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This study examined how schools prioritize ten key health concerns among their student populations over time and whether schools’ prioritization of alcohol and other drug use (AODU) corresponds to students’ substance use behaviours and cannabis legalization as a major policy change. Data were collected from a sample of secondary schools in Ontario, Canada across four years (2015/16–2018/19 [N2015/16 = 65, N2016/17 = 68, N2017/18 = 61 and N2018/19 = 60]) as a part of the COMPASS study. School-level prevalence of cannabis and alcohol use between schools that did and did not prioritize student AODU as a health concern was examined. Ordinal mixed models examined whether student cannabis and alcohol use were associated with school prioritization of AODU. Chi-square tests examined changing health priorities among schools pre–post cannabis legalization. School priority ranking for AODU was mostly stable over time. While AODU was identified as an important health concern, most schools identified mental health as their first priority across the four years of the study. No significant changes to school AODU priorities were observed pre–post cannabis legalization nor was school prioritization of AODU associated with student cannabis and alcohol use behaviours. This study suggests that schools may benefit from guidance in identifying and addressing priority health concerns among their student population.

Social determinants of health contribute to health disparities and inequities. We conducted a community forum on the topic of isolation with the objectives of (1) identifying and prioritizing key health-related issues needing attention in isolated communities in Puerto Rico; (2) developing strategies in terms of Policies, Programs, and Practices to address the community priorities we identified. We used the triangulation method for qualitative data, integrating the Colorado State University’s Tri-ethnic Center Model and the Delphi Technique for a better understanding of community health needs and priorities. The five community health-related priorities identified in the community forum were: (1) access to health services (physical and mental); (2) older adults; (3) access to basic services; (4) preparedness for future disasters/emergencies; and (5) COVID-19 and access to vaccination. The Alliance Leaders and Advisory Boards understand that we will work with the priorities of preparedness for future natural disasters/emergencies and COVID-19 and access to vaccination. Fifteen strategies were developed for these priorities and were grouped into five areas that require more attention in order to reduce health disparities. Isolated communities in Puerto Rico present an intersectionality of factors that affect a wide range of health-related risks and outcomes.

Women with schizophrenia and their newborns are at risk of adverse pregnancy, delivery, neonatal and child outcomes. However, robust and informative epidemiological estimates are lacking to guide health policies to prioritise and organise perinatal services. For the first time, we carried out a systematic review and meta-analysis to synthesise the accumulating evidence on pregnancy, delivery, neonatal complications, and infant mortality among women with schizophrenia and their newborns (N = 43,611) vs. controls (N = 40,948,272) between 1999 and 2021 (26 population-based studies from 11 high-income countries) using random effects. Women with schizophrenia had higher odds (OR) of gestational diabetes (2.35, 95% CI: [1.57-3.52]), gestational hypertension, pre-eclampsia/eclampsia (OR 1.55, 95% CI: [1.02-2.36]; 1.85, 95% CI: [1.52-2.25]), antepartum and postpartum haemorrhage (OR 2.28, 95% CI: [1.58-3.29]; 1.14, 95% CI: [1.04-1.24]), placenta abruption, threatened preterm labour, and premature rupture of membrane (OR 2.20, 95% CI: [2.02-2.39]; 2.91, 95% CI: [1.57-5.40]; 1.29, 95% CI: [1.06-1.58]), c-section (OR 1.33, 95% CI: [1.22-1.45]), foetal distress (OR 1.80, 95% CI: [1.43-2.26]), preterm and very preterm delivery (OR 1.79, 95% CI: [1.62-1.98]; 2.31, 95% CI: [1.78-2.98]), small for gestational age and low birth weight (OR 1.63, 95% CI: [1.48-1.80]; 1.75, 95% CI: [1.46-2.11]), congenital malformations (OR 1.86, 95% CI: [1.71-2.03]), and stillbirths (OR 2.06, 95% CI: [1.83-2.31]). Their newborns had higher odds of neonatal death (OR 1.41, 95% CI: [1.03-1.94]), post-neonatal death (OR 2.87, 95% CI: [2.11-3.89]) and infant mortality (OR 2.33, 95% CI: [1.81-3.01]). This large-scale meta-analysis confirms that schizophrenia is associated with a substantially increased risk of very preterm delivery, stillbirth, and infant mortality, and metabolic risk in mothers. No population-based study has been carried out in low- and middle-income countries in which health problems of women with schizophrenia are probably more pronounced. More research is needed to better understand the complex needs of women with schizophrenia and their newborns, determine how care delivery could be optimised, and define best practices. Study registration: PROSPERO CRD42020197446.

Primary mitochondrial disorders encompass a wide range of clinical presentations and a spectrum of severity. They currently lack effective disease-modifying therapies and have a high mortality and morbidity rate. It is therefore essential to know that competitively-funded research designed by academics meets core needs of people with mitochondrial disorders and their clinicians. The Priority Setting Partnerships are an established collaborative methodology that brings patients, carers and families, charity representatives and clinicians together to try to establish the most pressing and unanswered research priorities for a particular disease.\ud \ud We developed a web-based questionnaire, requesting all patients affected by primary mitochondrial disease, their carers, and clinicians to pose their research questions. This yielded 709 questions from 147 participants. These were grouped into overarching themes including basic biology, causation, health services, clinical management, social impacts, prognosis, prevention, symptoms, treatment, and psychological impact. Following the removal of ‘answered questions’ the process resulted in a list of 42 discrete, answerable questions. This was further refined by web-based ranking by the community to 24 questions. These were debated at a face-to-face workshop attended by a diverse range of patients, carers, charity representatives and clinicians to create a definitive ‘Top Ten of unanswered research questions for primary mitochondrial disorders’. These Top Ten questions related to understanding biological processes, including triggers of disease onset, mechanisms underlying progression and reasons for differential symptoms between individuals with identical genetic mutations; new treatments; biomarker discovery; psychological support; and optimal management of stroke-like episodes and fatigue.

BACKGROUND: Research and clinical outcomes that matter to people with lived experience can significantly differ from those outcomes studied by researchers. To inform a future Cochrane review of suicide and self-harm prevention interventions, we aimed to work with young people with relevant lived experience to agree on priority outcomes. DESIGN: Four participatory codesign workshops were completed across two sites (New Zealand, United Kingdom) with 28 young people in total. We iteratively adapted the methods over the course of the study. RESULTS: 'Improved coping' and 'safer/more accepting environment to disclose' were the final top-rated outcomes. 'Reduction of self-harm' was considered a low priority as it could be misleading, stigmatizing and was considered a secondary consequence of other improvements. In contrast to typical research outcomes, young people emphasized the diversity of experience, the dynamic nature of improvement and holistic and asset-based framing. Methodologically, dialogue using design materials (personas) to thematically explore outcomes was effective in overcoming the initial challenge of disparate quantitative ratings. DISCUSSION: The results will directly inform the development of a Cochrane review, enabling identification of whether and how outcomes of most importance to young people are measured in trials. Rather than producing discrete measurable outcomes that could be easily added to the systematic review, the young people challenged the academic conceptualization of outcomes, with implications for future evidence synthesis and intervention research, and for future codesign. PATIENT OR PUBLIC CONTRIBUTION: Young people with lived experience were codesigners of the outcomes, and their feedback informed iterative changes to the study methods.

The scope of this priority-setting process is communication and collaboration in transitional care for patients with acute stroke. Actively involving persons with stroke and their family caregivers is important both in transitional care and when setting priorities for research. Established priority-setting methods are time-consuming and require extensive resources. They are therefore not feasible in small-scale research. This article describes a pragmatic priority-setting process to identify a prioritized top 10 list of research needs regarding transitional care for patients with acute stroke.A pragmatic priority-setting approach inspired by the James Lind Alliance was developed. It involves establishing a user group, identifying the research needs through an online survey, analysing and checking the research needs against systematic reviews, culminating in an online prioritization of the top 10 list.The process was completed in 7 months. A total of 122 patients, family caregivers, health personnel and caseworkers submitted 484 research needs, and 19 users prioritized the top 10 list. The list includes the categories 'patients and caregivers' needs and health literacy', 'health personnel's common understanding', 'information flow between health personnel and patients and caregivers', 'available interventions and follow-up of patients and caregivers', 'interaction and collaboration between health personnel and caseworkers across hospital and primary healthcare' and 'disabilities after stroke'.This paper outlines a pragmatic approach to identifying and prioritizing users' research needs that was completed in 7 months. The top 10 list resulting from this priority setting process can guide future research relating to communication and collaboration during the transition from hospital to the community for patients with stroke.Members of three stroke organizations participated in the advisory group. They gave feedback on the scope and the process, distributed the surveys and prioritized the top 10 list. Persons with stroke and their caregivers submitted research needs in the survey.

