Regional Programs Research Articles

Benefits of HIV-1 transmission cluster surveillance: a French retrospective observational study of the molecular and epidemiological co-evolution of recent circulating recombinant forms 94 and 132.

Molecular surveillance is an important tool for detecting chains of transmission and controlling the HIV epidemic. This can also improve our knowledge of molecular and epidemiological factors for the optimization of prevention. Our objective was to illustrate this by studying the molecular and epidemiological evolution of the cluster including the new circulating recombinant form (CRF) 94_cpx of HIV-1, detected in 2017 and targeted by preventive actions in 2018. In June 2022, 32 HIV-1 sequence databases from French laboratories were screened to identify all individuals who had acquired CRF94_cpx or a similar strain, whatever the date of diagnosis. Phylogenetic analyses were performed with the sequences identified, and biological parameters were collected at the time of diagnosis and after the start of treatment to analyse the evolution of the cluster. Full genomes were sequenced to characterize the new strains. We analysed 98 HIV-1 isolates: 63 were CRF94, three were unclassifiable, and the other 32 formed a new cluster containing a new recombinant, CRF132_94B, derived from CRF94 and a subtype B strain. At least 95% of the individuals in both the CRF94 and CRF132 clusters were men who have sex with men (MSM), most of whom had acquired HIV less than 12 months before diagnosis. The number of CRF94 diagnoses declined drastically after 2018, but CRF132 strains spread widely between 2020 and 2022, into a different area of Ile-de-France region and within a younger population nevertheless aware of pre-exposure prophylaxis. Higher viraemia, lower CD4 cell counts and delayed treatment efficacy suggested that CRF94 was more virulent than CRF132, possibly due to the F subtype fragment of the vif gene. These findings highlight the role of the MSM transmission cluster in spreading HIV and new variants. They show also the benefits of cluster surveillance for improving the targeting of preventive interventions, detecting the emergence of new strains and enriching our knowledge on virulence mechanisms. However, these investigations require support with sufficient resources dedicated to a regional or national programme to be responsive and effective.

A program to improve sepsis management in the Emergency Department: a multicenter prospective study in France.

Implementation of a regional sepsis program to improve compliance with sepsis care bundles and optimize septic patient management and outcomes in the Emergency Department (ED). The program included a multifaceted intervention in 8EDs: creation of a regional sepsis team, meetings, education (yearly 6-h course and site visits) and sepsis alert. Clinical practice was evaluated in each ED during 1month every year over 3years. The primary outcome was the initiation of all criteria of the Surviving Sepsis Campaign (SSC) bundle within 3h after triage. Secondary outcomes were the initiation of the 3-h bundle in patients with hypotension (SBP ≤ 100mmHg), admission related to infection or not, proportion of organ supports, subsequent intensive care unit (ICU) admission, and early mortality (day 7). During the 3-month study period, 739 patients were identified with a sepsis including 8% with septic shock. Compliance with the SSC bundle improved during the three periods (P1: 28/176 (16%), P2: 42/272 (15%), P3:69/291 (24%), p = 0.023). In patients with hypotension (n = 142, 19%), no improvement was observed (P1:12/38 (32%), P2:18/46 (39%), P3: 28/58 (48%), p = 0.255). Mortality on day 7 was also similar (10% vs 11% vs 9%, p = 0.621). In multivariate analysis, age (OR = 1.03; 95% CI 1.01-1.05, p = 0.003) and confusion (OR = 2.37; 95% CI 1.37-4.14, p = 0.002) were independently associated with D7 mortality. Patients referred to ED for infection had a better prognosis compared to those with a non-specific reason (OR = 0.56; 95% CI 0.32-0.97, p = 0.038). A regional sepsis educational program appears to improve compliance with the SSC bundle. Pre-hospital identification of sepsis appears to improve further management.

