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Within dual diagnosis treatment, principles of recovery are increasingly acknowledged. Nevertheless, recovery-oriented rehabilitation often becomes an abstract concept, leaving professionals in various dilemmas. This article examines competing representations of recovery-oriented rehabilitation across Danish dual diagnosis treatment policy and practice from a post-structural, analytical perspective inspired by governmentality and problematization studies. The empirical foundation consists of a qualitative ethnographic study including conducting and examining 12 national policies relevant to contemporary Danish dual diagnosis treatment practice and 23 interviews with health/welfare professionals employed at a Danish in-patient, dual diagnosis rehabilitation unit. The analysis points to a complexity between three sets of competing representations reflected in 1) the conceptual relationship between rehabilitation and recovery , 2) perceptions of knowledge based on experience or evidence , and 3) ideals of optimization and emancipation. Finally, the article discusses convergences between the competing and, at times, conflictual ideals, attempting to explain the conceptual fluffiness , discrepancies, and dilemmas experienced by professionals in dual diagnosis treatment within broader epistemological and ideological debates in social sciences and humanities. • Recovery is a key, however ambiguous, principle in dual diagnosis treatment. • Different, competing representations of recovery-oriented rehabilitation exist. • The recovery concept reflects epistemological and ideological discrepancies. • A conceptual framework for understanding dilemmas in dual diagnosis care practices. [ABSTRACT FROM AUTHOR]

Young people's sexual and reproductive health (SRH) continues to be a major challenge in low and middle-income countries, with implications for public health now and in the future. Fortunately there is a growing array of evidence-based interventions, and commitments from governments, development partners and donors, to support programmes that aim to improve young people's SRH. However, in some situations, the technical assistance that governments feel that they need to strengthen and implement national policies and strategies, to move from words to action, is not available. The WHO Adolescent and Youth Sexual and Reproductive Health and Rights (AYSRHR) Technical Assistance (TA) Coordination Mechanism was initiated to help fill this technical assistance gap; to respond to TA requests from ministries of health in ways that are timely, efficient, effective and contribute to strengthening capacity. This paper describes the process of developing the Technical Assistance Coordination Mechanism (TA Mechanism) and the outcomes, experiences and lessons learned after three years of working. It triangulates the findings from a preliminary review of the literature and discussions with selected key informants; the outcomes from a series of structured review meetings; and the documented processes and results of the technical assistance provided to countries. The lessons learned focus on three aspects of the TA Mechanism. How it was conceptualized and designed: through listening to people who provide and receive AYSRHR TA and by reviewing and synthesizing past experiences of TA provision. What the TA Mechanism has achieved: a standardized process for TA provision, at different stages for a range of AYSRHR issues in ten countries in three geographic regions. And what worked well and what did not: which common challenges was the TA Mechanism able to address and which ones persisted despite efforts to avoid or resolve them. The paper ends with the implications of the lessons learned for future action. [ABSTRACT FROM AUTHOR]

Background: Health system responsiveness to public priorities and needs is a broad, multi-faceted and complex health system goal thought to be important in promoting inclusivity and reducing system inequity in participation. Power dynamics underlie the complexity of responsiveness but are rarely considered. This paper presents an analysis of various manifestations of power within the responsiveness practices of Health Facility Committees (HFCs) and Sub-county Health Management Teams (SCHMTs) operating at the subnational level in Kenya. Kenyan policy documents identify responsiveness as an important policy goal. Methods: Our analysis draws on qualitative data (35 interviews with health managers and local politicians, four focus group discussions with HFC members, observations of SCHMT meetings, and document review) from a study conducted at the Kenyan Coast. We applied a combination of two power frameworks to interpret our findings: Gaventa's power cube and Long's actor interface analysis. Results: We observed a weakly responsive health system in which system-wide and equity in responsiveness were frequently undermined by varied forms and practices of power. The public were commonly dominated in their interactions with other health system actors: invisible and hidden power interacted to limit their sharing of feedback; while the visible power of organisational hierarchy constrained HFCs' and SCHMTs' capacity both to support public feedback mechanisms and to respond to concerns raised. These power practices were underpinned by positional power relationships, personal characteristics, and world views. Nonetheless, HFCs, SCHMTs and the public creatively exercised some power to influence responsiveness, for example through collaborations with political actors. However, most resulting responses were unsustainable, and sometimes undermined equity as politicians sought unfair advantage for their constituents. Conclusion: Our findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to respond to public inputs is required. [ABSTRACT FROM AUTHOR]

