National Goals Research Articles

Abstract 4135630: Improving Cardiac Rehab Referral and Enrollment Post-Percutaneous Coronary Intervention Through a Workflow Intervention at the Minneapolis VA: A Quality Improvement Study

Introduction: Cardiac rehabilitation (CR) is a Class 1A recommendation post-percutaneous coronary intervention (PCI), yet it remains underutilized. At the Minneapolis VA, the referral and enrollment rates for CR post-PCI are significantly below the national goal of 70%, indicating a need for improved strategies to enhance veteran participation. Research Questions: This study investigates the impact of a workflow intervention on CR enrollment rates and seeks to understand how staffing changes may influence these rates. It also explores the potential for advanced practice providers to affect CR enrollment. Aim: We aim to increase CR enrollment to 40% and referrals to 50% post-PCI at the Minneapolis VA by August 2023, utilizing a nurse practitioner dedicated to interventional cardiology patients post-PCI. Methods: Utilizing the VA CART database, demographic data for patients undergoing PCI between October 2017 and August 2023 were analyzed, excluding those who died within 30 days of PCI. CR referrals within 90 days and enrollments within one year were tracked. Statistical process control charts were used to detect variations in referral and enrollment rates, with a t-test determining significance. The staffing change intervention occurred in May of 2020. Results: The intervention led to a significant increase in both referral and enrollment rates. The average monthly referral rate rose from 24% to 37%, and the enrollment rate from 14% to 28%. A statistical process control chart indicated special cause variation in the sample after the intervention, suggesting meaningful change. Statistical analysis confirmed these increases as significant (p<0.001). Conclusion: The staffing intervention at the Minneapolis VA significantly improved CR referral and enrollment rates post-PCI. This suggests that dedicated cardiac care providers can play a crucial role in enhancing CR utilization, potentially informing future quality improvement initiatives.

Guidelines Management to Promotion of Wushu in Schools Within Jinzhong City

Research Objective: Wushu in schools promotes physical fitness, self-discipline, and focus while also preserving cultural heritage and instilling a sense of tradition. It promotes teamwork, builds confidence, and instills lifelong values such as perseverance and respect. Thus, this research aimed to study construct guideline management to promote wushu in schools within Jinzhong City Shanxi Province China. Research Method: This research is qualitative. The population of 1250 persons as a sample from Taro Yamane table opened confidence at 95% sample group was 286 students were student in the wushu club from 10 high schools in Jinzhong City, the step of collection data a questionnaire survey from students, 7 Expert interviews, 10 experts for Focus group and5 experts for Connoisseurship discuss and confirm guideline. The statistics analysis of data used content analysis and mean(x̄) and standard division (S.D.) Results: The results showed that the guideline management for promoting wushu in school was planning, organization, leading, and controlling. The planning has 9 items The organization has 9 items The leading 9 items and the controlling has 7 items. Conclusion: This study developed comprehensive guidelines for promoting Wushu in secondary schools in Jinzhong City, Shanxi Province, China, using strategic planning, organizing, leading, and controlling methods. Key findings highlight the importance of structured planning, effective team organization, leadership in athlete development, and systematic evaluation processes. The study emphasizes that successful Wushu promotion requires aligning curriculum adjustments with national goals, continuous teacher and coach development, and the integration of modern technologies for training and evaluation.

