Priority Actions Research Articles

Identifying focus zones for the conservation and promotion of priority birds in Swiss farmland

AbstractModern agriculture faces conflicting objectives—increasing agricultural production while preserving and fostering biodiversity. As intensive agricultural management threatens biodiversity, legal obligations aim to halt biodiversity loss and safeguard threatened species. In Switzerland, agricultural priority species have been defined to set environmental goals for biodiversity, with limited success so far. This study spatially defines farmland focus zones with potential for the promotion of priority species for conservation in agricultural landscapes. We overlaid information about field‐level impact of agricultural activities using the Swiss Agricultural Life Cycle Assessment (SALCA‐BD) as “impact of agricultural activities” with the potential distribution of Swiss priority birds. The potential distribution was assessed by aggregating predictions from species distribution models of 27 bird priority species. We identified significantly high/low values for management impact and potential distribution using hotspot analyses. Multivariate clustering was used to identify zones that should be preserved (low management impact, high bird potential) and zones where conservation measures could be promoted (high management impact, high bird potential). Zones which were minimally impacted by management and had a high potential for birds included grassland with structures, covering ca. 18% of the studied farmland. Zones with high management impacts consisted mainly of arable land with little structures, covering ca. 31% of the studied farmland, occurring mainly in the Swiss lowlands. Our results help to assess and visualize the intertwined links between agricultural management and the species inhabiting these agricultural landscapes in a spatially explicit manner. This can help to identify zones and regions for ecological promotion and set priorities for action within future agricultural policies.

Four analysis moments for fuzzy cognitive mapping in participatory research

ABSTRACT Fuzzy cognitive mapping (FCM) is a practical tool in participatory research. Its main use is clarifying causal understandings from several knowledge sources. It provides a shared substrate or language for sharing views of causality. This makes it easier for different interest groups to agree what to do next. Each map is a collection of causal relationships with three elements: factors (cause and outcome), arrows linking factors, and weights indicating the perceived influence of each cause on its outcome. Stakeholder maps are soft models of how they see causes of an outcome, such as access to services or systemic racism. Based on a standardized FCM protocol, we present four moments in FCM analysis. (1) Agree shared meaning across maps. (2) Calculate the maximum influence of perceived causes. (3) Simplify the maps for communication. (4) Identify priorities for action. We provide explanations of the four moments in FCM analysis, with examples from five countries. FCM offers a practical means to guide health action. It incorporates local perspectives with transparent and traceable procedures.

Transforming the food system: Are farmers ready to take phosphorus stewardship action?

Ensuring global food security while halting ecosystem degradation is arguably one of the most fundamental current challenges. As a key component of fertilisers for which there is no substitute, phosphorus plays a central role in this challenge. Food production systems are critically vulnerable to phosphorus supply disruptions and price spikes, while high phosphorus-inefficiencies drive the greatest global threat to waters through diffuse pollution. Transformation to a more phosphorus sustainable and efficient system inevitably necessitates transition at the farm level, leading to the critical question of whether farmers are ready for such transition. This paper examines the relationship between the farmers’ perceived adaptive capacity and farm-level actions that can enable a positive phosphorus transition. We innovatively apply a second-generation psycho-social mobilisation approach to adaptive capacity (based on personal experience, place attachment, competing concerns, household dynamics, and risk attitudes) and establish its relation to an extended framework of phosphorus stewardship action, using Structural Equation Modelling in a UK-wide survey. Our results confirm that the second-generation approach provides a more nuanced approximation to the understanding of farmers’ adaptive capacity than traditional (first-generation) approaches (five capitals: human, natural, physical, financial, and social), allowing a more dynamic understanding and a more robust assessment of adaptive capacity. Beyond our specific results for the UK (which demonstrate relatively high levels of farmers’ readiness to adapt and promising predisposition to do so, if supported), our research illustrates how this framework can be used to identify priority actions to enhance farmers’ uptake of phosphorus stewardship actions more generally.