Human milk provides essential nutrition for infants and holds many health benefits for infants and mothers. When a mother's own milk is not available for her infant, the World Health Organization recommends feeding donor human milk (DHM) from a human milk banking facility. DHM is human milk produced, collected then donated to a human milk bank (HMB). HMBs serve many vital functions, including screening donor mothers, then collecting, processing, storing, and allocating DHM to recipients. The first HMB opened in 1909, and today there are more than 700 HMBs globally. Unfortunately, HMB facilities are not present in all locales, with notable gaps in South Asia and Africa. Additionally, there are no global standards to guide HMB operational procedures. Even though most HMBs attempt to employ quality control systems to provide safe DHM, differences in community needs, resource availability, and a range of methods and policies to execute processes result in significant variations in DHM quality and HMB operations. Robust and collaborative systems that ensure safe and equitable access to DHM are needed. In this paper, we present a global snapshot of current human milk banking practices; review an interdisciplinary framework to guide and support HMB activities as an integrated part of health and newborn care systems; discuss factors that contribute to HMB sustainability; outline barriers to scaling HMBs worldwide; and highlight knowledge, policy, and research gaps. Developing global HMB guidance and rigorous, adaptable standards would strengthen efforts to improve newborn health. Key messages: Safe donor human milk (DHM) from a human milk bank (HMB) is a WHO recommendation when the mother's own milk is not available.Over 700 HMBs exist globally, with varying operational models and a wide range of practices due to lack of global guidelines and the current practice of adaptation to local needs and health systems.Scaling up of HMBs to meet the global demand for DHM would be facilitated by the development of global standards to guide integration with breastfeeding promotion and quality controlled processing to ensure provision of safe DHM. [ABSTRACT FROM AUTHOR]

BACKGROUND: Respiratory tract infections are major contributors to the global disease burden. Quantitative microbial risk assessment (QMRA) holds potential as a rapidly deployable framework to understand respiratory pathogen transmission and inform policy on infection control. OBJECTIVES: The goal of this paper was to evaluate, motivate, and inform further development of the use of QMRA as a rapid tool to understand the transmission of respiratory pathogens and improve the evidence base for infection control policies. METHODS: We conducted a literature review to identify peer-reviewed studies of complete QMRA frameworks on aerosol inhalation or contact transmission of respiratory pathogens. From each of the identified studies, we extracted and summarized information on the applied exposure model approaches, dose–response models, and parameter values, including risk characterization. Finally, we reviewed linkages between model outcomes and policy. RESULTS: We identified 93 studies conducted in 16 different countries with complete QMRA frameworks for diverse respiratory pathogens, including SARS-CoV-2, Legionella spp., Staphylococcus aureus, influenza, and Bacillus anthracis. Six distinct exposure models were identified across diverse and complex transmission pathways. In 57 studies, exposure model frameworks were informed by their ability to model the efficacy of potential interventions. Among interventions, masking, ventilation, social distancing, and other environmental source controls were commonly assessed. Pathogen concentration, aerosol concentration, and partitioning coefficient were influential exposure parameters as identified by sensitivity analysis. Most (84%, 푛= 78) studies presented policy-relevant content including a) determining disease burden to call for policy intervention, b) determining risk-based threshold values for regulations, c) informing intervention and control strategies, and d) making recommendations and suggestions for QMRA application in policy CONCLUSIONS: We identified needs to further the development of QMRA frameworks for respiratory pathogens that prioritize appropriate aerosol exposure modeling approaches, consider trade-offs between model validity and complexity, and incorporate research that strengthens confidence in QMRA results. [ABSTRACT FROM AUTHOR]

Simple Summary: The current evidence regarding Indigenous* women and breast cancer in Australia shows lower prevalence but higher mortality rates. There are a range of reasons for this, including co-morbidities, lack of access to health services and low health information fluency. Perhaps most importantly, breast cancer health policy and service delivery practice do not meet the needs of Indigenous women in Australia, according to Indigenous women. Talking and listening to Indigenous women about breast cancer highlight that the solutions to improve breast cancer outcomes are available and that they are not complex. Indigenous women must be involved in the improvement of policy and practice in order for these outcomes to improve. *Terminology: We respectfully refer to Aboriginal and Torres Strait Islander people as "Indigenous". In Australia, the incidence rate of breast cancer is lower in Indigenous* women than non-Indigenous women; however, the mortality rate is higher, with Indigenous women 1.2 times more likely to die from the disease. This paper provides practical and achievable solutions to improve health outcomes for Indigenous women with breast cancer in Australia. This research employed the Context–Mechanism–Outcome (CMO) framework to reveal potential mechanisms and contextual factors that influence breast cancer outcomes for Indigenous women, stratified into multiple levels, namely, micro (interpersonal), meso (systemic) and macro (policy) levels. The CMO framework allowed us to interpret evidence regarding Indigenous women and breast cancer and provides nine practical ways to improve health outcomes and survival rates. [ABSTRACT FROM AUTHOR]

Purpose: Current and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review studies on ethnoculturally diverse older adults and health care show a lack of focus on their service use experiences. This study aims to report a meta-ethnography that addresses this knowledge gap through answering the review question: How do ethnoculturally diverse older adults who are immigrants experience health careservices? Design/methodology/approach: The authors applied a seven-phase method of meta-ethnography to guide the review. The authors conducted two literature searches (April 2018 and June 2020) in MEDLINE, CINAHL, Embase, Sociological Abstracts and Abstracts in Social Gerontology that yielded 17 papers eligible for review. Findings: "There's always something positive and something negative" is the overarching metaphor for answering the review question. Findings highlight positive and negative tensions within ethnoculturally diverse older adults' health care use experiences of understanding and being understood, having trust in providers and the health care system, having needs, preferences and resources met and desire for self-care over dependency. The majority of experiences were negative. Tipping points towards negative experiences included language, fear, provider attitudes and behaviours, service flexibility, attitudes towards Western and traditional health care and having knowledge and resources. Originality/value: The authors propose concrete actions to mitigate the tipping points. The authors discuss policy recommendations for health care system changes at the micro, meso and macro service levels to promote positive experiences and address mainstream service policy inequities. [ABSTRACT FROM AUTHOR]

