Structural characteristics and drivers of greenhouse gas emissions at county-level and long-time scales: A case study of the Anji County, China

To achieve carbon neutrality, the Chinese government needs to gain a comprehensive understanding of the sources and drivers of greenhouse gas (GHG) emissions, particularly at the county level. Anji County in eastern China is a typical example of an industrial transformation from quarrying to a low-carbon economy. This study analyzed the decoupling types and structural characteristics of GHG emissions and the driving factors of carbon dioxide (CO2) emissions in the Anji from 2006 to 2019, and explored the differences between county-level and provincial-level or city-level results. It was observed that energy-related activities are the main source of GHG emissions in Anji and that economic development is the driving factor behind the increasing CO2 emissions. However, industrial transformation and upgradation coupled with the alternative use of clean energy limit the growth of GHG emissions. This study details the GHG emissions of county during the industrial transformation stage and provides corresponding policy recommendations for county governments.

Temporal-spatial analysis of transportation CO2 emissions in China: Clustering and policy recommendations

Reducing transportation-related carbon dioxide (CO2) emissions in China poses significant challenges due to the sector's growth potential and variations among provinces and transportation modes. This study utilizes the bottom-up approach and the Logarithmic Mean Divisia Index (LMDI) decomposition method to calculate transportation CO2 emissions and explores the temporal-spatial differences across Chinese provinces. The results reveal that national transportation CO2 emissions increased by 50.14% from 2010 to 2019, and emissions from private cars present the fastest growth among all transportation modes by 254% over the decade. Spatially, higher emissions are found in eastern provinces, and neighboring provinces notably distinguish from each other in terms of the emission proportion of different modes and the factor analysis from LMDI. Regarding the heterogeneity of the spatial emission characteristics, a cluster-based evaluation method is proposed for the 31 provinces according to the emission structure and the LMDI decomposition. Four clusters are derived, each featuring varied emission distribution and driving factors. Correspondingly, policy recommendations are proposed to address the characteristics of each cluster, such as controlling car ownership, promoting integrated transport modes, improving fuel economy, and electrifying urban transportation services. The cluster-based analysis method can provide more specific suggestions to province targeting its emission characteristics rather than its location, which is one of the major contributions of this study.

Microplastic pollution: Understanding microbial degradation and strategies for pollutant reduction

Microplastics are ubiquitous environmental pollutants with the potential for adverse impacts on ecosystems and human health. These particles originate from the fragmentation of larger plastic items, shedding from synthetic fibers, tire abrasions, and direct release from personal care products and industrial processes. Once released into the environment, microplastics can disrupt ecosystems, accumulate in organisms, cause physical harm, and carry chemical pollutants that pose risks to both wildlife and human health. There is an urgent need to comprehensively explore the multifaceted issue of microplastic pollution and understand microbial degradation to reduce environmental pollution caused by microplastics. This paper presents a comprehensive exploration of microplastics, including their types, composition, advantages, and disadvantages, as well as the journey and evolution of microplastic pollution. The impact of microplastics on the microbiome and microbial communities is elucidated, highlighting the intricate interactions between microplastics and microbial ecosystems. Furthermore, the microbial degradation of microplastics is discussed, including the identification, characterization, and culturing methods of microplastic-degrading microorganisms. Mechanisms of microplastic degradation and the involvement of microbial enzymes are elucidated to shed light on potential biotechnological applications. Strategies for reducing microplastic pollution are presented, encompassing policy recommendations and the importance of enhanced waste management practices. Finally, the paper addresses future challenges and prospects in the field, emphasizing the need for international collaboration, research advancements, and public engagement. Overall, this study underscores the urgent need for concerted efforts to mitigate microplastic pollution and offers valuable insights for researchers, policymakers, and stakeholders involved in environmental preservation.

Using photovoice to generate policy recommendations to improve the alcohol urban environment: A participatory action research project

The place where we live, work and play may influence our alcohol drinking behaviours. This study aimed to present local policy recommendations on urban determinants for alcohol consumption prevention in a low-income and a high-income area of Madrid (Spain) using a participatory action research method, with photovoice and nominal group techniques. Participants (n = 26) engaged in a photovoice project initiated a process of critical reflection by discussing and analysing their alcohol environment based on photographs they took themselves. At the end of six week group discussion sessions, participants identified 33 themes related to their alcohol environment. They later met to translate the final categories into urban policy recommendations using a logical framework approach. Then, with a nominal group, they prioritized these recommendations based on time, impact, feasibility, and cost. Finally, participants produced a total of 61 policy recommendations for the improvement of the alcohol environment, highlighting the need for researcher-community collaborations when designing public health interventions.

Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review

BACKGROUND

The provision of contraceptive care for incarcerated individuals has been largely inconsistent and has contributed to, at best, inadequate care, and at worst reproductive abuses, violence, and coercion. While previous research has identified strategies to remedy known issues, to date, very few recommendations have been implemented across the carceral system. To address this, we conducted a systematic review of policy and practice recommendations to improve contraceptive care to reproductive-aged, incarcerated individuals in the United States.

METHODS

We conducted this systematic review utilizing the Joanna Briggs Institute methodology and framed it within the National Implementation Research Network's (NIRN) Exploration stage. We searched PubMed, PSYCInfo, SCOPUS, ProQuest, Web of Science, MedLine, Social Science Citation Index and reference sections of included materials. Basic study information, explicitly stated policy and practice recommendations, and discussions and conclusions that subtly provide recommendations were extracted in full text. We utilized a thematic analysis approach to analyze the extracted text.

RESULTS

A total of 45 materials met the inclusion criteria. Seven overarching themes were identified: 1) policy changes needed to implement care; 2) need for contraceptive care in carceral systems; 3) justice agency barriers regarding contraceptive care provision; 4) policy barriers to contraceptive access; 5) funding strategies to improve care; 6) patient preferences for contraceptive care delivery; and 7) healthcare provider knowledge regarding contraceptive care. The seven themes identified shed light on the need for, gaps, barriers, and facilitators of current contraceptive care provision to incarcerated individuals.

CONCLUSION

This systematic review accomplished two goals of NIRN's Exploration stage. First, the compiled evidence identified a clear need for change regarding policies and practices pertaining to contraceptive care provision to incarcerated individuals in the United States. Second, our findings identified several evidence-based solutions supported both by research and professional healthcare organizations to address the identified need for change. This study provides an initial blueprint for correctional agencies to implement the necessary changes for improving contraceptive care provision to incarcerated populations. The correctional system is in a unique position to deliver much-needed care, which would result in many potential benefits to the individuals, correctional system, and community at large.

Civil society involvement in the governance of green infrastructure: An analysis of policy recommendations from EU-funded projects

Green Infrastructures (GI) help build and develop climate resiliency and biodiversity. Moreover, the ecosystem services (ESS) that GI generates can be a source of social and economic value. Public policies to support GIs are necessary, but they cannot be successful without the involvement of relevant stakeholders. Because GI is a rather obscure concept for most non-specialists, their contribution to sustainability is not always apparent, and this makes it difficult to mobilize resources. This paper analyzes the policy recommendations of 36 projects focused on GI governance, funded by the European Union (EU) in the last decade or so. Using the Quadruple Helix (QH) approach, we find that GIs are perceived as a mostly governmental responsibility, with civil society and business engaged to a limited extent. We argue that non-governmental players should be more actively involved in decisions concerning GI to foster more sustainable development.

[Investigation and analysis of late reporting and under-reporting of occupational diseases from 2018 to 2020 in China]

Objective: To understand the late reporting and the under-reporting of occupational disease from 2018 to 2020 in China and analyze the causes, so as to provide scientific evidence for improving the quality of occupational disease reports in China, timely acquiring the incidence of occupational disease, and assessing the occupational hazards. Methods: From May to December 2021, A total of 320 occupational disease diagnostic institutions were selected for investigation. The original documents of occupational disease diagnosis cases from 2018 to 2020 were compared with the online reported cases, and late reported and under-reported cases of occupational disease were analyzed. Results: A total of 32207 diagnosed cases from 2018 to 2020 were investigated, including 28934 confirmed cases and 3273 cases without occupational disease. The overall late reported rate and under-reported rate of confirmed cases were 20.2% and 2.1%, respectively. There were significant differences in the rate of late reporting and under-reporting of occupational diseases in different regions and different types of diagnostic institutions (P<0.001). The southwest region had the highest rates of late reporting and under-reporting, 61.6% and 7.9% respectively. The late reported rate of all kinds of occupational diseases was about 15.0%, and the under-reported rate was from 1.5.0% to 5.0%. Conclusion: At present, the phenomenon of late reporting and under-reporting occupational diseases is still obvious. It is necessary to strengthen the inspection of occupational disease reporting, improve the quality of occupational disease reporting, and provide scientific basis for the formulation of occupational disease prevention and control policies.

[Nursery Services for Children Under 3 in Sichuan Province]

Objective

To study the current status of nursery services for children under 3 in Sichuan Province, to analyze the problems and causes, and to provide policy recommendations for the high-quality development of nursery services in Sichuan Province for children under the age of 3.