A comprehensive experience-based framework of actionable priorities to enhance Canada’s health and social care system: discussions with older persons, clinicians, managers, and decision-makers using nominal group technique

BackgroundExisting frameworks of older persons’ experiences in health and social care systems are usually based on single stakeholder perspectives and focused on limited aspects that are independent from one another. This study aimed to describe such experiences from the perspective of diverse stakeholders and develop a comprehensive experience-based framework for actionable priorities to enhance Canada’s health and social care system.MethodsWe adapted a nominal group technique with a qualitative approach. We formed four groups of stakeholders (4 older persons, 7 clinicians, 5 managers, 4 decision-makers) in the province of Quebec. First, participants individually completed a questionnaire to rank the six domains of an international set of metrics of quality of care for older persons in terms of their importance. Then, we conducted a remote discussion with each stakeholder group, obtained consensus on the priority domains, and explored personal/professional experiences explaining prioritization processes and what changes are needed. An inductive-deductive thematic analysis was conducted to develop a framework for actionable health and social care priorities.ResultsThe framework included six key categories revolving around a core category of ‘health equity’. (1) ‘Access to services and care’ focused on improved accessibility of healthcare navigators, primary and home care services, and end-of life care. (2) ‘Respect for older persons’ involved individuality and uniqueness, daily needs, advocacy in defence of vulnerability, and decision-making valuing care preferences. (3) ‘Involvement of family and friends’ encompassed formal recognition, responsibilities, and trajectories associated with caregiving. (4) ‘Communication and education’ consisted of adaptive communication between older persons, caregivers, and professionals and societal-level education and awareness-raising. (5) ‘Coordination and integration of care’ comprised health and social services organization, cross-sectoral approaches, and interdisciplinary collaboration. (6) ‘Responsiveness to evolving needs’ of older persons involved timely response to health transitions and promoting holistic approaches.ConclusionsThis study illustrates the complex challenges of caring for older persons. The framework suggests several areas for improvement in care practices and policies for older persons and caregivers. Proposed intervention targets include public healthcare system navigators, standardized goals of care practices respecting persons’ wishes, formal recognition of caregiver contributions, society-level education, cross-sectoral initiatives, and holistic approaches.

Management of the Portfolio of Works For A Public Hospital Complex

Objectives: The main objective of this research is to develop a decision-making support model for prioritizing works projects in a public hospital complex, establishing criteria for characterizing and evaluating these projects. Theoretical reference: Strategic management; management control; project portfolio management; multi-criteria analysis; hospital works projects. Method: This is a quantitative exploratory research based on the Multi-Criterion Decision Support Methodology (MCDA), whose primary data are derived from semi-structured questionnaires. This methodology makes it possible to carry out a multi-criterion analysis of a large quantity of information, involving conflicting interests amongst themselves in decision-making contexts of high uncertainty and high complexity. Results and Discussion: A model for evaluating demands was developed, consisting of 16 criteria for analysis (descriptors), grouped into four thematic groups, whose measurement scales, once transformed into cardinal quantities, present the performance of each characteristic under study and make possible the construction of a global model for evaluating demands. These criteria are based on the decision-makers' perceptions of the institutional needs of works projects, revealing their concerns about the infrastructure problems in the body's buildings. Implications of Research: The implementation of this model leads to the creation of a service queue for the demands of works projects that materializes the priority actions in the area of infrastructure from the objectives, expectations and preferences of the decision makers. In the end, the model developed makes it possible, starting from the attribution and weighting of values, to define institutional priorities. Originality/Value: The research points to a path for overcoming major challenges in the decision-making on the prioritization of works projects in a public hospital, highlighting the high volume of demands, conflicts of interest, resource constraint and obsolescence of buildings and equipment.