Purpose: The Covid-19 pandemic has persisted for almost three years. States have since then enforced laws, policies and measures believed to be the most effective to handle the global pandemic. Along this line, the Indonesian Government opted to implement mandatory vaccination and refusal of which entails monetary penalties. Hence, this study aims to analyze two legal issues that touch upon the realm of International Human Rights Law: first, whether state has the authority to implement the said mandatory vaccine program to those who refuse to be vaccinated, and second, how is the more appropriate legal policy to obligate vaccination but without coercive sanction. Design/methodology/approach: This is a normative legal research that uses a qualitative method with case studies, conceptual, historical and comparative approaches. A descriptive-analytical deduction process was used in analyzing the issue. Findings: The results present, as part of state's right to regulate, it has the authority to enact mandatory vaccination with monetary penalties to fulfil its obligation to protect public health in times of emergency; this is legal and constitutional but only if it satisfies the requirements under the International Human Rights Law: public health necessity, reasonableness, proportionality and harm avoidance. Alternatively, herd immunity is achievable without deploying unnecessary coercive sanctions, such as improving public channels of communication and information, adopting legal policies that incentivize people's compliance like exclusion from public services, subsidies revocation, employment restrictions, higher health insurance premiums, etc. Research limitations/implications: This study analyzes in depth the following issues: of whether the government has the authority to apply mandatory vaccination laws enforced through monetary penalties for those who refused to be vaccinated and how does the government implement the appropriate legal policy to enforce mandatory vaccination without imposing penalties for non-compliance while maintaining a balance between the interests of protecting public health and the human rights of individuals to choose medical treatment for themselves, including whether they are willing to be vaccinated. Hence, the political affairs, economic matters and other non-legal related issues are excluded from this study. Originality/value: This paper hence offers a suggestive insight for state in formulating a policy relating to the mandatory vaccination program. Although the monetary penalties do not directly violate the rule of law, a more non-coercive approach to the society would be more favorable. [ABSTRACT FROM AUTHOR]

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The difficulties faced by youth with intellectual and developmental disabilities (IDDs) and their families as they move into adulthood are widely documented. The aim of the paper is to explore the current situation in terms of transition processes and outcomes in four countries (the US, UK, Australia and Czech Republic) and identify commonalities and differences that help elucidate what might determine different outcomes. Two research methods—expert knowledge and rapid literature review—were combined to identify sources from which information on transition policy, processes, support practices and outcomes was extracted and synthesised. This review identified gaps in the research evidence including inadequate collection and use of data to drive policy and determine effectiveness, limited evidence‐based models or frameworks for successful transition. There was little transition research that included the voices of young people with IDD. More research is necessary to study the practices of highly successful programmes, and to explore the impact of transition programmes and disability support services on a broader range of outcomes, capturing the experiences of young people themselves and identifying factors that determine successful outcomes. [ABSTRACT FROM AUTHOR]

Background: People with learning disabilities experience health and social inequalities, and research that could improve health services may not be implemented in real‐life settings. Building stakeholder networks that can share and implement research findings may address this. This paper presents a framework for building a stakeholder network that maximises the likelihood of research recommendations being implemented in practice. This was developed as part of the 'Making Positive Moves' (MPM) study, which explores the experiences of people with learning disabilities following discharge from a residential stay within a hospital inpatient setting. Methods: We reviewed the literature on existing theoretical frameworks to support the development of a model for dissemination of the MPM findings. Stakeholder categories were identified through consultation with the MPM researchers, experts by experience and the steering group and a hub and spoke model to represent all stakeholder categories was created. These categories include person moving; family of the person moving; specialist schools; social care; care providers; regulators; third sector organisations; policy organisations; academic community; and NHS professionals. After establishing the categories, we consulted with people with learning disabilities and other stakeholders and conducted online searches to create a stakeholder database. Through information gathering and direct contact with stakeholders, we assessed levels of interest, power and engagement to determine which stakeholders to prioritise in our dissemination activities. The Stakeholder Wheel was created to present the data captured within the database and engagement profiles in an illustrative way. Findings: We use two stakeholder sub‐categories, user‐led organisations and care providers, to demonstrate the methodological approach. The examples illustrate how a scoring system helped us to identify high‐priority stakeholders who we then contacted to collaborate within developing our dissemination strategy to maximise the impact of the MPM research findings. Conclusions: We developed a framework to map stakeholders for the MPM study and enable targeted dissemination to increase the impact of the research. This approach has the potential to reduce health inequalities among people with learning disabilities by increasing the awareness of and ability to implement evidence‐based recommendations in real‐life settings. The stakeholder mapping framework could be applied to research projects associated with learning disabilities to bridge the gap between research and practice and reduce health inequalities. Accessible Summary: People with learning disabilities experience unfair disadvantages relating to their health. These are known as health and social inequalities.Findings from research projects can help improve health and social care for people with learning disabilities, but only if people know about and are able to apply the research recommendations.Finding people and organisations who can make use of the research findings (known as stakeholders) is an important first step in sharing research. Working with stakeholders to think about how they use the findings to change practice can improve care and services.We have been doing this for one research project called Making Positive Moves and it has helped us plan how to share our findings. Our approach could be used by other researchers to make it more likely that their research findings will be used to make a difference in the lives of people with learning disabilities. [ABSTRACT FROM AUTHOR]

