Expert Opinion on the Utility of Telemedicine in Obesity Care: Recommendations on a Hybrid Multidisciplinary Integrated Care Follow-Up Algorithm

PURPOSE OF REVIEW

The proposed expert opinion was prepared by a panel of obesity and law specialists from Turkey to review the utility of telemedicine in obesity care and to provide a guidance document with recommendations on a hybrid multidisciplinary integrated care follow-up algorithm and the legislation governing telemedicine practice to assist obesity specialists in practicing the telemedicine.

RECENT FINDINGS

The efficacy and feasibility of telemedicine interventions in supporting obesity management programs even during pandemics confirm that obesity is a particularly well-suited field for telemedicine, emphasizing the strong likelihood of continued utilization of telemedicine in obesity management, beyond the pandemic period. Telemedicine has great potential to address several barriers to ongoing weight-management care, such as challenges of access to specialized care, cost, and time limitations as well as patient adherence to treatment. However, telemedicine practice should complement rather than replace the in-person visits which are unique in building rapport and offering social support. Accordingly, the participating experts recommend the use of a hybrid integrated care model in the management of obesity, with the use of telemedicine, as an adjunct to in-person visits, to enable the provision of suggested intensive obesity management via frequent visits by a multidisciplinary team of obesity specialists. Further research addressing the utility of telemedicine in terms of optimal modality and duration for successful long-term obesity management outcomes is necessary to develop specific guidelines on telemedicine practice. In addition, the legislation governing the norms and protocols on confidentiality, privacy, access, and liability needs to be improved.

European nanomaterial legislation in the past 20 years - Closing the final gaps

In 2004, the potential societal implications related to nanotechnology were highlighted in an influential report by the Royal Society and the Royal Academy of Engineering (RS & RAE). It was made clear that legislation is an important tool to tackle the challenges related to nanomaterials and a list of recommendations were put forward. Shortly after, the European Commission also proposed a list of recommendations on how to handle nanomaterial challenges and adopted the so-called "incremental approach", describing that current legislations should be adapted, where relevant, to handle nanomaterials. Now almost 20 years have passed and it seems relevant to take stock and investigate how legislations have been adapted to tackle nano-specific challenges. In this review, we analyze key pieces of European legislations relevant to nanomaterials and assess to what extent these legislations compare with the original recommendations from 2004 by the RS & RAE and the European Commission. We uncover the cross-cutting challenges that remain and provide recommendations on next steps that should be taken to address the risks of nanomaterials. For each recommendation, we assessed whether it was met to a high, medium or low degree by conducting targeted literature searches at Web of Science, screening legislations, guidance documents, databases etc., and applying expert judgement. We found that >90% of the recommendations put forward in 2004 by the RS & RAE and the European Commission have been either met to a high degree (13 out of 29) or met to a medium degree (14 out of 29). This suggests important advancements in the field of nanosafety. At the same time, it is important to address the concerns still left partly or fully unsolved. Such efforts entail e.g. further development of measuring instruments and standardised characterization and risk assessment methods for nanomaterials, application of a uniform nanomaterial definition, maximization of containment of free nanomaterials until hazards assessed/handled and elimination/minimisation of unintentional nanomaterial emission. Furthermore, we recommend prioritising future efforts to ensure enforcement and implementation of existing nano-specific provisions, as well as revision, where needed, of legislations that currently do not account for nanomaterials, such as the Waste Framework Directive.

Integration of electronic waste management: a review of current global generation, health impact, and technologies for value recovery and its pertinent management technique

The fast evolution of waste electrical and electronic equipment (WEEE) has developed into a prime environmental perturb in recent days. Today, electrical and electronic products merely become a needed part of people life's and professional lives. The whole process of e-waste contains an organized collection system, appropriate dismantling, and its treatment of recycling. The unparalleled hastening of e-waste and unceremonious discarding lead to an adverse impact on a country's development. Currently, challenges in e-waste have a lack of practical aid, poor structure, and insufficient economic support. Several legislations have been imposed which aim to enhance the handling of e-waste. Operative management of e-waste is now essential for the protective atmosphere and human beings as well. This article provides the systemic flow of the e-waste definition, global information, and generation of e-waste and composition of e-waste which were discussed. The study categorized the hazardous effect of e-waste on human beings, and the content analysis of e-waste in recent LCA applications was highlighted. Further different metal extraction and recovery techniques from e-waste have been reviewed. A few sets of current practices and some recommendations on a global scale level were provided. Finally, based on analysis, some approaches to e-waste was accomplished, and equitable environmental management was taken into account to identify the future outlook areas.

