Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide

OBJECTIVE

To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries.

METHODS

A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care.

RESULTS

The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement.

CONCLUSION

Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.

Prevalence of visual impairment and estimation of refractive errors among school children in Kakamega, Kenya

AIM

To investigate the prevalence of visual impairment (VI) and provide an estimation of uncorrected refractive errors in school-aged children, conducted by optometry students as a community service.

METHODS

The study was cross-sectional. Totally 3343 participants were included in the study. The initial examination involved assessing the uncorrected distance visual acuity (UDVA) and visual acuity (VA) while using a +2.00 D lens. The inclusion criteria for a subsequent comprehensive cycloplegic eye examination, performed by an optometrist, were as follows: a UDVA<0.6 decimal (0.20 logMAR) and/or a VA with +2.00 D ≥0.8 decimal (0.96 logMAR).

RESULTS

The sample had a mean age of 10.92±2.13y (range 4 to 17y), and 51.3% of the children were female (n=1715). The majority of the children (89.7%) fell within the age range of 8 to 14y. Among the ethnic groups, the highest representation was from the Luhya group (60.6%) followed by Luo (20.4%). Mean logMAR UDVA choosing the best eye for each student was 0.29±0.17 (range 1.70 to 0.22). Out of the total, 246 participants (7.4%) had a full eye examination. The estimated prevalence of myopia (defined as spherical equivalent ≤-0.5 D) was found to be 1.45% of the total sample. While around 0.18% of the total sample had hyperopia value exceeding +1.75 D. Refractive astigmatism (cil<-0.75 D) was found in 0.21% (7/3343) of the children. The VI prevalence was 1.26% of the total sample. Among our cases of VI, 76.2% could be attributed to uncorrected refractive error. Amblyopia was detected in 0.66% (22/3343) of the screened children. There was no statistically significant correlation observed between age or gender and refractive values.

CONCLUSION

The primary cause of VI is determined to be uncorrected refractive errors, with myopia being the most prevalent refractive error observed. These findings underscore the significance of early identification and correction of refractive errors in school-aged children as a means to alleviate the impact of VI.

Mother, child and adolescent health outcomes in two long-term refugee camp settings at the Thai-Myanmar border 2000-2018: a retrospective analysis

AIM

The study assessed mothers, children and adolescents' health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border.

BACKGROUND

Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project.

METHODS

This retrospective study looked at the trends of MCAH indicators of mortality and morbidity and compared them to the sustainable development goals (SDGs) indicators. A review of programme documents explored and triangulated the evolution and changing context of the PHC services, and associated project costs were analysed. To verify changes over time, interviews with 12 key informants were conducted.

FINDINGS

While maternal mortality (SDG3.1) remained high at 126.5/100,000 live births, child mortality (SDG 3.2) and infectious diseases in children under 5 (SDG 3.3) fell by 69% and by up to 92%, respectively. Maternal anaemia decreased by 30%; and more than 90% of pregnant women attended four or more antenatal care visits, whereas 80% delivered by a skilled birth attendant; caesarean section rates rose but remained low at an average of 3.7%; the adolescent (15-19 years) birth rate peaked at 188 per 1000 in 2015 but declined to 89/1000 in 2018 (SDG 3.7).

CONCLUSION

Comprehensive PHC delivery, with improved health provider competence in MCAH care, together with secured funding is an appropriate strategy to bring MCAH indicators to acceptable levels. However, inequities due to confinement in camps, fragmentation of specific health services, prevent fulfilment of the 2030 SDG Agenda to 'Leave no one behind'. Costs per birth was 115 EURO in 2018; however, MCAH expenditure requires further exploration over a longer period.

Microfluidic electrochemical biosensors: tools for advancing the sustainable development goals

New technologies can help to achieve the sustainable development goals (SDGs) of the United Nations. We discuss the contribution of microfluidic electrochemical biosensors to advancing the SDGs. These sensors can be applied in various fields given their low cost, self-powering ability, environmental compatibility, ease of use, and small sample volume requirements.