Study on carbon emissions of a small hydropower plant in Southwest China

Hydropower plants with a small installed capacity, which are widely distributed in mountainous areas with abundant rainfall and steep rivers, play an important role in resolving energy problems in remote rural areas. These plants are a crucial source of clean electricity generated from water power. Harnessing local water resources not only helps alleviate energy shortages, but also reduces reliance on fossil fuels, contributing significantly to China’s national goals of achieving peak carbon emissions and carbon neutrality. This study investigates the carbon footprint of the Huangshadong Reservoir Project in Chongqing, China. The entire life cycle of the hydropower plant is assessed, including the preparation, construction, operation and maintenance, and demolition phases. The uncertainty was evaluated using the error propagation method. Following analysis, suggestions for carbon footprint reduction measures were proposed. Results showed that the total carbon footprint and the carbon intensity of the Huangshadong Reservoir Project over its entire life cycle are 33,148.29 t CO2e and 417.75 g CO2e/kWh, respectively. Of the total carbon footprint, the preparation phase, construction phase, operation and maintenance phase, and demolition phase account for 0.04%, 67.06%, 26.2%, and 6.7%, respectively. It means that the requirement for cement during the construction phase represents an important contribution to the entire life cycle carbon footprint of a small hydropower plant. As an integrated water conservancy project, the carbon intensity of the Huangshadong Reservoir Project is higher than that of medium-sized and large hydropower plants. However, its carbon intensity is lower than the emission factor of fossil power plants. The research results provide reference for both planning and construction of small hydropower plants and low-carbon development of rural hydraulic engineering.

Spatial Transformation of the Higher Education System: Threats and Challenges to Single-Industry Towns

The article proposes an approach to analyzing the spatial organization of the Russian higher education system. Methodologically, the study relies on the theory of structural functionalism. In order to solve the stated research problems, the authors used comparative historical and economic-statistical analyses, as well as the quick survey method. The study characterizes the specifics of the Russian system of single-industry towns and justifies the role of a single-industry town as an integral and essential element of the settlement system. The study also reveals structural and functional changes inthe Russian system of higher education that significantly limit the possibility of preserving universities and/or their branches in single-industry towns. It was proved that the functions of higher education institutions in a single-industry town are multifaceted, complex in nature, and not limited only to the sphere of education. In spite of this, the higher education system in single-industry towns downsizes at a significantly faster rate than in the country as a whole. The performed analysis shows that the persisting trend toward increasing territorial concentration in the country’s system of higher education can create a set of negative effects that have a disruptive impact on the national settlement system, the continuity of complex value chains, and the social stability of local communities in single-industry towns. A conclusion is made about the need for comprehensive solutions regarding the development of higher education in single-industry towns that combine both national mechanisms for achieving national goals and the toolkits of regional, industrial, educational, and corporate policies.

Trend of immunization & gap in vaccine doses as observed in National Family Health Survey rounds in India

Background & objectives Immunization is an efficient and cost-effective way of lowering the infectious disease related morbidity and mortality in the community. The current study reviewed the trend of immunization, gaps in doses of vaccine given at the same time and gaps between the doses of same vaccine from National Family Health Survey (NFHS 1-5) rounds. Methods The current study extracted data from all five NFHS rounds conducted from 1992-93 to 2019-21. The study analyzed the State-wise and demography-wise distribution of trends of immunization from NFHS-1 to NFHS-5. State wise distribution of change in vaccination coverage between NFHS-4 and 5 was analyzed. The study also assessed the State-wise trends of fully vaccinated and unvaccinated children from NFHS 1-5. Results The northeastern States had maximum gap between the vaccination given at birth i.e., 47.3 per cent between BCG and Hepatitis B, and 32.8 per cent between BCG and birth dose of OPV in Manipur in NFHS -5. A gradual rise in the percentage of male (40.2%) and female (41.9%) childrens’ vaccination was found across the NFHS rounds with reduction in gap between the male and female vaccination from NFHS-1 (2.6%) to NFHS-5 (0.9%). The percentage of vaccination decreased proportionately with birth order. The vaccination coverage has increased in both urban and rural population, but the rise was higher in rural (45.9%) areas than urban (24.8%). An increase in percentage of fully vaccinated children by 41.2 per cent and decrease in percentage of non-vaccinated children by 26.4 per cent was observed from NFHS-1 to NFHS-5. Interpretation & conclusions Our analysis clearly suggests that immunization coverage has improved over a period of time but the variability in vaccine coverage across States and gap in vaccine doses needs attention of the policy makers to cover this for achieving our national immunization goals.