Health issues vary in the amount of attention and resources they receive from global health organisations and national governments. How issues are framed could shape differences in levels of priority. We reviewed scholarship on global health policy making to examine the role of framing in shaping global health priorities. The review provides evidence of the influence of three framing processes-securitisation, moralisation, and technification. Securitisation refers to an issue's framing as an existential threat, moralisation as an ethical imperative, and technification as a wise investment that science can solve. These framing processes concern more than how issues are portrayed publicly. They are socio-political processes, characterised by contestation among actors in civil society, government, international organisations, foundations, and research institutions. These actors deploy various forms of power to advance particular frames as a means of securing attention and resources for the issues that concern them. The ascription of an issue as a security concern, an ethical imperative, or a wise investment is historically contingent: it is not inevitable that any given issue will be framed in one or more of these ways. A health issue's inherent characteristics-such as the lethality of a pathogen that causes it-also shape these ascriptions, but do not fully determine them. Although commonly facing resistance, global health elites often determine which frames prevail, raising questions about the legitimacy of priority-setting processes. We draw on the review to offer ideas on how to make these processes fairer than they are at present, including a call for democratic representation even as necessary space is preserved for elite expertise.

British Pakistani women have exceptionally high rates of obesity and yet are seldom heard in a research priority setting concerning weight management. The objectives of this study were (i) to ascertain what multisectoral professionals perceive to be the most pressing unmet obesity needs or topic areas that need more research in relation to Pakistani women living in deprived areas of Bradford and (ii) to determine the top 10 obesity health priorities for this group to develop an obesity research agenda.A two-step process was adopted using the following: (i) a survey of a wide range of multisectoral professional stakeholders (n = 159) and (ii) a ranking exercise involving Pakistani women living in deprived areas of Bradford (n = 32) to select and prioritize their top 10 obesity health concerns and unmet needs from a list of 31 statements identified in the survey and previous research. Survey data were analysed using inductive content analysis and themes were identified. Themes were translated into statements to be ranked by Pakistani women. The ranking exercise was conducted by telephone either via voice or video call. Data were analysed using a reverse scoring system.Survey responses were grouped into statements reflecting the following three categories: education needs; healthy behaviour barriers and mental well-being. The highest rankings were given by Pakistani women to statements on mental health and the need for education. The top 10 prioritized statements were developed with members of the public into an obesity research agenda that reflected the target population.Actively engaging British Pakistani women in setting research priorities provided a unique opportunity to understand the key areas they think are important for future research. The culminating research agenda can be used by researchers to advance the field of obesity research in Pakistani communities, thus producing research outputs that are relevant to and have impact in this population.Participants in the ranking exercise collected data. Public contributors were involved in developing the prioritized statements into a research agenda.

Political economy factors are important in determining the adoption and implementation of health policies. Yet these factors are often overlooked in the development of policies that have the potential to influence health.Political economy analysis provides a way to take into consideration political and social realities, whether at the community, subnational, national, regional or global levels. We aim to demonstrate the value of political economy analysis and to promote its wider use in technical programmes of work.We provide examples from across a range of World Health Organization areas of work, including participatory governance, health financing, health taxes, malaria prevention and control, capacity-building and direct country support.Existing examples of how political economy analysis can be incorporated into technical support demonstrate the variability of this analytical approach, as well as its potential to support policy progress. Applying political economy analysis within the specified programmes of work has enabled more contextually relevant technical support to enhance the likelihood of advancing countries' health-related objectives.Embedding political economy into technical work has many benefits, including: enhancing voice and participation in health policies; supporting the adoption and implementation feasibility of technically sound policies; and building capacity to incorporate and understand political factors that influence health-related priorities.Les facteurs liés à l'économie politique jouent un rôle crucial dans l'adoption et la mise en œuvre de mesures sanitaires. Pourtant, ces facteurs sont souvent négligés lors de l'élaboration de politiques susceptibles d'avoir un impact sur la santé.Analyser l'économie politique représente un moyen de tenir compte des réalités politiques et sociales au niveau communautaire, infranational, national, régional ou international. Nous voulons démontrer l'importance de l'analyse de l'économie politique et promouvoir son usage dans les programmes techniques de travail.Nous donnons des exemples issus d'une série de domaines traités par l'Organisation mondiale de la Santé, parmi lesquels la gouvernance participative, le financement de la santé, les taxes sanitaires, la prévention et la lutte contre la malaria, le renforcement des capacités et l'appui direct aux pays.Les exemples portant sur l'intégration de l'analyse de l'économie politique dans l’appui technique illustrent la variabilité de cette approche analytique, mais aussi sa potentielle contribution aux progrès politiques. Appliquer une analyse de l'économie politique à des programmes de travail spécifiques a permis de fournir un soutien technique adapté au contexte, augmentant ainsi les chances d'avancement des pays vers la réalisation des objectifs en matière de santé.Incorporer l'économie politique dans le travail technique comporte de nombreux avantages: amélioration de la représentation et de la participation dans le cadre des mesures sanitaires; meilleures possibilités d'adoption et de mise en œuvre de politiques solides sur le plan technique; et enfin, renforcement des capacités afin de comprendre et d'inclure les facteurs politiques qui ont une influence sur les priorités relatives à la santé.Los factores de economía política son importantes para determinar la adopción y aplicación de las políticas sanitarias. Sin embargo, se suelen ignorar estos factores cuando se elaboran políticas que pueden influir en la salud.El análisis de economía política permite tener en cuenta las realidades políticas y sociales, ya sea a nivel local, subnacional, nacional, regional o mundial. El objetivo de este proyecto es demostrar el valor del análisis de la economía política y promover su uso generalizado en los programas técnicos de trabajo.Se ofrecen ejemplos de diversas áreas de trabajo de la Organización Mundial de la Salud, como la gobernanza participativa, la financiación sanitaria, los impuestos sanitarios, la prevención y la contención del paludismo, la creación de capacidades y el apoyo directo a los países.Los ejemplos existentes de cómo se puede incorporar el análisis de economía política al apoyo técnico demuestran la variabilidad de este enfoque analítico, así como su potencial para apoyar el progreso de las políticas. La aplicación del análisis de la economía política en los programas de trabajo especificados ha permitido que el apoyo técnico sea más pertinente según el contexto para aumentar la probabilidad de avanzar en los objetivos sanitarios de los países.Integrar la economía política en el trabajo técnico tiene muchos beneficios, entre los que se incluyen: potenciar las opiniones y la participación en las políticas sanitarias; apoyar la adopción y la viabilidad de la aplicación de políticas técnicamente sólidas; y crear capacidad para incorporar y comprender los factores políticos que influyen en las prioridades sanitarias.تعد عوامل الاقتصاد السياسي ذات أهمية في تقرير اعتماد السياسات الصحية وتنفيذها. إلا أنه غالبًا ما يتم تخطي هذه العوامل عند تطوير السياسات التي لديها القدرة على التأثير على الصحة.يوفر تحليل الاقتصاد السياسي وسيلة لوضع الحقائق السياسية والاجتماعية في الاعتبار، سواء على مستوى المجتمع، أو المستوى دون الوطني، أو الوطني، أو الإقليمي، أو العالمي. نحن نهدف إلى إظهار قيمة تحليل الاقتصاد السياسي، وتعزيز استخدامه على نطاق أوسع في البرامج الفنية للعمل.نحن نقدم أمثلة عبر مجموعة من مجالات عمل منظمة الصحة العالمية، بما في ذلك الحوكمة المشتركة، والتمويل الصحي، والضرائب الصحية، والوقاية من الملاريا ومكافحتها، وبناء القدرات، والدعم المباشر على مستوى الدولة.إن الأمثلة القائمة لكيفية دمج تحليل الاقتصاد السياسي في الدعم الفني، توضح تنوع هذا الأسلوب التحليلي، فضلاً عن قدرته على دعم تقدم السياسة. إن تطبيق تحليل الاقتصاد السياسي ضمن برامج العمل المحددة قد أتاح المزيد من الدعم الفني ذي الصلة بالسياق، لتعزيز احتمالية الارتقاء بالأهداف المتعلقة بالصحة في الدول.إن دمج الاقتصاد السياسي في العمل الفني له العديد من الفوائد، بما في ذلك: تعزيز الرأي والمشاركة في السياسات الصحية؛ ودعم اعتماد سياسات سليمة من الناحية الفنية وجدوى تنفيذها؛ وبناء القدرات لدمج العوامل السياسية التي تؤثر على الأولويات المتعلقة بالصحة، وفهمها.政治经济因素在决定采纳和实施卫生政策方面发挥重要作用。然而，在制定可能影响卫生的政策时，这些因素往往被忽视。.政治经济学分析提供了一种考虑政治和社会现实的方法，无论是在社区、地方、国家、地区还是全球层面。我们的目的在于说明政治经济学分析的价值，并促进其在技术性工作计划中更广泛的使用。.我们提供一系列来自世卫组织工作领域中的示例，包括参与式治理、卫生筹资、医疗税、疟疾预防和控制、能力建设和直接国家支持。.有关如何将政治经济学分析纳入技术支持的现有示例表明该分析方法的可变性，以及该方法在支持政策进展方面的潜力。在特定工作计划中应用政治经济学分析，可以提供更加因地制宜的技术支持，以促进实现国家卫生相关目标的可能性。.将政治经济学融入技术工作有许多益处，包括：增强对卫生政策的发言权和参与度；支持采用和实施技术完备政策的可行性；建设能力以纳入和理解影响卫生相关优先事项的政治因素。.Факторы политической экономии играют важную роль в определении принятия и осуществления политики в области охраны и укрепления здоровья. Однако эти факторы часто упускаются из виду при разработке политики, которая способна повлиять на охрану здоровья.Политэкономический анализ позволяет учитывать политические и социальные реалии как на уровне сообщества, так и на субнациональном, национальном, региональном или глобальном уровне. Авторы ставят перед собой цель продемонстрировать ценность политэкономического анализа и способствовать его более широкому использованию в технических программах работы.В статье приводятся примеры из различных областей деятельности Всемирной организации здравоохранения, включая управление на основе широкого участия, финансирование здравоохранения, налоги на здравоохранение, профилактику малярии и борьбу с ней, наращивание потенциала и прямую поддержку стран.Существующие примеры того, как политэкономический анализ может быть включен в техническую поддержку, свидетельствуют об изменчивости этого аналитического подхода, а также о его потенциале для поддержки прогресса в политике. Применение политэкономического анализа в рамках указанных программ работы позволило получить техническую поддержку, более соответствующую контексту, для повышения вероятности достижения странами целей, связанных со здравоохранением.Внедрение политэкономии в техническую работу имеет ряд преимуществ, в том числе повышение роли и участия в политике здравоохранения, поддержка принятия и реализации технически обоснованной политики, наращивание потенциала для учета и понимания политических факторов, оказывающих влияние на приоритеты в области здравоохранения.

