and intersecting oppressions. Service providers additionally emphasized the denial of rights and entitlements of family life as DV. This finding underscores the long-term risks that survivors navigate and suggests that international human rights policymakers should broaden conceptualizations of DV.

Exploring challenges and politics of knowledge production in the global South - Evidence from Bangladesh’s aid and development sector

This article takes Bangladesh as a case study and explores the motivations (or lack of), challenges, and politics of knowledge production with a particular focus on development scholarship and practice. This piece is based on qualitative research methods and draws from 25 semi structured interviews with highly experienced and senior Bangladeshi development practitioners and academics. Empirical evidence and consequent analysis presented in this work contribute to the debates around the schism in access to resources, politics of aid, and power over knowledge production. This article also reveals local cultural contexts as consultancy works are perceived to be more financially rewarding. This is manifested through current practices that have created a condition where local researchers and practitioners feel they have no time (or incentive and motivation) to engage in knowledge production. Moreover, this article explores whether one’s race and/or nationality play any role in knowledge production, and how the respondents reflect about these issues based on their lived experience. In doing so, findings of this study further the arguments of structural inequality and colour-blind approach within aid and global development landscape. This article offers a rich account of how existing practices favour staff members from the donor countries and exclude Bangladeshi researchers and practitioners from knowledge production processes. This article also brings forward an important issue which highlights that, as perceived by the respondents of this study, one’s institutional affiliation with prestigious Western institutions might matter more in knowledge production (as we know it) than the content, ideas and credibility of knowledge that are generated in the global South. This article contends that by excluding, rejecting, side-lining, and subjugating knowledges produced in the global South development policies and practices will continue to manufacture a particular type of knowledge that will circumvent equity in knowledge production and perpetuate Western hegemony.

In vivo biological screening of extract and bioactive compound from Ficus benghalensis L. and their in silico molecular docking analysis.

Ficus benghalensis has been used by local health care practitioners to treat pain, inflammation, rheumatism, and other health issues. In this study, the crude extract and diverse fractions, along with the isolated compound of F. benghalensis were examined for their roles as muscle relaxants, analgesics, and sedatives. The extract and isolated compound 1 were screened for muscle-relaxant, analgesic, and sedative actions. The acetic acid-mediated writhing model was utilized for analgesic assessment, the muscle relaxant potential was quantified through traction and inclined plan tests, and the open field test was applied for sedative effects. The extract/fractions (25, 50, and 100 mg/kg) and isolated compounds (2.5, 5, 10, and 20 mg/kg) were tested at various doses. A profound (p< 0.001) reduce in the acetic acid-mediated writhing model was observed against carpachromene (64.44%), followed by ethyl acetate (60.67%) and methanol (58.42%) fractions. A marked (p< 0.001) muscle relaxant activity was noticed against the isolated compound (71.09%), followed by ethyl acetate (66.98%) and methanol (67.10%) fractions. Regarding the sedative effect, a significant action was noted against the isolated compound (71.09%), followed by ethyl acetate (66.98%) and methanol (67.10%) fractions. Furthermore, the binding modes of the isolated compounds were explored using molecular docking. The molecular docking study revealed that the isolated compound possessed good binding affinity for COX2 and GABA. Our isolated compound may possess inhibitory activity against COX2 and GABA receptors. The extract and isolated compounds of Ficus benghalensis can be used as analgesics, muscle relaxants, and sedatives. However, detailed molecular and functional analyses are essential to ascertain their function as muscle relaxants, analgesics, and sedatives.

Religious Belief, Calling, and Marginalized Communities

This paper attempts to identify the Christian religious beliefs that motivate and sustain engagement in neighborhood revitalization efforts with marginalized communities and to identify a possible causal mechanism of these beliefs. The argument of the paper is that a transcendent calling forms consistently salient beliefs that operate on a deontological (versus utilitarian) level through sacred values. Using a mixed-method approach of quantitative (survey) and qualitative (interviews) data, the results find significant differences in beliefs between local congregants and practitioners in Evansville, Indiana, USA. In one-on-one semi-structured interviews, practitioners cite a transcendent calling with deontological language as the reason for their engagement with marginalized communities. Utilitarian language was not entirely absent during these interviews, but it occurred primarily in relation to the sustaining of the behavior, thereby hinting at a hierarchical and sequential structure where the primary and initial motivation is deontological in nature followed and sustained through utilitarian language. Narrative evidence for this initial deontological shift is that of taking a “step of faith.” The large majority of practitioners report receiving this call after their initial engagement with a marginalized community suggesting that increasing this behavior is more a matter of increasing personal exposure rather than articulating better rational arguments.