The Treatment Outcomes of Tuberculosis Patients at Adare General Hospital, Southern Ethiopia (A Five-Year Retrospective Study)

Ethiopia is among the countries most heavily affected by tuberculosis, where it is the leading cause of morbidity, the third cause of hospital admission and the second cause of death. To improve tuberculosis management and control, the early detection of cases, effective treatment and the persistent evaluation of treatment outcomes are vital issues that should be taken into consideration. This study was designed to determine the treatment outcomes and associated risk factors among TB patients registered at Adare General Hospital in Southern Ethiopia. A five-year retrospective study was conducted by reviewing the files of the TB patients registered from September 2013 to August 2017. The data were coded, cleaned, entered and analyzed using SPSS version 20 statistical software. Bivariate and multivariable logistic regression with odds ratios (OR) along with a 95% confidence interval was computed and interpreted. A p-value < 0.05 was declared as statistically significant. Among the 1122 cases, 620 (55.3%) were male, 748 (66.7%) were from urban areas, 319 (28.4%) were smear positive, 352 (31.4%) were smear negative and 451 (40.2%) were extra-pulmonary patients. Among the treated patients, 284 were declared cured, 753 completed their treatment, 29 were defaulters, 3 failed to follow up, and 53 died. The overall treatment success rate was 92.4%. The TB patients from urban areas (AOR = 1.44, 95% CI: 0.28, 0.67), and the HIV-negative TB patients (AOR = 5.48, 95% CI; 3.474, 8.64) were significantly associated with successful treatment outcomes. The treatment success rates of tuberculosis at Adare General Hospital were comparable to the national health facility-level coverage, but they should be maintained and strengthened further to attain tuberculosis-related national and millennium goals.

National goal, local resistance: How institutional gaps hinder local renewable energy development in Taiwan

In most countries, energy transitions are well supported by the public; however, the implementation of renewable energy policies at the local level is often beset with resistance. Previous research has mainly focused on factors influencing community acceptance and strategies to improve social acceptance. Meanwhile, there has been limited analysis of the institutional gaps that lead to local resistance and the dynamic effects of institutional factors on renewable energy implementation at the local level. This paper thus investigates Taiwan's regulations for renewable energy development, presenting a detailed case study from a local context. It examines the factors contributing to local resistance to the implementation of national renewable energy policy targets and explores the dynamics of these resistance actions. Furthermore, through the lens of multi-level governance, the study reveals the institutional gaps and interactions that influence the execution of national policy at the local level. Six major institutional gaps in Taiwan's renewable energy governance were identified, including the lack of energy governance authorizations for local governments, a lack of superordinate site selection criteria and evaluation mechanisms for development zones, lack of governance systems that can address multiple issues, lack of scientific and academic information, lack of information disclosure and public participation mechanisms, and the burden of carbon reduction responsibilities and costs on local communities with few or no benefits. Compounded together, these six institutional gaps lead to the buildup of negative experiences interacting with the government and the renewable energy industry and feelings of worry, panic, distrust, and injustice among the local populace. These ultimately trigger resistance attitudes and the adoption of protest actions, hindering solar farm developments from reaching national policy targets. This study highlights the critical role of multi-level governance in facilitating the energy transition, emphasizing that the successful development of renewable energy requires a robust institutional framework. Such a framework is essential for addressing the complex governance challenges that arise during this transition, particularly aspects supporting local engagement. The six institutional gaps identified from the Taiwan case can serve as policy references for countries or cities intending to promote ground-mounted solar power.

The benefits and burdens of wind power systems in reaching China’s renewable energy goals: Implications from resource and environment assessment