Microplastics: Occurrences, treatment methods, regulations and foreseen environmental impacts

Microplastics are a silent threat that represent a high degree of danger to the environment in its different ecosystems and of course will also have an important impact on the health of living organisms. It is evident the need to have effective treatments for their treatment, however this is not a simple task, this as a result of the behavior of microplastics in wastewater treatment plants due to their different types and nature, their long molecular chain, reactivity against water, size, shape and the functional groups they carry. Wastewater treatment plants are at the circumference of the release of these wastes into the environment. They often act as a source of many contaminations, which makes this problem more complex. Challenges such as detection in the current scenario using the latest analytical techniques impede the correct understanding of the problem. Due to microplastics, treatment plants have operational and process stability problems. This review paper will present the in-depth situation of occurrence of microplastics, their detection, conventional and advanced treatment methods as well as implementation of legislations worldwide in a comprehensive manner. It has been observed that no innovative or new technologies have emerged to treat microplastics. Therefore, in this article, technologies targeting wastewater treatment plants are critically analyzed. This will help to understand their fate, but also to develop state-of-the-art technologies or combinations of them for the selective treatment of microplastics. The pros and cons of the treatment methods adopted and the knowledge gaps in legislation regarding their implementation are also comprehensively analyzed. This critical work will offer the development of new strategies to restrict microplastics.

An overview on surfactants as pollutants of concern: Occurrence, impacts and persulfate-based remediation technologies

Surfactants are molecules that reduce interfacial energy and increase solubility of other pollutants in water. These properties make them suitable for various domestic and industrial applications, soil remediation, pesticide formulation, among others. The increase in their use and the lack of strict regulations regarding their disposal and management is a matter of concern and requires more attention since the release and distribution of these compounds into the environment can modify important water quality parameters. As a result of these changes, different toxicological effects to aquatic organisms are discussed and exposed herein. On this basis, we provide an overview of the classes of surfactants, as well as their occurrence in different aqueous matrices. In addition, existing regulations around the world regarding their concentration limit for different environments are discussed. Current research focuses on the application of conventional treatments, such as biological treatments; notwithstanding, more toxic and bioaccumulative products can be generated. Advanced Oxidation Processes are promising alternatives and have also been widely applied for the removal of surfactants. This study provides, for the first time, an overview of the application of persulfate-based processes for surfactants degradation based on recent literature findings, as well as the various factors related to the activation of the persulfate anions. This review also highlights the challenges and opportunities for future research to overcome the obstacles to the practical application of this process.

Barriers and factors associated with the use of helmets by Motorcyclists: A scoping review

Road Traffic Injuries (RTIs) have imposed a great global burden on public health. Motorcyclists and pedestrians comprise the most significant proportion of this burden. Several studies have demonstrated a link between helmet wearing and a decline in the impact of RTIs in motorcyclists. In this study, we aimed to review the barriers to helmet utilization by motorcyclists. This scoping review has been conducted in accordance with the guidelines for the systematic review of observational studies and the PRISMA Checklist. The search was conducted by using related keywords in EMBASE, PubMed, Scopus, and Cochrane Library. Four independent reviewers carried out the screening. The main outcomes of interest were barriers to helmet usage among motorcyclists, drawn from the finally included studies. Fifty-three records were selected for data extraction. According to these reports, the barriers and factors associated with helmet usage among motorcyclists were categorized into five entities as: legislations/enforcement strategies, helmet disadvantages (discomfort, visual/auditory blockage, and thermal dysregulation), risky behaviors (riding while drunk or high on drugs), sex and/or age factors, and the location and time of the injury event (rural vs. urban locations, day vs. night riding). From the perspective of policymakers, the findings of this review are of utmost importance and could be used in addressing the challenge of inadequate compliance with helmet use.

An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%-70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, β-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly.