Large-scale flood risk assessment in data-scarce areas: an application to Central Asia

Abstract. The countries of Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan in Central Asia are highly prone to natural hazards, particularly floods, earthquakes, and landslides. The European Union, in collaboration with the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), created the programme Strengthening Financial Resilience and Accelerating Risk Reduction in Central Asia (SFRARR) to advance disaster and climate resilience in the region. As part of the SFRARR project, the “Regionally consistent risk assessment for earthquakes and floods and selective landslide scenario analysis for strengthening financial resilience and accelerating risk reduction in Central Asia” was developed to achieve the project's objectives. This article presents the data, model, methodology, and results for the five Central Asian countries of the flood risk assessment, which represents the first high-resolution regional-scale transboundary risk assessment study in the area aiming to provide tools for decision-making. The output information will inform and enable the World Bank to initiate a policy dialogue. A fully probabilistic risk assessment for fluvial floods has been carried out for these countries to support regional and national risk financing and insurance applications, including potential indemnity and/or parametric risk financing solutions for a regional programme. A homogenised risk assessment methodology for the five countries and across multiple hazards (floods and earthquakes) and asset types has been adopted to obtain strategic financial solutions consistent across geographical areas and economic sectors. The largest relative (to the total exposed value) expected annual damages are found in Kazakhstan and Tajikistan, with values above 6 ‰. In the five considered countries, the largest relative expected annual damages by sector are found for the transport and agricultural sectors. Climate change is expected to have contrasting impacts, with increases in risk for some regions (the most severe increase is found in the Mangistauskaya region in Kazakhstan) and decreases for other regions (Lebap, Turkmenistan; Khatlon, Tajikistan; Samarkand, Uzbekistan; and Batken, Kyrgyz Republic).

Assessment of Four Essential Features of the Alive & Thrive Initiative to Improve Maternal, Infant, Young Child, and Adolescent Nutrition.

Alive & Thrive has been a major global nutrition initiative that aimed to learn how to improve maternal, infant, young child, and adolescent nutrition and health on a large scale. During 2009-2014, Alive & Thrive developed and implemented interventions to improve infant and young child feeding at scale in three countries. Subsequently, Alive & Thrive expanded its work to more than 15 geographies, including six country-specific and two regional programs, to additionally address maternal and adolescent nutrition while adding agriculture and social protection programs to improve maternal, infant, and young child nutrition. Reflecting on the big picture of what the Alive & Thrive initiative has accomplished in its 16 years and how it did so, four features warranted emphasis because additional learning was needed. These four features were: commitment to exemplary large-scale social and behaviour change communication, explicit focus on policy and advocacy to achieve and sustain change, promotion of country-led initiatives through technical assistance, and attention to quality assurance and improvement in programming. For each feature, an assessment across the Alive & Thrive portfolio was commissioned, each led by an external consultant or team. The assessments highlighted designing and implementing exemplary social and behaviour change programming and policy advocacy in each country, undertaking a large-scale effort through careful, in-depth, and evidence-based planning that is bolstered by strong engagement with relevant stakeholders at multiple levels. The assessments also highlighted technical assistance that is responsive to country contexts to support country-led initiatives and attention to assuring and improving the quality of programming to achieve effectiveness.

Exploring the interplay between religion, tolerance, fundamentalism, and attitudes towards immigrants: a semi-automatic literature review

ABSTRACT Migration has profoundly impacted national political agendas and public perceptions of immigrants. Many factors, such as the perceived threat to the residents’ economic stability and cultural integration, affect the attitudes toward immigrants. Academics have explored the influence of some socioeconomic and political factors, regional welfare programs, and support for right-wing parties in shaping these perceptions. The study reviews specifically the importance of the role of religion in shaping attitudes towards immigrants. Through a semi-automatic literature extraction, the study aims to explore the intersectionality of religious tolerance with fundamentalism and attitudes towards immigrants. The study aims to shed light on the underlying grounded theories and suggest future studies in the field. Bibliometric analysis of a database of selected studies reveals strong associations between words such as ‘Muslims,’ ‘integration,’ ‘attitudes,’ and ‘immigrants,’ underscoring their interconnectedness in scholarly analysis. Thus, the study provides a general overview and understanding of the complex relationship between religion and three connected variables: religious tolerance, fundamentalism and attitudes towards immigrants.

