Older persons making a life closure: experiences of loneliness in an academic nursing home - a phenomenological qualitative interview study.

BACKGROUND: Loneliness is a public health concern and more than half of the residents in nursing homes experience lonliness. Risk factors are age and loss of close relatives. PURPOSE: This study aimed to describe experiences of loneliness among older people living in an academic nursing home. METHODS: Qualitative semi-structured interviews were conducted with ten older people and data analysed with systematic text condensation inspired by a phenomenological approach. RESULTS: Three themes were identified: "Relatives and health care professionals matter"; "Acceptance and meaningful existence alleviate loneliness"; and "Challenges affecting the experience of loneliness". The older persons described themselves as lonely, but their experience of loneliness differed. They managed loneliness by adapting to it or getting used to it; some also chose to be alone. To add meaningfulness to their daily life, talking about memories and their past were appriciated. Personality traits and variations in functional ability were identified as barriers to social interactions. CONCLUSIONS: Health care professionals can reduce negative experiences of loneliness by listening to nursing home residents, creating a meaningful daily life with individualized activities, and by encouraging contacts with close relatives. This can be a way of maintaining older persons' dignity and coping with the longing for what has been.

[The characteristics of prevention of drug addiction and narcotism in municipal formation of city of Novorossiysk].

The drug addiction is one of most serious deviant behavior seriously harming both addict person and one's relationship. The drug using is considered as deviant because means using substances from non-legal turn-over or applied in non-medical purposes. Then follows degradation of health of person and one's positioning into physical and mental dependence on them. With time, personal dependence on drugs becomes stronger. The addicted person looses possibility to experience joy from natural stimuli and more difficulties in controlling drug using appear. Persons using drugs frequently commit crimes to have money to maintain one's dependence. Therefore, issues of prevention narcotism and struggle with drug addiction are fundamental ones for whole system of prevention in Novorossiysk. The article presents analysis of implemented activities and adopted measures of struggle with drug addiction in population of Novorossiysk.

Retrospective analysis of laboratory diagnostic data to assess the prevalence and seasonal variation of Ehrlichia ruminantium in commercial farms of Lephalale Municipality, Limpopo, South Africa.

Heartwater is an economically important disease of livestock and some wild ruminants in Southern Africa. The study used retrospective laboratory data from Lephalale Veterinary Laboratory, Limpopo to establish the prevalence and seasonal occurrence of heartwater in commercial farms of Lephalale Municipality between 2010 and 2022. A total of 472 brain samples from livestock (cattle, goats, sheep) and game carcasses brought to the laboratory for postmortem examination were subjected to heartwater testing using Giemsa staining technique. The overall prevalence of heartwater in Lephalale Municipality was 34.1% (95% CI = 29.9-38.6, p < 0.001). During the years under investigation, there was a significant (p < 0.001) variation, with the highest and lowest prevalence in 2022 (72.2%) and 2019 (6.3%), respectively. The prevalence of heartwater was high in springbok (57.1%), sheep (49.3%), cattle (36.6%) and goats (32.2%). Heartwater was detected throughout the year with autumn having the highest (40.6%) frequency followed by summer (40.3%), spring (30.5%) and winter (25.5%). This study is the first to establish the prevalence and seasonality of heartwater in Lephalale Municipality which will serve as a baseline for prevention and control strategies as well as future epidemiological studies. Official surveillance programmes, more research on the distribution and genotypes of E. ruminantium in the area need to be undertaken for better understanding of the disease in the area.

Characterization and Quantification of Vehicular Emissions in Abuja Municipality-Implications for Public Health.

Background: Air pollution from vehicular emission and other sources accounts for over seven million global deaths annually and contributes significantly to environmental degradation, including climate change. Vehicular emission is not prioritized for control in Nigeria, thus undermining public health and the Sustainable Development Goals 3, 11 and 13. This study aims to characterize vehicular emissions in Abuja municipality and quantify exhaust air pollutants of commonly used vehicles. Methodology: Cross-sectional exhaust emissions study of vehicles in Abuja Municipal Area Council. Information on the type and age, fuel type, purchase and use category of 543 vehicles on routine Annual Road Worthiness Test at the Computerized Test Center, Abuja. Exhaust levels of CO, CO2 HCHO and PM10 were measured using hand-held devices. IBM SPSS version 26.0.0.0 (2019) statistical software. Results: Toyota brand comprised 52.5% of the vehicles. Over 80% were older than 10 years; 85.5% preowned and 87.3% used for private purposes. PMS was the dominant fuel used (91.1%). Except PM10, older vehicles emitted higher levels of the measured pollutants than newer ones. The differences were significant for CO and HCHO. Diesel-fueled and commercial vehicles also emitted higher levels of CO, HCHO and PM10 compared to PMS-fueled and private vehicles respectively. Conclusions: Strong regulatory policies that discourage over-aged vehicles; speedy adoption of the ECOWAS guidelines on cleaner fuels and emission limits; and coordinated implementation of effective Inspection & Monitoring programme by relevant government agencies are required to safeguard public health and the environment. We also recommend the introduction of vehicles powered by alternative energy, use of bicycles, designation of one-way traffic and pedestrian zones. Key Message: Reducing the threats to the public's health from vehicular air pollution in Abuja municipality requires strong policy and coordinated monitoring programs for effective control.

