Local Practices Research Articles

How Big Tobacco exploits the UN SDGs to advance its own goals

Abstract Globally, the tobacco industry poses a major barrier to the advancement of the Sustainable Development Goals through its influence on SDG 3 (health and well-being), 8 (decent work and economic growth), 13 (climate action), and 17 (partnerships for the goals). Soon after the launch of the SDGs report, Big Tobacco immediately used it to promote its own agenda for development in LMICs such as Lebanon. Using the commercial determinants of health model, this presentation will highlight global and local tobacco monopoly practices, specifically the Lebanese Regie, as a commercial actor and their practices linked to the SDGs to illustrate how the tobacco industry compromises SDG advancement. The presentation will also address some of the system level attributes that serve to perpetuate such practices in Lebanon, allowing for tobacco industry free reign in the country. The presentation will end with suggestions on how LMICs, such as Lebanon, can address the growing industry influence on advances in SDGs and discuss potential measures to curb harmful commercial actor practices.

Strengthening public health professionals in policymaking in the Eastern WHO European region

Abstract Background The collaborative research between EUPHA and WHO aimed to explore factors impacting public health professionals’ (PHP) involvement in health policy processes in the Eastern WHO European Region, addressing barriers, enablers, and capacity-building needs. Methods Utilizing a mixed methodology, the study employed document analysis, scoping review, and interviews to triangulate data, with the document analysis focusing on 4 published Essential Public Health Operations Self-Assessment Reports, the scoping review analysing 15 key articles, and 5 semi-structured interviews providing additional insight from key country stakeholders. Results Core findings revealed significant barriers impeding PHPs' participation in policy processes. Among others, these included limited intersectoral collaboration, shortage of skilled public health (PH) personnel, financial resource constraints and inadequate governance structures. Conversely, several enablers were identified, such as a positive trend in increased intersectoral collaboration and innovative governance structures during Covid-19, the development of more trained PHPs and the utilization of International Health Organisations. The two main capacity building needs reported were the importance of modernizing PH education and promoting intersectoral collaboration. Conclusions This study offers a preliminary overview of how PHPs' involvement in health policy processes in these countries can be enhanced: More intersectoral collaboration, updated PH education curricula and trainings, and governance re-design building on positive trends seen during the pandemic. Following actions are recommended: Creation of an international platform for cross-sectoral PH communication & exchange, direct support for universities and PH researchers, development of comprehensive PH trainings, assistance in forming or strengthening national public health associations and identification & sharing of effective local governance practices. Key messages • This research identifies barriers to PHPs’ participation in Eastern WHO European Region's health policy processes, while highlighting enablers like increased collaboration during Covid-19 to build on. • Recommendations to harness the enablers include clear actions such as creating an international public health platform for interaction and exchange or build-up of national public health associations.

Needs Assessment for Primary Care for Best Practice Implementation: The CIRCE Joint Action

Abstract Introduction CIRCE is a Joint Action (JA) supporting the transfer of six best practices (BPs) to new primary care settings in Europe. High-quality needs assessment can set the foundation for strong planning and implementation of the CIRCE-JA best practices in these new primary care settings. Methods A needs assessment tool was developed based on the TO-REACH knowledge transfer framework and learnings from a scoping review of international knowledge transfer frameworks. The needs assessment provides structured tool for local sites to self-assess the alignment of the BP with local priorities, readiness of the local site to successfully implement the BP, the availability of necessary leadership, resources and partnerships, and an examination of barriers to local BP implementation and mitigation strategies. Results Twenty-six CIRCE-JA teams completed the needs assessments. Local teams identified the CIRCE-JA BPs were value-adding and aligned with local priorities. Cross-cutting barriers were identified which were common among the six CIRCE-JA best practices across five thematic areas: (1) provider level, (2) intervention level, (3) health system/policy level, (4) partnership and physical resources and (5) information technology. The needs assessment supported primary care sites with a structured approach to planning for transfer of BPs to their local setting that is based on established international best practices and knowledge transfer frameworks including early identification of barriers and mitigating strategies. Conclusions The needs assessment has supported teams with conducting a self-assessment and informing initial planning for adoption of the BP in their local primary care practice. Given the importance of the local needs assessment to high quality implementation of BP the CIRCE-JA experience with local needs assessment may provide learnings for future BP transfer initiatives. Key messages • Local needs assessment supports the transfer of best practices to primary care settings, which is a critical component of service transformation during the post-COVID-19 period. • For successful transfer of best practices in primary care, it is vital to give to examine such as provider capacity, available human resources, health policy, and information technology.