Methods

Using a combination of qualitative and quantitative methods, we analyzed the current status of nursery services in Sichuan Province and the problems encountered in the development of nursery services in Sichuan Province by collecting information on relevant government policies of Sichuan and the status quo of nursery services for children under 3 in the 21 cities/prefectures of Sichuan through policy research, interviews conducted at nursery service institutions, questionnaire surveys, and expert panel discussions.

Results

The supply of nursery services, or nursery enrollment capacity, in Sichuan Province reached 3 nursery enrollment opportunities per thousand people, with the enrollment utilization rate reaching 48.2%. Among all the nursery service institutions in the province, 55.4% were concentrated in the Chengdu, Mianyang, and Meishan regions. There were 1667 pilot nursery service institutions providing government-subsidized affordable nursery services and supplying 72971 subsidized affordable enrollment opportunities, accounting for 28.7% of the total number of all nursery service institutions and 29.1% of their total enrollment. There were a total of 37995 nursery service professionals, including 28468 caregivers (including teachers), with an average of 6 employees per institution and 5 caregivers per institution. 49.6% of the nursery service institutions hired healthcare workers on a part-time basis and 11.3% of them did not have healthcare workers on their staffs.

Conclusion

Nursery services for children under 3 years old have developed rapidly in Sichuan Province, but there are a number of problems, including uneven distribution of resources in different regions, inadequate supply of government-subsidized affordable nursery services, mismatch between supply and demand, insufficient utilization of services, lack of professionals, and insufficient driving force for sustainable development in the industry. We have suggested that actions be taken to improve the policy and regulatory system for nursery services, actively develop care facilites that are government-subsidized affordable services, integrated daycare service for all preschool children, and integrated medical and education facilites, provide support for home care, establish an information system for nursery services, optimize the professional training and development system, strengthen scientific research and international exchanges on nursery services, and comprehensively promote the high-quality development of nursery services and the construction of a childrearing-friendly environment in Sichuan Province.

COVID-19 vaccine policy development in a sample of 44 countries - Key findings from a December 2021 survey of National Immunization Technical Advisory Groups (NITAGs)

National Immunization Technical Advisory Committees (NITAGs) are tasked with the responsibility of guiding ministries of health and national immunization programmes in their policy development processes. Many NITAGs rely on evidence reviewed by the World Health Organization's (WHO) Strategic Group of Experts(SAGE) on immunization and aim to adapt WHO's recommendations to their respective contexts. This relationship took on exceptional importance since the onset of the COVID-19 pandemic, during which NITAGs have expressed a notable struggle to craft appropriate policies on population prioritization and vaccine utilization in the face of supply constraints and complex programmatic and delivery logistics. This online survey was conducted to assess the usefulness of the SAGE guidance documents for COVID-19 vaccine policies and to examine the persisting needs and challenges facing NITAGs. Results confirmed that SAGE recommendations concerning COVID-19 vaccines are easy to access, understand, and adapt. They have been found to be comprehensive and timely under the data and time constrained circumstances confronting SAGE. The Global NITAG Network (GNN) appears to be the most popular vehicle for addressing questions among high income countries, in contrast to lower income countries who favour WHO Country or Regional Offices. NITAGs place much value on interaction with other NITAGs, which requires facilitation and could benefit from increased opportunities, especially within regions. It is further noted that some NITAGs have had to tackle issues during the pandemic not typically considered by SAGE, such as supply chain logistics and vaccine demand. Learning from the COVID-19 experience offers opportunities to strengthen NITAGs and the pandemic recovery effort through the development of more concrete procedures and consideration of more varied types of data, including implementation effectiveness and uptake data. There is also an opportunity for an increasing involvement of Country Office WHO personnel to support NITAGs, while ensuring information and evidence needs of countries are adequately reflected in SAGE deliberations.

European Governments' Responses to the COVID-19 Pandemic during the First Wave: Resetting Governance Systems to Cope More Effectively with Future Shocks

The emergence of the current global crisis induced by the rapid spread of the COVID-19 pandemic brings about an urgent need to rethink and reshape recovery strategies adapted to this specific challenging context. Neglecting this reconfiguration could lead to system lockdown, affecting all sectors, both on medium and long term. The coronavirus has penetrated various countries with different degrees of intensity, thus being spatially diversified; even within the same country, with the same lockdown measures, an enormous variety in cases is encountered. Subsequently, even if crises may manifest heterogeneously and the long-term impact of implementing recovery policies cannot be accurately known ex ante by governments, institutions could adapt themselves to changing circumstances and respond promptly and appropriately to emerging shocks only if their functioning framework had been well set up by the outbreak of the crisis. Considering these aspects, the main questions that this paper aims to answer are: How effective have governmental measures in European countries been in combating the COVID-19 crisis?; Could the solutions offered by the European states' governments have an influence on diminishing the intensity of negative effects of a possible more serious return of this health crisis? What more could national authorities and international actors do to control the epidemiological evolution of SARS-CoV-2? Is a generic European Union policy helpful or should there be a case for local policy? Based on these issues, a comprehensive picture of the differences between the East and the West of Europe in terms of some medical, socio-economic, institutional and cultural factors will be outlined, in order to emphasize which of the two groups better-handled the COVID-19 situation in the first wave, covering the lockdown period (March 1, 2020 - June 1, 2020) and the relaxation period (June 1, 2020 - September 1, 2020); at the same time, some policy recommendations on how governments should more effectively manage future similar crises to generate a higher resilience of the systems will be provided.