Adaptive capacity to reduce disaster risks in informal settlements.

The eMalahleni Local Municipality (eLM) in Mpumalanga province, South Africa, has a number of informal settlements because of the influx of people seeking employment in the municipal area. These informal settlements are exposed to a number of hazards, including underground fires, air and water pollution, sinkholes, abandoned mining areas and acid mining drainage. South Africa's National Development Plan (NDP) incorporates the United Nation's Sustainable Development Goals, which are intended to upgrade informal settlements on suitable land. The Department of Human Settlement recognised the gap in the policy because upgrading only included physical structures and did not include adaptive capacity for communities to create resilience to withstand disasters. The researcher used a case study research design for the inquiry intended to recommend adaptive capacity and reduce disaster risks in informal settlements in the eLM. Purposive sampling was used to select 25 participants from eLM, provincial government departments and informal settlements. The data were analysed using thematic analysis based on the study's conceptual framework. The research findings revealed that the government has not done much to involve vulnerable communities during the development of policies to reduce disaster risks within informal settlements. In particular, the failure of the government to promote and reinforce public participation in disaster risk reduction programmes leaves the vulnerable communities defenceless. Contribution: This study strengthens the intergovernmental structures and public participation to reduce disaster risks in communities. This study discourages a silos mentality and encourages coordination between government departments to identify root causes by applying the pressure and release model for effective disaster risk reduction.

Community-Working Occupational Therapists' Involvement in Research and Development Projects in Norway.

The aim of this study was to explore community-working occupational therapists' involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities.

On the Efficacy of Indigenous Knowledge Systems in Responding to the COVID-19 Pandemic: Unsettling Coloniality.

Indigenous groups across Africa mobilized Indigenous Knowledge (IK) practices, albeit not without challenges, to respond to the COVID-19 pandemic. Yet Indigenous Knowledge Systems (IKS) continue to be sidelined in formal healthcare policies and programmes. This underscores the urgency to liberate Africa's epistemologies. Employing the decoloniality lens, this paper examined the colonial influences inherent in African responses to COVID-19 while also exploring the role of IKS in the uMkhanyakude District Municipality (UKDM). The argument is made that, in the case of the UKDM, the efficacy of IKS was demonstrated in the response to and fight against the COVID-19 pandemic. This is the basis for the call to embrace and recognize that IKS is a legitimate body of knowledge comparable to Western science. Such recognition paves the way for more equitable, contextually relevant, and sustainable health strategies that can better address the complexities of current and future pandemics.

Municipality-level differences in disability retirement in Finland: The contribution of local social characteristics.

AIMS: Large differences exist in the risk of disability retirement between Finnish municipalities. This study examined whether individual-level and municipality-level characteristics explain these differences and which municipality-level characteristics are particularly important for the risk of disability retirement. METHODS: Individual-level register data were supplemented with 10 municipality-level characteristics from various databases. A 20% sample of the Finnish population (N=626,391) was followed for transition to disability retirement from 2016 to 2019 using multilevel Weibull models. RESULTS: Of the total variation in the risk of disability retirement, 4.3% was attributed to the municipal-level and decreased to 1.8% when individual-level characteristics (gender, age, education level and entitlement to special reimbursement for medical expenses, reflecting morbidity) were controlled for. Further adjustment for municipality-level characteristics fully erased the differences between municipalities. The proportion of municipality-level variation was larger for disability retirement due to somatic illnesses than mental disorders. Of the municipality-level characteristics, socioeconomic structure, unemployment rate, poverty, net migration between municipalities, dependency ratio, the amount of tax revenue per capita and morbidity were associated with the risk of disability retirement. CONCLUSIONS: The municipality-level variation in the risk of disability retirement is largely explained by the individual characteristics of the inhabitants. However, various characteristics of the municipalities show associations with the risk of disability retirement. Recognizing such factors is essential for shaping policies that mitigate disability retirement risk.