Organization of provision of primary health care to the population of the Syzran district at medical outpatient clinics, paramedic-obstetric stations, offices of general doctors

Thanks to the regional program for modernization of primary healthcare in the Samara region for 2021–2025, implemented within the framework of the national project «Healthcare» initiated by the President of the Russian Federation Vladimir Putin, six new modular paramedic-obstetric stations and one medical outpatient clinic have opened their doors in the Syzran district.

Statistical study of regional differences in the educational potential of the population

Purpose: of the presented research is to characterize the educational potential of the population based on an integrated assessment of educational activities and the material, technical and information base of education in the subjects of the Russian Federation.Methods: the work used tabular and graphical methods of data representation, grouping, methods for calculating integral indicators, as well as the method of correlation and regression analysis.Results: the article examines the concept of the "educational potential" and systematizes it’s defining indicators. The characteristics of the main target indicators characterizing educational activities and the material, technical and information base of education in the subjects of Russia are given. The authors present the integral indicators characterizing educational activities and the material, technical and information base of education. On the basis of the integral indicator characterizing educational activity and determining the indicator of educational performance – the share of the employed population aged 15 years and older with higher education in the total number of employed population, the regression model is constructed. According to the results of the comparison of the integral indicators characterizing educational activities and the material, technical and information base of education in the regions of Russia, the leading and lagging subjects were identified. According to these indicators, the multidimensional grouping has been developed that characterizes the lag of subjects from the national average based on the values of the generalizing indicators.Conclusions and Relevance: the compiled ratings of the subjects of the Russian Federation on the integral assessment of the educational potential of the population can become the basis for the development of differentiated measures aimed at stimulating the development of education, as well as for evaluating the effectiveness of the implementation of relevant regional programs. The study of the Index of Educational activity and the index of the material, technical and information base of education will allow us to identify problem regions according to certain characteristics of education, since they can affect certain elements of the field of education. This will enable the Ministry of Science and Higher Education of the Russian Federation to respond more quickly to problems in this area in the regional context.

Development of telecommunications in the Arctic regions of the Sakha Republic (Yakutia)

The article examines the prospects and directions for the development of communications in the Arctic regions of the Republic of Sakha (Yakutia), where ensuring stable and high-quality communications is critical for the social and economic integration of the region, as well as for improving the standard of living of the local population. The paper analyzes the current state of the telecommunications infrastructure, covering satellite, mobile and fiber-optic networks, with a special focus on the key challenges faced by residents of remote areas: high costs of services, complex logistics and limited availability of broadband Internet. The article also considers federal and regional programs, such as the Arctic Synergy project and the Polar Express underwater communication line, aimed at improving telecommunications coverage, eliminating digital inequality and reducing social isolation in remote areas. Technological solutions are proposed, including the introduction of 4G and 5G networks, the use of satellite systems and the integration of renewable energy sources, which are assessed as strategic approaches that can improve the quality of services and support the development of digital infrastructure. In conclusion, the authors point out that sustainable development of communications in the Arctic requires not only the introduction of modern technologies, but also continued government support, including subsidies to reduce the cost of services. They also emphasize the importance of developing infrastructure adapted to extreme climatic conditions and creating backup communication channels that will ensure the reliability and stability of telecommunications services in remote Arctic regions.