A growing number of researchers are trying to provide explanations for continuity and change in drug policy in different contexts. Such research predominantly falls in the pluralist realm of public policy where various actors compete to have their policy proposals accepted. Using a critical framework called Policy Constellations (PC), developed by Stevens and Zampini, this paper attempts to explain reactions of the British Government to Novel Psychoactive Substances (NPS) between 2008 – 2016. Qualitative data comes from in-depth interviews with stakeholders (N = 15), including NGO workers, a former Home Secretary, drugs ministers, governmental advisors, a former senior police officer, former Deputy Drug Coordinator, and a former Advisory Council for the Misuse of Drugs (ACMD) member. Two 'constellations' competed in British NPS policy setting. The PC framework illustrates power imbalances between these competing stakeholders. Abstinence orientated actors (the conservative constellation) enjoyed strategic advantages and media power which allowed them to create a favourable policy setting. These advantages were not enjoyed by the liberal constellation who struggled to access the policy setting and influence policy developments. The prohibitive nature of the policy used to counter NPS can be explained with the domination of actors whose values align with the conservative constellation. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) set up the messenger ribonucleic acid (mRNA) technology transfer programme in June 2021 with a development hub in South Africa and 15 partner vaccine producers in middle-income countries. The goal was to support the sustainable development of and access to life-saving vaccines for people in these countries as a means to enhance epidemic preparedness and global public health. This initiative aims to build resilience and strengthen local vaccine research, and development and manufacturing capacity in different regions of the world, especially those areas that could not access coronavirus disease 2019 (COVID-19) vaccines in a timely way. This paper outlines the current global vaccine market and summarizes the findings of a case study on the mRNA technology transfer programme conducted from November 2022 to May 2023. The study was guided by the vision of the WHO Council on the Economics of Health for All to build an economy for health using its four work streams of value, finance, innovation and capacity. Based on the findings of the study, we offer a mission-oriented policy framework to support the mRNA technology transfer programme as a pilot for transformative change towards an ecosystem for health innovation for the common good. Parts of this vision have already been incorporated into the governance of the mRNA technology transfer programme, while other aspects, especially the common good approach, still need to be applied to achieve the goals of the programme. [ABSTRACT FROM AUTHOR]

In this paper, we apply the reproductive justice framework to discuss how gendered racism disadvantages pregnant and parenting young Black women aging out of foster care. Specifically, we highlight the reversal of Roe v Wade as reflective of the United States' long legacy of efforts to control Black women's reproduction. We then discuss the structural factors contributing to the reproductive injustices of young Black women aging out of care, including a lack of access to sexual and reproductive health education, barriers to educational attainment, and foster care-based relational and placement deficits. We conclude with research, practice, and policy enhancements. [ABSTRACT FROM AUTHOR]

Policy PointsThe health care sector is increasingly investing in social conditions, including availability of safe, reliable, and adequate transportation, that contribute to improving health.In this paper, we suggest ways to advance the impact of transportation interventions and highlight the limitations of how health services researchers and practitioners currently conceptualize and use transportation.Incorporating a transportation justice framework offers an opportunity to address transportation and mobility needs more comprehensively and equitably within health care research, delivery, and policy. [ABSTRACT FROM AUTHOR]

Objectives Aging populations and an increasing number of immigrants in recent years have led to numerous changes in intergenerational relationships. Although many studies have investigated the impact of providing care to a parent with dementia, little is known about the impact of caregiving activities provided from a distance, such as in the case of immigration, and over a long period of time to a person with dementia. Our understanding of how transnational caregiving for a person with dementia affects relationships is also limited. Using the Intergenerational Solidarity Theory as a theoretical framework, this paper examines the experiences of adult children and immigrant caregivers of a parent with dementia living in Poland. Methods A qualitative, semistructured interview was conducted with 37 caregivers living in the United States while providing transnational care to a parent with Alzheimer's disease or other forms of dementia. The data analysis was based on the thematic analysis strategy. Results Four themes were identified: (1) filial obligations and solidarity, (2) caregivers' contradictory emotions regarding transnational care, (3) financial and emotional exhaustion, and (4) challenges of nursing home dilemmas. Discussion Transnational caregivers represent a unique group who face distinctive challenges related to competing demands and limited resources. This study contributes to a better understanding of their experiences whereas the findings highlight the importance of addressing the mental and physical well-being of immigrant caregivers of individuals with dementia and have important implications for health care professionals and immigration policies. Implications for future research were also identified. [ABSTRACT FROM AUTHOR]