Analyzing national telemedicine policies in China from the perspective of policy instrument (1997-2020)

BACKGROUND

In recent years, the Chinese government has frequently issued policies to promote the rapid development of telemedicine with the aim of improving the primary medical service capacity and public medical conditions in remote areas of China.

METHODS

A three-dimensional analytical framework was built to analyze the rationality of existing national telemedicine policies, providing valuable insights for the future construction and formulation of telemedicine policy. In total, 271 telemedicine policy documents with 537 policy clauses in relation to telemedicine were identified, and they are subjected to a rigorous analysis from the perspectives of policy instrument, telemedicine development stage, and telemedicine development element.

RESULTS

China's telemedicine policies have grown rapidly since 1997 and gradually moved towards exploratory stage (9/551, 1.68%), normative stage (93/551, 17.62%), mature stage (239/551, 44.51%), and rapid growth stage (196/551, 36.50%). Meanwhile, the types of telemedicine policy instruments adopted include mandatory tools (360/551, 61.71%), voluntary tools (82/551, 14.88%), information tools (74/551, 13.43%), and economic tools (55/551, 9.98%). The majority of telemedicine policies were related to platform construction, accounting for 45.07% (242/537), while telemedicine policies relating to service operation (20.67%, 111/537), service application (20.86%, 112/537), and organizational management (13.41%, 72/537) were comparatively less.

CONCLUSION

China's policy instruments have developed from simplification to diversification, from relative imbalance to equilibrium, and the balance between the vertical and horizontal objectives of the policy have also strengthened. However, some policy tools are improperly applied at the policy stage, and there is still room for improvement in the allocation of policy elements.

Evaluation of energy-saving retrofit projects of existing rural residential envelope structures from the perspective of rural residents: the Chinese case

The existing residential envelope in rural areas has low energy efficiency, with low energy utilization and serious energy waste for winter heating. However, in recent years, farmers have not undertaken energy efficiency retrofit projects for existing buildings in rural areas. This study proposed an evaluation model based on the logistic-AHP-TOPSIS method from the perspective of farmers. First, this study conducted a questionnaire survey of 208 rural households and used logistic models to determine which existing evaluation indicators significantly impact farmers' willingness to participate in energy efficiency retrofit projects. Second, the weights of the eight indicators were determined using AHP. Finally, this study evaluated the retrofit program of a case in Gansu Province using the TOPSIS method. In the analysis, total investment, annual winter heating costs and energy efficiency improvements were found to be the most important factors for farmers. The highest score for existing buildings was 0.3747 because there is no additional investment required; the option of partial retrofitting according to the actual needs of households scored 0.3350 because it balances economic performance with energy efficiency performance; The entire retrofit program has the highest investment and a long payback period, and its score is the lowest with 0.2904. Furthermore, the study recommended that a self-build and self-repair organization led by village collectives be developed to unify the retrofit design and construction and lower renovation costs. Bulk purchases could enable farmers to increase their power in negotiations.

Addressing Racial Capitalism's Impact on Black Essential Workers During the COVID-19 Pandemic: Policy Recommendations

Black Americans are more likely to be essential workers due to racial capitalism. Because of the COVID-19 pandemic, essential workers are less able to adhere to social distancing and stay-at-home guidelines due to the nature of their work, because they are more likely to occupy crowded households, and are more likely to possess pre-existing health conditions. To assist Black essential workers in preventing infection or reducing the intensity of symptoms if contracted, vaccination against the virus is essential. Unfortunately, Black essential workers face considerable barriers to accessing vaccinations and are hesitant to receive the vaccine due to widespread misinformation and justified historical mistrust of the American medical system. The purpose of this work is to (1) describe the disproportionate impact of COVID-19 on Black essential workers due to racial capitalism, (2) outline the socioeconomic and racial barriers related to vaccination within this population, and (3) to suggest policy-related approaches to facilitate vaccination such as access to on-site vaccination opportunities, the funding of community outreach efforts, and the mandating of increased employee benefits.