Nutritional and Organoleptic Characteristics of Sausage Based on an Autochthonous Ecuatorian Fish, Old Blue (Andinoacara rivulatus)

The consumption of fisheries and aquaculture products has been increasing in recent decades, and it is necessary to strike a balance between production and sustainability in aquaculture; this is essential homework to support the demand for human food. This study aimed to investigate the sensory and nutritional characteristics of a sausage made from the fillet of the native fish Old Blue (Andinoacara rivulatus) to stimulate the local economy. A multifactorial A*B*C design was used, with Factor A being rearing systems (wild and farmed), Factor B being types of protein (quinoa meal and soybean meal), and Factor C being lipids of animal (pork fat) and vegetable (sunflower oil) origin. Highly significant differences were observed in all formulas, according to Tukey (p < 0.05). The highest protein percentage was with soybean flour at 11.24%, while quinoa flour had 10.80% of the product. In sensory characteristics, the best attributes were for texture in the mouth with a hedonic scale from 0 to 5, with 4.2 firmness being mostly acceptable, odor at 4.5, the aromatic attribute with the highest and best value, and color was the clearest at 4.3 acceptability. The flavor was 4.3, mostly more pleasant according to the tasters. The yield of farmed fillets was 23.16% compared to wild 13.89%, and the balance of sausage yield was 393 g with a yield of 76.33% of the total weight. Microbiological analysis of the sausage with the native species showed the absence of pathogenic microorganisms. A commercial shelf life of 30 days was also established for the sausage, demonstrating an added value through this processing, allowing its exploitation in areas further away from the fishing sites and, thus, a greater possibility of social development in the area.

Multi-functional xylanase from Aspergillus sydowii: biosynthesis of nanoconjugates, optimization by Taguchi approach and biodeinking potential

The search for effective production of xylanase which is an important industrial enzyme led to the present study that explored xylanase production by Aspergillus sydowii SF through Taguchi optimization that incorporated nanoconjugates in submerged fermentation. Calcium and zinc oxide nanoconjugates biosynthesized by xylanase were characterized via UV-Vis spectroscopy, Fourier transform infrared spectroscopy, and Transmission electron microscopy (TEM). The xylanase-mediated calcium oxide and zinc oxide nanoconjugates with λmax of 374 and 316 nm, respectively, and were 5.32-17.69 nm in size. Xylanase production was improved by 2.90-10.58 folds (64.24-234.15 U/mL) through Taguchi optimization cum nanoconjugates, and ANOVA showed that nanoconjugates contributed 13.62-65.97% to improved production. The xylanase had up to 88.38% deinking activity, with 49.60-84.64% removal of blue color. The remarkable xylanase production, its use to biosynthesize nanoconjugates and biodeinking potentials contribute to the development of versatile biocatalysts with applications in biotechnology, nanotechnology, and sustainable paper production. To the best of our knowledge, this represents the first report of xylanase for biosynthesis of calcium oxide and zinc oxide nanoparticles, as well as nanosupplementation to induce xylanase production, which can open new vista in bioprocess optimization.

Emerging challenges in antimicrobial resistance: implications for pathogenic microorganisms, novel antibiotics, and their impact on sustainability

Overuse of antibiotics is accelerating the antimicrobial resistance among pathogenic microbes which is a growing public health challenge at the global level. Higher resistance causes severe infections, high complications, longer stays at hospitals and even increased mortality rates. Antimicrobial resistance (AMR) has a significant impact on national economies and their health systems, as it affects the productivity of patients or caregivers due to prolonged hospital stays with high economic costs. The main factor of AMR includes improper and excessive use of antimicrobials; lack of access to clean water, sanitation, and hygiene for humans and animals; poor infection prevention and control measures in hospitals; poor access to medicines and vaccines; lack of awareness and knowledge; and irregularities with legislation. AMR represents a global public health problem, for which epidemiological surveillance systems have been established, aiming to promote collaborations directed at the well-being of human and animal health and the balance of the ecosystem. MDR bacteria such as E. coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., Acinetobacter spp., and Klebsiella pneumonia can even cause death. These microorganisms use a variety of antibiotic resistance mechanisms, such as the development of drug-deactivating targets, alterations in antibiotic targets, or a decrease in intracellular antibiotic concentration, to render themselves resistant to numerous antibiotics. In context, the United Nations issued the Sustainable Development Goals (SDGs) in 2015 to serve as a worldwide blueprint for a better, more equal, and more sustainable existence on our planet. The SDGs place antimicrobial resistance (AMR) in the context of global public health and socioeconomic issues; also, the continued growth of AMR may hinder the achievement of numerous SDGs. In this review, we discuss the role of environmental pollution in the rise of AMR, different mechanisms underlying the antibiotic resistance, the threats posed by pathogenic microbes, novel antibiotics, strategies such as One Health to combat AMR, and the impact of resistance on sustainability and sustainable development goals.