A systematic review on options for sustainable treatment and resource recovery of distillery sludge

Distillery sludge generated from the alcohol production plants is considered as a nuisance. It is one of the main sources of environmental pollution because of the presence of high amount of sulphate, phenolic compounds (500.3 ± 26.46 mg/kg), melanoidins, organic matter (14%) and heavy metals (like 18% Mn, 6% Ni and 4% Pb). Hence, advancement in the available techniques for managing this sludge is a prerequisite for its safe and sustainable disposal. The article delivers an assessment of the challenges involved in the treatment of distillery sludge, existing practices, disposal and possible routes for energy recovery. Considering the high nutritional and energy values of the distillery sludge, the associated limitations and challenges of the available sludge management options, it was aimed to highlight alternative methods of its treatment. The present review also compares the current distillery sludge management solutions concerning their environmental sustainability. The most widely used methods, including treatment and disposal techniques considering the current legislation in different countries, have also been dealt with. Furthermore, the study also deals with the resource recovery approaches in order to recover value-added products and available nutrients from distillery sludge. Resource and energy recovery options are therefore considered as sustainable solutions to fulfill the present and future energy requirement and visualize it as a potential opportunity instead of a nuisance.

Suggested policy and legislation reforms to reduce deleterious effect of pesticides in Lebanon

Countrywide pesticide management activities are resource draining, even for developed countries, which sometimes fall short in achieving the optimum protection against pesticides deleterious effects on humans and environment. Additionally, in Lebanon, basic flaws exist at different levels of pesticide management cycle. In this study, through an extensive review of relevant literature regarding the pesticides impact on humans and environment in Lebanon and adopted policies in existing legislation, several gaps have been identified. Accordingly, recommendations to reduce pesticide risk through a combination of reforms at the policy level and its tools, particularly legislation, are proposed. In our opinion, the starting point is to adopt a minimum list of lower risk pesticides supported by a combination of: “prescriptions” based on a comprehensive registration and an effective implementation systems, a suitable IPM/ICM government-supported credit system, traceability systems of agricultural commodities and pesticides containers, Pesticide stock management system to reduce the quantity of obsolete pesticides, and containers recycling system. For a global sustainability of pesticides risk reduction, a binding global intervention fostered by the UN, based on human rights for safe food, is called upon to ban hazardous pesticides-except those of WHO class IV- trafficking in developing countries scoring low in an international official assessment of their pesticides lifecycle management. At the same time, global funds should support pesticides alternatives and the enhancement of the developing countries capacities for pesticides lifecycle management, which is a part of a larger global matrix in risk reduction.

Cardiovascular Events Following Smoke-Free Legislations: An Updated Systematic Review and Meta-Analysis

BACKGROUND

Legislations banning smoking in indoor public places and workplaces are being implemented worldwide to protect the population from secondhand smoke exposure. Several studies have reported reductions in hospitalizations for acute coronary events following the enactment of smoke-free laws.

OBJECTIVE

We set out to conduct a systematic review and meta-analysis of epidemiologic studies examining how legislations that ban smoking in indoor public places impact the risk of acute coronary events.

METHODS

We searched MEDLINE, EMBASE, and relevant bibliographies including previous systematic reviews for studies that evaluated changes in acute coronary events, following implementation of smoke-free legislations. Studies were identified through December 2013. We pooled relative risk (RR) estimates for acute coronary events comparing post- vs. pre-legislation using inverse-variance weighted random-effects models.

RESULTS

Thirty-one studies providing estimates for 47 locations were included. The legislations were implemented between 1991 and 2010. Following the enactment of smoke-free legislations, there was a 12 % reduction in hospitalizations for acute coronary events (pooled RR: 0.88, 95 % CI: 0.85-0.90). Reductions were 14 % in locations that implemented comprehensive legislations compared to an 8 % reduction in locations that only had partial restrictions. In locations with reductions in smoking prevalence post-legislation above the mean (2.1 % reduction) there was a 14 % reduction in events compared to 10 % in locations below the mean. The RRs for acute coronary events associated with enacting smoke-free legislation were 0.87 vs. 0.89 in locations with smoking prevalence pre-legislation above and below the mean (23.1 %), and 0.87 vs. 0.89 in studies from the Americas vs. other regions.

CONCLUSION

The implementation of smoke-free legislations was related to reductions in acute coronary event hospitalizations in most populations evaluated. Benefits are greater in locations with comprehensive legislations and with greater reduction in smoking prevalence post-legislation. These cardiovascular benefits reinforce the urgent need to enact and enforce smoke-free legislations that protect all citizens around the world from exposure to tobacco smoke in public places.