Evidence based policy making during times of uncertainty through the lens of future policy makers: four recommendations to harmonise and guide health policy making in the future

The Covid-19 pandemic has not only outlined the importance of using evidence in the healthcare policy making process but also the complexity that exists between policymakers and the scientific community. As a matter of fact, scientific data is just one of many other concurrent factors, including economic, social and cultural, that may provide the rationale for policy making. The pandemic has also raised citizens' awareness and represented an unprecedented moment of willingness to access and understand the evidence underpinning health policies.This commentary provides policy recommendations to improve evidence-based policy making in health, through the lens of a young generation of public policy students and future policymakers, enrolled in a 24-hour course at Sciences Po Paris entitled "Evidence-based policy-making in health: theory and practice(s)".Four out of 11 recommendations were prioritised and presented in this commentary which target both policymakers and the scientific community to make better use of evidence-based policy making in health. First, policy makers and scientists should build trusting partnerships with citizens and engage them, especially those facing our target health care issues or systems. Second, while artificial intelligence raises new opportunities in healthcare, its use in contexts of uncertainty should be addressed by policymakers in terms of liability and ethics. Third, conflicts of interest must be disclosed as much as possible and effectively managed to (re) build a trust relationship between policymakers, the scientific community and citizens, implying the need for risk management tools and cross border disclosure mechanisms. Last, well-designed and secure health information systems need to be implemented, following the FAIR (findable, accessible, interoperable and reusable) principles for health data. This will take us a step further from data to 'policy wisdom'.Overall, these recommendations identified and formulated by students highlight some key issues that need to be rethought in the health policy cycle through elements like institutional incentives, cultural changes and dialogue between policy makers and the scientific community. This input from a younger generation of students highlights the importance of making the conversation on evidence-based policy making in health accessible to all generations and backgrounds.

Changing tracks: identifying and tackling bottlenecks in European rail passenger transport

For Europe's urban agglomerations to be economically competitive, it is vital that international destinations be easily accessible. Although much has been invested in the construction of European rail infrastructure over the past century, passenger transport by rail has not grown as fast as transport by road and air. So why do people not use international trains more, even though they have an extensive international rail network at their disposal? Based on a series of in-depth interviews with relevant public and private stakeholders and two expert meetings, we identify the main bottlenecks and constraints. In order to understand the complexity of international rail transport, we have divided the existing bottlenecks into four groups corresponding to four layers of the rail transport system: mobility services, transport services, traffic services, and the physical and digital infrastructure. We formulate concrete policy recommendations for improvements to be made in the various components of the rail transport system.

Environmental fate of microplastics in the world's third-largest river: Basin-wide investigation and microplastic community analysis

Rivers have been recognized as major transport pathways for microplastics into the sea but large-scale quantitative data on the environmental fate of riverine microplastics remains limited, hindering proper risk assessment and development of regulatory measures. Microplastics in the whole Yangtze River Basin of China were systematically investigated by sampling the water, sediment, and soil. Microplastics were detected in all samples, with an average abundance of 1.27 items/L, 286.20 items/kg, and 338.09 items/kg for water, sediments, and soils, respectively, with polypropylene and polyethylene being the most abundant polymers. A generally increasing trend of microplastic abundance from upstream to downstream was identified, which were co-attributed by geographical and anthropogenic factors including elevation, longitude, distance from the nearest city, population density, urbanization rate, and land use. Microplastics in the sediments showed more prominent vertical migration than those in the soils, and the density and size of microplastics may be the key factors governing the migration of microplastics across different compartments. Community analysis showed that microplastics in different compartments were significantly different and highly correlated with geographical distance. Major cities at the middle and lower reaches were considered pivotal nodes of microplastic pollution in the Yangtze River Basin. Policy recommendations were also proposed towards better remediation of microplastic pollution involving riverine systems.

COVID-19 and the efficiency of health systems in Europe

BACKGROUND

This study aims at analyzing the efficiency of the health systems of 31 European countries in treating COVID-19, for the period January 1, 2020 - January 1, 2021, by incorporating some factors from a multidimensional perspective.

METHODS

The methodology used in the research was Data Envelopment Analysis (DEA), through which efficiency scores for health systems have been calculated. The research was performed considering three stages: the first wave (January 1-June 15), the relaxation period (June 15-October 1) and the second wave (October 1-December 31). In evaluating the determinants of the efficiency of health systems, six major fields of influence were taken into account: health care, health status, population, economic, cultural/societal and governmental issues, all covering 15 indicators. After measuring the efficiency, we used the Tobit type regression to establish the influencing elements on it.