Principles, barriers and enablers to agroecological animal production systems: a qualitative approach based on five case studies

Agroecology is among the most promising options to alleviate the negative impacts of animal farming on the environment and build local food systems based on ethically-acceptable production methods. So far, most of the research on agroecological animal production systems was conducted at farm scale, and the potential of agroecological principles addressing social dimensions and food system level approaches has been underexplored. Here, we analyze how the whole set of agroecological principles was mobilized in five case studies on grassland-based, silvopastoral or integrated crop-livestock systems in Switzerland, Guadeloupe, French uplands, Bulgaria and Andalucía. Following a multilevel perspective, we propose a new eight-category framework to categorize barriers and enablers in these different socioecological contexts, and discuss the implications of these results for scaling out and scaling up agroecological niche innovations in animal production areas. Though we could observe activities related to each agroecological principle in each case study, the relative importance of each principle differed. For instance, in Switzerland the focus was on ecological processes operating in multi-species mixtures, and therefore on mobilizing principles of input reduction, synergy, soil health and biodiversity, while in Andalucía, a civil society organization, a regional agricultural office, researchers, and farmers mainly mobilized transformational principles at the food system level, e.g. social values, connectivity and participation. Such contrasts highlight how agroecology allows different equilibria among principles, adapting to the needs of farmers and local communities. Inadequate infrastructure and lack of technology were frequently reported as barriers to agroecological transitions. Policy needs to go beyond the mere support of agroecological practices on livestock farms and adopt a systems approach looking downstream and upstream if it is to enable a large-scale agroecological transition with EU public policies. Market as an enabler was linked to direct sales and short distribution circuits, generating added value to the benefit of local communities. Most agroecological systems benefited from a positive image among citizens and consumers, but cultural barriers resulted from change in product characteristics, e.g. veal meat color in dairy system that promote long-lasting cow-calf contact. All case studies were very advanced in the social dimensions of agroecology, and cooperation networks were always reported among the enablers for scaling out. The multi-actor network approach fostered knowledge exchange between farmers, researchers and citizens, and allowed participants to share values. Long-term commitment from local practitioners is required so that co-designed solutions are implemented, which can strengthen the economic and social viability of animal production areas.

Practitioners' Needs for Addressing the Challenges of Sea-Level Rise-A Qualitative Assessment.

Practitioners at the local and regional scale are under increased pressure to reduce risks to people and property posed by the threats of sea-level rise (SLR) and associated impacts. To achieve this, a dialog between practitioners and scientists is imperative. Current research documents impacts of SLR, evaluates local SLR adaptation activities, identifies barriers to action, and works to assess local adaptive capacity. Despite this work, there has been little qualitative assessment of practitioners' needs when it comes to translating SLR science into local changes. To fill this gap, we used a combination of semi-structured interviews and surveys. The interviews revealed practitioners' needs, the tools they use, the challenges they face, and the contexts in which they make decisions. The survey allowed practitioners to rank potential interventions according to the level of impact they believed it would have on coastal adaptation planning. In total our study includes the perspectives of 142 practitioners from 24 states, Puerto Rico, the Mariana Islands, and Barbados. Corroborating earlier work, we find that resources broadly and funding specifically is the largest barrier faced by practitioners. We find that practitioners need more localized information and models supported by on the ground monitoring, decision support resources that allow for comparison of different scenarios, and communication tools that will enable them to engage with key audiences. These needs suggest a critical shift toward building trusted relationship between scientists and local practitioners and the need to bolster organizations that can support a bridge between these two contexts.