Synergizing remote sensing and ecological indicators (RSEIs) for evaluating ecological environmental quality (EEQ) in Asansol Municipal Corporation: an integrated approach.

Human activities have dramatically affected global ecology over the past few decades. Geospatial technologies provide quick, efficient, and quantitative evaluation of spatiotemporal changes in eco-environmental quality (EEQ). This study focuses on a novel approach called remote sensing-based ecological indicators (RSEIs), which has used Landsat imagery data to assess environmental conditions and their changing trends. Four ecological indicators, mainly heatness, dryness, wetness, and greenness, have been used to assess the EEQ in Asansol Municipal Corporation Region (AMCR). Assembling all the indicators to generate RSEI, the principal component analysis (PCA) approach was applied. Our findings show that wetness and greenness favorably impact the province's EEQ, whereas dryness and heat create a negative impact. The RSEI assessment revealed that 24.53 to 28.83% of the area was poor and very poor, whereas the areas with very good decreased from 18.80 to 4.01% from 2001 to 2021 due to urban expansion and industrialization. The relative importance analysis indicates that greenness has a positive relation with RSEI, and dryness and heatness have a negative relation with RSEI. Finally, the receiving operating characteristic (ROC) was used for validation (AUC-0.885) of the RSEI. This study offers valuable insights for ecological management decision-making, guiding planners, and policymakers.

Improving maternal and child nutrition services in community based health planning and services zones in the jirapa municipality of northern ghana-challenges and strategies: the perspective of community health officers.

BACKGROUND: The Community-based Health Planning and Services (CHPS) initiative plays a key role in delivering maternal and child health nutrition services in Ghana. This study explored bottle necks hindering the delivery of maternal and child nutrition services at CHPS zones and searched for strategies to address them from the perspective of community health officers in rural Northern Ghana. METHODS: An exploratory qualitative cross-sectional study design using key informant interviews involving the municipal nutrition officer and Community Health Officers (CHOs) from eleven CHPS zones was carried out in April 2019. Manual data analysis was done using the framework analysis approach in qualitative data analysis for applied policy research. RESULTS: This study identified challenges of maternal and child nutrition services in the Jirapa municipality to be municipal health directorate and CHPS zone based in nature. Municipal health directorate based challenges were inadequate logistics/medicines; lack of staff training; lack of supervision/monitoring; and inadequate financial support/motivation/incentives. CHPS zone based challenges were lack of planning activities by staff; inadequate home visits; lack of commitment by staff; and lack of community meetings/engagements. Proposed strategies to address municipal health directorate based challenges included adequate provision of logistics/medicines; frequent training of staff in maternal and child nutrition related issues; frequent supervision/monitoring activities from the municipal health directorate; and providing financial support/motivation/incentives at the CHPS zones. Proposed strategies to address CHPS zone based challenges were planning of activities; improved home visits; increased commitment towards delivering maternal and child nutrition services; and frequent community meetings/engagements. CONCLUSION: In order to improve maternal and child nutrition services at CHPS zones, there is the need to address certain systemic challenges at both the municipal or district health directorate and CHPS zones levels of the primary health care system. It is recommended that, the Municipal Health Directorate; the Municipal Health Management Team; the Municipal Assembly and all relevant stakeholders involved in improving maternal and child nutrition services at the community level, actively engage CHOs to help address the systemic challenges.

Investigating the socioeconomic impacts of sewage spillages on businesses in the Umhlanga Rocks coastline area.

Sewage spillage is fast becoming a significant concern in South Africa because of the deteriorating infrastructure and substandard service delivery. Thus, this study investigated the socioeconomic impacts of sewage spillages on businesses in the Umhlanga Rocks coastline area. A questionnaire with open and closed-ended questions was used to collect data from business owners in the affected area. One hundred business owners were handed questionnaires to complete, and 95 completed questionnaires were collected. The qualitative data from the questionnaires were analysed using thematic analysis, whereby line-by-line coding was manually completed using Excel. The quantitative data were analysed in R studio using numerous statistical tests, including the Shapiro-Wilk test, the Chi-square test, the Kruskal-Wallis test, Dunn's test, and Cohen's d test. The thematic analysis and statistical testing results showed that sewage spillages disrupted businesses significantly. Results indicated that businesses of different sizes experienced socioeconomic losses differently. Consequently, the results of this study have implications for business owners and communities living in the affected area. Moreover, findings have revealed practical strategies and interventions that may be used by micro- to medium-scale businesses to mitigate the socioeconomic impact of sewage spillages. Contribution: The practical strategies revealed in this study contribute to reducing the vulnerability of communities and businesses to sewage spillages. Findings of the study have also been disseminated to the business owners and other relevant stakeholders to provide them with alternative solutions in 'softening the blow' caused by the spillages.