Systematizing the risk management process in clinical radiotherapy practice: Recommendations of the working group on risk management of the DGMP

PurposeThe Deutsche Gesellschaft für Medizinische Physik [German Society of Medical Physics] has recently published two coherent reports, No. 25 and No. 28, detailing the design and implementation of a risk management (RM) process for German radiotherapy (RT) departments. This study offers an overview and background of the efforts behind these reports. Methods and MaterialsFor three years, up to nine medical physicists (MPs) with practical RM experience held weekly meetings to develop recommendations for a clinical RM process. Care was taken to ensure that the recommendations were equally applicable to RT departments of various sizes. A process-based method derived from the failure mode and effects analysis (FMEA) was created to identify and address risks from unintentional radiation exposure. This method was applied to exemplarily analyze the hazardous scenarios in breast RT using surface guidance and deep inspiration breath hold (DIBH) techniques. Three common criticality methods—risk matrix, risk priority number, and action priority—were applied, and each step was schematically explained for first-time users. Each report was peer-reviewed by two radiation oncologists and 11 MPs. ResultsIn report No. 25, basic requirements were outlined for running the RM process, conducting risk assessments, and monitoring clinical procedures. A three-year plan-do-check-act cycle was proposed for continuous improvement. In report No. 28, general process lists for external beam radiotherapy (EBRT), brachytherapy, and radionuclide therapy were designed. Based on the EBRT process list, 45 hazardous scenarios in the surface-guided breast RT in DIBH were identified. Two scenarios were used to illustrate handling instructions for the three criticality methods. ConclusionsThe recommendations provide clinical MPs and other health professionals with a pragmatic approach to RM, balancing both the needs of smaller practices and larger clinics in Germany. The risk of unintended exposures of patients is viewed acceptable once it has been lowered to a state that is as low as reasonably achievable.

Investigating Associations Between Climate Change Anxiety and Children's Mental Health in Pakistan: Impacts and Priority Actions.

Climate anxiety has a negative impact on the mental health and psychological wellbeing of the vulnerable population. The goal is to assess many factors that affect mental health and psychological wellbeing, as well as how climate change affects mental health in Pakistan's vulnerable population. This study provides evidence-based insights on the long- and medium-term impacts of extreme weather events on mental health. To obtain information on these variables, this research uses a quantitative approach and a cross-sectional survey design with a multivariate regression model for empirical tests on a sample of parents and children with an impact on mental health from climate change anxiety. Results indicate that individuals experience shock and climate change anxiety, and their effects on mental health and psychological wellbeing. Climate change can have detrimental effects on children's mental health. (1) disaster risk health (2) children's stress index (3) public health concerns, (4) climate change anxiety, (5) generalized anxiety disorder, and (6) major depression disorder, as reported by the children with mental health outcomes. The findings of this study show that climate change has a stressful effect on mental health. The paper concludes with a discussion on strategies to address the anticipated mental health issues among children due to climate change.

Bayesian hierarchical spatiotemporal modelling of tuberculosis—Human immunodeficiency virus co-infection in Ethiopia

Understanding the epidemiological patterns of tuberculosis-human immunodeficiency virus (TB-HIV) co-infection over space and time is crucial because it assists in identifying areas with high risks that need special control strategies. This article aimed to determine districts in Ethiopia that are most vulnerable to TB-HIV co-infection by examining the spatiotemporal patterns of the co-infection across four years, from 2015 to 2018. The study’s data came from Ethiopia’s Federal Ministry of Health. The data was analysed by applying the Bayesian hierarchical spatiotemporal modelling. We considered four models with different space–time interaction structures via the Integrated Nested Laplace Approximation (INLA) in the R-INLA package. In addition, we have applied the Deviance Information Criterion to select the most suitable model. The mean raw annual TB-HIV relative risk (RR) continuously decreased from 2015 to 2018, and the raw RRs of co-infection varied over districts and years. The spatiotemporal model, which allows for space–time interaction with independent spatial random effect and dependent temporal random effect, was the preferred model for describing the variations in TB-HIV co-infection across different districts over time. The prior variance for the spatial structured random effect had a smaller precision mode than the spatial unstructured random effect. This difference reveals that the former accounted for more spatial autocorrelation than the latter, indicating an information-borrowing effect amongst districts. Furthermore, the findings exhibit that the relative risk of TB-HIV co-infection had significant spatiotemporal variation and clustering. Through this research, further information was obtained regarding the temporal evolution of the geographical spread of TB and HIV co-infection at the district level in the country. It also made it possible to determine districts that should receive priority for control actions because of their high risk of co-infection.