Recognizing the economy’s growing reliance on global energy landscape transformation on wind power deployment, as well as the general reality that renewable facilities require lower operational but higher up-front inputs than fossil-based power systems, this paper focuses on the life-cycle burdens of wind power systems and their substitution benefits compared with coal-fired power systems. The estimation considers the consumption of nonrenewable sources of energy, emissions of greenhouse gases, and other environmental resource factors that have received significantly less research attention, such as industrial land use, water use, PM2.5, SO2, NOX, and Hg emissions. The scope of this study differs from earlier ones in that it includes a comprehensive description of all the equipment, materials, and services used, as opposed to earlier studies that either omit crucial supporting infrastructure or just focus on the plant’s physical structure as its primary materials. Results based on a typical plant in China show that the state-of-the-art onshore wind power systems can provide significant reductions in nonrenewable energy use (9.2 MJ/kWh) and GHG emissions (782.8 GtCO2/kWh). To produce an equivalent amount of electricity, wind power systems require more than three times industrial land use and almost one-third of industrial water use of that for traditional coal-fired power systems. The avoided SO2, Hg, PM2.5, and NOX emissions per unit of electricity generation account for 60.6%-89.3% of the total air pollution emissions induced by supercritical coal-fired power systems. By integrating 3797 operating plant-specific data and fixed-point wind energy information, this study scales up results of the single plant to a country level. The macro picture implies different opportunities born by wind power systems in easing multiple resource and environmental pressures, highlighting the significance of designing hierarchical strategies to improve penetration levels of wind power. By 2050, cumulative climate benefits obtained from onshore wind power technology are predicted to reach 74.2 Gt CO2, achieving around 17.2%-45.5% of the national carbon-neutral goal.

Основные направления и инструменты политики низкоуглеродного развития Бразилии

Brazil has a strong potential to achieve national climate goals and can also be an important decarbonization partner for other countries, especially in the supply of green hydrogen and critical raw materials for the production of new climate- neutral technologies. This article highlights the main tools and policies for Brazilʼs decarbonization and identifies potential areas in which the country can not only achieve its nationally determined contributions (NDCs), but also ensure innovative green economic growth. Low carbon intensity energy sources can ensure a low carbon footprint for industrial products, which can make goods more attractive in the face of increasing requirements and the introduction of measures such as the European Unionʼs (EU) carbon border adjustment mechanism (CBAM). Extensive deployment of renewable energy creates opportunities for the country to produce sustainable hydrogen, which will be in demand both domestically and globally. The main challenge for Brazilʼs decarbonization is its extensive agriculture, as well as widespread deforestation, the rate of which increased under the Bolsonaro administration. For agricultural products,which make up a large share of exports, deforestation regulations like those adopted in the EU would be a real barrier and could close European and other markets. The min- ing and processing of critical raw materials could be a potential breakthrough for the countryʼs economic growth due to the widespread decarbonization of the global economy. The low carbon intensity of the countryʼs industry, including mining, due to renewable energy sources appears to be a significant advantage. Lulaʼs return has given the international community hope that, at least in forestry and agriculture, significant efforts can be expected from Brazil, including international support, financing, and auditing.

Improving health outcomes in Cameroon through competency-based curricula and stakeholder engagement in accreditation

This review article explores the accreditation process for health personnel training in Cameroon, emphasizing its critical role in ensuring quality education and improving healthcare delivery. It begins with an overview of the current state of health education institutions and regulatory mechanisms, highlighting the need for robust national guidelines for accreditation. The review examines the importance of autonomous councils for each health specialty, emphasizing their role in establishing specialized standards, monitoring compliance, and promoting ethical values in training. It also discusses the historical context and evolution of accreditation, identifying past limitations and the necessity for updated standards. The strengths and challenges of the proposed guidelines are analyzed, focusing on their potential impact on the competence of health professionals. Comparative assessments with successful accreditation systems in other African nations, such as Nigeria and Ghana, provide valuable insights into best practices. The perspectives of various stakeholders, including government agencies, educational institutions, and healthcare providers, are examined. The article concludes with recommendations for enhancing accreditation processes, including capacity building and continuous stakeholder engagement, ultimately supporting the development of a competent healthcare workforce aligned with national health goals.

Sustainability-driven electrical engineering optimizing energy efficiency through ai and developing eco-friendly electronics

This paper explores the transformative potential of AI-driven solutions in optimizing energy efficiency and the development of eco-friendly materials for electronics. As global energy consumption and electronic waste continue to rise, innovative technologies are essential to mitigate their environmental impact. AI models have shown significant promise in enhancing the performance of smart grids and residential and industrial energy systems by predicting and adjusting energy usage in real time. Additionally, the research and development of sustainable materials for semiconductors and electronic components offer an important pathway to reducing the environmental footprint of electronics manufacturing. By aligning these advancements with national sustainability and climate goals, this paper highlights the critical role of AI and sustainable materials in creating a more energy-efficient and environmentally responsible future. The paper concludes by suggesting areas for future research, emphasizing the long-term impact of these technologies on the electrical engineering field and their contribution to sustainability.