Examining the Tourism Development in Bulacan Province, Philippines: Assessing Factors Shaping Tourism Growth

This research endeavors to assess the current state of tourism in Bulacan Province in the Philippines, examining the factors that influence its growth. It aims to provide valuable insights for local policymakers, stakeholders, and industry practitioners. Employing a quantitative approach, data is collected through surveys and statistical analyses to gain a comprehensive understanding of tourism dynamics in Bulacan. Key factors affecting tourism expansion, such as landscape, accessibility, and hospitality, are closely examined. Challenges faced by tourists, particularly in transportation and accommodation, are highlighted as significant factors influencing their experiences. Strategies to address these challenges are explored, offering practical recommendations to enhance the province’s tourism potential. The study’s findings contribute to the existing knowledge on destination management and regional tourism development. They offer guidance to policymakers, tourism planners, and industry stakeholders in devising effective strategies to leverage Bulacan’s unique attributes, promoting sustainable tourism growth and establishing the province as a prominent tourist destination.

Treatment ineffectiveness towards Haemonchus contortus is highly prevalent in sheep and goat farms of North-Eastern Italy

BackgroundAnthelmintic resistance (AR) is a global threat to grazing livestock farming. In Italy, anthelmintic efficacy remains high compared to other European countries, but many parts of the country haven’t been investigated yet. Local veterinary practitioners from Trentino and Veneto regions reported suspected inefficacy towards anthelmintic drugs in some of their farms, prompting a study on AR in sheep and goat farms of northern Italy. The study aimed to assess anthelmintic effectiveness using genus-specific faecal egg count reduction tests (FECRT), to detect differences in treatment response among nematode genera involved in the infection.ResultsTwelve farms (6 sheep and 6 goat farms) were included based on clinical suspicion of AR. Treatments were carried out with either benzimidazoles (BZ) or macrocyclic lactones (ML) Treatment was effective in 3/6 goat trials, with reduced effectiveness to BZ in two farms and to ML the last one. In sheep farms (6/6), effectiveness was consistently and more severely insufficient. Ineffectiveness was particularly high towards Haemonchus contortus, while Oesophagostomum/Chabertia maintained susceptibility in nearly all trials. Trichostrongylus/Teladorsagia exhibited intermediate results.ConclusionsThis study reveals diminished efficacy of both BZ and ML in small ruminant farms in north-eastern Italy, an area previously lacking data on the topic, except for goats in South Tyrol. Variability in treatment responses among nematode genera support suspicions of AR, and further concerns are raised by the prevalence of treatment ineffectiveness against the highly pathogenic Haemonchus contortus. This finding underscores the urgent need for comprehensive AR monitoring in the area and improved management practices to prevent further resistance development and protect livestock health.

Towards understanding capacity development as a system: perceptions from multiple conservation stakeholder groups in Bhutan

Summary Capacity development is crucial for enduring conservation success. Recent scholarship has called for a systems perspective based on input from local stakeholders to better understand and develop conservation capacity. However, few studies have adopted such an approach to explore interactions among capacities or how capacity development needs and priorities evolve. We address this gap through a case study from Bhutan, centred on perceptions from 52 local conservation practitioners, planners, funders and community members. We use mixed methods to identify which capacities have been important for conservation success, which capacities are needed for future success, which capacities are foundational and how capacities interact. We find that capacity needs have shifted from individual-level knowledge and skills to community- and societal-level capacities in response to changing political and economic dynamics. Participants identified political support and leadership, reliable and sufficient funding, strengthening the research base, and increasing community awareness and engagement as critical future needs. Investing in these capacities holds the promise of further augmenting capacity development, thus increasing the value of limited resources. Our results demonstrate that capacity development should be viewed as a dynamic process and supported by strategic investment even in countries with track records of conservation success.

Literature Review: Innovations in Business Learning to Enhance Competencies and Insights of Vocational Students

This research focuses on improving the competencies and insights of students in business learning at Vocational High Schools (SMK). Lack of innovation in teaching methods often results in a disinterest and lack of understanding of business materials. The study aims to explore and implement innovative approaches, such as technology integration and project-based learning, to enhance students' learning experiences. The use of technology, project-based learning, and collaboration with local business practitioners have shown positive results in increasing students' interest and understanding of business materials. The study emphasizes the importance of adopting innovative teaching methods to improve the relevance and effectiveness of business education in Vocational high schools.