Developing a Statewide Strategic Plan for Prevention, Early Identification, and Treatment of Psychosis.

Access to evidence-based programs that address early psychosis is a substantial public health concern. The authors describe the community-engaged, data-driven process that informed the development of the Massachusetts Strategic Plan for Early Psychosis, an effort to identify actionable priorities to build a system of prevention and care that responds to the needs of individuals who experience psychosis and their caregivers. A multiphase, mixed-methods approach was used to gather knowledge from young adults experiencing early psychosis and their caregivers, including two symposia with diverse stakeholders. Six overarching goals were identified, each with possible action steps and stigma reduction strategies: connecting and supporting individuals who experience psychosis and their families, promoting early identification of and intervention for psychosis through community education, providing specialized support to key community members, providing specialized support to medical and behavioral health care professionals, supporting specialized treatment teams in the delivery of evidence-based care, and developing a statewide system of psychosis services. Next steps for and operationalization of the statewide strategic plan for psychosis in Massachusetts will require a population health approach that engages the community through intersectoral and multisectoral strategies.

Toowoomba Healthy Towns: A Citizen Science Initiative on Active Transport in Regional South East Queensland, Australia.

Engaging in active transport will enable individuals across the life course to increase their habitual levels of physical activity. The aim of this study was to engage citizen scientists (CS) to identify factors that influence active transport in their community. The Our Voice citizen science methodology developed at Stanford University was employed. CS completed a "discovery walk," taking photos of things that help or hinder active transport. Three groups were recruited: children aged 10-12years (n = 11), adults (n = 12), and older adults >65years (n = 10). CS rated each photo and provided a narrative explaining their reason for taking the photo. Once all CS in a specific age group had completed the walk, they met for a group discussion. The CS worked together to analyze the data, arranging them into themes and identifying priority actions. Two CS representatives from each age group presented their findings to the local council decision makers. Children highlighted the need for safer crossings, especially from their school to the local park, and suggested zebra crossings as a solution. The adults highlighted that road signs prioritized vehicles, not pedestrians, and requested that this be reversed. Older adults noted that the poor condition of the pavements made it harder for people in wheelchairs to navigate. The CS recommendations have informed the council's walking and cycling network program. Engaging with citizen science provided the community with an opportunity to advocate for meaningful yet realistic improvements in the built environment that could promote neighborhood active transport and physical activity across the lifespan.

From the first European Climate Risk Assessment to action in policy and practice

Abstract The first European Climate Risk Assessment (EUCRA), produced by the European Environment Agency in March 2024, engaging nearly 100 authors across Europe, highlights health among the most at-risk sectors. According to the structured risk assessment that was conducted to support the transparent identification of priorities for policy action, more and urgent action is needed to reduce health risks from heat indoors and outdoors; from wildfires and outbreaks of vector- and water-borne diseases. The responsibility for managing risks lies both with the EU and Member States, and the policy readiness varies depending on the risk. The European Climate and Health Observatory, set up to better understand, anticipate and prevent climate risks to human health in Europe, in the most recent report ‘Responding to climate change impacts on human health in Europe: focus on floods, droughts and water quality’ provides in-depth analyses of some climate-related risks to health and presents examples of responses to them in both policy and practice. Both assessments emphasise that without fast and systemic action to increase societal resilience, the health impacts of the changing climate will worsen, affecting already disadvantaged or vulnerable groups the most. Health and health-determining sectors have the opportunity to address the health impacts of climate change by, among others, increasing the climate resilience of health systems; developing, updating and implementing national health adaptation plans; and supporting the education and training of public health and healthcare professionals on climate change threats. At the same time, addressing health impacts from climate extremes requires responses across sectors, actors and spatial scales.