Reconstructing the Cooperative Rule of Law as an Alternative for Economic Empowerment of Rural Communities in Indonesia

Cooperatives in the Indonesian economic system function as one of the efforts to achieve national development goals, namely creating a just and prosperous society in accordance with the principles of Pancasila and the 1945 Constitution. The legal basis of cooperatives in Indonesia is regulated by Law Number 25 of 1992 concerning Cooperatives. The purpose of this research is to study the development of cooperative law in Indonesia as an alternative to economic empowerment of rural communities, and analyse the legal construction of cooperatives as an alternative to economic empowerment of rural communities in Indonesia. This research is a normative legal research with a legislative approach and conceptual approach. The results show that the weaknesses in Law No. 25/1992 on Cooperatives, such as the unclear definition of cooperatives, unfulfilled principles, and lack of strict sanctions, indicate that the regulation needs to be reconstructed to address the existing problems and increase public trust in cooperatives. Thus, the reconstruction of Law Number 25 of 1992 on Cooperatives will not only improve cooperative governance, but also make a significant contribution to the economic empowerment of communities in Indonesia, especially in rural areas.

Rethinking adult education in Ethiopia: the quest for interventions to overcome implementation challenges and foster effectiveness

The introduction of modern education, especially adult education, has a long history in Ethiopia. However, consistent implementation remains a big challenge to reach all adults. Considering this situation in mind,the current study was conducted to scrutinise the fundamental challenges faced by adult education programs and identify promising interventions that need to be taken into account to overcome the exisitng challenges and improve implementation effectiveness. In doing so, the current study employed a qualitative research method with a case study design. Data was collected through interviews with purposefully selected fourteen participants and through document analysis. Thematic analysis was used to analyse the data collected. Accordingly, the study results revealed the following major findings: The presence of traditional attitudes and cultural stigma that devalue adult education limits its reach to broader adults. Additionally, the existence of insufficient political commitment from the government often results in limited support for adult education initiatives. There is also criticism that the current adult education practice has limited adaptability due to its ‘one-size-fits-all’ approach and its inability to meet the dynamic learning needs of adults. Furthermore, the presence of inadequate resources poses a multifaceted challenge. To address these issues and promote success, some actionable interventions are identified that could be prioritised into three thematic areas. These include the centrality of equity and access, the need for a context-specific structure, and the importance of aligning adult education programs with the country’s national development goals. These proposed interventions hold multifaceted promise for improving the practices of adult education programs. At the end, further discussions and conclusions are forwarded.

Environmentally sustainable health and social care – A proposal for goals and steering for Finland

Abstract Issue Health and social services cause significant environmental impacts. In Finland, national steering towards environmentally sustainable health and social care has been lacking. Description of the problem A multidisciplinary research project (EKO SOTE 2022-2023) was designed to investigate aims and steering mechanisms for environmentally sustainable social and health care in Finland. The project aimed to propose national steering and monitoring mechanisms for stronger environmental sustainability within the sector. Data for the proposal was collected from literature, review of national legislation, interviews, surveys, and co-development events. The project also aimed to calculate the carbon footprint of Finnish health and social care with the EEIO model ENVIMAT. Results It was estimated that health and social care contributed to 6.5% of Finland’s national carbon footprint in 2019, of which the share of health care was 4.2%. The new goal ‘Social and health care is carbon neutral and minimizes the environmental burden by 2035’ was proposed to be incorporated in the national strategic steering. Wellbeing service counties (WSC) as public care providers were suggested to be included as responsible actors in the Finnish Climate Act. National networks and targeted project funding for WSCs were found important. Three sets of indicators were designed for monitoring environmental sustainability: minimum indicators for all WSCs for national monitoring, voluntary indicators for regional monitoring, and indicators for advanced regions to pioneer best practices. Lessons According to the informants, national steering for environmentally sustainable health and social care is urgently needed. The national goal should be ambitious, wide-ranging, and feasible, and cover environmental aspects broadly. The steering requires multiple mechanisms: normative, strategic, informational, and economic. WSCs should be empowered to develop suitable means to achieve the national goal. Key messages • The project provided an ambitious, feasible, and comprehensive national goal and steering model for reducing the environmental impact of health and social care in Finland. • Collaborative efforts and joint steering model could advance environmental sustainability in health and social care.