RESULTS

The results for the public health systems of European states were determined for each country and period. We evaluated the efficiency of health systems in Europe against COVID-19, starting from health inputs (COVID-19 cases, physicians, nurses, hospital beds, health expenditure) and output (COVID-19 deaths). The obtained outputs show that, especially in the first phase of the pandemic, the inefficiency of the health systems was quite high, mainly in Western countries (Italy, Belgium, Spain, UK). In the relaxation phase and in the second wave, the Western states, severely affected at the beginning of the pandemic, began to take adequate measures and improve the efficiency of their sanitary systems. Instead, Eastern European countries were hit hard by the inefficiency of health systems (Bulgaria, Greece, Hungary, Romania). After Tobit regression, results of the study show that the influencing elements are different for the three stages: concerning the first wave, comobirdities, population age, and population density are important; for relaxation period a great influence have government effectiveness and power distance; with respect to second wave, the relevant factors are education and population density.

CONCLUSIONS

The results obtained could serve as starting points for health policymakers to perform comparative analyzes in terms of good practices in the health system and to develop national plans to better deal with health crises. At the same time, they can be used internationally to achieve a coherent and effective community response to the pandemic.

Suicide prevention in the context of COVID-19: An Indian perspective

The ongoing COVID-19 pandemic has impacted the health and wellbeing of communities worldwide. Measures to limit transmission, have enhanced vulnerability of individuals to well identified risk factors associated with mental illness and suicide. These include a sense of loneliness, anxiety, depression, insomnia, PTSD, harmful alcohol and drug use. Given that the potential for increased rates of suicide persist, the suicide prevention agenda remains urgent and essential. The same is one of the cornerstones of resilience in a society that is facing an array of challenges due to the pandemic. In this article, we recommend few possible strategies for attenuating suicide risk amidst the COVID-19 pandemic with particular relevance to the Indian context.

From outbreak of COVID-19 to launching of vaccination drive: invigorating single-use plastics, mitigation strategies, and way forward

The unforeseen outbreak of the COVID-19 epidemic has significantly stipulated the use of plastics to minimize the exposure and spread of the novel coronavirus. With the onset of the vaccination drive, the issue draws even more attention due to additional demand for vaccine packaging, transport, disposable syringes, and other allied devices scaling up to many million tonnes of plastic. Plastic materials in personal protective equipment (PPE), disposable pharmaceutical devices, and packaging for e-commerce facilities are perceived to be a lifesaver for the frontline healthcare personnel and the general public amidst recurring waves of the pandemic. However, the same material poses a threat as an evil environmental polluter when attributed to its indiscriminate and improper littering as well as mismanagement. The review not only highlights the environmental consequences due to the excessive use of disposable plastics amidst COVID-19 but also recommends mixed approaches to its management by adopting the combined and step-by-step methodology of adequate segregation, sterilization, sanitization activities, technological intervention, and process optimization measures. The overview finally concludes with some crucial way-forward measures and recommendations like the development of bioplastics and focusing on biodegradable/bio-compostable material alternatives to holistically deal with future pandemics.

How food systems change (or not): governance implications for system transformation processes

This paper argues that supporting food system transformation requires more than obtaining science-based understanding and analysis of how components in the system interact. We argue that changing the emergent properties of food systems (what we call food system synthesis) is a socio-political challenge that is affected by competing views regarding system boundaries and purposes, and limited possibilities for central steering and control. We point to different traditions of ‘systems thinking’ that each emphasize particular types of interventions for achieving system change, and argue that food systems are best looked at as complex multi-dimensional systems. This implies that we need to move beyond rational engineering approaches to system change, and look for approaches that anticipate and accommodate inherent social tensions and struggles in processes of changing food system dynamics and outcomes. Through a case study on the persistence of an undesired emergent property of food systems (i.e. poverty) we demonstrate that a multi-level perspective (MLP) on system transformation is useful in understanding both how food system transformation has happened in the past, and how desirable transformations is prevented from happening today. Based on such insights we point to key governance strategies and principles that may be used to influence food system transformation as a non-linear and long-term process of competition, negotiation and reconfiguration. Such strategies include the creation and nurturing of diversity in the system, as well as process interventions aimed at visioning, destabilization and formation of discourse coalitions. Such governance interventions imply a considerable re-orientation of investments in food system transformation as well as a rethinking of the role that policy-makers may play in either altering or reproducing undesirable system outcomes.

Knowledge, attitudes, and practices of the general population about Coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis with policy recommendations

Objectives

This study aimed to investigate and synthesize the current evidence on knowledge, attitudes, and practices (KAPs) of the general population regarding COVID-19.

Study design

This is a systematic review and meta-analysis.

Methods

We conducted a systematic search on PubMed/LitCovid, Scopus, and Web of Sciences databases for papers in the English language only, up to 1 January 2021. We used the Joanna Briggs Institute checklist developed for cross-sectional studies to appraise the quality of the included studies. All stages of the review conducted by two independent reviewers and potential discrepancies were solved with a consultation with a third reviewer. We reported the result as number and percentage. A meta-analysis conducted using a random effect model with a 95% confidence interval.