4.P. Round table: Advancing genomic diagnostics for rare genetic diseases: a focus on non-clinical domains of HTA

Abstract Genetic rare diseases are a burning global public health issue requiring a thorough assessment of the related burden. Unfortunately, curative therapies are oftentimes unavailable for genetic rare diseases; nevertheless, a prompt diagnosis could allow clinicians to elaborate supportive care plans for patients and their caregivers, determine the best care setting, and potentially consider enrolling them in clinical trials, if suitable. Innovative, effective, and sustainable diagnostic techniques, such as Whole genome sequencing (WGS), are needed to address this growing health concern. At global level, there is a paucity of research that specifically investigates the implementation of WGS into clinical practice which is even more constrained at the European level. Furthermore, given the current challenges impacting pediatric patients suspected of having genetic diseases without a definitive diagnosis, there is an urgent need to improve the diagnostic workflow based on genomic techniques, such as WGS. Delving into this topic could contribute valuable insights that can inform policymakers, at macro-level, and health professionals, at micro-level, on how to develop suited genomic policies and clinical guidelines for the proper adoption of WGS within the daily clinical practice. From an international standpoint, it could be argued that these considerations resonate with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (i.e., “Good health and well-being”) and 10 (i.e., “Reduced inequalities”), as a priority for research and action. Notwithstanding, the broader implementation of WGS encounters hindrances owing to its complexity and the multifaceted social, economic, organizational, and ethical implications. In view of these challenges, Health Technology Assessment (HTA), as an integrated and multidisciplinary process, provides a comprehensive framework for the evaluation of these dimensions. This round table is intended to provide attendees with insights into nonclinical domains of HTA of WGS which, unlike clinical domains, demand a nuanced approach within the framework of the HTA. The intended objective is pursued through the initial presentation of a case study on the evaluation of WGS in paediatric genetic disorders from the Italian National Health Service perspectives followed by an open discussion with experts. The discussion will delve into issues related to economics, genomics, health services organization and ethics. Key messages • For pediatric patients suspected of having a genetic disease, WGS could shorten the so-called diagnostic odyssey. • Context-depending aspects of implementing WGS should be properly taken into account through HTA.

5.E. Round table: Crafting Policies for Health Promotion: evidence from local settings

Abstract As communities vary in their needs, challenges, and resources, tailoring health promotion policies to specific contexts becomes imperative for effectiveness. Drawing upon the expertise of seasoned practitioners, policymakers, and researchers, this workshop offers a multifaceted perspective on navigating the complexities inherent in designing, implementing, and evaluating locally tailored health promotion policies, with a specific focus on environmental and social factors. The workshop will make it possible to compare different experiences from various European countries, with high-level speakers who have different backgrounds and roles in their countries and regions, thus providing an interesting and interactive way of comparing and examining real-world examples and best practices. The examples provided delve into: participatory techniques to design healthier environments, to identifying, collecting and elaborating evidence upon which to build policies and actions that are effective in addressing specific health challenges. Through the examples presented, we will seek to make the case for multi-actor and multisectoral collaboration. In addition, we will try to understand How do subnational authorities and partners identify priorities for action. A common question asked to the speakers will therefore: how can a variety of actors (local and regional authorities, university and research centres...) come together to support cross-sectoral action? How can policymakers be supported towards creating environments that prioritize the well-being of all, ensuring a healthier and more prosperous future for everyone? The end goal will be to enable attendees to be equipped with actionable strategies and tools to foster meaningful change within their own communities, by understanding the intricate interplay between community dynamics, stakeholder engagement, evidence-based practices, and policy implementation strategies. The workshop is being organized by the WHO Regions for Health Network (RHN). Key messages • Tailoring health promotion policies to specific contexts is imperative for effectiveness, considering the diverse needs, challenges, and resources of different communities. • Subnational authorities and partners must identify priorities for action and collaborate across sectors to address specific health challenges effectively. Speakers/Panelists Klara Dokova Medical University of Varna, Varna, Bulgaria Camilla Ihlebaek Norwegian University of Life Sciences, Aas, Norway Jo Peden Public Health Wales, Cardiff, UK Odile Mekel NRW Centre for Health, Bochum, Germany Liesbeth van Holten Province of Utrecht, Utrecht, Netherlands