Austerity measures have become a contentious topic, shaping the landscape of health care systems around the world. As governments grapple with economic challenges, the impact of austerity on health care has emerged as a critical concern. This study focuses on the consequences of austerity actions adopted by the Zimbabwean government under the Transitional Stabilization Program (TSP) from August 2018 to December 2025. This research examines the impact of austerity measures on Zimbabwe's health care sector, exploring its connections with health infrastructure and resources, accessibility and affordability of health care, health funding, health care inequalities, and the health care workforce. Using a quantitative approach and data from 970 participants, including the general populace, health care providers, and government officials, significant positive correlations between austerity measures and these health care variables were identified. The findings indicated a noteworthy positive correlation between the independent variable "austerity measures" and five dependent variables: health care accessibility and affordability, health care inequalities, infrastructure and resources, health care funding, and health care workforce. The t -statistics values exceeded the threshold of 1.96, with values of 5.085, 3.120, 6.459, 8.517, and 3.830, respectively. These findings highlight the importance of considering the effects of austerity on health care access, health funding, health care inequalities, health workforce, health infrastructure and resources development. Policymakers should prioritize equitable resource allocation and targeted investments to strengthen the resilience of the health care system during economic challenges. Understanding these associations is crucial for evidence-based policy decisions and fostering a more equitable and resilient health care system in Zimbabwe. [ABSTRACT FROM AUTHOR]

Introduction: The implementation of evidence-informed policies and practices across systems is a complex, multifaceted endeavor, often requiring the mobilization of multiple organizations from a range of contexts. In order to facilitate this process, policy makers, innovation developers and service deliverers are increasingly calling upon intermediaries to support implementation, yet relatively little is known about precisely how they contribute to implementation. This study examines the role of intermediaries supporting the implementation of evidence-informed policies and practices in the mental health and addictions systems of New Zealand, Ontario, Canada and Sweden. Methods: Using a comparative case study methodology and taking an integrated knowledge translation approach, we drew from established explanatory frameworks and implementation theory to address three questions: (1) Why were the intermediaries established? (2) How are intermediaries structured and what strategies do they use in systems to support the implementation of policy directions? and (3) What explains the lack of use of particular strategies? Data collection included three site visits, 49 key informant interviews and document analysis. Results: In each jurisdiction, a unique set of problems (e.g., negative events involving people with mental illness), policies (e.g., feedback on effectiveness of existing policies) and political events (e.g., changes in government) were coupled by a policy entrepreneur to bring intermediaries onto the decision agenda. While intermediaries varied greatly in their structure and characteristics, both the strategies they used and the strategies they didn't use were surprisingly similar. Specifically it was notable that none of the intermediaries used strategies that directly targeted the public, nor used audit and feedback. This emerged as the principle policy puzzle. Our analysis identified five reasons for these strategies not being employed: (1) their need to build/maintain healthy relationships with policy actors; (2) their need to build/maintain healthy relationships with service delivery system actors; (3) role differentiation with other system actors; (4) perceived lack of "fit" with the role of policy intermediaries; and (5) resource limitations that preclude intensive distributed (program-level) work. Conclusion: Policy makers and implementers must consider capacity to support implementation, and our study identifies how intermediaries can be developed and harnessed to support the implementation process. [ABSTRACT FROM AUTHOR]

Research to assess and inform health policy is an essential component of the policymaking process to advance equity in public health practice. This study investigated health disparities during the COVID-19 pandemic (2020–2022) in older adult institutional settings in Philadelphia, PA, to inform policy initiatives, interventions, and infrastructure development. We first explored the changing patterns of nursing staffing levels (total direct care staff and registered nurses [RNs]) measured by hours per resident per day (HPRD) before and after COVID-19. Our findings revealed that HPRD levels consistently fell below the Centers for Medicare and Medicaid Services recommended standards from 2018 to 2022, with notable declines observed starting from 2021. Results from multilevel modeling showed significant declines in HPRD for total direct care nursing staff in nursing homes located in zip codes with a high proportion of Black residents (≥40%). In contrast, HPRD for RNs significantly declined in nursing homes located in zip codes with a lower proportion of Black residents (<40%). Moreover, higher reported direct care HPRD and RN HPRD were associated with any reported COVID-19 cases only within zip codes with a low proportion of Black residents. These findings indicate the need for additional policies to address these observed patterns in staffing levels. Our study provides a foundation for future policy reviews utilizing a conceptual framework that is health equity-centric for local and state health departments program and units intended for institutional care settings for older adults. [ABSTRACT FROM AUTHOR]