Risk communication with migrants: Lessons learned from the COVID-19 Pandemic experience in Malmö

Abstract Background During the COVID-19 pandemic, many migrants faced challenges in accessing, comprehending and implementing information, leading to mis- and disinformation and distrust. The pandemic underscored the importance of effective risk communication (RC) and community engagement (CE) that reaches all segments of society, both for managing health effects and preventing the reinforcement of discrimination and stigmatization. This study aims to describe the experience of RCCE targeting migrants in Malmö, Sweden, from an expert perspective. Further, to gain an in-depth understanding of the requirements for inclusive RCCE actions and to identify alternative or complementary strategies based on good local practices. Methods Individual interviews were conducted with experts representing civil society and public authorities who were purposely sampled based on their engagement with RCCE targeting migrants. The interview guide was based on a review of international guidelines addressing aspects of RCCE, and analysed with content analysis. Results Three key organisations working towards undocumented migrants; unaccompanied minors; and newly arrived refugees, respectively, were included. Findings are synthesized into three key insights: a) RC through trusted sources in safe spaces; b) Understanding migrant living conditions c) Promoting intersectoral collaboration and feedback loops. Experts underscored the importance of cultivating sustainable and relationships with migrant communities to effectively communicate, aiding in compliance and counter distrust. The significance of intersectoral collaboration and communication pathways was highlighted for assessing migrant specific needs and designing appropriate interventions. Conclusions Long-term trusting relationship facilitate RC. Embedding sustainability within intersectoral collaboration structures is imperative to facilitate swift mobilization during health crises, foster resilience, and counter health inequities.

Mortality and causes of death in Serbia: redistribution of garbage codes to ischemic heart disease

Abstract Background Cardiovascular diseases are ranked as the number one cause of death in Serbia, and one-fifth of them present ischemic heart disease (IHD). However, the physicians certifying the cause of death have either not been adequately involved in how to complete a death certificate according to the current International Statistical Classification of Diseases (ICD-10) or due to a high level of administrative tasks sometimes fail to complete the process of death certification. That is why we aimed to investigate the garbage codes (GCs) and the effects of their redistribution on underlying cause of death (CoD) estimates for IHD for 2015 and 2020. Methods Data from Belgrade mortality statistics in 2015 and 2020 were used to describe the occurrence and redistribution of garbage codes (GCs), defined as unspecified or impossible causes of death. In order to redistribute GCs we observed the underlying, antecedent, immediate causes and other conditions that contributed to deaths. Redistribution was done by consulting GBD methodology for GC proportional redistribution. The ICD-10 code range for IHD is I20-I25. Results In Belgrade, 17% (4022/23663) and 20.9% (5818/27775) of the deaths were coded with a garbage code in 2015 and 2020, respectively. In 2015, 2102 deaths (10.7% of all well-defined CoD) were attributed to IHD, while in 2020, 1806 (8,2% of all well-defined CoD) deaths were attributed to IHD. Finally, we redistributed a total of 452 deaths (GC type 1 203.9, GC type 2 122.1 and GC type 3 126.2 deaths) and 572 deaths (GC type 1 250.1, GC type 2 110.9, GC type 3 210.7 and GC type 4 22) due to IHD in 2015 and 2020, respectively. These calculations indicate a total number of 2554 and 2378 deaths due to IHD in 2015 and 2020, respectively. Conclusions A more detailed analysis of local practices, as well as continuing medical education in the field of death certification, could be a step forward in the future process of decreasing the number of GCs. Key messages • Since the huge number of deaths was added to ischemic heart disease in 2015 and 2020, it is crucial to focus on a more reliable disease surveillance system including better coding practices. • A deep understanding of the garbage codes and their redistribution could significantly shape future decisions on factors contributing to ischemic heart diseases.