Introduction. Giardiasis is caused by an intestinal protozoan, Giardia lamblia. Despite its high prevalence and geographical transmission variability, there is no risk stratification tool available to prioritize interventions. Objective. To estimate the prevalence of G. lamblia in Peruvian preschoolers and schoolchildren by ecoregion from 1990 to 2018. Methods. Based on a previous meta-analysis, we conducted a G. lamblia prevalence sub-analysis by ecoregions from data of 26 studies in Peruvian preschoolers and school-aged children between 1990 and 2018. The data was extracted by district, a classification by ecoregions was made through Google Earth. Heterogeneity was analyzed using Cochrane Q test and publication bias applying the Egger method with StatsDirect version 3.2.7. The absolute risk method was performed to stratify the prevalence at district level, and 4 strata were defined based on percentiles or arbitrarily. Results. Forty-three district-level prevalence data was estimated, including 7,606 participants. The highest pooled prevalences by the randomeffects method of G. lamblia were 47.0% (95% CI: 40.0-54.0) in the Pacific desert, 27.9% (95% CI: 22.8-33.2) in the lowland forest and 26.9% (95% CI 22.5-31.5) in the Puna. Conclusions. Of every 100 preschoolers and school-aged children living in the Pacific desert, lowland forest, and in the Puna ecoregions, 47, 28, and 27 minors are infected with G. lamblia, respectively. Likewise, 4 risk strata are proposed based on prevalence: sporadic (0 to, Introducción. La giardiasis es ocasionada por el protozoario intestinal Giardia lamblia, su transmisión tiene variabilidad geográfica y a pesar de ser muy frecuente, no existe una herramienta de estratificación de riesgo para priorizar las intervenciones. Objetivo. Estimar la prevalencia de G. Lamblia en preescolares y escolares peruanos por ecorregiones entre 1990 a 2018. Métodos. A partir de un metaanálisis previo, se realizó un subanálisis por ecorregiones de la prevalencia de G. lamblia en 26 estudios en preescolares y escolares peruanos entre 1990 a 2018. Se extrajeron los datos por distrito y utilizando Google Earth fueron clasificados en ecorregiones. La heterogeneidad fue analizada mediante la prueba de Q de Cochrane y el sesgo de publicación mediante el método de Egger con StatsDirect versión 3.2.7. Se utilizó el método de riesgo absoluto para estratificar la prevalencia a nivel de distrito y se definió 4 estratos en base a los percentiles o arbitrariamente. Resultados. Se identificaron 43 datos de prevalencia a nivel de distrito que incluyeron 7606 participantes. Las prevalencias combinadas más altas por el método de efectos aleatorios de G. lamblia fueron de 47,0% (intervalo de confianza (IC) 95%: 40,0 -54,0) en el desierto del Pacífico; 27,9% (IC95%: 22,8 - 33,2) en selva baja y 26,9% (IC95%: 22,5 - 31,5) en la Puna. Conclusiones. De cada 100 preescolares y escolares que viven en las ecorregiones del desierto del Pacífico, selva baja y Puna, 47, 28 y 27 menores de edad, respectivamente, están infectados con G. lamblia. Asimismo, se propone 4 estratos de riesgo en función de la prevalencia: esporádico (0 a

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities.

Introduction AO Spine RECODE-DCM was a multi-stakeholder priority setting partnership (PSP) to define the top ten research priorities for degenerative cervical myelopathy (DCM). Priorities were generated and iteratively refined using a series of surveys administered to surgeons, other healthcare professionals (oHCP) and people with DCM (PwDCM). The aim of this work was to utilise word clouds to enable the perspectives of people with the condition to be heard earlier in the PSP process than is traditionally the case. The objective was to evaluate the added value of word clouds in the process of defining research uncertainties in National Institute for Health Research (NIHR) James Lind Alliance (JLA) Priority Setting Partnerships. Methods Patient-generated word clouds were created for the four survey subsections of the AO Spine RECODE-DCM PSP: diagnosis, treatment, long-term management and other issues. These were then evaluated as a nested methodological study. Word-clouds were created and iteratively refined by an online support group of people with DCM, before being curated by the RECODE-DCM management committee and expert healthcare professional representatives. The final word clouds were embedded within the surveys administered at random to 50% of participants. DCM research uncertainties suggested by participants were compared pre- and post-word cloud presentation. Results A total of 215 (50.9%) participants were randomised to the word cloud stream, including 118 (55%) spinal surgeons, 52 (24%) PwDCM and 45 (21%) oHCP. Participants submitted 434 additional uncertainties after word cloud review: word count was lower and more uniform across each survey subsections compared to pre-word cloud uncertainties. Twenty-three (32%) of the final 74 PSP summary questions did not have a post-word cloud contribution and no summary question was formed exclusively on post-word cloud uncertainties. There were differences in mapping of pre- and post-word cloud uncertainties to summary questions, with greater mapping of post-word cloud uncertainties to the number 1 research question priority: raising awareness. Five of the final summary questions were more likely to map to the research uncertainties suggested by participants after having reviewed the word clouds. Conclusions Word clouds may increase the perspective of underrepresented stakeholders in the research question gathering stage of priority setting partnerships. This may help steer the process towards research questions that are of highest priority for people with the condition.

ObjectiveThe purpose of this British Association for Cardiovascular Prevention and Rehabilitation (BACPR) research priority setting project (PSP) was to identify a top 10 list of priority research questions for cardiovascular prevention and rehabilitation (CVPR).MethodsThe PSP was facilitated by the BACPR clinical study group (CSG), which integrates as part of the British Heart Foundation Clinical Research Collaborative. Following a literature review to identify unanswered research questions, modified Delphi methods were used to engage CVPR-informed expert stakeholders, patients, partners and conference delegates in ranking the relevance of research questions during three rounds of an anonymous e-survey. In the first survey, unanswered questions from the literature review were ranked and respondents proposed additional questions. In the second survey, these new questions were ranked. Prioritised questions from surveys 1 and 2 were incorporated in a third/final e-survey used to identify the top 10 list.ResultsFrom 459 responses across the global CVPR community, a final top 10 list of questions were distilled from an overall bank of 76 (61 from the current evidence base and a further 15 from respondents). These were grouped across five broad categories: access and remote delivery, exercise and physical activity, optimising programme outcomes, psychosocial health and impact of the pandemic.ConclusionsThis PSP used a modified Delphi methodology to engage the international CVPR community to generate a top 10 list of research priorities within the field. These prioritised questions will directly inform future national and international CVPR research supported by the BACPR CSG.

Social determinants of health (SDoH) affect under-resourced communities. Such communities are seldom involved in defining and prioritizing local SDoH for policy action.Apply community-partnered, participatory research (CPPR) to identify community stakeholder priorities for addressing SDoH in South Los Angeles.Over 10 months, CPPR was applied to develop a multi-sector partnership and working group to plan and host a symposium for community stakeholders. 148 individuals and 16 organizations participated and engaged in focus and symposium-wide discussions. Themes were identified through collaborative inductive content analysis.Results and Lessons Learned: Participants identified ten specific SDoH, such as housing, with structural racism and discrimination as the underlying cause.Using CPPR to gain community members' insight about local factors that drive individual and community health is feasible and viewed by the community as socially responsible, suggesting it holds promise to address root causes of health inequality in under-resourced communities.