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries (ECC) is a global public health challenge that requires innovation, infrastructure, and health system influences to bolster initiatives for its management and control. The aim of this scoping review was to investigate the published evidence on the association between ECC and the targets of the Sustainable Development Goal 9 (SDG9) concerned with industry, innovation, and infrastructure development. Methods: The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A search was conducted in PubMed, Web of Science, and Scopus between July and August 2023 using a search strategy related to the promotion of resilient infrastructure, sustainable industries, scientific research and innovation, access to the internet and ECC. Only English language publications were included. Studies that solely examined ECC without reference to the SDG9 targets were excluded. Results: The search yielded 933 studies for review. After screening for the eligibility and removing duplicates, 916 unique articles remained for further screening. However, none of the identified studies provided data on the association between resilient infrastructure, sustainable industries, scientific research and innovation, access to the internet and ECC. Conclusion: There were no primary studies that assessed the association between ECC and SDG9, even though the plausibility of a potential relationship exists. Future studies are needed to generate evidence on the link between ECC and SDG9 as this link may contribute to the reduction in the proportion of children with untreated ECC. [ABSTRACT FROM AUTHOR]

Background The application of foresight to the field of public health is limited. There is growing need to anticipate uncertain future trends and to plan for them. Foresight provides tools to experts and policymakers to discuss and plan for possible futures. Hence, the aim of this study is to illustrate how the foresight six-step approach can be applied in public health, and to provide recommendations on dealing with challenges, drawn from the Population Health Information Research Infrastructure (PHIRI) foresight exercise. Methods In this tutorial, we describe the six-step approach as part of foresight methodology and give examples of possible challenges. Step 1 comprises the formulation of study objectives. Step 2 focuses on developing a conceptual model and applying the Demographic Economic Sociocultural Technological Ecological and Political-Institutional (DESTEP) framework to identify and prioritize driving forces for the topic of interest. In Step 3, a time horizon and spatial level are defined. Step 4 discusses scenario logics. Steps 5 and 6 discuss different types of scenarios and associated tools for analyses. Possible challenges encountered whilst applying the foresight methodology at each of the steps, were drawn from experiences during PHIRI foresight exercise. Results Challenges associated with applying the foresight six-step approach included: formulating concise objectives, developing a conceptual model, understanding driving forces and uncertainty and difficulties in building scenarios. Conclusions Understanding concepts used in the six-step approach and how they relate to each other remained difficult. Support from foresight experts, conducting more foresight exercises, tutorials and guidelines can enhance understanding and support building capacity. [ABSTRACT FROM AUTHOR]

Objective: Access to improved sanitation is a fundamental human right and an important aspect of Public Health. However, an estimated thousands of people in Ghana especially, the West Mamprusi Municipal Assembly (WMMA) still have no access to adequate toilet facilities. This has brought untold health repercussions to the inhabitants, the community, and the environment at large. To address this menace, the community-led total sanitation (CLTS) was implemented. This study aimed to assess communities' perspectives on the implementation of CLTS and to understand the factors influencing its success and failures. Methods: A mixed-method approach involving sequential qualitative and quantitative methods was employed in this study. Participants for the quantitative study were randomly selected and surveyed using questionnaires. The qualitative study employed focus group discussion involving purposively sampled participants including assembly members, opinion leaders, and assembly staff. Results: The CLTS program in WMMA realized an apparent use of construction and proper use of household latrines leading to a reduction of open defecation free (ODF) and two communities achieving sanitized status in the history of the study area, enabling the training of latrine artisans and natural leaders to facilitate the CLTS expansion and sustainability, improved sanitation and hygiene, strengthened the enforcement of community rules and regulations and many others. Conclusion: The CLTS program has received more widespread acceptance in the study area than the previous government policy of constructing public toilets, which was greeted with massive failures due to poor implementation. To ensure that gains achieved through CLTS implementation are sustained longer, it is recommended that chiefs and opinion leaders should be involved in the CLTS programs to ensure checks and enforcement. The entrenchment of bylaws and more education to address enduring myths and misconceptions will sustain the program. Subsidies in the form of sanitation loans for latrine construction materials by the government and supporting non-governmental organizations (NGOs) will be paramount in sustaining ODF. [ABSTRACT FROM AUTHOR]

Background: Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. Aim: This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. Design: A qualitative study was carried out using semi‐structured telephone interviews. Setting: This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). Method: We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. Results: Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. Conclusion: Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. Patient or Public Contribution: The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co‐applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co‐applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision‐making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice. [ABSTRACT FROM AUTHOR]

Background Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019. Methods The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission's recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured. Results The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure. Conclusions By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable. [ABSTRACT FROM AUTHOR]

Background: This scoping review explored the evidence in the peer-reviewed published journal literature to identify the facilitators and barriers to implementing the 4Ms Framework of Age-Friendly Health Systems in inpatient and outpatient clinical settings. Methods: Our search strategy focused on primary and secondary data sources that described the barriers and facilitators of incorporating the 4Ms Framework in clinical settings. We focused on older adults 65 years and older and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-SCR). Results: The evidence analyses of the 19 identified articles revealed six facilitator themes and five barrier themes to implementing the 4Ms Framework of Age-Friendly Health Systems in inpatient and outpatient clinical settings. The most recurring facilitator theme was embedding the 4Ms Framework into routine clinical practice with clinical pathways and designated personnel. The most frequently reported barrier theme was the lack of clinicians' buy-in. Conclusions: Future research may translate the findings of this scoping review into a facilitator and barrier checklist or a "reality-check" measure to monitor the progress of the journey of embracing the 4Ms Framework in outpatient or inpatient clinical settings. This study was not registered. [ABSTRACT FROM AUTHOR]