Echo triaging works. How to use international guidelines

Abstract Introduction Transthoracic echocardiography (TTE) is the first-choice non-invasive imaging modality for the assessment of cardiac structure and function due to its wide availability, speed, cost-effectiveness and reproducibility. Therefore, there is exponential increase in demand in TTE across all specialties in medicine and surgery. Hence, it is important to carefully triage patients according to current international guidelines. Purpose To reduce inappropriate TTE scans by using guideline driven indications in triaging echo scans in the UK tertiary hospital. Methods Strict list of guidelines driven indications adapted to local practice was used for triaging echo requests which included both inpatient and outpatient TTEs. The 4 objectives: appropriateness, completeness of requests as well as impact of performed studies on the follow-up and patient management plan were assessed before and after implementation of new triaging tool. To ensure similar working and staff environment was sustained we studied the pattern of referrals in the same month of the year- September. The triage process was conducted by accredited physiologists. The same month was chosen to reflect true change of practice. Change in patient management and follow up were evaluated for a minimum duration of 6-months. Results Overall there were 1112 TTEs performed in September 2022 and 1081 - in September 2023. Prospective TTE referral triaging began in March 2023. We have studied and analyzed above criteria retrospectively. In 2022 there were 18% inappropriate requests; 37% of requests lacked sufficient clinical information and 10% of studies did not lead to change in management plan according to clinical letters. There was also high proportion of inappropriate requests for inpatients (9%). Within 6 months of implementation there was a significant improvement in the appropriateness (82% vs. 99%, p<0.001), with increase in supply of adequate clinical information (63.4% vs. 86.1%, p<0.001). However, there was no significant change using TTE study results in changing patient management (10%). All inpatients had 100% appropriate requests. Conclusion The implementation of triage criteria resulted in a significant improvement in TTE referrals: both in appropriateness and completeness of requests. However, some clinicians did not use echo in patient management plan. Future research on lack of use of TTE results in clinical practice might help to utilize the limited echo capacity to full.

Effects of Habitat Loss on Tenebrionidae in Gravel–Sand Mulching Areas of Desert Steppe in Ningxia, China

The desert steppe in Ningxia is the largest natural steppe type in the region, characterized by a fragile ecological environment and low carrying capacity. Gravel–sand mulching, a local agricultural practice, involves using a sand and gravel covering layer to maintain soil warmth and moisture. However, this method has led to ecological problems, such as habitat loss and biodiversity loss. Tenebrionidae, one of the most widely distributed beetle families, is commonly used to indicate habitat degradation and is a significant steppe pest in desert steppe areas. This study, conducted in the gravel–sand mulching areas of Shapotou District, Zhongwei City, Ningxia, classified the habitat loss from low to high in these areas into five grades (I-V) and examined the effects of habitat loss on Tenebrionidae. We collected 6565 Tenebrionidae, with Blaps femoralis, Anatolica nureti, and Pterocoma vittata being the dominant species. The findings reveal that habitat loss grade I had the highest abundance, diversity index, and evenness index of Tenebrionidae, significantly higher than those of grades II–IV. Habitat loss had a significant negative effect on Tenebrionidae abundance, a significant positive effect on the richness index, no significant effect on the vegetation diversity index, a significant positive effect on soil available potassium (APP), and a significant negative effect on soil total phosphorus (TP). Redundancy analysis indicated a positive correlation between Tenebrionidae abundance and the vegetation diversity index; a negative correlation between Tenebrionidae richness, the diversity index, and vegetation indices; a positive correlation between Tenebrionidae abundance and soil TP; and a negative correlation between the Tenebrionidae diversity index and soil TP and soil APP. These findings will contribute to biodiversity conservation and ecological restoration and provide a theoretical basis for steppe management, sustainable agricultural development, and pest monitoring in desert steppe environments.