Results

Forty-eight studies encompassing 76,848 participants were included in this review. 56.53% of the participants were female. The mean age of the participants was 33.7 years. 85.42% of the included studies were scored as good quality, 12.50% as fair quality, and the remaining (2.08%) as low quality. About 87.5% examined all three components of the KAPs model. The knowledge component was reported as good and poor in 89.5% and 10.5% of the included studies, respectively. Of the studies that examined the attitude component, 100% reported a positive attitude. For the practice component, 93.2% reported satisfactory practice, and 6.8% poor practice. The result of the meta-analysis showed that the overall score of KAPs components about COVID-19 were 78.9, 79.8, and 74.1, respectively.

Conclusions

This systematic review and meta-analysis showed that the overall KAP components in the included studies were at an acceptable level. In general, knowledge was at a good level, the attitude was positive and practice was at a satisfactory level. Using an integrated international system can help better evaluate these components and compare them between countries.

PROSPERO registration code

(CRD42020186755).

Lessons learned from using a decision-support tool for precision placement of conservation practices in six agricultural watersheds in the US midwest

While conservation of natural resources on agricultural landscapes has been a priority for public agencies for more than 80 years, the ability of conservation planners to place conservation practices for enhanced environmental benefits remains elusive. To increase both adoption of conservation practices and efficient use of conservation funding, conservation planners are turning to decision support tools (DSTs), such as the Agricultural Conservation Planning Framework (ACPF). However, less is known about how DSTs facilitate a whole-landscape approach to conservation planning, and the strategies that are employed by conservation planners to engage with producers using new GIS-enabled planning technologies. With the goal of contributing to both the policy and practice of precision conservation, we present findings from semi-structured in-depth interviews conducted with 21 conservation professionals in six watersheds in the US Midwest. Results suggest that the ACPF encourages conservation professionals to think at a watershed scale, supports their approach to conservation planning, and helps them in watershed planning and stakeholder engagement. Results also highlight the importance of conservation professionals employing a suite of strategies, such as being mindful of the scale of producer engagement (i.e., single farm vs community based) and accounting for producers' personalities, to create 'enabling conditions' for producer engagement when adopting a precision approach to conservation. Policy recommendations for precision conservation technologies include the need to streamline and expedite the process of conservation delivery, and that DSTs are a means to an end, but not a universal remedy, because conservation planning is most effective when localized interactions of rural landscapes and social dynamics are considered in an adaptive approach.

The unaccountability case of plastic pellet pollution

Plastic preproduction pellets are found in environmental samples all over the world and their presence is often linked to spills during production and transportation. To better understand how these pellets end up in the environment we assessed the release of plastic pellets from a polyethylene production site in a case study area on the Swedish west coast. The case study encompasses; field measurements to evaluate the level of pollution and pathways, models and drifters to investigate the potential spread and a revision of the legal framework and the company permits. This case study show that millions of pellets are released from the production site annually but also that there are national and international legal frameworks that if implemented could help prevent these spills. Bearing in mind the negative effects observed by plastic pollution there is an urgent need to increase the responsibility and accountability of these spills.

A review of promoting access to medicines in China - problems and recommendations

BACKGROUND

Despite recent reforms, distorting funding mechanisms and over-prescribing still maintain severe financial barriers to medicines access in China. Complicated and interrelated problems in the pharmaceutical sector require a common framework to be resolved as fragmented solutions do not work. We present a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and propose policy recommendations for promoting universal access to medicines in China.

METHODS

Drawing on multiple sources of information, including a review of published literatures and official national data, field investigations in six provinces and interviews with key opinion leaders, this paper presents a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and proposes policy recommendations for promoting universal access to medicines in China.

RESULTS

Public expenditure on medicines has been strictly controlled since the national healthcare reforms of 2009. Yet total pharmaceutical expenditure (TPE) and total health expenditure growth rates continuously outpaced the growth of gross domestic product (GDP). With 2.4% of GDP, TPE now exceeds that of most high income countries. The distorted provider and consumer incentives in the Chinese health system have not fundamentally changed. Price-setting and reimbursement mechanisms do not promote cost-effective use of medicines. Inappropriate price controls and perverse financial incentives are the un-resolved root causes of preference of originator brands for some major diseases and shortages of low-cost and low-consumption medicines. In addition, access to expensive life-saving medicines is yet systematically addressed.