Icelandic Prevention Model in Rural Appalachian Communities: Gauging Stakeholder Experience with the Core Processes Three Years into County-Level Implementation

Background: This study assessed stakeholder experience with the core processes of The Integrated Community Engagement (ICE) Collaborative, a primary prevention approach addressing adolescent substance use in rural West Virginia, after three years of county-level implementation. Objectives: Guided by the Icelandic Prevention Model (IPM), the ICE Collaborative aims to enhance cooperation between researchers, policy makers, local practitioners, and community members and facilitate a paradigm shift in youth and community substance use prevention. This shift involves moving away from strategies focused on the repeated allocation of short-term grants that fund time-limited programs to a long-term, holistic, and sustainable approach overseen by local practitioners and coalitions. Results: We conducted qualitative interviews and focus groups with 33 stakeholders during the fall of 2022. Data analyses generated six major themes: 1) It Takes a Village to Prevent Adolescent Substance Use, 2) Improving Understanding and Commitment to Prevention Through Outreach, 3) Enhancing Student Engagement and Program Accessibility, 4) Addressing the Chronic Underfunding of Prevention and Youth Development Programs, 5) Acknowledging Family Contexts and Family Member Substance Use as Risk Factors, and 6) ICE/IPM Inspiring Solution-based Conversations, Goal Setting, and Strategy Selection. Conclusions: Stakeholders reported multiple positive characteristics of ICE for their communities and applauded the long-term focus and access to local data. Several suggestions for improved strategies were also reported. Results are discussed in line with the theoretical underpinnings of the IPM and current discourse around community health promotion in rural areas.

Needs and opportunities for developing health and well-being profiles in Estonian local governments

Abstract The creation and implementation of health and wellbeing profile, an evidence-based framework for planning health promotion as holistic process, is the responsibility of public health practitioners, who tend work part-time and sometimes lack professional competences. The current study maps the level of awareness, attitudes, needs and possibilities of local government leaders and public health practitioners to develop and implement profiles effectively in Estonian local governments. Semi-structured interviews with leaders in local governments (10) and practitioners (9) were conducted in 2022-2023. Data was analysed using qualitative content analysis. Sample included representatives from all Estonian local governments (79 in total) and were categorized into subgroups based on local governments size, status of the profile, public health specialist employment, and educational background. Preliminary results indicate that leaders find as a supportive factors for enabling and encouraging profile compilation process for example: mandatory requirement; motivated implementors; well organized and effective workplan. Specialists find supportive factors to be cooperation on the national level, good communication practices and joint responsibility. Barriers for health promoters are the lack of time, motivation, financial resources, stakeholders understanding and meaningful action. The first qualitative study on these topics in Estonia highlight that creating a profile is supported by previous positive experience and have per contra an opposite negative effect to start the process. In general, the profile was considered necessary for helping identify problems and support decision-making processes for managing resources, however, assessment whether the profile should be obligatory is needed. In addition, there is a need for further support for the evidence-based decision-making process on the local level in health promotion by offering education and guidance from the national level. Key messages • Knowledge about the importance of public health, barriers and decision-making principles of local government leaders and specialists helps to develop interventions based on actual needs. • Continuously updated health and well-being profile ensures sustainability of health promotion action and is useful knowledge to policymakers, local government leaders and public health practitioners.

The adoption of a place-based framework to inform municipal health strategies

Abstract Background Health is a place-based issue. Research shows that inequalities in health are significantly influenced by social, economic, and environmental factors, making local policies related to these domains critical determinants. Yet, place-based health planning remains underutilized by local practitioners, not receiving adequate attention from policy-makers. Departing from the Municipal Health Strategy of Coimbra, this presentation aims to showcase the framework used for guiding municipal health planning, addressing multidimensional factors, geographic analysis, intersectoral collaboration and participatory approaches. Methods The conceptual and methodological framework followed a population health approach with a geographic lens, looking at how the health outcomes and health determinants were geographically distributed across the municipality (data disaggregated at sub-municipal level), as well as the extent to which policies from multiple sectors can address them. The planning cycle followed an iterative seven-stage process based in five key actions: 1 - Assess (Health Profile), 2 - Prioritize (Priorities), 3 - Plan (Objectives and Strategies), 4 - Implement (Action Plan) and 5 - Monitor (Targets and Measures, Monitoring Plan). Participatory processes were conducted involving local stakeholders and citizens to identify needs, establish priorities and actions. Results The framework for action integrates 14 goals and 94 actions across six policy domains: Sustainable Mobility and Public Places, Safe and Adequate Housing, Accessible Healthcare, Social Cohesion and Participation, Education and Health Literacy and Intersectoral and Collaborative Leadership. Conclusions Adopting a place-based framework to health planning, involving a geographical and multidimensional health assessment as well as the participation of local stakeholders and citizens, was considered effective in turning evidence into practice. Key messages • Municipal health strategies should be developed with a place-based perspective, prioritizing health as the focal point across various intersectoral municipal policies. • The integrated framework shed light on the experience of co-creation to inform health-oriented planning, ensuring that actions address specific needs of localities.