IMPLEMENTASI PROGRAM REVITALISASI BAHASA DAERAH OLEH KANTOR BAHASA PROVINSI KALIMANTAN TIMUR

This study aims to determine the implementation of the Kenyah Language Revitalization Program by the East Kalimantan Provincial Language Office in Pampang Village, Samarinda City, and its inhibiting factors. This research uses a descriptive type with qualitative methods, with primary data sources through interviews with key informants of the Kenyah Language Revitalization Coordinator of the East Kalimantan Provincial Language Office. Secondary data sources include press release information, documents, and archives related to the revitalization program. Data collection techniques include observation, interviews, and documentation. The data analysis used was an interactive model analysis developed by Miles, Huberman and Saldana. The implementation of the Kenyah Language revitalization program in Pampang Village was successfully carried out by the East Kalimantan Provincial Language Office as the implementor. This is evident from the six stages of the regional language revitalization program from the 17th episode of the Merdeka Belajar curriculum that have achieved their goals. Starting from the coordination meeting stage, group discussions, teacher training, transmission to the Provincial Mother Language Bud Festival were successfully realized in the revitalization of Kenyah language in Pampang Village. However, during the process it turned out that there were obstacles that caused each stage not to be maximized perfectly, namely: 1) not maximizing the implementation of Samarinda Mayor Regulation Number 15 of 2022 which does not have specific policy derivatives related to local content-based revitalization and 2) community-based revitalization modules that cannot be applied in Pampang Village schools due to the absence of local content of Kenyah Language in the school.

Implementation and Evaluation of a High-Fidelity, Interprofessional Simulation Project Using Standardized Patients to Address Aggression in a Psychiatric Emergency Department.

Increased aggression in a regional Comprehensive Psychiatric Emergency Program (CPEP) led to a significant rise in physical assaults, restraints, and use of security personnel. Root cause analysis revealed a need for more extensive training on de-escalation, teamwork and communication. This quality improvement project evaluated the impact of an interprofessional, high-fidelity simulation project on interdisciplinary collaboration to manage de-escalation and aggression safely and effectively. Interdisciplinary team members (N = 171 nurses, psychiatrists, social workers, crisis specialists, and safety officers) participated in a 2.5-hr educational initiative that included Crisis Prevention Intervention (CPI) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) interventions, high-fidelity simulation using standardized patients, observation, and debriefing. Quantitative data collection and analysis included the use of the Confidence in Coping with Patient Aggression Instrument (CCPAI), TeamSTEPPS Perception Questionnaire (T-TPQ), pre-post data on restraints, injuries, and an educational survey. A qualitative analysis of debriefing themes was also performed. Statistically significant improvement was noted in individuals' confidence to manage aggression. In addition, data collected over a 5-month period before and after simulation demonstrated a 35% reduction in restraints and a 52% reduction in injuries. Interestingly, quantitative evidence revealed no changes in perceptions of teamwork. Results from the educational survey highlighted the positive impact of standardized patients and debriefing, and gaining new insights into patient care. Qualitative analysis of debriefing themes revealed educational opportunities to improve communication, role clarity, de-escalation, and insights into patient impact. The use of high-fidelity simulation with standardized patients has the potential to strengthen interdisciplinary collaboration to safely manage aggression in an acute psychiatric setting.

Travel to historical sites as a factor in the development of territorial entrepreneurship and culture of society

This study is devoted to the development of domestic tourism to historical sites, brief descriptions of the most interesting historical sites (estates) are given Moscow and St. Petersburg, as well as the regions of the country. Analytical data on tourist flows in the two capitals for the first nine months of 2023–2024 are presented. The role of tourism development for the segment of small and medium–sized enterprises is outlined.The results of the study are drawn to the disproportionality of the applied preferential programs in different regions of the Russian Federation. The author notes that it is necessary to develop preferential programs based on the incomes and opportunities of the subjects of the Russian Federation, so that no region is left without attention from the Government of the Russian Federation, and the development of tours to historical sites will not only form spiritual values among young people, promote education and enlightenment of families with children, but also It will increase the number of SMEs in all regions of the country and increase their contribution to the territorial and federal budgets.