Purpose: Investing in prevention could be of great benefit to public health. Especially for people with health risks, such as overweight, depressive symptoms, low social-economic status or people who experience loneliness or a sedentary lifestyle. In the Netherlands, different parties are responsible for financing and organising selective and indicated preventive interventions: the government, municipalities and health insurance companies. The aim of this study was two-fold: First, to describe the transition towards a sustainable prevention infrastructure. And second, to gain insight into barriers and facilitators associated with intersectoral collaboration regarding organising prevention for high-risk groups. Design/methodology/approach: A longitudinal qualitative study was conducted among collaborative networks working together to build a prevention infrastructure. During a five-year study period, 86 semi-structured interviews were held. The COM-B model was used for data analysis. Findings: Barriers to intersectoral collaboration are: unknown (cost-)effectiveness, limited incentives to invest in collaboration, lack of clarity about responsibilities, differences in priorities and organisational culture between municipalities and health insurers. Facilitators are commitment, trust, sharing knowledge between parties, meeting regularly within the network and acknowledgement of mutual responsibilities. Also, national policy interventions targeted at the development of regional prevention infrastructures facilitated collaboration. Originality/value: This study shows that collaboration regarding prevention is becoming increasingly common. It can be concluded that the transition towards a sustainable prevention infrastructure has started. The relationship between key stakeholders, like municipalities and health insurers, is generally stronger than it was five years ago. They have a better understanding of each other's interests and expectations. [ABSTRACT FROM AUTHOR]

Due to the coronavirus pandemic, telerehabilitation has become increasingly important worldwide. While the effectiveness of telerehabilitation is considered proven for many indications, there is comparatively little knowledge about the implementation conditions. Therefore, this scoping review summarises the current state of facilitating and inhibiting factors that may influence the uptake of telerehabilitation. The review follows the JBI methodology for scoping reviews. The article search was carried out in five databases (MEDLINE, EMBASE, Web of Science, Cochrane and Psyndex) in May 2022, with an update in October 2023. Two independent researchers identified relevant studies according to the inclusion and exclusion criteria. The Consolidated Framework for Implementation Research served as the theoretical basis for the categorisation of the facilitating and inhibiting criteria in the organisational context. A total of 28 studies (timespan 2012 to 2023) have been included. The most relevant barriers identified are technical issues and a lack of technical skills. The factors considered most favourable for implementation are patients' motivation and the involvement of high-level leaders. The results provide clear indications of factors that inhibit and facilitate implementation, but also show that further research is needed. [ABSTRACT FROM AUTHOR]

People with disabilities (PWDs) are often excluded from health-promoting activities in their communities. Inclusive policy, systems, and environmental (PSE) changes can promote access to healthy lifestyle choices for PWDs. However, implementation of inclusive PSEs in community-based settings is challenging and we lack an understanding of what factors impact implementation of inclusive PSEs. The purpose of this study was to examine barriers and facilitators experienced by community coaches while planning and implementing inclusive PSEs. Semi-structured interviews (n = 10) were conducted with coaches as part of the Reaching People with Disabilities through Healthy Communities project. Interviews were coded using directed content analysis guided by the Theoretical Domains Framework and were categorized into barriers and facilitators within the COM-B framework (which identifies Capability, Opportunity, and Motivations as components that can impact Behavior). The opportunities domain, consisting of social influences and environmental context and resources, most impacted disability-inclusive PSE implementation. Within this domain, facilitators included community support, strong partnerships, technical assistance from experts, and alignment with ongoing initiatives. Barriers included the community's lack of knowledge about disability, fear regarding resources needed for inclusive changes, and lack of resources (time, staff, funding). Supports addressing the opportunities domain should be considered to facilitate the implementation of disability-inclusive PSEs to build healthy, accessible communities for all. [ABSTRACT FROM AUTHOR]

Objective. As part of the efforts to build a practical, effective, and diversified medical insurance payment method, it is crucial for China to deepen the reform of ambulatory patient groups (APGs). This study was aimed to explore the mechanism and effect of this policy from three dimensions, including medical expenses, medical insurance funds, and medical services. Methods. In 2020, China's pilot reform of APG was initiated in Jinhua City, Zhejiang Province. Descriptive statistics, correlation analysis, and OLS regression analysis were utilized to evaluate the effect of the APG reform in Jinhua. Results. The implementation of the reform can contribute significantly to establishing a comprehensive medical service governance mechanism of classified settlement and coordinated promotion. It also plays a critical role in safeguarding people's lives and health by promoting the high-level development of medical insurance systems and public hospitals, optimizing the quality of medical services, and improving the efficiency of medical insurance funds. Conclusion. Through the lens of policy evaluation, our findings can provide useful experience for the implementation of the outpatient medical insurance payment method in developing countries. [ABSTRACT FROM AUTHOR]