PURPOSE: Priority settings are important to plan and direct future research. The aim of this study was to identify the top ten pediatric and child health nursing research priorities from the perspectives of consumers, community, and healthcare professionals in Western Australia. DESIGN AND METHODS: This study used an adapted James Lind Alliance Priority Setting Partnership design with three phases. 1) A planning workshop to inform a survey. 2) A survey using five open-ended-questions distributed between October 2020 and January 2021 through social media and healthcare professionals' emails. Responders' statements were analyzed with content analysis. 3) A consensus workshop to finalize and rank the themes. RESULTS: The planning workshop participants (n = 25) identified gaps such as community child healthcare and confirmed lack of consumer engagement in previous studies. The survey responses (n = 232) generated 911 statements analyzed into 19 themes. The consensus workshop participants (n = 19) merged and added themes, resulting in 16 final themes. The top three ranked themes were: 'access to service', 'mental health and psychological wellbeing', and 'communication'. CONCLUSIONS: The research themes are necessarily broad to capture the wide range of issues raised, reflecting the scope of pediatric and child health nursing. PRACTICE IMPLICATIONS: The priorities will inform future research to be directed to areas of priority for stakeholders who have often not had a say in setting the research agenda.

Sepsis is a worldwide public health problem due to its high incidence and accompanying mortality, morbidity, and financial burden. It is a major cause of admission to paediatric intensive care units; despite advances in the diagnosis and treatment, both incidence and mortality are high in low-income and middle-income countries. There are several barriers in addressing the enormous burden of paediatric sepsis in these countries, which include: lack of data of incidence and mortality; unfamiliarity of sepsis by the lay public, leading to failure to seek care early, and by health professionals, leading to failure to treat emergently; and insufficient government funding for sepsis care programmes leading to inadequate staffing, material, and financial resources, and therefore, poor health systems. Socioeconomic inequalities, such as inequity and marked variation in income and education, high rates of malnutrition, high percentage of young population, and health systems that do not meet the population's demands also represent barriers in the care of children with sepsis in Latin America. In this Viewpoint, we draw attention to the problem of paediatric sepsis in Latin America and call for action to reduce the disease burden by proposing some solutions.

Background Technological advances have led to more youth with medical complexity (YMC) who are living into adulthood and being transferred from pediatric to adult care. The transition to adult care is a complex and challenging process, partly due to differences in how pediatric and adult systems deliver health care. YMC and their families need support from their health care providers to ease this transition. To identify how to better support transitioning YMC, a needs assessment was conducted to examine the current state of transitional support for youth and families cared for by a pediatric Complex Care Program. Aims The aims of this needs assessment were to understand the transition practices of pediatric Complex Care Programs, explore transition-related needs of YMC and their families, and identify priorities for future quality improvement. Methods This project involved three components: a literature review, a benchmarking survey of pediatric Complex Care Programs in Ontario, and key informant interviews. Findings The benchmarking survey identified transition planning and transfer of care as areas of strength in the Complex Care Program, while transition readiness and transfer completion provided opportunities for improvement. Stakeholder collaboration, an early start, and knowledgeable providers facilitated a successful transition. Barriers included lack of time, poor access to adult services and resources, higher medical complexity, and inadequate support for adult health care providers. Conclusions Recommendations for improving transitional care for YMC are provided, along with resources, tools, and considerations for implementation.

Medical societies have a social responsibility to disseminate knowledge and inform health authorities on threats to public health posed by various diseases. Advocacy for health protection programmes and for medical research funding is now embedded into the missions of most scientific societies. To promote kidney research funding in Europe, the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA), rather than acting as an individual society advocating for the fight against kidney disease, has actively helped to create an alliance of national associations centred on kidney diseases, the European Kidney Health Alliance (EKHA), and joined the Biomedical Alliance (BMA). The ERA-EDTA is fully committed to supporting its working groups (WGs) and consortia of its members to allow them to produce valuable kidney research. The framing and formalization of projects, and the regulatory issues related to submission to the European Commission, are complex. To help WGs to gain expert advice from agencies with specific know-how, the ERA-EDTA has adopted a competitive approach. The best research projects proposed by WGs and consortia of other European investigators will receive seed funding to cover the costs of consultancy by expert agencies. Via its broader platforms, the EKHA and the BMA, the ERA-EDTA will strive towards broader recognition of kidney disease and related clusters of non-communicable diseases, by European and national agencies, as major threats to the qualities of life of their populations and their economies.

O objetivo deste artigo é desenvolver um índice de priorização para aceleração do cumprimento das metas nacionais de saúde propostas pela Agenda 2030. Trata-se de estudo ecológico que abordou as Regiões de Saúde do Brasil. O índice incorporou 25 indicadores com proximidade analítica aos indicadores oficiais da Agenda 2030, para os quais existem dados de fontes públicas no nível municipal para o período de 2015 a 2019. O índice apresentou-se como potente método para apoiar a decisão da gestão em saúde. Os resultados permitiram identificar que a Região Norte do país apresenta os territórios mais vulneráveis e, portanto, prioritários para a alocação de recursos. Além disso, a análise dos subíndices permitiu destacar os gargalos locais de saúde, reforçando a necessidade de os municípios de cada região estabelecerem suas próprias prioridades na decisão de alocação dos recursos da saúde. Ao indicar as Regiões de Saúde e os temas prioritários para maiores investimentos, esta investigação aponta caminhos que podem apoiar a implementação da Agenda 2030 do nível local ao nacional, além de fornecer elementos por meio dos quais os formuladores de políticas podem minimizar os efeitos das iniquidades sociais sobre a saúde, priorizando os territórios com piores índices. El objetivo fue desarrollar un índice de priorización para acelerar el cumplimiento de las metas nacionales de salud propuestas por la Agenda 2030. Se trata de un estudio ecológico que abordó las Regiones de Salud de Brasil. El índice incorporó 25 indicadores con proximidad analítica a los indicadores oficiales de la Agenda 2030 para los cuales existen datos de fuentes públicas a nivel municipal para el período 2015-2019. El índice se presentó como potente método para apoyar la decisión de la gestión en salud. Los resultados permitieron identificar que la Región Norte del país cuenta con los territorios más vulnerables y, por tanto, áreas prioritarias para la asignación de recursos. Además, el análisis de los subíndices permitió resaltar cuellos de botella locales en salud, reforzando la necesidad de que los municipios de cada región establezcan sus propias prioridades en la decisión de asignación de recursos en salud. Al indicar las Regiones de Salud y los temas prioritarios para mayores inversiones, esta investigación apunta caminos que pueden apoyar la implementación de la Agenda 2030 desde el nivel local al nacional, además de proporcionar elementos a través de los cuales los formuladores de políticas pueden minimizar los efectos de las inequidades sociales sobre la salud, priorizando los territorios con peores índices. This study aimed to develop a prioritization index to speed up the achievement of national health targets proposed in the 2030 Agenda. This is an ecological study that addressed the Health Regions in Brazil. The index incorporated 25 indicators with analytical proximity to the official indicators of the 2030 Agenda whose data are available from public municipal sources for the period of 2015-2019. According to our study, the index was a powerful method to support health management decisions. The results showed the most vulnerable territories are located in the North Region of the country, and therefore, these are priority areas for resource allocation. The analysis of subindices highlighted local health bottlenecks, reinforcing the need for municipalities in each region to set their own priorities while making decisions for health resource allocation. By indicating Health Regions and priority themes for more investments, this investigation shows paths to support the implementation of the 2030 Agenda, from the local to the national level, in addition to providing elements that can be used by policy makers to minimize the effects of social inequalities on health, prioritizing territories with worse indices.

ObjectivesA rapid review is a form of evidence synthesis considered a resource-efficient alternative to the conventional systematic review. Despite a dramatic rise in the number of rapid reviews commissioned and conducted in response to the coronavirus disease 2019 pandemic, published evidence on the optimal methods of planning, doing, and sharing the results of these reviews is lacking. The Priority III study aimed to identify the top 10 unanswered questions on rapid review methodology to be addressed by future research.Study Design and SettingA modified James Lind Alliance Priority Setting Partnership approach was adopted. This approach used two online surveys and a virtual prioritization workshop with patients and the public, reviewers, researchers, clinicians, policymakers, and funders to identify and prioritize unanswered questions.ResultsPatients and the public, researchers, reviewers, clinicians, policymakers, and funders identified and prioritized the top 10 unanswered research questions about rapid review methodology. Priorities were identified throughout the entire review process, from stakeholder involvement and formulating the question, to the methods of a systematic review that are appropriate to use, through to the dissemination of results.ConclusionThe results of the Priority III study will inform the future research agenda on rapid review methodology. We hope this will enhance the quality of evidence produced by rapid reviews, which will ultimately inform decision-making in the context of healthcare.