Ensuring sustainable impact of the national report on climate change and health in Germany 2023

Abstract Issue/problem The Robert Koch Institute recently coordinated a status report on climate change and health for Germany, detailing the current and future impact of climate change on health through 14 chapters. Description of the problem A central aim was to ensure the report’s long-term impact and public health value. Essential areas of focus have therefore been stakeholder-specific communication and establishing a network of experts for continued scientific exchange. Results The publication of the report as peer-reviewed articles has served to reach the scientific community. Another target group are public health practitioners and decision makers at subnational levels, who can contribute towards climate change mitigation and adaptation measures relevant to health, as recommended in the report. This latter group was reached through various methods and formats of science communication, including conferences aimed at the public health sector, through target-group oriented podcasts, social media engagement and digital town hall discussions. Following publication, the experts involved in writing, reviewing and using the report were invited to establish a network in order to support long-term scientific exchange and collaborations and in turn ensure the report’s sustainable impact and value. Lessons Through follow-up evaluations, the reception of the report and the further communication needs of this target group were analysed. A major lesson was to include the insights of public health practitioners more systematically and at an earlier stage in any future reports. As for the establishment of a network, a survey amongst the authors and other experts showed what this group considers the goals of this network: creating synergies and connections with existing initiatives and providing a platform for further exchange, especially amongst researchers addressing similar questions, such as the efficacy of mitigation and adaptation measures, from different angles. Key messages • Local public health practitioners are important stakeholders for climate change and health for ensuring public health impact. • The expertise in the network will support continued scientific exchange on climate change and health and thus ensure the national report’s sustainability.

Long-Term Effects of Empagliflozin in Patients with Chronic Kidney Disease.

In the EMPA-KIDNEY trial, empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, had positive cardiorenal effects in patients with chronic kidney disease who were at risk for disease progression. Post-trial follow-up was designed to assess how the effects of empagliflozin would evolve after the discontinuation of the trial drug. In the active trial, patients with chronic kidney disease were randomly assigned to receive either empagliflozin (10 mg once daily) or matching placebo and were followed for a median of 2 years. All the patients had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m2 of body-surface area or an eGFR of at least 45 but less than 90 ml per minute per 1.73 m2 with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Subsequently, surviving patients who consented were observed for 2 additional years. No trial empagliflozin or placebo was administered during the post-trial period, but local practitioners could prescribe open-label SGLT2 inhibitors, including open-label empagliflozin. The primary composite outcome was kidney disease progression or cardiovascular death as assessed from the start of the active-trial period to the end of the post-trial period. Of the 6609 patients who had undergone randomization in the active trial, 4891 (74%) were enrolled in the post-trial period. During this period, the use of open-label SGLT2 inhibitors was similar in the two groups (43% in the empagliflozin group and 40% in the placebo group). During the combined active- and post-trial periods, a primary-outcome event occurred in 865 of 3304 patients (26.2%) in the empagliflozin group and in 1001 of 3305 patients (30.3%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.72 to 0.87). During the post-trial period only, the hazard ratio for a primary-outcome event was 0.87 (95% CI, 0.76 to 0.99). During the combined periods, the risk of kidney disease progression was 23.5% in the empagliflozin group and 27.1% in the placebo group; the risk of the composite of death or end-stage kidney disease was 16.9% and 19.6%, respectively; and the risk of cardiovascular death was 3.8% and 4.9%, respectively. There was no effect of empagliflozin on death from noncardiovascular causes (5.3% in both groups). In a broad range of patients with chronic kidney disease at risk for progression, empagliflozin continued to have additional cardiorenal benefits for up to 12 months after it was discontinued. (Funded by Boehringer Ingelheim and others; EMPA-KIDNEY ClinicalTrials.gov number, NCT03594110; EuDRACT number, 2017-002971-24.).