Prioritizing health, well-being, active ageing needs in Lithuania: insights from stakeholders

Abstract Background The rate of aging in Lithuania is faster than the EU average. The number of long-term health problems in older (65+yrs) people increases, posing changes in societal needs. The aim of our study was to identify the most important needs of older people in Lithuania. Methods Generic qualitative inquiry employed purposeful sampling of stakeholders in Lithuania: policymakers, administration, academia, civil society, health care, social service, public health, organizations of elderly. 43 experts, engaged in online focus groups, generated a list of needs for health, wellbeing, active ageing in elderly; they deliberated to prioritize top 5; scientific team condensed a list of 10 for voting to determine final 5 national needs. Research was done within project “Roadmap to improve the health and well-being of the ageing population in the Baltic Sea Region (AgeFLAG)”, 2020. Results Top needs identified were: shaping healthy lifestyle habits and motivation for change (72%) / age friendly environment and virtual assistive technologies (72%); person centred care (domiciliary care, residential care and nursing, social activities and etc. depending on the needs and wishes of the older person) (58%); increasing and maintaining physical capacity (56%); intersectoral collaboration and integration of social and health services (53%); establishment of positive public attitudes towards elderly people (50%). All stakeholders indicated that “Establishment of positive public attitudes towards elderly people” is the corner stone of all priorities for action to healthy ageing in Lithuania. Conclusions The main issue hindering active and healthy ageing in Lithuania - negative image of ageing in the society. Recommendations on the public health actions included promoting intergenerational conversation, reducing stigmas around ageing, strengthening social inclusion, generating age-friendly environments, and creating a safe space for self-realization and development. Key messages • The main issue hindering active and healthy ageing in Lithuania – negative image of ageing in the society. • The change in the population requires the transformation of health care and social care systems building age friendly environments in Lithuania.

A multicriteria decision-making model for risk management in an integrated management system

PurposeThis paper proposes a multicriteria model for risk management to identify and assess risks associated with an integrated management system (IMS). The main benefit of the proposed model is its systemic and logical visualization, which may facilitate the understanding of this proposal’s practical application.Design/methodology/approachThe research design consists of four stages: (1) conduct a literature review to establish risk management models in IMS; (2) collect data concerning risk management models in IMS from a large multinational automotive company; (3) propose a multicriteria model to define and assess risks as well as prioritize mitigation actions and (4) apply the proposed multicriteria model to the data collected in case-based research to evaluate the practical viability of the model to contribute to methods traditionally used.FindingsThe results showed that the proposed risk management model contributes to more reliable decision-making in an IMS. The application of the proposed model identified 85 risks in the total processes of the IMS, 31 of which were classified as high risk; thus, priority actions to be taken were defined. The risk classification and prioritization facilitated the implementation of measures to mitigate or eliminate risks, as pointed out by the company managers.Research limitations/implicationsOne of the limitations is the fact that specific knowledge is required to maintain and update the multicriteria decision-making tool used in this study. Another one implies the approach to managing risks under the different ISO standards and sector-specific requirements, since this may require updates and customization of the proposed risk management model.Practical implicationsThe implementation of IMS in contemporary business environments can be supported by a robust risk management approach. In addition, it provides the leadership with a holistic view of multiple aspects related to a company and fosters continuous improvement.Social implicationsThe social implications of this study are assessed indirectly. This study contributes to the improvement of company management models.Originality/valueTraditionally, the methods used for risk management in IMS are usually applied independently of techniques such as failure mode and effect analysis. The model developed in this work enables to manage risks continuously to achieve a systemic view of organizational issues and greater transparency of the processes.

