Priority Actions Research Articles

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.

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.

Deconstructing the geography of human impacts on species’ natural distribution

It remains unknown how species’ populations across their geographic range are constrained by multiple coincident natural and anthropogenic environmental gradients. Conservation actions are likely undermined without this knowledge because the relative importance of the multiple anthropogenic threats is not set within the context of the natural determinants of species’ distributions. We introduce the concept of a species ‘shadow distribution’ to address this knowledge gap, using explainable artificial intelligence to deconstruct the environmental building blocks of current species distributions. We assess shadow distributions for multiple threatened freshwater fishes in Switzerland which indicated how and where species respond negatively to threats — with negative threat impacts covering 88% of locations inside species’ environmental niches leading to a 25% reduction in environmental suitability. Our findings highlight that conservation of species’ geographic distributions is likely insufficient when biodiversity mapping is based on species distribution models, or threat mapping, without also quantifying species’ expected or shadow distributions. Overall, we show how priority actions for nature’s recovery can be identified and contextualised within the multiple natural constraints on biodiversity to better meet national and international biodiversity targets.

Prioritization of Source Data Necessary for the Valuation of Real Estate with Mineral Deposits: The Case of Poland

Real estate valuation with mineral deposits in Poland can be conducted using comparative, income, and cost approaches. When determining the value of such real estate, a property valuer must obtain information from multiple sources. These sources not only help to establish the legal status but also allow for determining the type of geological and mining asset of the deposit, characterizing and assessing the quality of the deposit, describing the deposit's resources, and evaluating the exploitation potential. Analysis of the source documentation also enables the assessment of the environmental state post-exploitation and helps determine the external conditions related to the liquidation of deposits after exploitation. The need to include the above information in the appraisal report requires the property valuer to gather a large amount of source information scattered across private and institutional resources. Therefore, this study aims to identify and prioritize the source data necessary for the valuation process of land properties with mineral deposits in Poland using selected business techniques. As part of achieving the research goal, the method of valuing the subject special property will be recognized, and the source materials will be identified. Their prioritization will be performed using two business techniques: the MoSCoW method and the Action Priority Matrix. In the final stage of the study, utility classes of the source materials for the valuation of the subject property will be developed

Regional Approach to Boosting Local Pharmaceutical Manufacturing Capacity: A Critique of the East African Community Pharmaceutical Manufacturing Plan of Action

Abstract The East African Community (EAC) has had a chequered history, evidenced by multiple changes of names and objectives, and a hiatus lasting more than two decades following a collapse in 1977. It was resuscitated in 1999 by its founding members (Uganda, Tanzania, and Kenya). That four other partner states have since joined is a clear testament to the effectiveness of its overhaul. The community is regulated by the EAC Treaty which promotes collective actions in several areas of mutual interests. Plagued by an ongoing access-to-medicines conundrum, EAC governments have considered collective action as recommended by the Treaty. This effort began around the 2010s when policy measures aimed at exploring collective solutions were adopted with a view to replacing reliance on importation and external drug donation with a gradually developed regional pharmaceutical production capacity. EAC policies such as the Policy/Protocol on TRIPS Flexibilities, the Medicines Registration Harmonisation Initiative, the Draft Anti-Counterfeit Policy, and a Pharmaceutical Manufacturing Plan of Action (EAC PMP) have since been developed to achieve this ambitious goal. Using both doctrinal and empirical (semi-structured interviews) methods, this paper examines the EAC PMP – the ‘be all’ of the policies. The priority actions outlined under the plan’s six pillars and presented as a bankable pathway to self-sufficiency in pharmaceutical production are critiqued. The paper finds considerable implementation of the drug harmonisation theme, while the others (leveraging TRIPS flexibilities, ensuring coherence, and boosting research and development and technology transfer) remain largely unimplemented.

Progress and challenges in implementing the Sendai Framework for Disaster Risk Reduction at sub-national levels: insights from Aceh, Indonesia

ABSTRACT Common gaps in the current reporting system regarding the progress of meeting the targets Sendai Framework for Disaster Risk Reduction (SFDRR) implementation in low- and middle-income countries include (1) systematic bias towards central governments’ interests and narratives; (2) reports suffer from lack of independent process committed to evidence-based reporting; (3) progress reports do not reflect adequate aggregation of progress from sub-national levels. This research focuses on assessing the progress of SFDRR implementation at sub-national levels in Aceh province, Indonesia – the place where Indian Ocean Tsunamis killed around 170,000 people on Boxing Day 2004. The authors combined key informant interviews and content analysis of policy documents to collect evidence of the progress in the four SFDRR priorities for action. Two case villages in Aceh demonstrated challenges and opportunities at local levels. Findings suggest gaps in SFDRR implementation include a lack of deliberation of risk assessment and knowledge dissemination, discontinuity of regional DRR forums, lack of incentives for mitigation and shared commitments, and responsibility. Progress at village levels is equally challenging due to the lack of funding allocation, discontinuity of village-level preparedness, and lack of adoption of sustainable recovery and community participation. In summary, since the progress of implementing DRR across four priority areas of the SFDRR in Aceh is not optimal, Aceh authorities (e.g. provincial and district secretariats), provincial and district Disaster Management (DM) Agencies, and other relevant DM actors need to comprehensively improve DRR across all four Priorities for Action of the framework in the province.