Tenaga Kependidikan: Pengawas dan Kepala Sekolah

This research aims to find out the roles, functions, and problems of coaching supervisors and school principals. This research was conducted using a literature study method with a systematic approach. The data sources used are scientific articles, books, and research reports published in the 2014-2024 period. Literature searches are carried out through academic databases, namely Google Scholar using keywords relevant to the research topic. Data analysis is carried out by identifying the main themes and synthesizing findings from various sources to obtain comprehensive conclusions. The results of the analysis show that supervisors and school principals play a vital role in improving the quality of education. However, challenges in motivation, resource dispersal, and quality culture need to be overcome so that they can carry out their duties more effectively. Sustainable, need-based coaching from teachers and collaborative supervision are essential to achieve national education goals optimally.

Islamic Education Planning: The Concept of Educational Management in Madrasah

This study aims to understand the important role of educational management planning in Madrasah in achieving national education goals. The methodology used is a literature study with a qualitative approach, collecting data from references to books, journals, archives, and related documents. The results of the study indicate that educational management planning has a significant influence on the effectiveness of other management functions, such as organizing, motivating, and supervising. In conclusion, good planning allows educational institutions to direct strategic steps towards achieving long-term visions effectively and efficiently. The novelty of this study lies in the in-depth analysis of the application of educational philosophy in educational management planning in Madrasah, as well as its influence on the national education system. The recommendation from this study is the need to increase awareness among education stakeholders to adopt a more responsive and innovative planning model to face future educational challenges

Are health inequalities decreasing in Sweden?

Abstract Background The overarching national goal for the Swedish public health policy is to create societal conditions for good and equitable health for all and to eliminate avoidable inequalities within a generation (until 2048). To know whether we are heading towards the public health policy goal, a surveillance system which follows a combination of several inequality measures over time, is needed. Methods All-cause mortality in age 25-64 and life expectancy at age 30, in the total population of Sweden, were used as measures of health and followed 2006-2022. Education (low, middle, high) was used to measure socioeconomic position. Both absolute and relative, and both simple and complex measures were used to analyse inequalities in mortality: rate difference (RD), relative risk (RR), population attributable fraction (PAF) and population attributable number (PIN). Life expectancy was analysed as absolute and relative difference in remaining number of years. Results Life expectancy has increased and mortality in age 25-64 have decreased in the Swedish general population. Comparing those with low and high education, both absolute and relative inequalities have increased, e.g. differences in life expectancy increased to > 6 years among men and almost 7 years among women, and relative inequality in mortality in age 25-64 increased to > 3 times higher risk (RR 3.1; CI 3.0-3.3). Inequality, measured with regard to all groups in the population, showed no noticeable changes over time. Conclusions The results show that Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25-64. To use a combination of health inequality measures strengthens the surveillance system and gives a more nuanced picture of the development. It enables, in parallel with universal health improving efforts, focus on the groups with the poorest health, where efforts have the greatest effect. Key messages • Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25–64. • A more nuanced picture of inequalities is crucial to be able to parallel universal health-improving efforts with a focus on the groups with the poorest health, where efforts have the greatest effect.