Estimation of Environmental Burden of Disease related to Arsenic exposure in European Populations

Abstract Background Arsenic (As) exposure poses significant health risks to exposed populations, with exposure occurring predominantly via diet for the general population as recently referred by the European Food Safety Authority. This study assesses the environmental burden of disease (EBD) for three cancer types related to arsenic, across Europe. Methods A literature review was conducted to 1) identify the dose-response function (DRF) to assess the cancer risk in European populations, and 2) define EBD approaches applicable to the available data. Country-specific data (Belgium, Denmark, Portugal) for EBD calculation (exposure, socioeconomic status, health outcomes) were gathered. Disability-Adjusted Life Years (DALY) estimations were performed by calculating attributable cases (AC). Results Two main references are used for DRF: the United States Food and Drug Administration DRF for assessing bladder and lung cancer risks, and the United States Environmental Protection Agency DRF for skin cancer. Preliminary results for Belgium indicate that inorganic arsenic dietary exposure ranges from 0.084 [0.080 - 0.088] to 0.102 [0.097 - 0.107] µg/kg body weight per day, varying with education level. Stratified estimates suggest that individuals with higher educational attainment (ISCED levels 5 & 6) have a marginally higher average daily intake of arsenic compared to those with lower educational attainment (ISCED levels 0, 1 & 2). DALY attributable to inorganic arsenic exposure follow the same trend as exposure levels, i.e. individuals with a higher education level bear a higher burden of disease than individuals of the low education stratum. This concerns the three studied cancers. Conclusions This study quantifies DALY related to inorganic arsenic from dietary exposure for different European countries. Our findings will contribute to better target public health policies and interventions for arsenic risk mitigation. Key messages • Exposure to inorganic arsenic is confirmed in European countries. • EBD studies guide action priorities to tackle chemical risk factors.

Driving the zero-carbon construction strategy: key barriers and enablers

PurposeIn the fast-changing field of zero-carbon construction there is a gap in understanding how zero-carbon construction strategies are experienced in practice. This paper aims to identify the key barriers and enablers to driving a zero-carbon construction strategy by industry, policymakers and educators.Design/methodology/approachThe research was conducted in two stages. The first stage used a literature review to determine thematic areas from which to develop discussion points for the second stage of the research, which gathered insights into key barriers and enablers to driving a zero-carbon construction strategy from analysing recorded discussion with industry, policymakers and educators. This study adopts a qualitative research methodological design underpinned by dialectical approach of enquiries involving 31 participants. The philosophical standpoint aligns with a constructivist participatory worldview based on multiple stakeholder perspectives. Data involving virtual and face-to-face engagement held simultaneously in Australia and India were transcribed, coded and synthesised to identify the barriers and enablers to driving zero-carbon construction strategy.FindingsThe paper identified key barriers and enablers driving zero-carbon construction strategy. Barriers included limited awareness of industry dynamics; fixed mental models of professional practice; complexities in identifying appropriate skillsets; difficulties associated with reviewing education and training models and integrating sustainable strategies at early stages of projects. Enablers included: fostering education reform and supporting frameworks and procurement strategies for developers and clients; implementing efficient building designs, construction and operationalisation of zero-carbon buildings and; utilising an industry-led integrated approach. A framework was developed to provide an illustrative view of the linkage between the research projects’ focus areas and emergent themes.Originality/valueThe paper provides zero-carbon action priorities for four significant stakeholder groups in the build environment, developers, building occupiers, educators and government. As the priorities are derived in the research from examination of current literature and analysis of stakeholder viewpoints, this paper presents a unique, realistic and timely identification of barriers and key enablers driving zero-carbon construction strategies. Methodology applied in terms of data collection involved a public discourse and a unique technology-driven collaborative approach where participants simultaneously contributed across countries and time zones in a synchronous manner across key topics related to driving the zero-carbon construction strategy.

'You have to make it accessible and it's really not': priority actions to support disabled people to be physically active.

Disabled people are more likely than non-disabled people to be physically inactive, placing them at increased risk of ill-health. Many disabled people want to be more physically active yet feel there is inadequate support to do so. Evidence on the tangible actions that would support disabled people to be active is limited. The aim of this study was to explore the key actions that would best support disabled people's participation in physical activity. Twenty-one disabled people (62% >45 years, 48% male) were purposively sampled to take part in online focus groups (2-6 participants per group). Six focus groups were undertaken using a semi-structured guide, with transcripts thematically analysed. Thirteen themes were identified across four levels of the ecological model - interpersonal, institutional, community, and policy. Priority actions include mandatory training on how to support disabled people, improvements to the accessibility of facilities and equipment, improved frequency of public transport to activity centres, and actions to improve societal attitudes towards disabled people. A systems-based approach is needed, combining actions across levels of the ecological model, to ensure equitable access to physical activity for disabled people.