A country's efforts toward creating an advanced practice nurse in public health

AIM

The study goal was to inform the creation of a blueprint for an advanced practice nurse (APN) in public health.

BACKGROUND

No internationally accepted standard for an APN in public health exists. Activities of public health nurses (PHN) traditionally have centered on health promotion and disease prevention, but many have added other population-based activities such as chronic and acute disease treatment.

INTRODUCTION

An APN in public health is needed to address the global challenges threatening the physical, social, and mental health of populations worldwide.

METHODS

This qualitative study was comprised of six focus groups, each containing a different group of stakeholders (n = 40). Study results followed the requirements of the consolidated criteria for reporting qualitative research (COREQ).

FINDINGS

Two major themes emerged: the APN role in public health and core expectations. From the APN role theme, four subthemes emerged on APN domains of public health practice and functions. From the core expectations theme, nine subthemes emerged on the APN's qualifications and behaviors.

DISCUSSION

Agreement among stakeholders was found in the nine core expectations; however, among the four different visions of an APN in public health, two fit a population-based model rather than the traditional PHN model.

CONCLUSIONS

A single APN role in public health is insufficient to address the breadth and complexity of today's global challenges as detailed by the sustainable development goals. Due to the interaction between health and the biopsychosocial environments, we need APNs with different areas of expertise.

IMPLICATION FOR NURSING POLICY

Nurses working at universities, in public health services, and as healthcare policymakers are needed to create a multistage strategy that gradually introduces several different types of APNs in public health.

Global trends and spatial drivers of diabetes mellitus mortality, 1990-2019: a systematic geographical analysis

Objective

Diabetes mellitus is the leading cause of death worldwide, and multiple risk factors associated with diabetes mortality.

Methods

Employing spatial statistics, we characterized the spatial distribution and patterns of diabetes mortality, and revealed the spatial relationship between diabetes mortality and 11 socioeconomic and environmental risk factors at the country level, from 1990 to 2019.

Results

Globally, significantly high rates of diabetes mortality were primarily clustered in countries with limited land areas or located on islands, such as Fiji, Kiribati, Eswatini, and Trinidad and Tobago. Countries with weaker economic independence are more likely to have higher diabetes mortality rates. In addition, the impact of socioeconomic and environmental factors was significant at the country level, involving health expenditure, number of physicians, household and ambient air pollution, smoking, and alcohol consumption. Notably, the spatial relationship between diabetes mortality and ambient air pollution, as well as alcohol consumption, showed negative correlations. Countries with high diabetes mortality rates generally had lower levels of ambient air pollution and alcohol consumption.

Conclusion

The study highlights the spatial clustering of diabetes mortality and its substantial variation. While many risk factors can influence diabetes mortality, it's also essential to consider the level of these factors at the country level. Tailoring appropriate interventions based on specific national circumstances holds the potential to more effectively mitigate the burden of diabetes mortality.

Chlorine Water Taste Threshold and Acceptability among Indigenous and Non-Indigenous Populations in Rural Panama

Although gains in access to water services over the past two decades have been large, more than two billion people still lack access to safely managed drinking water. This study examines and compares free chlorine taste and acceptability thresholds of rural Indigenous Ngäbe and rural Latino Panamanians to study if taste aversion may be a limiting factor in chlorination of community systems in Panama using the three-alternative forced choice test methodology. This study is the first to establish a best-estimate taste threshold for a rural Indigenous group and the only study in Latin America to report best-estimate taste thresholds using those methods. Median taste thresholds were 0.87 mg/L Cl2 for Indigenous Ngäbe participants (n = 82) and 1.64 mg/L Cl2 for Latino participants (n = 64), higher than both the minimum concentration for biologically safe water (0.2 mg/L) and the recommended concentration range in Panama (0.3-0.8 mg/L). Median acceptability thresholds were established much higher than taste thresholds at 3.45 mg/L Cl2. The results show that the ability to accurately taste chlorine may not be the limiting factor for adoption of safe water initiatives in remote and Indigenous communities.