Penyelesaian Perkara Pidana Medik Bagi Tenaga Medis dalam Hukum Kesehatan: Studi Perbandingan Hukum di Indonesia, Belanda dan Britania Raya

The realization of a country's national development goals is a measure of a country's success, namely through law enforcement and a good health index of its citizens in that country. This research specifically discusses the enforcement of health law where it is not only looked at from the perspective of the laws that apply in Indonesia, but a comparison is made of the resolution of problems in health law that arise as a result of actions carried out by medical personnel that are related to their competence (unprofessionalism: medical errors in the form of omission, negligence, and/or intentional) which resulted in lawsuits and lawsuits based on legal provisions in the Netherlands and the United Kingdom. The research method used is prescriptive analysis and qualitative approach data analysis. The research results show that the settlement of lawsuits, especially the settlement of medical cases in Indonesia, the Netherlands and the United Kingdom, is currently still within the jurisdiction of the general courts; in Indonesia it is regulated in Law Number 2 of 1986 concerning General Courts along with amendments to the two Laws in Law Number 49 of 2009; in the Netherlands it is regulated in the Judicial Organization Act, the Judicial Sector (Funding) Decree of 2005, and the Constitution of the Kingdom of the Netherlands 2002; whereas in the United Kingdom it is based on the Criminal Procedure Rules 2020 and Criminal Practice Directions 2023

Examining purchasing strategies in public food procurement: Integrating sustainability, nutrition, and health in Spanish school meals and social care centres

Sustainable Public Food Procurement (SPFP) is pivotal in advancing sustainable and healthier food systems. However, practical gaps persist in understanding how policies function at the local implementation. This study addresses these gaps by analysing 22 SPFP contracts for school meals and social care centres in Spain, focusing on implementation while contextualizing findings within the broader policy cycle. This research categorizes SPFP criteria in tenders and evaluate their potential for actionability across sustainability, nutrition, & health dimensions. It also explores how these criteria are combined into purchasing strategies to achieve simultaneous or individual goals. Key findings reveal a strong use of product quality criteria, particularly organic foods, supported by policy and ease of implementation. However, non-ambitious targets, market constraints and procurement officers’ limited knowledge hinder progress. The study highlights significant adoption of nutritional & health criteria, though non-mandatory policies and varying regional targets impede consistent implementation and reveal gaps in promoting healthy and sustainable dietary practices. Environmental criteria are widely used signalling policy priorities within the EU policy framework. In contrast, proximity and social criteria are underutilized due to regulatory constraints and insufficient guidance. Despite these challenges, innovative local procurement strategies are utilized to overcome barriers. At the strategy level, the study reveals diverse approaches to SPFP implementation, highlighting adaptability but underscoring the need for flexible frameworks that accommodate local variations while aligning with broader EU or national goals. This research advocates for a holistic approach to SPFP that addresses both the practical challenges of implementation and the systemic issues present in the earlier stages of policy development.

Modern approaches in the diagnosis, treatment and prevention from obesity

Today, from 1.0 to 1.9 billion adults are overweight, including 312-650 million of them, and 124 million children and adolescents are obese. In Russia and Europe, about 60% of residents are obese and overweight. According to WHO forecasts, by 2025 the number of obese patients will double and will account for 30-50% of the population of economically developed countries. Morbid obesity is usually a multifactorial disease that is acquired and progresses under the influence of many factors (geography, level of economic development, cultural values, lifestyle, and others) as well as hereditary predisposition. Among people suffering from comorbid obesity, there is an atypical course of concomitant comorbid diseases. Against the background of morbid obesity, the likelihood of acquiring other diseases of organs and systems increases: the cardiovascular system, hormonal system, digestive tract, erosive esophagitis, fatty liver dystrophy, cirrhosis of the liver, obstructive sleep apnea, osteoarthritis, etc. To confirm the presence of morbid obesity in humans, the following indicators are evaluated: the number of kilograms per square meter of human body area (BMI calculation), waist circumference, triglyceride index, as well as the use of instrumental diagnostics: radiation and ultrasound methods to study the level of obesity of internal organs. To date, orlistat, sibutramine and liraglutide have been registered in Russia for the conservative therapy of morbid obesity, i.e. the choice of drugs is very limited. Surgical methods and electrical stimulation of the stomach are also used. Obesity ranked 5th in the world ranking of risk factors for premature death. A targeted policy and an integrated approach aimed at improving the system of medical care for overweight and obese patients should become key factors in achieving the national goal of improving people's health and well-being. The expansion of preventive measures at the local, regional and federal levels will help significantly reduce the spread of this pathology and prevent the development of an "obesity pandemic".