The power law of resource abundance and their corresponding extraction: Evidence to be accounted in the frame of the critical raw materials initiatives for the energy transition

Responsible sourcing of minerals and metals is critical for the transition to a low-carbon energy system. The increased demand for these materials requires a shift towards more efficient and environmentally friendly mining practices, as well as better recycling and reuse of these materials. Based on a transdisciplinary approach, in this work, the power law, normally used to model biological systems, is applied for the first time to model the relationship between the abundance of strategic elements and their extraction, at different times (in 1999 and 2023). An increase in the exponent of the power law when analyzing materials production data in 1999 and 2023 (the data can be fitted by two power laws with an exponent of 0.61 and 0.74, respectively) suggests changes in production dynamics, which could be driven by factors such as increased demand, improved efficiency, resource diversification, regulatory changes, market dynamics, or environmental considerations. Understanding these changes is crucial for assessing the sustainability and long-term viability of material production systems. Overall, the proposed power law offers a valuable framework for analyzing the dynamic relationship between material abundance and production over time, providing insights that can inform decision-making and support efforts toward sustainable resource management and economic development. This is particularly important with the recently established policies about the increase of mining activities in the EU countries.Based on these findings, this study suggests several priority actions, to achieve the objectives of the Critical Raw Materials Act, thereby enhancing the effectiveness of the proposed European plan to increase the availability of strategic materials. This involves diversifying resource inputs, promoting renewable and alternative materials, and adopting practices that prioritize conservation and responsible stewardship of natural resources.

Exploring the prevalence of chlamydial and gonorrheal infections in pregnant women: a multicenter study in Egypt

BackgroundChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are widespread, treatable sexually transmitted infections (STIs) of global significance, affecting millions annually. Left untreated, they pose significant risks, including pelvic inflammatory disease (PID), infertility, and complications during pregnancy. The U.S. Centers for Disease Control recommends annual chlamydial screening for sexually active women to address these risks. Responding to this global challenge, the World Health Organization (WHO) has formulated a global health sector strategy on sexually transmitted infections, outlining priority actions to strengthen STI responses in countries. However, STI epidemiological studies encounter challenges in developing nations like Egypt due to socio-cultural factors, poverty, and limited diagnostic facilities. In Egypt, STI diagnosis primarily relies on clinical presentations, lacking structured screening programs for CT and NG. This study’s main objective is to estimate the prevalence of Chlamydial and gonorrheal infections, advocating for supportive STI strategies in Egypt. Additionally, the study aims to provide a foundation for national prevalence estimates of CT and NG infections.MethodsA cross-sectional study encompassed five antenatal clinics in different regions of Egypt. A total of 1040 pregnant women attending these clinics were consecutively sampled. Data collection involved structured questionnaires, and urine samples were subjected to the GeneXpert CT/NG qualitative real-time PCR test.ResultsThe prevalence of CT infections was 0.29% (95% CI, 0.10–0.86%), with no detected NG infections. The three CT-positive cases were distributed across different recruitment centers, with no statistically significant differences observed between infected and non-infected participants. Notably, 40.3% of recruited women reported gynecological symptoms, primarily discharge. Additionally, 9.6% had undergone previous testing for sexually transmitted infections, with 8.2% receiving positive results.ConclusionsThis study provides valuable data on the prevalence of CT and NG infections among pregnant women attending ANC clinics in Egypt. The findings underscore the importance of ongoing surveillance, routine screening, and targeted interventions to ensure the reproductive health and well-being of pregnant women and their infants. Further research is warranted to explore the broader implications of STIs in different populations and to inform evidence-based guidelines for screening and management in diverse settings. Trial registration: IRB no.: 17,400,017; WHO ERC Protocol Id. A66005.