Assessing the impacts of land use and climate change on the distribution patterns of Ulex europaeus L. (Fabaceae) in the Canary Islands

AbstractBiological invasions are one of the major threats to biodiversity, but their impact is particularly detrimental on oceanic islands like the Canary Archipelago. The common gorse (Ulex europaeus L. (Fabaceae)) is a highly invasive shrub with established populations in Tenerife, the sole island of the archipelago where it is present. Understanding the habitat preferences of U. europaeus is essential for predicting its current and potential future distribution across Tenerife and other Canary Islands, guiding effective local management practices. In 2019 and 2020, we surveyed different populations of U. europaeus in Tenerife, retrieving information on its abundance, presence of other invasive species and most frequent natural and anthropogenic characteristics of the landscape. We used this information to build explanatory and predictive models to identify the key natural and anthropogenic drivers of U. europaeus abundance in Tenerife and estimate the potential distribution of the species across the whole archipelago under current and future climatic conditions. Our findings showed that U. europaeus thrives in humid areas impacted by human activities where other invasive species persist. Both current and future climatic conditions do not support the presence of the species in the more arid islands of the archipelago (i.e., Fuerteventura and Lanzarote), rather highlight that the windwards, and thus more humid, areas of the other islands might support the species also under future warmer climatic scenarios. These findings deepen our understanding of U. europaeus local dynamics and are crucial to inform targeted management strategies to mitigate its impact across the Canary Archipelago and, ultimately, oceanic islands.

Minga as a placemaking tool in peripheral neighbourhoods. Co-design experience in Calderon, Quito

ABSTRACT This article explores the role of local vernacular socio-spatial practices in co-design and placemaking in Calderon, a peripheral urban parish in Quito, Ecuador. Using a case-study method and transformative paradigm theory, the research employs a mixed-methods approach for data collection and analysis. The focus is on ‘Minga’, a collaborative community effort manifested in two forms: ‘community mingas’ organised autonomously by communities, and ‘megamingas’ coordinated by public institutions. Community mingas enhance residents’ sense of belonging and pride, empowering them in shaping public spaces through a bottom-up approach. In contrast, megamingas exhibit top-down organisation with limited community engagement, raising concerns about social impacts. The study underscores mingas’ potential for social cohesion, cultural expression, and sustainable development in urban design. It emphasises the nuanced understanding needed for fostering active participation and addresses challenges such as sustaining community ownership. Despite yielding immediate benefits in public space enhancement, sustaining long-term engagement is crucial. The study concludes that mingas offer a valuable avenue for residents to actively contribute to public space improvement, fostering shared responsibility and long-term sustainable development in low-income neighbourhoods.

New constellations of care: between local and transnational care practices of young Europeans living in the UK during the (im)mobility regimes of a pandemic

ABSTRACT The restrictions to international travel during the COVID-19 pandemic have posed significant barriers to transnational family life. This paper focusses on the negotiation of familial obligations of over 300 young EU nationals aged 14–25 living in Britain. We examine how care practices were reconfigured within families, as forced immobility, absence and loss became part of transnational family life. Young people’s agency was activated to engage in desirable circulations of care, while they also engaged in acts of citizenship locally that had a care dimension. Many young people contributed to local initiatives of caring for others, such as mutual aid initiatives and local groups extending care practices to non-familial relations. We examine thus the range of care receiving and care giving practices and resources involved, including material resources, time, affection and sharing information. These practices involved family members locally or at a distance, but also non-familial relations, to shape new constellations of care.

A budget impact analysis of exclusive human milk diet in very low birth weight infants in United Arab Emirates