Interrogating the effectiveness of service engagement for underserved populations in complex health and social care systems: towards an equitable engagement strategy

There are increased sector-wide efforts within health and social care systems to engage those with lived experience in service design, delivery, and monitoring – aiming to secure more equitable health outcomes. However, critical knowledge gaps persist around how national whole-system engagement strategies can account for the challenges experienced by populations that encounter exclusion within complex multi-layered systems. This includes a failure to delineate shared challenges across groups, and to develop transferable cross-group frameworks to assist sector-wide change. There is, therefore, a danger that those groups already least heard will be collectively left behind. With a view to informing a more inclusive engagement strategy in Ireland, this national study aims to investigate multi-level (policy and strategic, operational, on-the-ground services, individual) shared challenges impacting engagement for five populations who have been identified as underserved groups in a complex health and social care system, including: (1) those who misuse drugs and alcohol, (2) those who are experiencing homelessness, (3) those experiencing mental health, (4) migrants and those of minority ethnicies, and (5) Irish Travellers. Adopting a mixed-methods approach which draws on an evidence-informed multistakeholder perspective, this study employs data from: focus groups and life-course interviews with lived-experience populations (n=136), five focus groups (n=39) and a national on-line survey (n=320) with population-specific services providers; and national-level stakeholder interviews (n=9). Two cross-group participatory consultative forums with lived-experience and provider participants (n=28) were used to co-produce priority action areas based on study findings. This article presents findings on shared challenges in engaging these groups around leadership and commitment, implementation and action, population capacities, trust, and representation, stigma, and discrimination. Derived from these challenges, six development areas are presented to advance an inclusive equitable engagement approach in Ireland. These comprise: 1) balancing top-down prioritisation, and bottom-up direction; 2) sustaining multi-level, multi-form implementation; 3) measuring effectiveness and action; 4) embedding inclusive equitable engagement; 5) trust as a prerequisite, and outcome; and 6) an equalising, agency empowering agenda.

Перспективы международного транзита по Северному морскому пути

The Northern Sea Route (NSR) serves as a vital route for Russia, driven by both economic demands and the need for industrial development in the Arctic. The country primarily uses the NSR to supply goods to its northern regions, with the route also used by Russian companies involved in Arctic projects. As a result of economic growth in the Russian Arctic, advances in transportation technologies for navigating harsh Arctic conditions, and ongoing climate change, the NSR is expected to grow in significance as a global transport corridor, including its role in international trade. This article analyzes freight traffic and assesses the NSR’s potential for international transit. The study aims to identify promising directions for the future development of international transit along the NSR. It examines domestic and transit freight traffic dynamics over an eleven-year period, concluding that recent geopolitical events in Ukraine and the resulting anti-Russian sanctions have impacted transit traffic volumes. Key challenges to the development of NSR transit freight traffic are identified, along with their potential consequences. The study assesses the NSR’s transit capacity and outlines priority actions for unlocking its full potential. Two primary areas for future transit development are highlighted: facilitating transit traffic from China and increasing container traffic volumes, both of which warrant further exploration. The relevance of this study is underscored by the growing need to enhance NSR transit freight traffic. The scientific contribution of this research lies in its evaluation of the NSR’s transit potential using statistical analysis and in identifying strategic directions for transit development. The practical significance of the study is reflected in its recommendations, which aim to support the growth of the NSR as a key international transit route.

Developing a city-wide, community-engaged cancer disparities research agenda.

In response to high levels of cancer disparities in Philadelphia, PA, three NCI-designated clinical cancer centers formed Philadelphia Communities Conquering Cancer (PC3) to bring stakeholders together and establish infrastructure for future cancer reducing initiatives. The PC3 coalition aimed to develop a prioritized cancer disparities research agenda in order to align cancer center resources and research interests with the concerns of the community about cancer, and to ensure that initiatives were patient- and community-centered. Agenda development activities culminated in a city-wide cancer disparities conference. The conference, attended by 55 diverse stakeholders, was the venue for small group discussion sessions about cancer concerns related to prevention, early detection, treatment, survivorship, and quality of life. Sessions were guided by a moderator guide and were audiorecorded, transcribed, and analyzed by the PC3 leadership team. Results were reviewed and consensus was achieved with the help of PC3's Stakeholder Advisory Committee. Stakeholders identified four thematic areas as top priorities for cancer disparities research and action in Philadelphia: communication between patients, providers, and caregivers; education that reaches patients and community members with tailored and targeted information; navigation that assists people in finding and accessing the right cancer screening or treatment option for them; and representation that diversifies the workforce in clinics, cancer centers, and research offices. A community-informed, prioritized research agenda provides a road map for the three cancer centers to collaborate on future initiatives that are important to patients and stakeholders, to ultimately reduce the burden of cancer for all Philadelphians.