The International Master’s Program in Oceanography and Applications in Benin

The state and dynamics of the oceans and seas that surround Africa are changing at an increasing pace due to anthropogenic pressures. The livelihoods of many Africans depend on fishing and ocean-​driven monsoon rains, and some African coastlines are eroding rapidly, potentially with catastrophic results to populations and infrastructure. Yet few African scientists are prepared to engage in ocean-related research. To address this deficit, the Master’s program in Oceanography and Applications1 was launched in 2008 in Benin, targeting the West African region. This program is designed to build capacity in support of regional research programs in oceanography such as PIRATA (Prediction and Research Moored Array in the Tropical Atlantic; Bourlès et al., 2019), AMMA-EGEE (African Monsoon Multidisciplinary Analyses - Oceanic Circulation and Ocean-​Atmosphere Exchanges in the Gulf of Guinea; Redelsperger et al., 2006; Bourlès et al., 2007), and PROPAO (Regional Program of Physical Oceanography in West Africa; Sohou et al., 2020).

Food insecurity as a target for suicide prevention (literature review)

Background. The review presents a summary of English-language sources that explore the relationship between food insecurity and suicidal behavior in humans. The study was conducted to analytically identify a new target for suicide prevention. The hypothesis was tested that food insecurity could be a pro-suicidal factor, i.e., one that increases levels of suicidal activity and mortality, and thus serves as a potential target for suicide prevention. Relevance: The lack of access to adequate and quality nutrition poses a significant psychological, socio-economic, and medical challenge. It contributes to elevated levels of depression, anxiety, and suicidal behavior, particularly among vulnerable population groups such as adolescents, students, older adults, and veterans. Purpose – the study aims to analyze the impact of food insecurity on mental health and suicidal behavior. It identifies the potential of leveraging food security improvement approaches for suicide prevention. Materials and Methods. A systematic review of the literature from the past five years using international databases (PubMed, Scopus, Web of Science). Content analysis of studies and reports to uncover key hypotheses and relationships. A multidisciplinary approach, integrating insights from psychology, sociology, economics, and medicine. Results and discussion. The study confirms that food security plays a vital role in supporting mental health, while its absence is a significant risk factor for developing suicidal behavior. Impact of Food Insecurity on Mental Health: Individuals experiencing food deficits are more prone to anxiety, depression, and suicidal thoughts. For example, in the United States, youth with insufficient food security were three times more likely to develop suicidal ideation compared to their food-secure peers. In Tanzania, schoolchildren suffering from food scarcity had twice the frequency of suicide attempts as their well-fed counterparts. Global Trends: Regions in Africa with chronic food shortages report high levels of suicidal thoughts – up to 30% among adults. In Canada, acute food deprivation was linked to reduced life expectancy and increased suicide risk. Among older adults in low-income countries, inadequate nutrition tripled the likelihood of suicide attempts. Youth and Students as Vulnerable Groups: Food insecurity profoundly impacts the mental health of adolescents and students. In Canada, up to 13% of adolescents facing food insecurity reported suicidal thoughts. Similarly, in Bangladesh, 75.5% of university students experienced food insecurity, which was associated with high rates of suicidal ideation, plans, and attempts. Challenges Faced by Military Veterans: Among U.S. military veterans, food insecurity was associated with nearly a fourfold increase in the risk of suicidal thoughts. This risk was particularly pronounced among those with co-existing mental health disorders. Social Mechanisms of Influence: Food insufficiency leads to stress, feelings of social isolation, and hopelessness – factors that significantly increase the likelihood of suicidal thoughts. It was found that up to 46% of this link is mediated by stress and isolation. Heterogeneity in Data and Methodology: Some aspects of the research remain unevenly addressed. Differences in measuring food insecurity complicate the comparison of results; however, all sources confirm its substantial impact on mental well-being. Results. The results highlight the need for a comprehensive approach to addressing food security issues. Recognizing the absence of food security as a major risk factor for mental health opens new avenues for developing targeted suicide prevention programs. Ensuring access to quality food, conducting localized research, and integrating food security parameters into national policy plans can significantly reduce suicide risks. Notably, the creation of regional support programs targeting vulnerable groups can ensure both physical and psychological well-being. Conclusion: The findings confirm that food security is not merely a socio-economic issue but also a crucial psychological category that demands attention from both the scientific community and governments. Ensuring food security transcends the fulfillment of physical needs, encompassing complex socio-economic and psychological challenges. Its provision is a vital step toward preserving mental health and saving lives globally. Recognizing food insecurity as a target for suicide prevention offers new opportunities to alleviate social tension and safeguard human lives.