Introduction Very low birth weight (VLBW) infants have the highest rate of neonatal intensive care unit (NICU) admissions owing to the higher comorbidities associated with premature birth and long hospital stays. VLBW infants fed a bovine (BOV)-based diet have higher mortality rates, necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and other comorbidities than those fed 100% human milk-based products. This study aims to evaluate the budgetary impact of adopting an exclusive human milk diet (EHMD) instead of a BOV-based diet in VLBW infants from Al-Ain Hospital, Sheikh Shakhbout Medical City, and Dubai Health Authority (DHA) in the United Arab Emirates (UAE). Methods We use a decision tree model to estimate the budget impact of adopting EHMD versus the current local practice (BOV) over five years. Patients enter the tree model and have a probability of transitioning to one of the following mutually exclusive health states: NEC, which may be treated medically or surgically; LOS, NEC, and LOS; or neither NEC nor LOS. Depending on the feeding strategy, infants in the aforementioned health states are likely to develop any of the following complications: retinopathy of prematurity, bronchopulmonary dysplasia, or short bowel syndrome. The model accounts for the costs associated with diet, management of health states and complications, and the follow-up period. Results Al-Ain Hospital saved United Arab Emirates Dirham (AED) 3.3 million ($1.4million) in the first year of the EHMD feeding arm and AED 16.6 million ($7.1million) over the course of five years. In comparison to Sheikh Shabout Medical City and DHA, AED 36.7 million ($15.8million) and AED 24 million ($10.3million) were saved over five years, respectively, with AED 7.3 million ($3.1million) and 4.8 million ($2million) saved in the first year. The estimated pooled results across the three institutions were AED 5.1 million ($2.2million) and AED 25.7 million ($11million) savings in the first year and over five years, respectively. Conclusion Implementing the EHMD feeding scheme in VLBWs that has significant clinical benefits has resulted in substantial budget savings from the payer’s perspective in the UAE owing to fewer comorbidities associated with premature birth and shorter hospital stays. It is highly recommended for the Emirati health care settings to evaluate the real-world neonatal complication rates.

Haematological and Biochemical Reference Intervals Towards a Proactive Health Monitoring Approach in Norwegian Atlantic Salmon Farming.

Haematological and plasma parameters are used in veterinary medicine as a diagnostic tool, allowing for the early detection of potential health and welfare issues. For the implementation of monitoring strategies, reference intervals (RIs) are needed to know when deviations in those parameters become clinically relevant. Here, haematological and plasma biochemical RIs of Norwegian Atlantic salmon (Salmo salar Linnaeus) are presented for 29 biomarkers. Two subgroups were defined from the reference population based on water type, referred to as pre-adult (freshwater, 166.8 ± 118.4 g, N = 979) and adult (seawater, 2655 ± 2883 g, N = 4941), collected at 93 fish farms along the Norwegian coast. While the influence of various pre-analytical variables on RIs is well documented, aquaculture practitioners cannot always control those variables in the field. Here, RIs were calculated from blood samples collected based on local pre-analytical practices and then further processed under standardised conditions (analytical phase). RIs are therefore considered highly relevant for the application in the field. Finally, when taking blood samples in the field, it is advised to centrifuge whole blood as soon as possible, while plasma parameters investigated were stable for 168 h at 4°C or 72 h at room temperature.

The Hybridisation, Resilience, and Loss of Local Knowledge and Natural Resource Management in Zambia

AbstractThe contribution of Indigenous and local knowledge (ILK) to natural resource management has recently gained increasing prominence in academia, policymaking, and civil society. However, persistent knowledge gaps concerning the contribution of ILK to sustainable landscape management remain. We investigate existing local knowledge and practices of the Tonga of Kalomo District, Zambia, and their contribution to sustainable landscape management by combining walking interviews with photovoice. Especially Tonga women and youth are important knowledge holders for land management, agricultural practices, and tree conservation. We found that local knowledge is often ‘hybridised’ with ‘external knowledge’ when local knowledge alone is deemed insufficient. In some cases, introduced ‘external knowledges’ are simply reconstituted long-standing local practices. Nevertheless, local communities often perceive external knowledge holders as “knowing better.” Finally, we show how local knowledge and associated practices have been simultaneously eroded and lost and describe those that have remained resilient to provide insights into the complexity of hybridisation processes where different knowledge systems interact.