Fungi: friends or foes-an outreach science initiative for the collection of airborne fungal spores by high school students.

Fungi mostly reproduce through spores that are adapted for airborne dispersal; hence, fungal spores (and fungi) are found virtually everywhere. Fungi can be "friends or foes." Our friends include fungi used in the food and biotech industries, fungi that contribute to the cycling of carbon and nutrients, and those involved in the decontamination of polluted soils and/or water, to mention just a few examples. Many species, however, are foes-they are detrimental to plants, animals, and/or humans. Annually, >1.5 million people die due to invasive fungal infections. With the aim of enhancing microbiology literacy and the understanding of microbial concepts, we set up a project for the collection of airborne spores (the principal agent through which human airways are exposed to fungi). Students from five high schools in the Oeiras municipality partnered with us as citizen scientists; they carried out sampling by collecting fungal spores on adhesive stickers. The fungal spores collected by the students were subsequently processed in the schools and our research laboratory. Results obtained by the students themselves revealed a large variety of fungal species capable of growing in a rich medium at 30°C. In the research laboratory, using selective isolation conditions, 40 thermotolerant fungi were isolated, 32 of which were taxonomically identified as aspergilla, mostly from within the Aspergillus fumigatus taxa, yet exhibiting high genetic heterogeneity. The protocols and results were presented to the students, who were made aware of the local dispersal of airborne fungal spores, including some from potentially pathogenic fungi. Through carrying out scientific activities, the students developed both the interest and the self-confidence needed to implement future environmental investigations.

A regulatory framework for bottled water quality monitoring: A case of Emfuleni local municipality.

Background: The quality of drinking water has recently become of utmost concern to consumers worldwide, especially in areas where Water Service Authorities (WSAs) failed to provide safe water. To combat this challenge, government entities regulate water to ensure that safe water is provided. The Emfuleni Local Municipality (ELM) has experienced cases of water contamination by human excretion, whereby communities were affected. As a result, there was a sharp increase in bottled water (BW) use, which however gave rise to unregulated and counterfeit versions of popular brands. This situation poses threats to public health. Aim: This study sought to determine the regulation of drinking water and to assess whether environmental health practitioners (EHPs) monitor the quality of water sources (BW and tap water) in ELM as outlined by the National Environmental Health Norms and Standards (NEHNS). Settings: The study was conducted in the Emfuleni Local Municipality in South Africa. Methods: A quantitative cross-sectional study design was employed in this research. Fifteen online questionnaires using a Google Forms survey were distributed amongst all EHPs servicing ELM. Secondary data that included the Integrated Development Plan (IDP) and Service Delivery Budget Implentation Plan (SDBIP) for the 2017-2020 financial years were also evaluated, specifically for water quality monitoring (tap and bottled water). The dataset was analysed using the Statistical Package for the Social Sciences (SPSS) version 29. Results: Due to complexity in the legislation and NEHNS in relation to Municipal Health Services (MHS), bottled water was not sampled at all. A number of EHPs were also not conversant with the regulations governing BW. Moreover, NEHNS consider bottled water as food, which does not fall under the MHS. Conclusion: There should be clarity in the legislation to ensure that bottled water monitoring is intensified to protect public health within the WSAs. Contribution: The findings of this study could assist policy-makers to make informed decisions on water quality monitoring, as well as clarify legislative issues on bottled water.

Allocating municipal services to individuals with complex rehabilitation needs - a discourse analysis of individual administrative decision letters.

