Politiche di pianificazione territoriale e attuazione della Convenzione I piani paesaggistici regionali

Twenty years on, the implementation of the Landscape Convention has been just partially applied to landscape management. This is due to the Cultural Heritage and Landscape Code and its insistence on landscape assets, whose regulations appear to be divergent from the principles of the Convention. Nonetheless, the regional landscape plans approved so far present some innovative planning guidelines where it seems possible to identify a number of the principles of the Convention, even if local implementation is still limited.

Using the Consolidated Framework for Implementation Research to design and implement a perinatal education program in a large maternity hospital

Background Implementation science aims to embed evidence-based practice as ‘usual care’ using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR). Method Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation. Results This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital. Conclusion This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.

From European forestry strategies to implementing local policies: a study on public forest workers in the Tuscany region of Italy

Even though forests represent almost half of the EU territory, the implementation of forestry strategies is delegated to local government institutions. This study proposes an overview of the main European forestry strategies, national (Italian) guidelines and local implementation instruments (in Tuscany). This approach made it possible to identify the actual executors of forestry policies, i.e., the public forest workers. The paper provides a framework of the recent dynamics of regional forestry instruments, their effects on available financial resources and their technicaloperational consequences. Furthermore, Tuscan public forest worker profiles were defined through an online questionnaire. The results show that it is essential to activate constant monitoring of local actions in order to verify the effectiveness of superordinate forestry policies.

Cost-effectiveness of a Community-based Hypertension Improvement Project (ComHIP) in Ghana: results from a modelling study

ObjectiveTo undertake a cost-effectiveness analysis of a Community-based Hypertension Improvement Project (ComHIP) compared with standard hypertension care in Ghana.DesignCost-effectiveness analysis using a Markov model.SettingLower Manya Krobo, Eastern Region, Ghana.InterventionWe evaluated ComHIP, an intervention with multiple components, including: community-based education on cardiovascular disease (CVD) risk factors and healthy lifestyles; community-based screening and monitoring of blood pressure by licensed chemical sellers and CVD nurses; community-based diagnosis, treatment, counselling, follow-up and referral of hypertension patients by CVD nurses; telemedicine consultation by CVD nurses and referral of patients with severe hypertension and/or organ damage to a physician; information and communication technologies messages for healthy lifestyles, treatment adherence support and treatment refill reminders for hypertension patients; Commcare, a cloud-based health records system linked to short-message service (SMS)/voice messaging for treatment adherence, reminders and health messaging. ComHIP was evaluated under two scale-up scenarios: (1) ComHIP as currently implemented with support from international partners and (2) ComHIP under full local implementation.Main outcome measuresIncremental cost per disability-adjusted life-year (DALY) averted from a societal perspective over a time horizon of 10 years.ResultsComHIP is unlikely to be a cost-effective intervention, with current ComHIP implementation and ComHIP under full local implementation costing on average US$12 189 and US$6530 per DALY averted, respectively. Results were robust to uncertainty analyses around model parameters.ConclusionsHigh overhead costs and high patient costs in ComHIP suggest that the societal costs of ensuring appropriate hypertension care are high and may not produce sufficient impact to achieve cost-effective implementation. However, these results are limited by the evidence quality of the effectiveness estimates, which comes from observational data rather than from randomised controlled study design.

Transitional Employment Programs within Clubhouses as a Means of Promoting Recovery for Individuals Living with Mental Illness: Reviewing the Case for Québec

Transitional employment (TE) within the Clubhouse model has been adopted across Canada and the world for its effectiveness in promoting work and recovery for persons living with mental illness. However, attempts to establish a TE program in the province of Québec have been met with numerous roadblocks. Using a qualitative phenomenological approach, this study aimed to synthesize knowledge that could inform local implementation of TE. Experiences of Montréal Clubhouse members and Canadian Clubhouse directors were examined. Member narratives identified employment-program and systemic shortcomings, while directors provided key strategies for overcoming barriers to TE implementation.