Особенности пространственного развития периферийных, центральных регионов и регионов СЗФО: сравнительный анализ

The Russian Federation, having a large regional space, is characterized by a high level of its heterogeneity. For regions, the level of accessibility, which allows expanding its spatial boundaries for trade and economic relations, plays an important role in matters of territorial development. Territories with a remote location have opportunities for developing foreign economic cooperation, since in most cases these are border regions. The main manifestation of the negative impact of peripheral territories is a high level of remoteness from other regions and markets of the country. The presence of the remoteness effect reduces the possibility of increasing market share by entering other Russian markets. An additional negative manifestation of the remoteness of the territory from the center of the country is the presence of transport and logistics costs, which are added to the main production costs. The study examined the influence of the factor of remoteness of the territory from the center of the Russian Federation. The level of remoteness is determined as a result of calculating the peripherality index for Russian regions. The result obtained for the regions of the Russian Federation made it possible to determine a group of central and peripheral regions. It is proposed to consider several groups of regions: central, peripheral and regions of the Northwestern Federal District, which determines the object of the study. The aim of the study is to assess the regional heterogeneity of territories with different levels of remoteness from the central part of the Russian Federation. The study is conducted using statistical information and data from Rosstat. Comparative assessments of the selected groups of regions are based on the use of ranking procedures, comparative and spatial analysis. The heterogeneity assessment uses the ranking method as a tool. The results obtained can be used in writing strategic documents for the development of territories, as well as development programs for border regions.

Framework for cross-border governance: from cross-border critical factors to sustainable development

ABSTRACT Cross-border regions became a central discussion space regarding political stability and global sustainability. In this context, cross-border governance (CG) proposes interdependency management to achieve better results. Our research aims to identify the critical factors for CG and proposes theoretical/practical tools for helping border regions advance towards sustainable development (SD). To do so, we conducted a systematic literature review and interviews with experts. The data resulted in a framework with 12 critical factors in four CG dimensions – Territorial, Resources, Institutional, and Political-Regulatory, and a CG model that can help political cooperation for integrated regional programmes towards SD.

Export of Medical Services in the Tyumen Region: Nosological Analysis for 2023

Introduction. Since 2019, the export of Russian medical services has been realized in accordance with the “Development of the export of medical services” regional project that is being implemented in 70 subjects of the Russian Federation. This initiative has drawn significant interest from the scientific community, particularly regarding the strategies developed by various regions to promote inbound medical tourism and export of medical services. While much of the focus has been on the export potential and programs aimed at attracting foreign patients, there is a scarcity of studies of nosologies, or medical specialties, which are the basis of the strategy for regional export of medical services.The goals of the study were to analyze the export of medical services in the Tyumen Region in the context of export-oriented medical specialties in demand from foreign citizens, to determine the strategic significance of certain medical specialties within the export system, as well as to identify the strategic development of their export potential upon graphical data. As statistical report on the export of medical services for this year is unified, this study aims at setting the standard for nosological analysis for regional management teams involved in project implementation.Results and conclusion. The study was based on the data on the export of medical services in the Tyumen region for 2023. The work discusses revenue by sources of financing, including the types of medical care (inpatient, outpatient, and day hospital). Average costs of medical care and medical specialties being of particular interest for the development of regional export programs not only in terms of profitability but also with focus on the burden on the healthcare system, were identified. The possible strategies for developing the potential of certain medical specialties were determined by the method of graphical analysis.