Local government cultural economy data practices and futures: Capacity, decision-making and partnerships

Local government cultural economy data practices and futures: Capacity, decision-making and partnerships

Design and Use of a Stratum-Based Yield Predictions to Address Challenges Associated with Spatial Heterogeneity and Sample Clustering in Agricultural Fields Using Remote Sensing Data

Machine learning (ML) models trained with remote sensing data have the potential to improve cereal yield estimation across various geographic scales. However, the complexity and heterogeneity of agricultural landscapes present significant challenges to the robustness of ML-based field-level yield estimation over large areas. In our study, we propose decomposing the landscape complexity into homogeneous zones using existing landform, agroecological, and climate classification datasets, and subsequently applying stratum-based ML to estimate cereal yield. This approach was tested in a heterogeneous region in northern Morocco, where wheat is the dominant crop. We compared the results of the stratum-based ML with those applied to the entire study area. Sentinel-1 and Sentinel-2 satellite imagery were used as input variables to train three ML models: Random Forest, Extreme Gradient Boosting (XGBoost), and Multiple Linear Regression. The results showed that the XGBoost model outperformed the other assessed models. Furthermore, the stratum-based ML approach significantly improved the yield estimation accuracy, particularly when using landform classifications as homogeneous strata. For example, the accuracy of XGBoost model improved from R2 = 0.58 and RMSE = 840 kg ha−1 when the ML models were trained on data from the entire study area to R2 = 0.72 and RMSE = 809 kg ha−1 when trained in the plain area. These findings highlight that developing stratum-based ML models using landform classification as strata leads to more accurate predictions by allowing the models to better capture local environmental conditions and agricultural practices that affect crop growth.

48 Evaluation without representation: Paediatric residents perspectives on CBME

Abstract Background Paediatrics transitioned in 2021 to Competence By Design (CBD), a postgraduate education model spearheaded by the Royal College of Physicians and Surgeons of Canada (Royal College). CBD replaced a time-based training system with one based on competencies demonstrated through regular observations of trainee performance. Although intended to be learner-centered, resident voices have been underrepresented in CBD’s design. Objectives We sought to (1) understand how paediatric residents perceived CBD as impacting their education and evaluation, and (2) explore their ideas to improve its implementation. Design/Methods We compared three Canadian postgraduate paediatric residency programs. First, we reviewed Royal College and program-specific documents regarding CBD to understand local and national priorities for its implementation. Program directors and local education leads were then interviewed to understand local priorities and implementation practices at these programs. Lastly, we conducted interviews with paediatric residents that began residency the year that CBD was launched. We used reflexive, inductive analysis to analyze their perspectives on how CBD has affected their education and develop learner-informed recommendations for improvement. Results We interviewed six program directors and CBD leads. Identified programmatic benefits included improved trainee surveillance, facilitated curriculum change, and competency committees. Challenges included untrained faculty, workplace-based assessment tensions, and administrative burden on residents and staff. Subsequent interviews with ten paediatric residents demonstrated CBD as having limited benefit to their education, leading to a checklist mentality of EPA completion and disengagement with the CBD system. These perceptions were influenced by (1) administrative burden, (2) poor quality feedback from disengaged staff with limited coaching experience, and (3) a lack of collaborative communication between the residents, their programs, and the Royal College. Residents suggested improvements, including: decreasing the number of assessments to alleviate time burden on both residents and faculty; implementing formal coaching instruction for residents and staff; and improving dialogue between Royal College, competency committees, and residents and physician evaluators to build buy-in with the system and facilitate continuing process improvement. Conclusion If we are to effectively adapt postgraduate educational systems to equip learners with the skills to meet the needs of the societies they serve, centering resident voices in curricular revision is paramount to maximize learner buy-in, minimize unintended administrative burden, and guide the development of necessary institutional supports (e.g., formal coaching) to ensure successful system transformation.

Predicting Subsurface Drainage Requirement for Different Soil Desalinization Goals in Coastal Reclamation Areas