Strengthening public health system resilience to disasters in Türkiye: Insights from a scorecard methodology

BackgroundTürkiye is a country that faces many disasters, especially earthquakes and floods, which have serious short- and long-term consequences for public health. The importance of disaster risk reduction activities in building resilience before a disaster strikes is increasingly recognized. Furthermore, resilience assessment is considered to be the starting point for these activities. However, there is a substantial gap in the scientific evidence on systematic assessments of the resilience of the public health system and also a serious lack of activities to strengthen the system against disasters in Türkiye. AimUsing a Scorecard methodology, the study aimed to systematically assess the resilience of the public health system in Türkiye by examining key indicators related to disaster risk management and preparedness, and subsequently to recommend priority actions. A systematic assessment of resilience can provide the scientific evidence needed to identify weaknesses in the system. Furthermore, identifying priority actions based on this evidence allows progress to be made towards strengthening the system. MethodsThis mixed-methods study was conducted in two separate regions of Türkiye with the highest earthquake (Esenler/Istanbul) and flood risk (Ortahisar/Trabzon). Based on the Scorecard methodology, two-stage workshops (online and face-to-face) were held. During the online stage, qualitative data were collected by interviewing participants about their evaluation of the situation in the counties regarding the Scorecard indicators, and quantitative data were collected through scoring. In the face-to-face stage, strategies were developed to improve the resilience of the public health system. Quantitative data were expressed with numbers and percentages, and thematic analysis was utilized for qualitative data analysis. ResultsThe lowest scoring indicators were as follows (Esenler and Ortahisar, respectively): addressing mental health needs associated with disasters (2.17 ± 1.29; 2.27 ± 1.16), resilience of key healthcare facilities (2.22 ± 0.55; 2.91 ± 1.08), and protection and identification of ecosystem services (2.39 ± 1.04; 2.13 ± 1.49). In this study, participants recommended increasing the resilience of the public health infrastructure and improving human resources and ecosystem services to ensure the resilience of the public health system. ConclusionsThe study found that the weakest areas in terms of public health system resilience were the seismic safety and infrastructure of health facilities, the capacity of disaster-related mental health services, and disaster-related ecosystem services. To improve the resilience of public health systems, it is essential to strengthen these areas of weakness and ensure collaboration between all stakeholders in the system. The identification of weaknesses in the study has guided the determination of priority actions to build a baseline of resilience. In addition, the results of the study have highlighted priority areas for investment to improve disaster response and the overall health of the population in the context of disasters.

Inclusive Education for Children with Developmental Disabilities in Ethiopia: Stakeholder Views on Benefits, Disadvantages and Priorities for Action.

Children with developmental disabilities (DD) including intellectual disability and autism, experience exclusion from social life and education in Ethiopia. Including children with DD in mainstream inclusive classes has potential to expand access to education and uphold their right to learn alongside typically developing peers. However, inadequate support in inclusive settings can hinder their participation and educational achievement. This study explores the perspectives of stakeholders on the ways in which inclusive education can support the needs or exacerbate the challenges of children with DD in Addis Ababa, Ethiopia, and on recommendations to address the challenges. Thirty-nine participants with expertise or experience relevant to children with DD, including caregivers, educators, clinicians and other experts, took part in semi-structured interviews. Their responses were analysed using thematic template analysis. The themes developed identify four aspects which are most relevant to the potential positive and negative consequences of inclusive education for children with DD: learning and development, peer relationships, safety in school and inclusion in society. The themes encompass sub-themes of positive and negative consequences, and suggested improvements to facilitate positive effects. Identified priorities for action include enhanced teacher training, awareness-raising initiatives, tailoring infrastructure and manpower to safeguard children with DD and promoting government focus on successful inclusion. These recommendations can be implemented to facilitate well-structured inclusive education, where children with DD are supported to participate alongside typically developing peers, as well as to safeguard against the potential negative consequences of inclusion, paying sufficient attention to the distinctive needs of children with DD.

COLLABORATIVE PLATFORMS SUPPORTING CIRCULARITY IN THE BUILT ENVIRONMENT. IDENTIFYING STRATEGIC ACTIONS AND REPLICABLE GOOD PRACTICES

This contribution highlights the role that collaborative platforms can offer for the promotion of circularity in the construction sector, through the interaction between different stakeholders and, in particular, through the collection and promotion of good practices. In fact, the work reports the outcomes of stakeholder consultation experiences, developed within the Italian Circular Economy Stakeholder Platform, aimed at identifying the strategic areas and priority actions for the scale-up circular solutions to a large scale, and activities of collection, selection and analysis of good practices at different scales (products, buildings, tools) that exemplify the possibility of concretely implementing - in a highly replicable manner - the circular solutions, until now often considered experimental cases that are difficult to be repeated.