BACKGROUND: Rehabilitation is considered paramount for enhancing quality of life and reducing healthcare costs. As a result of healthcare reforms, Norwegian municipalities have been given greater responsibility for allocating rehabilitation services following discharge from hospital. Individual decision letters serve as the basis for implementing services and they have been described as information labels on the services provided by the municipality. They play an important role in planning and implementing the services in collaboration with the individual applicants. Research indicates that the implementation of policies may lead to unintended consequences, as individuals receiving municipal services perceive them as fragmented. This perception is characterised by limited user involvement and a high focus on body functions. The aim of this study was to examine how municipal decision letters about service allocation incorporate the recommendations made in the official national guideline and reflect a holistic approach to rehabilitation, coordination and user involvement for individuals with comprehensive needs. METHODS: The decision letters of ten individuals with moderate to severe brain injury allocating rehabilitation services in two municipalities were examined. It was assessed whether the content was in accordance with the authorities' recommendations, and a discourse analysis was conducted using four tools adapted from an established integrated approach. RESULTS: The letters primarily contained standard texts concerning legal and administrative regulations. They were predominantly in line with the official guideline to municipal service allocation. From a rehabilitation perspective, the focus was mainly on medically oriented care, scarcely referring to psychosocial needs, activity, and participation. The intended user involvement seemed to vary between active and passive status, while the coordination of services was given limited attention. CONCLUSIONS: The written decision letters did fulfil legal and administrative recommendations for service allocation. However, they did not fulfil their potential to serve as a means of conveying rehabilitation issues, such as specification of the allocated services, a holistic approach to health, coordination, or the involvement of users in decision processes. These elements must be incorporated throughout the allocation process if the policies are to be implemented as intended. Findings can have international relevance for discussions between clinicians and policy makers.

Estimated number of deaths attributable to NO2, PM10, and PM2.5 pollution in the Municipality of Milan in 2019.

BACKGROUND: there is growing evidence that exposure to environmental pollutants affects health, including mortality, chronic diseases, and acute diseases. The World Health Organisation has recently revised downwards the safety thresholds for exposure to environmental pollutants. The City of Milan (CoM) has particularly high levels of pollution; this is due both to the presence of various emission sources and to climatic and orographic conditions. OBJECTIVES: to describe the health effects of exposure to pollutants, measured by deaths due to environmental exposure to NO2, PM10, and PM2.5 in 2019. DESIGN: observational study. Using a pollutant concentration estimation model, annual mean values of NO2, PM10, and PM2.5 were estimated for the CoM in 2019. The number of deaths attributable to each exposure was estimated using risk functions available in the literature; the values recommended by the new World Health Organisation guidelines were used as counterfactual exposure limits. SETTING AND PARTICIPANTS: the population assisted by the Agency for Health Protection of Milan and resident in the CoM on 01.01.2019, aged 30 years or older. The place of residence was georeferenced and the population was followed up until 31.12.2019. Deaths and their causes were obtained from the Causes of Death Registry. MAIN OUTCOME MEASURES: deaths attributable to exposure from non-accidental causes, cardiovascular diseases, respiratory diseases, and lung cancer were estimated. RESULTS: in 2019, the estimated annual average level of NO2 was 36.6 µg/m3, that of PM10 was 24.9 µg/m3, and that of PM2.5 was 22.4 µg/m3, with levels varying across the city area. Concerning exposure to NO2, in 2019 10% of deaths for natural causes were estimated to be attributable to annual mean levels of NO2 above 10 µg/m3. As regard PM2.5, 13% of deaths for natural causes and 18% of deaths from lung cancer were attributable to an annual mean level above 5 µg/m3. The impact of exposure to particulate matter on mortality does not seem to be the same in all the areas of the CoM. CONCLUSIONS: the health impact of exposure to airborne particulate matter in the CoM population is high. It is important that citizens, policy-makers, and stakeholders address this issue, because of its impact on both health and healthcare costs.

The implication of water accessibility challenges to urban water governance in Morogoro municipality, Tanzania.

This study investigates water accessibility challenges in urban and peri-urban areas and its implication to urban water governance in Morogoro Municipality, Tanzania. A cross-sectional research design was adopted using a survey of 90 randomly selected households. The key informant interview was used to collect key information. Quantitative data were analyzed using descriptive statistics. The Mann-Whitney U Test was employed to establish the extent to which factors affected water accessibility differently in urban and peri-urban areas. Content analysis was used to analyse qualitative information. Approximately 69% of the respondents accessed water from public piped water system. Some accessed water from public water taps while others used private boreholes and tank carts. Water supply, more so in peri-urban areas, was not reliable. In addition, water leakage, cost of connecting to the public piped water system, cost for constructing a borehole, climatic and environmental factors piled up into challenges of water accessibility suggesting poor urban water governance. The Mann-Whitney U Test showed that households in peri-urban areas were significantly affected by the challenges compared to households in urban areas at 5% level of significance where p = 0.000. The study concludes presence of challenges in water access due to multiple factors with implications on urban water governance. Therefore, urban water governance should be improved to heighten water accessibility. Further studies should focus on developing an urban water governance framework in Tanzania.