Health foundations provide significant financial resources for community health. Foundation priorities, therefore, can play a key role in setting community agenda, but little is known about the criteria foundations use to prioritize projects.To understand the priorities that guide decision makers in health foundations and compare those priorities with what is known about nonprofit hospitals, public health, and community-based nonprofits.An online survey with a discrete choice experiment and open-ended questions, asking respondents to choose between different types of community health projects based on project characteristics.Survey respondents were employed by health foundations located in the United States.Respondents were leaders at health foundations (n = 173), the majority of which (56.2%) worked at foundations with assets greater than $50 million. These respondents were compared with an earlier survey (n = 561) from nonprofit hospitals, public health, and community-based nonprofits.A conditional logit model was used to estimate how various project characteristics led to greater or lesser support of a given health project. Open-ended questions aided interpretation. A two sample t test was used to compare groups.Foundation decision makers placed the greatest value on programs with coalitions of community partners, programs with a growing or existing base of evidence for effectiveness, and programs that focus on social determinants of health. These priorities are similar to those of community nonprofits, public health departments, and health systems. However, foundation leaders are more willing to fund interventions with longer time horizons and interventions that are not yet fully evidence-based. Foundations are also less interested in clinical care and more interested in advocacy programs.Cooperation in funding and implementation is essential to community health improvement, and major organizations could benefit from everyone clearly articulating their priorities. There are good reasons to intentionally foster both similarities and differences in priorities across organizations.

Objective: To systematically review research into the use of humour‐based health promotion strategies for addressing public health issues during the past 10 years. Method: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results: Thirteen studies were included in the review. Mental health, breast and testicular cancer self‐examination, safe sex, skin cancer and binge drinking public health issues were targeted. Humour‐based strategies were used to influence health attitudes and behaviours, encourage interpersonal sharing to indirectly affect health behaviour, and investigate the level of threat and humour associated with positive outcomes. Findings provided some evidence to support the use of humour‐based strategies as determined by the right combination of audience characteristics, level of humour and amusement evoked, and message persuasion and behaviour change methods underpinning strategies. Conclusion: Methodologies varied limiting comparability, although overall results indicate that humour‐based health promotion strategies may be a useful tool for increasing awareness and help‐seeking behaviour for public health priorities, particularly those associated with stigma. Implications for public health: Humour interventions vary widely because there can never be a standardised approach to evoking humour. Further research examining humour and public health promotion is needed.

ContextIt remains unclear whether there would be societal support for a lifestyle criterion for the healthcare priority setting. This study examines the viewpoints of experts in healthcare and the public regarding support for a lifestyle-related decision criterion, relative to support for the currently applied criteria, in the healthcare priority setting in the Netherlands.MethodsWe conducted a Q methodology study in samples of experts in healthcare (n = 37) and the public (n = 44). Participants (total sample N = 81) ranked 34 statements that reflected currently applied decision criteria as well as a lifestyle criterion for setting priorities in healthcare. The ranking data were subjected to principal component analysis, followed by oblimin rotation, to identify clusters of participants with similar viewpoints.FindingsWe identified four viewpoints. Participants with Viewpoint 1 believe that treatments that have been proven to be effective should be reimbursed. Those with Viewpoint 2 believe that life is precious and every effort should be made to save a life, even when treatment still results in a very poor state of health. Those with Viewpoint 3 accept government intervention in unhealthy lifestyles and believe that individual responsibility should be taken into account in reimbursement decisions. Participants with Viewpoint 4 attribute importance to the cost-effectiveness of treatments; however, when priorities have to be set, treatment effects are considered most important. All viewpoints were supported by a mix of public and experts, but Viewpoint 1 was mostly supported by experts and the other viewpoints were mostly supported by members of the public.ConclusionsThis study identified four distinct viewpoints on the healthcare priority setting in the Netherlands, each supported by a mix of experts and members of the public. There seems to be some, but limited, support for a lifestyle criterion—in particular, among members of the public. Experts seem to favour the decision criteria that are currently applied. The diversity in views deserves attention when policymakers want to adhere to societal preferences and increase policy acceptance.

Background Decision making process for Official Development Assistance (ODA) for healthcare sector in low-income and middle-income countries involves multiple agencies, each with their unique power, priorities and funding mechanisms. This process at country level has not been well studied. Methods This paper developed and applied a new framework to analyze decision-making process for priority setting in Ethiopia, Nigeria, and Tanzania, and collected primary data to validate and refine the model. The framework was developed following a scoping review of published literature. Interviews were then conducted using a pre-determined interview guide developed by the research team. Transcripts were reviewed and coded based on the framework to identify what principles, players, processes, and products were considered during priority setting. Those elements were further used to identify where the potential capacity of local decision-makers could be harnessed. Results A framework was developed based on 40 articles selected from 6860 distinct search records. Twenty-one interviews were conducted in three case countries from 12 institutions. Transcripts or meeting notes were analyzed to identify common practices and specific challenges faced by each country. We found that multiple stakeholders working around one national plan was the preferred approach used for priority setting in the countries studied. Conclusions Priority setting process can be further strengthened through better use of analytical tools, such as the one described in our study, to enhance local ownership of priority setting for ODA and improve aid effectiveness.

Background Deciding how best to invest in healthcare is never an easy task and prioritization is therefore an area of great interest for policymakers. Too low public vaccine confidence, which results in insufficient vaccine uptake, remains an area of concern for EU policy-makers. Within the European Joint action on vaccination, a work-package dedicated to research aims to define tools and methods for priority-setting in the field of vaccination research. We therefore propose a prioritization framework to identify research priorities towards generating and synthesizing evidence to support policies and strategies aiming at increasing vaccine coverage. Materials/methods We used a multi-criteria decision analysis (MCDA) method inspired by the Child Health and Nutrition Research Initiative developed by Rudan et al. This quantitative methodology follows a series of steps involving different groups of experts and relevant stakeholders. The first step consists in identifying key research questions through a broad consultation. In parallel, a first group of experts is tasked to select criteria for prioritization of research questions, taking into consideration the ultimate goal of the exercise. Another group of experts is then requested to assess a weight to each of the criteria, using pair-wise comparisons. The final step consists in gathering experts who will assess each research question against the weighted criteria. This evaluation leads to assigning a score to each individual research question, which can then be ranked in order of priority. Results We focused our work on four pre-selected pilot vaccines (pertussis, measles containing combination vaccines, influenza and HPV). The consultation generated 124 questions, which were secondarily sorted and re-worded to obtain 27 questions to be ranked. Criteria for setting priorities were the following: accessibility, answerability, deliverability, disease prevalence/incidence, effectiveness, equity, generalization, and territory. During a final face-to-face meeting international experts ranked the 27 questions and agreed on a consensual list of six top-priorities. Conclusions We have developed a transparent, evidence-based rigorous framework to defined key research questions to generate evidence towards the design of policies and strategies to increase vaccine coverage. Results were disseminated broadly and submitted to the EC for potential funding in the context of The Horizon Europe Program. The same process will be conducted in 2021 to identify vaccination research priorities regarding all vaccines used in the EU as well as COVID-19 vaccines.

Background: Breast cancer screening in Ontario, Canada, was deferred during the first wave of the COVID-19 pandemic, and a prioritization framework to resume services according to breast cancer risk was developed. The purpose of this study was to assess the impact of the pandemic within the Ontario Breast Screening Program (OBSP) by comparing total volumes of screening mammographic examinations and volumes of screening mammographic examinations with abnormal results before and during the pandemic, and to assess backlogs on the basis of adherence to the prioritization framework. Methods: A descriptive study was conducted among women aged 50 to 74 years at average risk and women aged 30 to 69 years at high risk, who participated in the OBSP. Percentage change was calculated by comparing observed monthly volumes of mammographic examinations from March 2020 to March 2021 with 2019 volumes and proportions by risk group. We plotted estimates of backlog volumes of mammographic examinations by risk group, comparing pandemic with prepandemic screening practices. Volumes of mammographic examinations with abnormal results were plotted by risk group. Results: Volumes of mammographic examinations in the OBSP showed the largest declines in April and May 2020 (> 99% decrease) and returned to prepandemic levels as of March 2021, with an accumulated backlog of 340 876 examinations. As of March 2021, prioritization had reduced the backlog volumes of screens for participants at high risk for breast cancer by 96.5% (186 v. 5469 expected) and annual rescreens for participants at average risk for breast cancer by 13.5% (62 432 v. 72 202 expected); there was a minimal decline for initial screens. Conversely, the backlog increased by 7.6% for biennial rescreens (221 674 v. 206 079 expected). More than half (59.4%) of mammographic examinations with abnormal results were for participants in the higher risk groups. Interpretation: Prioritizing screening for those at higher risk for breast cancer may increase diagnostic yield and redirect resources to minimize potential long-term harms caused by the pandemic. This further supports the clinical utility of risk-stratified cancer screening.