ABSTRACTBuilding subsurface drainage systems for more efficient salt leaching with the natural rainfall or artificial irrigation is a widely accepted practice for saline soils reclamation, but the high initial cost of the system construction often limits its adoption, and the uncertainty in drainage intensity requirement to meet desired desalinization goals for field crop production challenges the system design. In this paper, we proposed a soil desalinization model based on the field hydrology model‐DRAINMOD, predicted number of years required to lower soil salinity to a threshold level under different subsurface drainage conditions, and estimated the net return from different subsurface drainage system layout based on a case study in a coastal reclamation area in eastern China. The results showed that, DRAINMOD accurately predicted water table fluctuations in artificially drained fields: the root mean square error to standard deviation ratio (RSR) was 0.4 and 0.54, and the Nash Sutcliffe efficiency (NSE) was 0.84 and 0.68, respectively, during the model calibration and validation periods. The DRAINMOD based soil desalinization model predicted a negative relationship between subsurface drainage intensity and the soil desalinization period, that is, improving drainage condition shortened the time requirement for soil desalinization. For the study area, the model's predictions showed that installing subsurface drainage at 20 m spacing and 1.2 m deep lowered soil salinity to the slightly saline level in less than 7 years under the rainfall leaching only, and such system layout produced the maximum economic return based on the local agricultural practice. The results indicate that, early investment in adequate subsurface drainage systems is beneficial for field crop production in the salt impacted farmland areas. Findings from this research may provide technical references for saline soil reclamation or land improvement in both rain fed and irrigated agricultural areas.

Qualitative drivers of postoperative prophylactic antibiotics use and resistance in Ethiopia.

The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians' perspectives on antibiotics resistance and stewardship in Ethiopia. We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy.

Multimorbidity and Person-Centred care in a socioeconomically deprived community: a qualitative study.

Multimorbidity (>2 long-term conditions) has poorer outcomes in areas of high socioeconomic deprivation (SED). High-quality Person-Centred Care (PCC) is important in multimorbidity but socially vulnerable populations have not informed current PCC models. To explore how wider community factors influence management of multimorbidity in the context of high SED, how high-quality PCC is defined by patients, and whether this influences healthcare management. Ethnographically informed case study in community experiencing high SED in Scotland. Participant observation (hours = 142) within 4 community groups who also took part in 2 participatory workshops. 25 in-depth interviews with people with multimorbidity, recruited from local General Practices; emerging findings discussed with interviewees in one focus group. Field notes/transcripts analysed using inductive thematic analysis. Key aspects of PCC were "patient as person", "therapeutic relationship", "co-ordination" and "power-sharing"; power sharing was particularly enabling but rarely happened (barriers often unseen by practitioners). Shared community experiences of "being known", "stigma" and "none of the systems working" influenced how people approached health services, and healthcare decisions. High quality PCC may have been particularly effective in this setting because of its influence on ameliorating wider shared negative community experiences. In a high SED setting PCC is important and can enhance engagement. Wider community factors have a critical influence on engagement with healthcare in areas of high SED and PCC may be particularly important in this context because of its influence ameliorating these. Policy makers should prioritise and resource PCC.

Utilization Postnatal Care Services in Hyolmo Community

Postnatal care (PNC) utilization among the Hyolmo community highlights significant gaps in existing literature and underscores the critical need for targeted healthcare interventions in remote and ethnically distinct populations. This study reveals that, while considerable attention is given to urban and accessible rural populations, remote communities face unique challenges that can impede access to essential maternal health services. The results demonstrate that age, education, and socio-economic factors significantly influence PNC uptake, suggesting disparities that are compounded in remote areas like the Helambu Rural Municipality of Sindhupalchowk District. This study shows that younger mothers, often less aware or hindered by accessibility barriers, are less likely to utilize PNC services compared to their older counterparts. This disparity highlights the necessity for community-specific educational programs that can enhance understanding and encourage the use of PNC services among younger women. Additionally, the influence of education and socio-economic status on PNC utilization points to the broader implications of systemic inequities in healthcare access. Moreover, the study brings to light the role of cultural practices and beliefs in shaping healthseeking behaviors, which varies significantly across different communities. In the traditional beliefs may conflict with modern healthcare practices, there is a clear need for culturally sensitive health interventions that respect and integrate local customs and practices. This research not only contributes to a deeper understanding of the factors affecting PNC service uptake in a specific Nepalese community but also calls for comprehensive policy responses. By addressing the multifaceted challenges faced by the Hyolmo community ranging from geographic isolation to cultural and educational barriers the study advocates for a holistic approach to healthcare. This should include the development of policies that ensure equitable access to health services, enhance community health education, and promote cultural competence among healthcare providers. Ultimately, such efforts are essential for improving maternal and infant health outcomes in remote communities, ensuring that every individual, regardless of their socio-economic or cultural background, has access to the necessary postnatal care.