Health-related quality of life among adults living with chronic non-communicable diseases in the Ho Municipality of Ghana: a health facility-based cross-sectional study.

BACKGROUND: Morbidity and mortality rates from chronic non-communicable diseases (CNCDs) are increasing globally. In Ghana, CNCDs account for 43% of all deaths. We examined the Health-Related Quality of Life (HRQoL) and associated factors among adults living with CNCDs in the Ho Municipality. METHODS: This was a health facility-based descriptive cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of Ghana. The study adopted the EQ-5D-5L instrument and the Ugandan value set to compute respondents' HRQoL index. Quantile regression models were used in analysing the data with STATA v17.0 at 95% Confidence Intervals, and statistical significance set at p < 0.05. RESULTS: 63.7% of our respondents reported having a problem across the five dimensions of the EQ-5D-5L. The most problems were reported in the dimensions "Anxiety/Depression" (94.4%) and "Pain/Discomfort" (91.4%). Divorced/separated respondents (aOR=-0.52, 95% CI=-0.71, -0.33) and those living with comorbidities (aOR=-0.95, 95% CI=-0.15, -0.04,) were less likely to report high index for HRQoL. However, respondents diagnosed with CKD (aOR = 0.26, 95% CI = 0.10, 0.42), diabetes (aOR = 0.28, 95% CI = 0.11, 0.45), hypertension (aOR = 0.35, 95% CI = 0.19, 0.50) and stroke (aOR = 0.26, 95% CI = 0.11, 0.40) were more likely to report higher index than those diagnosed with cancer. CONCLUSION: Our study revealed elevated proportions of reported problems in the "Anxiety/Depression" and "Pain/Discomfort" dimensions, indicating noteworthy concerns in these areas of HRQoL. The prevalent issues reported across HRQoL dimensions are cause for concern, posing potential exacerbation of health conditions. We advocate for collaborative efforts from the Ministry of Health, Ghana Health Service, and relevant stakeholders to scrutinize and implement interventions targeting social and psychological factors. These efforts should specifically address contributors to diminished health-related quality of life, particularly among less educated, divorced, and comorbid individuals.

The contribution of Dutch municipalities to stimulate smoke-free outdoor sports clubs: a qualitative study.

Local governments may play a key role in making outdoor sports clubs smoke free. This study aims to assess the activities, motives, challenges and strategies of Dutch municipalities regarding stimulating outdoor sports clubs to become smoke free. Semi-structured interviews were conducted with 19 policy officers of different municipalities in the Netherlands. The included municipalities varied in terms of region, population size and degree of urbanization. Data were analyzed using content analysis. Municipalities stimulated sports clubs to become smoke free by providing information and support and, to a lesser extent, by using financial incentives. Motives of municipalities varied from facilitating a healthy living environment for youth, responding to denormalization of smoking and aligning with goals formulated in national prevention policy. Policy officers faced several challenges, including limited capacity and funds, a reluctance to interfere with sports clubs and little support within the municipal organization. These challenges were addressed by employing various strategies such as embedding smoke-free sports in a broader preventive policy, setting a good example by creating outdoor smoke-free areas around municipal buildings, and collaborating with stakeholders in the municipality to join forces in realizing smoke-free sports clubs. Municipalities demonstrated evident motivation to contribute to a smoke-free sports environment. Currently, most municipalities fulfil an informative and supportive role, while some municipalities still explore their role and position in relation to supporting sports clubs to become smoke free. Other municipalities have established, according to them, effective strategies.

Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults.

Oral health care is essential, and digital training may influence healthcare professionals' attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals' experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals' attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers.

OBJECTIVE: To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. DESIGN: Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. RESULTS: Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. CONCLUSIONS: The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

The Norwegian Infection Control Act gave comprehensive responsibility and authority for local COVID-19 pandemic management to the municipalities and the Municipality Chief Medical Officers (MCMOs).The MCMOs highlighted several challenges and shortcomings of the municipal crisis preparedness, of which lack of detailed organizational plans was the most prominent.Teamwork, digital networking and collective sensemaking seemed to enhance pandemic collaboration and resilience within and across municipalities.Most MCMOs gained a leading role at a higher organizational level within the municipality through the COVID-19 pandemic.To strengthen future crisis management, arrangements must be made, both organizationally and financially, for preparedness to remain on the agenda even between epidemics and pandemics.