Background The novel COVID-19 pandemic threatened to disrupt access to human immunodeficiency (HIV) treatment for persons living with HIV (PLHIV), two-thirds of whom live in sub-Saharan Africa. To inform a health system response supportive of continuity of care, we sought to understand clients’ HIV care experiences and health priorities during the first wave of COVID-19 outbreak in Lusaka, Zambia. Methods Leveraging a study cohort of those who completed periodic SMS surveys on HIV care, we purposefully sampled 25 PLHIV after first confirmed COVID-19 case was reported in Zambia on 18th March 2020. We phone-interviewed participants, iteratively refining interview guide to capture emergent themes on COVID-19 awareness, health facility interactions, and social circumstances, which we analyzed using matrix analysis. Results All participants were aware of COVID-19, and HIV care experiences and health priorities of clients were affected by associated changes at health system, household, and individual level. The health system instituted early clinic visits to provide 6-months of antiretroviral therapy (ART) for stable patients and 3-months for unstable patients to reduce clinic visits and wait times. Most patients welcomed this long-desired extended appointment spacing. Some reported feeling respected and engaged when health care workers telephoned requesting their early clinic visit. However, others felt discouraged by an absence of physical distancing during their clinic visit due to ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2) infection concerns. Several expressed a lack of clarity regarding next viral load monitoring date and means for receiving results. Patients suggested regular patient-facility communication by telephone and SMS. Patients emphasized that COVID-19 restrictions led to loss of employment and household income, exacerbating poverty and difficulties in taking ART. At individual level, most participants felt motivated to stay healthy during COVID-19 by ART adherence and regular laboratory monitoring. Conclusions Clients’ HIV care and health priorities during the first wave of COVID-19 in Lusaka province were varied with a combination of positive and negative experiences that occurred especially at health system and individual levels, while at household level, the experiences were all negative. More research is needed to understand how patients practice resiliency in the widespread context of socio-economic instability. Governments and patients must work together to find local, health systems solutions to support ART adherence and monitoring. Additionally, the health system should consider how to build on changes for long-term HIV management and service delivery.

Background: Public resources to answer pertinent research questions about the impact of illness and treatment on people with mental health problems are limited. To target funds effectively and efficiently and maximize the health benefits to populations, prioritizing research areas is needed. Research agendas are generally driven by researcher and funder priorities, however, there is growing recognition of the need to include user-defined research priorities to make research more relevant, needs-based and efficient. Objective: To gain consensus on top priorities for research into early intervention in psychosis through a robust, democratic process for prioritization enlisting the views of key stakeholders including users, carers and healthcare professionals. We also sought to determine which user-prioritized questions were supported by scientific evidence. Design and Methods: We used a modified nominal group technique to gain consensus on unanswered questions that were obtained by survey and ranked at successive stages by a steering group comprising users, carer representatives and clinicians from relevant disciplines and stakeholder bodies. We checked each question posed in the survey was unanswered in research by reviewing evidence in five databases (Medline, Cinahl, PsychInfo, EMBASE and Cochrane Database). Results: Two hundred and eighty-three questions were submitted by 207 people. After checking for relevance, reframing and examining for duplicates, 258 questions remained. We gained consensus on 10 priority questions; these largely represented themes around access and engagement, information needs before and after treatment acceptance, and the influence of service-user (SU) priorities and beliefs on treatment choices and effectiveness. A recovery SUtheme identified specific self-management questions and more globally, a need to fully identify factors that impact recovery. Discussion and Conclusions: Published research findings indicated that the priorities of service users, carers and healthcare professionals were aligned with researchers' and funders' priorities in some areas and misaligned in others providing vital opportunities to develop research agendas that more closely reflect users' needs. Patient and Public Contribution: Initial results were presented at stakeholder workshops which included service-users, carers, health professionals and researchers during a consensus workshop to prioritize research questions and allow the opportunity for feedback. Patient and public representatives formed part of the steering group and were consulted regularly during the research process.

In March 2020, the Toronto Region COVID-19 Hospital Operations Table developed a policy to guide visitor restrictions at six hospitals (Toronto Region COVID-19 Hospital Operations Table 2021). We conducted nine interviews with the developers and implementers of the policy based on the accountability for reasonableness (A4R) framework. Participants agreed that the A4R principles were met suggesting fair development and implementation of the policy. However, recurrent themes suggested that the policy disadvantaged those unable to advocate for themselves and that there were unaccounted costs to patients, such as lost time and function. We suggest that visitor policies incorporate equity considerations upfront and predetermine metrics to measure harms to patients.

This case study illustrates state legislative advocacy in action in Maryland. Success in strengthening maternal and child health is described using the Academic Pediatric Association's 4-step approach to advocacy: (1) Identify the Issue and Target Audience; (2) Craft the Message; (3) Develop Relationships and Coalitions, and (4) Communicate the Message. Starting with state legislation and formation of a Maryland Maternal Child Health Task Force led to maternal child health named as 1 of 3 state population health priorities. This guided subsequent programmatic investment and attention. Further dissemination of task force recommendations has led to additional supportive legislation.

Background To report our recommended methodology for extracting and then confirming research uncertainties – areas where research has failed to answer a research question – derived from previously published literature during a broad scope Priority Setting Partnership (PSP) with the James Lind Alliance (JLA). Methods This process was completed in the UK as part of the PSP for “Common Conditions Affecting the Hand and Wrist”, comprising of health professionals, patients and carers and reports the data (uncertainty) extraction phase of this. The PSP followed the robust methodology dictated by the JLA and sought to identify knowledge gaps, termed “uncertainties” by the JLA. Published Cochrane Systematic Reviews, Guidelines and Protocols, NICE (National Institute for Health and Care Excellence) Guidelines, and SIGN (Scottish Intercollegiate Guidelines Network) Guidelines were screened for documented “uncertainties”. A robust method of screening, internally verifying and then checking uncertainties was adopted. This included independent screening and data extraction by multiple researchers and use of a PRISMA flowchart, alongside steering group consensus processes. Selection of research uncertainties was guided by the scope of the Common Conditions Affecting the Hand and Wrist PSP which focused on “common” hand conditions routinely treated by hand specialists, including hand surgeons and hand therapists limited to identifying questions concerning the results of intervention, and not the basic science or epidemiology behind disease. Results Of the 2358 records identified (after removal of duplicates) which entered the screening process, 186 records were presented to the PSP steering group for eligibility assessment; 79 were deemed within scope and included for the purpose of research uncertainty extraction (45 full Cochrane Reviews, 18 Cochrane Review protocols, 16 Guidelines). These yielded 89 research uncertainties, which were compared to the stakeholder survey, and added to the longlist where necessary; before derived uncertainties were checked against non-Cochrane published systematic reviews. Conclusions In carrying out this work, beyond reporting on output of the Common Conditions Affecting the Hand and Wrist PSP, we detail the methodology and processes we hope can inform and facilitate the work of future PSPs and other evidence reviews, especially those with a broader scope beyond a single disease or condition.

In the context of complex public health challenges led by interdependent changes such as climate change, biodiversity loss, and resistance to treatment, it is important to mobilize methods that guide us to generate innovative interventions in a context of uncertainty and unknown. Here, we mobilized the concept-knowledge (CK) design theory to identify innovative, cross-sectoral, and cross-disciplinary research and design programs that address the challenges posed by tick-borne Lyme disease in France, which is of growing importance in the French public health and healthcare systems. Within the CK methodological framework, we developed an iterative approach based on literature analysis, expert interviews, analysis of active French research projects, and work with CK experts to contribute to design “an action plan against Lyme disease.” We produced a CK diagram that highlights innovative concepts that could be addressed in research projects. The outcome is discussed within four areas: (i) effectiveness; (ii) environmental sustainability in prevention actions; (iii) the promotion of constructive involvement of citizens in Lyme challenges; and (iv) the development of care protocols for chronic conditions with an unknown diagnosis. Altogether, our analysis questioned the health targets ranging from population to ecosystem, the citizen involvement, and the patient consideration. This means integrating social and ecological science, as well as the multidisciplinary medical patient journey, from the start. CK theory is a promising framework to assist public health professionals in designing programs for complex yet urgent contexts, where research and data collection are still not sufficient to provide clear guidance.

Background High scores in Medically Necessary, Time-sensitive (MeNTS) scoring system, used for elective surgical prioritization during Coronavirus Disease 2019 pandemic, are assumed to be associated with worse outcomes. We aimed to evaluate the MeNTS scoring system in patients undergoing elective surgery during restricted capacity of our institution with or without moderate or severe postoperative complications. Study Design In this prospective observational study, MeNTS scores of patients undergoing elective operations during May-June 2020 were calculated. Postoperative complication severity (classified as Group Clavien-Dindo, Medically Necessary Time-Sensitive (MeNTS) score was proposed to objectively prioritize elective surgery during COVID-19. Whether higher MeNTS score is associated with worse outcomes was not examined. Despite higher MeNTS score in patients with moderate and severe postoperative complication, it had low prediction capability for these complications.