Promoting Sustainable Development Goals by Optimizing City-Level Solar Photovoltaic Deployment in China

Solar photovoltaic (PV) installations, which enable carbon neutrality, are expected to surge in the coming decades. This growth will support sustainable development goals (SDGs) via reductions in power-generation-related environmental emissions and water consumption while generating new jobs. However, where and to what extent PVs should be utilized to support SDGs must be thoroughly addressed. Here, we use multiple PV deployment scenarios to compare the benefits of PVs and related SDGs progress in 366 prefectural-level cities in China. We developed an assessment framework that integrates a PV allocation model, an electricity system optimization model, and a benefit assessment approach. We identify vast differences in PV distribution and electricity transmission and elucidate trade-offs and synergies among the SDGs under various PV implementation scenarios. The water conservation-oriented scenario yields substantial carbon reduction, air pollutant mitigation, and water saving cobenefits, leading to the greatest SDGs improvements. Prioritizing employment creation enhances job-relevant SDGs but inhibits environmental resource benefits. SDGs in less developed cities present greater progress across all scenarios. This study highlights the need to consider spatial heterogeneity and the potential trade-offs between different SDGs and regions when designing energy transition strategies.

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Advances in Biological Wastewater Treatment Processes: Focus on Low-Carbon Energy and Resource Recovery in Biorefinery Context

Advancements in biological wastewater treatment with sustainable and circularity approaches have a wide scope of application. Biological wastewater treatment is widely used to remove/recover organic pollutants and nutrients from a diverse wastewater spectrum. However, conventional biological processes face challenges, such as low efficiency, high energy consumption, and the generation of excess sludge. To overcome these limitations, integrated strategies that combine biological treatment with other physical, chemical, or biological methods have been developed and applied in recent years. This review emphasizes the recent advances in integrated strategies for biological wastewater treatment, focusing on their mechanisms, benefits, challenges, and prospects. The review also discusses the potential applications of integrated strategies for diverse wastewater treatment towards green energy and resource recovery, along with low-carbon fuel production. Biological treatment methods, viz., bioremediation, electro-coagulation, electro-flocculation, electro-Fenton, advanced oxidation, electro-oxidation, bioelectrochemical systems, and photo-remediation, are summarized with respect to non-genetically modified metabolic reactions. Different conducting materials (CMs) play a significant role in mass/charge transfer metabolic processes and aid in enhancing fermentation rates. Carbon, metal, and nano-based CMs hybridization in different processes provide favorable conditions to the fermentative biocatalyst and trigger their activity towards overcoming the limitations of the conventional process. The emerging field of nanotechnology provides novel additional opportunities to surmount the constraints of conventional process for enhanced waste remediation and resource valorization. Holistically, integrated strategies are promising alternatives for improving the efficiency and effectiveness of biological wastewater treatment while also contributing to the circular economy and environmental protection.

Barriers to Adopting a Plant-Based Diet in High-Income Countries: A Systematic Review

Adopting a plant-based diet (PBD) has been shown to reduce the risk of developing certain diseases and is linked to environmental benefits. This review synthesises the evidence on the barriers adults aged 18 to 65 living in high-income countries (HIC) may experience when adopting a PBD. A systematic literature review was conducted using four search databases: Medline, Embase, Global Health, and Web of Science. Barriers were mapped to behaviour change strategies using the COM-B model. Ten studies were included in the final review, including 1740 participants. Five were qualitative, four were cross-sectional, and one was a pre- and-post-intervention study. In total, 40 barriers were identified and synthesised into 11 themes: financial, lack of knowledge, emotional, health, convenience, social, enjoyment of meat, environmental, accessibility, personal ability, and media. Of the 40 barriers, nutritional intake/requirements (categorised into the "health" theme) had the most evidence. This barrier encompassed concerns around being able to meet nutritional needs if an individual were to adopt a PBD. Habits (in the "personal ability" theme), which included established eating habits and habitual behaviours relating to animal-source foods, had the second most evidence alongside the barrier of not knowing what to eat as part of a PBD (in the "lack of knowledge" theme). Education interventions and communication/marketing policies were the behaviour change mechanisms mapped onto these barriers. Future interventions should focus on informing individuals about what to consume as part of a nutritionally balanced PBD and facilitating habitual dietary change.