Background: The European Association for Palliative Care (EAPC) acknowledges palliative sedation as an important, broadly accepted intervention for patients with life-limiting disease experiencing refractory symptoms. The EAPC therefore developed 2009 a framework on palliative sedation. A revision was needed due to new evidence from literature, ongoing debate and criticism of methodology, terminology and applicability. Aim: To provide evidence- and consensus-based guidance on palliative sedation for healthcare professionals involved in end-of-life care, for medical associations and health policy decision-makers. Design: Revision between June 2020 and September 2022 of the 2009 framework using a literature update and a Delphi procedure. Setting: European. Participants: International experts on palliative sedation (identified through literature search and nomination by national palliative care associations) and a European patient organisation. Results: A framework with 42 statements for which high or very high level of consensus was reached. Terminology is defined more precisely with the terms suffering used to encompass distressing physical and psychological symptoms as well as existential suffering and refractory to describe the untreatable (healthcare professionals) and intolerable (patient) nature of the suffering. The principle of proportionality is introduced in the definition of palliative sedation. No specific period of remaining life expectancy is defined, based on the principles of refractoriness of suffering, proportionality and independent decision-making for hydration. Patient autonomy is emphasised. A stepwise pharmacological approach and a guidance on hydration decision-making are provided. Conclusions: This is the first framework on palliative sedation using a strict consensus methodology. It should serve as comprehensive and soundly developed information for healthcare professionals. [ABSTRACT FROM AUTHOR]

Family policies not only provide money, time and infrastructure to families, but also convey normative assumptions about what is considered desirable or acceptable in paid work and family care. This study conceptualises and empirically investigates how priming respondents with brief media report-like information on existing day care policy entitlements and economic consequences of maternal employment interruptions may change personal normative judgements about parental work–care arrangements. Furthermore, we analyse whether these effects differ between groups of respondents assumed to vary in their degree of affectedness by the information as well as previous knowledge. The theoretical framework builds on the concept of normative policy feedback effects combined with social norm theory and human cognition theories. The study is based on a fully randomized survey experiment combined with a vignette experiment in Wave 12 of the German Family Panel (pairfam). It applies linear and ordinal logistic regressions with cluster-robust standard errors to a sample of 5,783 respondents. Our results suggest that priming respondents with information on day care policy and long-term economic risks of maternal employment interruptions increases acceptance of intensive day care use across the full sample and especially for mothers with children below school entry age. It further increases support for longer maternal hours spent in paid work among childless women and mothers with school-aged children. Norms regarding paternal working hours are largely unaffected by the information given in this survey experiment. [ABSTRACT FROM AUTHOR]

Background : Governments have relied on their citizens to adhere to a variety of transmission-reducing behaviours (TRBs) to suppress the Covid-19 pandemic. Understanding the psychological and sociodemographic predictors of adherence to TRBs will be heavily influenced by the particular theories used by researchers. This review aims to identify the theories and theoretical constructs used to understand adherence to TRBs during the pandemic within the UK social and legislative context. Methods: A systematic review identified studies to understand TRBs of adults in the UK during the pandemic. Identified theoretical constructs were coded to the Theoretical Domains Framework. Data are presented as a narrative summary. Results: Thirty-five studies (n = 211,209) investigated 123 TRBs, applied 13 theoretical frameworks and reported 50 sociodemographic characteristics and 129 psychological constructs. Most studies used social cognition theories to understand TRBs and employed cross-sectional designs. Risk of sampling bias was high. Relationships between constructs and TRBs varied, but in general, beliefs about the disease (e.g. severity and risk perception) and about TRBs (e.g. behavioural norms) influenced behavioural intentions and self-reported adherence. More studies than not found that older people and females were more adherent. Conclusions: Behavioural scientists in the UK generated a significant and varied body of work to understand TRBs during the pandemic. However, more use of theories that do not rely on deliberative processes to effect behaviour change and study designs better able to support causal inferences should be used in future to inform public health policy and practice. Prospero Registration: CRD42021282699. [ABSTRACT FROM AUTHOR]

To address recognized gaps in community rehabilitation service coordination and advance delivery of rehabilitation services for adults living outside of institutions, we have developed a conceptual framework to inform the design of community rehabilitation policy, planning, care, and research. Employing a multimethod qualitative approach, we developed a draft framework based on a document review as well as interviews with community rehabilitation service and system providers, older people receiving community rehabilitation services, and family caregivers. We then consulted with community rehabilitation service and system providers, older adults, and family caregivers to revise the framework. We identified 194 relevant documents and 30 programs, and we analyzed interview data from 29 service and system providers as well as 6 dyads of older persons and family caregivers. We developed a definition of community rehabilitation and identified 11 components for the draft framework, which was presented to 16 participants for consultation. We used their feedback to revise the terms and definitions for the 11 components. We organized the final set of components into two categories: principles (culturally safe; equity-focused; evidence-informed; person and family-centred; restorative) and organization (appropriate; coordinated; continuity; evaluated; stepped; team-based). The contextualized, action-oriented conceptual framework for adult community rehabilitation (CFACR) is supported by older people, family caregivers, and community rehabilitation health system providers. Continued work to refine and validate the components in more population groups and contexts will facilitate implementation and application of the CFACR. [ABSTRACT FROM AUTHOR]