This paper reviews the work of the United Nations specialized agencies and programmes within the framework of their cooperation in the area of public health in Morocco

Purpose The purpose of this paper is to study the factors associated with the occurrence of diseases and beriberi among prisoners incarcerated in the two largest Remand and Correctional Facilities (RCF). Design/methodology/approach This was a cross-sectional descriptive and analytical study carried out from April 20 to May 19, 2017, in the RCFs of Ouagadougou and Bobo-Dioulasso. All prisoners who consulted and those referred to the health center by the health-care team were included in the study. Complaints and diagnosed diseases information were collected using the second version of the International Classification of Primary Care (ICPC-2). The authors used a logistic regression model to perform univariate and multivariate analyses. Findings Of the 1,004 prisoners from the two RCFs included in the study (32.6%), 966 (96%) were male. The median age was 31.6 years. The distribution of diseases diagnosed using the ICPC-2 showed a predominance of gastrointestinal tract, skin and respiratory tract diseases among 206 (19.3%), 188 (17.6%) and 184 (17.2%) prisoners, respectively. A total of 302 prisoners (30.1%) had clinical beriberi, and 80 prisoners (8%) were underweight. Being incarcerated for more than nine months was independently associated with a high risk of digestive and respiratory diseases as well as beriberi. Research limitations/implications This study highlighted higher frequencies of digestive, skin and respiratory complaints and diseases in the two largest detention centers in Burkina Faso. These diseases are variously related to age, penal status and length of incarceration. In addition, underweight and thiamin vitamin deficiency responsible for beriberi are more frequent in adult prisoners, those not attending school, convicted prisoners and those with a length of stay in detention of more than nine months. These concrete results should help define a strategy and priority actions needed to reduce morbidity in prisons. Practical implications The actions should include the intervention of specialists in the field of common diseases in prisons, the improvement of individual hygiene conditions and environment, the improvement of the quality and quantity of the food ration, a strategy to reduce prison overcrowding. Other actions must be planned to allow specific groups such as women and minors to have access to health care that is adapted to them. Beyond the central concern of promoting the rights of prisoners and humanizing prisons, actions to improve the health of prisoners are part of an overall public health approach with its socio-economic and environmental implications. Social implications There is a need for a strong commitment from the State to develop a prison health policy that prioritizes the prevention of communicable and non-communicable diseases that are particularly prevalent in this context, without forgetting mental health and nutrition. This requires a collaboration of stakeholders based on better intersectorial communication, the implementation of a monitoring and evaluation system for the health of prisoners, an enhancement of the status of health-care providers working in prisons and an increase in the funding allocated to the health of prisoners with the mobilization of the necessary funds. Originality/value This study uses a primary health care classification to assess the health of inmates in a prison in Africa. It contributes to the weak evidence around prison health surveillance and health profiling of prisoners in Africa.

Dynamically adapting the allocation of COVID-19 vaccines to the evolving epidemiological situation could be key to reduce COVID-19 burden. Here we developed a data-driven mechanistic model of SARS-CoV-2 transmission to explore optimal vaccine prioritization strategies in China. We found that a time-varying vaccination program (i.e., allocating vaccines to different target groups as the epidemic evolves) can be highly beneficial as it is capable of simultaneously achieving different objectives (e.g., minimizing the number of deaths and of infections). Our findings suggest that boosting the vaccination capacity up to 2.5 million first doses per day (0.17% rollout speed) or higher could greatly reduce COVID-19 burden, should a new wave start to unfold in China with reproduction number ≤1.5. The highest priority categories are consistent under a broad range of assumptions. Finally, a high vaccination capacity in the early phase of the vaccination campaign is key to achieve large gains of strategic prioritizations., In the context of limited supply, strategies for optimising allocation of COVID-19 vaccines are needed. Here, the authors explore time-varying strategies that adapt to the epidemiological situation and simultaneously optimise for multiple objectives including reducing numbers of infections, hospitalisations, and deaths.

The World Health Assembly has adopted the World Health Organization's (WHO) recommended target of achieving a 15% reduction in physical inactivity by 2030. The WHO Global Action Plan on Physical Activity provides a framework for countries to achieve this, using a systems-based approach to address the social and environmental determinants of physical inactivity. Lack of progress in many countries indicates a need to identify new ways of addressing this public health priority. WHO continues to highlight the importance of legislative and regulatory measures within the multicomponent and multisectoral action needed to reduce physical inactivity. Yet research into the role of law for addressing physical inactivity has been limited, in contrast to the legal approaches to other major noncommunicable disease risk factors such as smoking and alcohol use. Conceptual frameworks for public health law offer a method for mapping and understanding the determinants, mechanisms and outcomes of law-making for the promotion of physical activity within populations. We describe the development and application of a framework that aligns legal strategies with the WHO Global Plan policy objectives. This new framework - the Regulatory Approaches to Movement, Physical Activity, Recreation, Transport and Sport - can help policy-makers to use the untapped potential of legal interventions to support or strengthen a whole-system response for promoting physical activity. The framework illustrates the role of legal interventions to improve physical activity and identifies opportunities for research to advance understanding, implementation and evaluation of legal responses to this issue.L'Assemblée mondiale de la Santé a adopté l'objectif recommandé par l'Organisation mondiale de la Santé (OMS) visant à réduire l'inactivité physique de 15% d'ici 2030. L'OMS a élaboré un Plan d'action mondial pour l'activité physique, qui propose aux pays des orientations leur permettant d'atteindre cet objectif, grâce à une approche systémique qui aborde les déterminants sociaux et environnementaux à l'origine de l'inactivité physique. L'absence de progrès dans de nombreux pays indique un besoin d'identifier de nouveaux moyens de faire de cet enjeu de santé publique une priorité. L'OMS continue à souligner l'importance des mesures législatives et réglementaires au cœur de l'action multisectorielle à composantes multiples nécessaire à la promotion de l'exercice physique. Pourtant, les recherches sur la capacité de la loi à lutter contre l'inactivité physique sont limitées, contrairement aux démarches juridiques entamées vis-à-vis d'autres grands facteurs de risque de maladies non transmissibles, comme la consommation de tabac ou d'alcool. Les cadres théoriques régissant le droit sanitaire offrent des méthodes d'analyse et de compréhension des déterminants, mécanismes et impacts du travail législatif sur la promotion de l'activité physique au sein des populations. Dans cet article, nous décrivons le développement et l'application d'un cadre qui aligne les stratégies juridiques sur les objectifs politiques du Plan mondial de l'OMS. Ce cadre inédit – les réglementations relatives au mouvement, à l'activité physique, aux loisirs, au transport et au sport – peut aider les législateurs à utiliser le potentiel inexploité des interventions légales pour soutenir ou renforcer une réponse globale destinée à encourager l'exercice physique. Il illustre le rôle des interventions légales visant à améliorer l'activité physique et identifie les possibilités de recherche en vue de faire progresser la compréhension, la mise en œuvre et l'évaluation des solutions juridiques apportées à ce problème.La Asamblea Mundial de la Salud ha adoptado el objetivo recomendado por la Organización Mundial de la Salud (OMS) de lograr una reducción del 15% de la inactividad física para 2030. El Plan de Acción Mundial de la OMS sobre la Actividad Física proporciona un marco para que los países lo logren, utilizando un enfoque basado en sistemas para abordar los determinantes sociales y ambientales de la inactividad física. La falta de progreso en muchos países indica la necesidad de identificar nuevas formas de abordar esta prioridad de salud pública. La OMS sigue destacando la importancia de las medidas legislativas y reglamentarias dentro de la acción multicomponente y multisectorial necesaria para reducir la inactividad física. Sin embargo, la investigación sobre el papel de la ley para abordar la inactividad física ha sido limitada, en contraste con los enfoques legales de otros factores de riesgo de enfermedades no transmisibles importantes, como el tabaquismo y el consumo de alcohol. Los marcos conceptuales del derecho de la salud pública ofrecen un método para trazar y comprender los determinantes, mecanismos y resultados de la elaboración de leyes para la promoción de la actividad física en las poblaciones. Describimos el desarrollo y la aplicación de un marco que alinea las estrategias legales con los objetivos políticos del Plan Global de la OMS. Este nuevo marco –enfoques normativos del movimiento, la actividad física, el ocio, el transporte y el deporte– puede ayudar a los responsables políticos a utilizar el potencial sin explotar de las intervenciones legales para apoyar o reforzar una respuesta de todo el sistema para promover la actividad física. El marco ilustra el papel de las intervenciones legales para mejorar la actividad física e identifica las oportunidades de investigación para avanzar en la comprensión, implementación y evaluación de las respuestas legales a este tema.اعتمدت جمعية الصحة العالمية الهدف الذي أوصت به منظمة الصحة العالمية (WHO)، والذي يتمثل في تحقيق خفض بنسبة 15% في الخمول البدني بحلول عام 2030. إن خطة العمل العالمية لمنظمة الصحة العالمية بشأن النشاط البدني، توفر إطار عمل للدول لتحقيق هذا الهدف، وذلك باستخدام نهج قائم على النظم للتعامل مع المحددات الاجتماعية والبيئية للخمول البدني. يشير عدم إحراز تقدم في العديد من الدول إلى الحاجة إلى تحديد طرق جديدة للتعامل مع هذه الأولوية الصحية للعامة. تواصل منظمة الصحة العالمية التركيز على أهمية التدابير التشريعية والتنظيمية ضمن الإجراءات متعددة المكونات ومتعددة القطاعات، اللازمة للحد من الخمول البدني. ورغم ذلك، فإن الأبحاث الخاصة بدور القانون في التعامل مع الخمول البدني كانت محدودة، على العكس من أساليب التعامل القانونية مع عوامل خطر الأمراض غير المعدية الرئيسية الأخرى، مثل التدخين وتعاطي الكحول. توفر أطر العمل المفاهيمية لقانون الصحة العامة طريقة لتخطيط وفهم محددات وآليات ونتائج وضع القوانين الساعية للارتقاء بالنشاط البدني بين السكان. نحن نقوم بوصف تطوير وتطبيق إطار عمل يتولى التنسيق بين الاستراتيجيات القانونية وأهداف سياسة الخطة العالمية لمنظمة الصحة العالمية. إن إطار العمل الجديد هذا (وهو الأساليب التنظيمية للحركة والنشاط البدني والترفيه والنقل والرياضة)، يمكنه أن يساعد واضعي السياسات على استخدام الإمكانات غير المستغلة للتدخلات القانونية لدعم أو تقوية استجابة النظام بأكمله للارتقاء بالنشاط البدني. يوضح إطار العمل دور التدخلات القانونية لتحسين النشاط البدني، ويحدد فرص الأبحاث لتعزيز فهم وتنفيذ وتقييم الاستجابات القانونية لهذه القضية.世界卫生大会通过了了世界卫生组织 (WHO) 建议的目标，即到 2030 年不参加体育活动的人数减少 15%。WHO《体育活动全球行动计划》为各国实现该目标提供了框架，以使用系统方法解决缺乏运动的社会和环境决定因素。多个国家没有取得进展表明需要找到解决该公共卫生重点问题的新方法。WHO 不断强调立法和监管措施在减少缺乏运动所需的多组分和多部门行动中的重要性。然而，与其它重大非传染性疾病风险因素（如吸烟和饮酒）的法律措施相比，关于法律在解决缺乏运动中作用的研究比较有限。公共卫生法律的概念性框架提供绘制和了解提高人口体育活动的立法决定因素、机制和成果的方法。我们描述了符合 WHO 全球计划政策目标法律策略的框架制定和应用过程。该新框架——运动、体育活动、娱乐、交通与体育活动监管办法——可帮助政策制定者使用法律干预的未开发潜力支持或加强促进体育活动的全系统响应。框架介绍了法律干预对促进体育活动的作用，并确定了提高对该问题法律响应的了解、实施和评估的研究机会。.Всемирная ассамблея здравоохранения приняла цель, рекомендованную Всемирной организацией здравоохранения (ВОЗ), — добиться сокращения физической неактивности среди населения на 15% к 2030 году. Глобальный план действий ВОЗ по повышению уровня физической активности обеспечивает странам основу для достижения этой цели с использованием системного подхода для определения социальных и экологических детерминант недостаточной физической активности. Отсутствие прогресса во многих странах указывает на необходимость определения новых способов решения этой приоритетной задачи общественного здравоохранения. ВОЗ по-прежнему подчеркивает важность законодательных и нормативных мер в рамках многокомпонентных и многосекторальных действий, необходимых для снижения уровня физической неактивности. Однако исследований роли закона в решении проблемы недостаточной физической активности проводилось ограниченное количество, в отличие от правовых подходов к другим основным факторам риска развития неинфекционных заболеваний, таким как курение и употребление алкоголя. Концептуальные основы законодательства в области общественного здравоохранения предлагают метод для картирования и понимания детерминант, механизмов и результатов законотворческого процесса, направленного на повышение уровня физической активности среди населения. Авторы описывают разработку и применение механизма, который приводит правовые стратегии в соответствие с концептуальными целями Глобального плана ВОЗ. Этот новый механизм, включающий подходы к регулированию передвижения, физической активности, отдыха, транспорта и спорта, может помочь представителям правительственных структур использовать нереализованный потенциал правовых действий для поддержки или усиления ответных мер на уровне всей системы, направленных на поощрение физической активности. Механизм иллюстрирует роль правовых действий для повышения уровня физической активности и определяет возможности для исследований, направленных на углубление понимания, реализации и оценки правовых мер реагирования на эту проблему.