Regional Hereditary Cancer Program in Chile: A scalable model of genetic counseling and molecular diagnosis to improve clinical outcomes for patients with hereditary cancer across Latin America

BackgroundBreast cancer is a leading cause of cancer-related mortality worldwide, with hereditary forms accounting for approximately 10% of cases. In Chile, significant gaps exist in genetic counseling and testing, particularly within the public health system. This study presents the implementation and outcomes of the first regional hereditary cancer program in the Maule region of Chile, aimed at improving detection and management of hereditary breast cancer.MethodsA cohort of 48 high-risk breast cancer patients from the Hospital Regional de Talca received genetic counseling and underwent Next-Generation Sequencing multigene panel testing. The program was established through collaboration between multiple institutions, leveraging telemedicine and outsourcing sequencing analysis to address regional gaps.ResultsPathogenic or likely pathogenic variants were identified in 12% of patients, including in BRCA1, BRCA2, TP53, and PALB2. Notably, novel pathogenic variants in BRCA1 (rs80357505) and TP53 (rs1131691022) were discovered, highlighting the unique genetic landscape of the Chilean population. Additionally, 70 variants of uncertain significance were found across 42 genes, particularly in FAN1, MSH6, and FANCI, underscoring the need for further research. The program’s collaborative approach effectively bridged critical gaps in genetic services, providing high-quality care within the public health system despite limited resources.ConclusionsThe Regional Hereditary Cancer Program addresses significant gaps in genetic counseling and testing in Chile’s public health system. This scalable model enhances early detection and personalized treatment for hereditary cancer patients and could be adapted to other regions across Latin America.

Escaping the resource curse: does resource dependence reduction mitigate income inequality?

This paper quantifies the impact of resource dependence reduction on income inequality. Using an exogenous shock triggered by China’s sustainable program for resource-based regions and prefecture-level data during 2004–2020, we perform a difference-in-differences estimation and find that reducing resource dependence has a sizable narrowing effect on urban-rural income gap. On average, the sustainable program reduces the gap (as measured by a ratio indicator) by 4.11%, with the effect being more pronounced in regions with initial low institutional quality. Further evidence suggests that the rise of labor-intensive industries and the increased rural investment, which benefit the poor more, help explain the narrowing effect. This paper sheds light on the sustainable development of resource-dependent regions.

The strategy of attracting investments to the region (the case of the Voronezh region)

The competitive advantages of the region, which provide investment attractiveness for Russian and foreign investors, are revealed. Strategic vectors for the development of the region's economy until 2035 have been selected. A set of tools and measures for institutional support to attract investors to the region's economy has been determined. The industrial development program is focused on accelerating regional development centers using regional and federal development programs.

Impact of forward head posture correction on craniovertebral angle, neck disability, and spinal electromyography: A randomized controlled trial

Background Forward head posture (FHP) is a common malalignment affecting the cervicothoracic spine. This deviation is associated with neck disability and muscle imbalance. Objective This study aimed to investigate the efficacy of FHP correction using regional versus comprehensive spinal programs on the craniovertebral (CV) angle, neck disability, and spinal muscle activity. Methods Sixty participants with FHP were randomly assigned to receive either a cervicothoracic correction program (control group) or a cervicothoracic plus lumbopelvic program (experimental group). The CV angle, neck disability index (NDI), and normalized electromyography as a percentage of maximum voluntary isometric contraction (%MVIC) from spinal muscles were measured before and after the intervention. Results Post-intervention, both groups showed significant improvement across time in CV angle and NDI (p < 0.001, p = 0.002). However, the between-group comparison was not statistically significant. The NDI showed significant improvement only in the experimental group ( p = 0.005). The minimal clinical important difference (MCID) obtained was 6.44 for the NDI. A reduction in %MVIC over time was observed in both groups for cervical erector spinae (Right, p = 0.006, Left, p = 0.001). The between-group comparison of spinal muscle activation was not significantly different. Conclusion The study suggested that FHP management using a cervicothoracic or cervicothoracic plus lumbopelvic protocol could improve cervical posture and lower cervical muscle demand. Incorporating a lumbopelvic into the cervicothoracic protocol was more effective in reducing short-term neck pain and disability than a cervicothoracic protocol alone. A comprehensive spine program may be a clinically beneficial rehabilitation protocol for FHP to improve neck pain and disability.