CONCLUSIONS

The complicated and interdependent problems interact in a way that leads to significant system problems in China, which create dual challenges that both the developing country and the developed countries are facing. To further promote access to medicines, China should speed up the re-assessment of the quality and efficacy of domestically produced generic medicines; coordinate various reforms of price determination, insurance payments, and procurement policies; address medicine shortages through comprehensive policies and legislation; establish specific mechanisms to achieve sustainable equitable access to expensive essential medicines with health technology assessment as a tool to ensure that policy and priority setting are created in a coherent and evidence-based way.

[Policy recommendations for the implementation of fall and fracture prevention in community-dwelling older persons]

Several factors impede the implementation of effective strategies for fall and fracture prevention. The Centre of Expertise for Fall & Fracture prevention Flanders organized a symposium, "Implementation of fall en fracture prevention in older people", with the aim to elaborate on the facilitation of effective strategies for falls and fall-related injuries in community-dwelling older people in Flanders. This article summarizes the main bottlenecks for implementation and provides recommendations for optimizing dissemination and implementation.

Greek health professionals' perceptions of the HPV vaccine, state policy recommendations and their own role with regards to communication of relevant health information

Background

Every year in Europe 60,000 women develop cervical cancer and 30,000 die from the disease. HPV vaccines are currently believed to constitute an important element of cervical cancer control strategy. Currently in Greece, the HPV vaccine is given on demand after prescription by a healthcare professional. Health care professionals’ role is key as they are in a position to discuss HPV vaccination with parents, adolescents and young women. This study is aiming to explore health care professionals’ perceptions of the HPV vaccine, state policy recommendations and their own role with regards to communication of relevant health information.

Methods

This was an in-depth, qualitative study, employing a stratified, purposeful sampling. Fifteen face-to-face, semi-structured interviews were conducted with health care professionals from a variety of disciplines: pediatrics, obstetrics and gynecology, infectious diseases, pharmacy, dermatology, general practice. Thematic qualitative analysis was used to analyze participants’ accounts.

Results

Five major themes were identified: health care professionals’ perceptions towards the HPV vaccine (recognition of importance, concerns about safety, effectiveness and impact of long-term use), animosity between medical specialties (territorial disputes among professional bodies, role advocacy, role limitations), health care professionals’ perceptions of the public’s attitudes (effects of cultural beliefs, health professionals’ attitudes, media and family), the role of the state (health policy issues, lack of guidance, unmet expectations) and their own role (provision of health information, sex education).

Conclusions

Health professionals’ concerns, lack of role definition and uniform information provision have led to territorial disputes among professional bodies and distrust among different medical specialties. Positive and negative judgements deriving from a multitude of sources have resulted in the confusion of the general public, as manifested by low vaccination rates. Due to the lack of clear regulation of vaccination prescription, administration and mode of delivery, factors such as lack of knowledge, cultural beliefs and personal attitudes have shaped the vaccination landscape. These factors have neither been explored nor addressed prior to the initiation of this public health effort and as such there is an evident less than efficient use of resources.

Confidentiality in Sports Medicine

This article synthesizes existing literature to provide a summary of the ethical issues concerning patient confidentiality in sport. It outlines the medical principle of confidentiality and identifies cross-cultural ethicolegal variations that shape its implementation. Clinicians' multiple obligations, physical environments, and practice and policy contexts are discussed, and research detailing experiences of maintaining patient confidentiality in sport is reviewed. Policy recommendations for enhancing compliance with this ethical principle are summarized. It is argued that the context of sport exacerbates pressures on clinicians to break patient confidentiality, breaches occur regularly, and interventions are required to enhance ethical compliance in sports medicine.

Projections and opinions from 100 experts in long-acting reversible contraception

OBJECTIVE

This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods.

STUDY DESIGN

We identified 182 authors of 59 peer-reviewed papers on LARC use published since 2013. A total of 104 completed an internet survey. We used descriptive and multivariate analyses to assess LARC use barriers and respondent characteristics associated with LARC projections and opinions.

RESULTS

The most commonly identified barrier was the cost of the device (63%), followed by women's knowledge of safety, method acceptability and expectations about use. A shortage of trained providers was a commonly cited barrier, primarily of primary care providers (49%). Median and modal projections of LARC use in the absence of these barriers were 25-29% of contracepting women. There was limited support for provider incentives and almost no support for incentives for women to use LARC methods, primarily out of concern about coercion.

CONCLUSIONS

Clinical and social science LARC experts project at least a doubling of the current US rate of LARC use if barriers to method provision and adoption are removed. While LARC experts recognize the promise of LARC methods to better meet women's contraceptive needs, they anticipate that the majority of US women will not choose LARC methods. Reducing unintended pregnancy rates will depend on knowledge, availability and use of a wider range of methods of contraception to meet women's individual needs.

IMPLICATIONS

Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women's reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use.