The supply limitations of COVID-19 vaccines have led to the need to prioritize vaccine distribution. Obesity, diabetes and hypertension have been associated with an increased risk of severe COVID-19 infection. Approximately half as many individuals with a cardiovascular risk factor need to be vaccinated against COVID-19 to prevent related death as compared with individuals without a risk factor. Adults with body-mass index ≥30kg/m2, diabetes or hypertension should be of a similar priority for COVID-19 vaccination to adults 10 years older with a body-mass index 20 to

Personal health responsibility has different meanings. One might mean that unhealthy lifestyles bring about disease and illness, or that the outcome of physiotherapy treatment depends on the patient’s effort. But it can also mean that we have moral obligations towards ourselves, those close to us, or the society. When these obligations are not met, personal responsibility can entail guilt and blame. The purpose of this paper is to show how the concept accommodates both the uncontroversial and the far more controversial. Therefore, there is a danger of talking past each other when discussing the topic. Since personal responsibility is a natural part of physiotherapy, through the emphasis on training and home exercises, there is reason to think about the concept.

The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.

Public engagement in priority-setting for health is increasingly recognized as a means to ensure more ethical, inclusive and legitimate decision-making processes, especially in the context of Universal Health Coverage where demands outweigh the available resources and difficult decisions need to be made. Deliberative approaches are often viewed as especially useful in considering social values and balancing trade-offs, however, implementation of deliberative engagement tools for priority-setting is scant, especially in low- and middle-income settings. In order to address this gap, we implemented a context-specific public deliberation tool in a rural community in South Africa to determine priorities for a health services package. Qualitative data were analysed from seven group deliberations using the engagement tool. The analysis focused on understanding the deliberative process, what the participants prioritized, the reasons for these selections and how negotiations took place within the groups. The deliberations demonstrated that the groups often considered curative services to be more important than primary prevention which related to the perceived lack of efficacy of existing health education and prevention programmes in leading to behaviour change. The groups engaged deeply with trade-offs between costly treatment options for HIV/AIDS and those for non-communicable disease. Barriers to healthcare access were considered especially important by all groups and some priorities included investing in more mobile clinics. This study demonstrates that deliberative engagement methods can be successful in helping communities balance trade-offs and in eliciting social values around health priorities. The findings from such deliberations, alongside other evidence and broader ethical considerations, have the potential to inform decision-making with regard to health policy design and implementation.

PurposeThis paper aims to investigate the Portuguese general public views regarding the criteria that should guide critical COVID-19 patients to receive medical devices (ventilators and IUC beds) during the current pandemic context. Based on rationing principles and protocols proposed in ethical and medical literature the authors explore how Portuguese general public evaluates the fairness of five allocation principles: “prognosis”, “severity of health condition”, “patients age”, “instrumental value” (frontline healthcare professionals should be prioritized during the pandemic) and “lottery”.Design/methodology/approachAn online questionnaire was used to collect data from a sample of 586 Portuguese citizens. Descriptive statistics and non-parametric tests were used to define a hierarchy of prioritization criteria and to test for the association between respondents support to them and their socio-demographic and health characteristics.FindingsRespondents gave top priority to prognosis when faced with absolute scarcity, followed closely by the severity of health condition, patient’s age with instrumental value receiving lowest support, on average. However, when the age of the patients was confronted with survival, younger-first principle prevailed over recovery. In a pandemic context, lottery was considered the least fair allocation method. The findings suggest that respondents’ opinions are aligned with those of ethicists but are partially in disagreement with the protocol suggested for Portugal.Originality/valueThis study represents the first attempt to elicit public attitudes towards distributive criteria during a pandemic and, therefore, in a real context where the perception is that life and death decisions have to be made.

Community engagement (patient and public involvement) is gaining prominence in health research worldwide. But there remains limited ethical guidance on how to share power with communities in health research priority setting, particularly that which has been informed by the perspectives of those being engaged. This article provides initial evidence about what they think are important ways to share power when setting health research projects’ topics and questions. Twenty-two people with lived experience, engagement practitioners, and members of the public who have been engaged in health research in the United Kingdom and Australia were interviewed. Thematic analysis identified 15 key ways to share power, many of which are relational. This study further demonstrates that tensions exist between certain ways of sharing power in health research priority setting. More research is needed to determine how to navigate those tensions.

Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources. Here, we analyse the criteria and processes that ten of the largest public and non-profit research funders use to choose between competing grant applications. Our data suggest that research funders rarely instruct reviewers to consider disease burden or to prioritise research for sicker or more disadvantaged populations, and typically only include scientists in the review processes. This is liable to undermine efforts to link research funding to health needs.