Increased Stigma, and Physical and Sexual Violence Against Men Who Have Sex with Men and Transgender Women in Sub-Saharan Africa: A Qualitative Evidence Synthesis Analyzing Social and Structural Barriers to HIV Testing and Coping Behaviors

In sub-Saharan Africa, accessing HIV testing services is a significant challenge for men who have sex with men (MSM) and transgender women (TGW). In this qualitative evidence synthesis, our aim is to understand social and structural barriers and how they hinder MSM's and TGW's access to HIV testing services in sub-Saharan African countries. We searched four selective databases (PubMed, Web of Science and CINAHL complemented with Google Scholar) for qualitative studies, published in English between January 2005 and December 2023, generated 1507 articles, of which 22 were included. Thematic synthesis was conducted for data synthesis. This led to five barriers that hinder HIV test uptake among MSM and TGW, which included: non-availability of tailored HIV testing services, stigma, lack of trust among service providers, sexual and physical violence, and criminalization of same sex relationship. To navigate these social and structural barriers and cope with fears of discrimination and criminalization, MSM and TGW engaged into riskier behaviors, including avoiding HIV testing, non-disclosure, or relying on informal or alternative sources of HIV testing. Decriminalization of same-sex relationship and peer-led HIV testing services were noted to address structural barriers, including stigma and poor access, and subsequently increase the participation in HIV testing services.

Urban heat mitigation by green and blue infrastructure: Drivers, effectiveness, and future needs

The combination of urbanization and global warming leads to urban overheating and compounds the frequency and intensity of extreme heat events due to climate change. Yet, the risk of urban overheating can be mitigated by urban green-blue-grey infrastructure (GBGI), such as parks, wetlands, and engineered greening, which have the potential to effectively reduce summer air temperatures. Despite many reviews, the evidence bases on quantified GBGI cooling benefits remains partial and the practical recommendations for implementation are unclear. This systematic literature review synthesizes the evidence base for heat mitigation and related co-benefits, identifies knowledge gaps, and proposes recommendations for their implementation to maximize their benefits. After screening 27,486 papers, 202 were reviewed, based on 51 GBGI types categorized under 10 main divisions. Certain GBGI (green walls, parks, street trees) have been well researched for their urban cooling capabilities. However, several other GBGI have received negligible (zoological garden, golf course, estuary) or minimal (private garden, allotment) attention. The most efficient air cooling was observed in botanical gardens (5.0 ± 3.5°C), wetlands (4.9 ± 3.2°C), green walls (4.1 ± 4.2°C), street trees (3.8 ± 3.1°C), and vegetated balconies (3.8 ± 2.7°C). Under changing climate conditions (2070-2100) with consideration of RCP8.5, there is a shift in climate subtypes, either within the same climate zone (e.g., Dfa to Dfb and Cfb to Cfa) or across other climate zones (e.g., Dfb [continental warm-summer humid] to BSk [dry, cold semi-arid] and Cwa [temperate] to Am [tropical]). These shifts may result in lower efficiency for the current GBGI in the future. Given the importance of multiple services, it is crucial to balance their functionality, cooling performance, and other related co-benefits when planning for the future GBGI. This global GBGI heat mitigation inventory can assist policymakers and urban planners in prioritizing effective interventions to reduce the risk of urban overheating, filling research gaps, and promoting community resilience.

Decoding the synergistic potential of MAZ-51 and zingerone as therapy for melanoma treatment in alignment with sustainable development goals

Melanoma, an invasive class of skin cancer, originates from mutations in melanocytes, the pigment-producing cells. Globally, approximately 132,000 new cases are reported each year, and in South Africa, the incidence stands at 2.7 per 100,000 people, signifying a worrisome surge in melanoma rates. Therefore, there is a need to explore treatment modalities that will target melanoma's signalling pathways. Melanoma metastasis is aided by ligand activity of transforming growth factor-beta 1 (TGF-β1), vascular endothelial growth factor-C (VEGF-C) and C-X-C chemokine ligand 12 (CXCL12) which bind to their receptors and promote tumour cell survival, lymphangiogenesis and chemotaxis. (3-(4-dimethylaminonaphthelen-1-ylmethylene)-1,3-dihydroindol-2-one) MAZ-51 is an indolinone-based molecule that inhibits VEGF-C induced phosphorylation of vascular endothelial growth factor receptor 3 (VEGFR-3). Despite the successful use of conventional cancer therapies, patients endure adverse side effects and cancer drug resistance. Moreover, conventional therapies are toxic to the environment and caregivers. The use of medicinal plants and their phytochemical constituents in cancer treatment strategies has become more widespread because of the rise in drug resistance and the development of unfavourable side effects. Zingerone, a phytochemical derived from ginger exhibits various pharmacological properties positioning it as a promising candidate for cancer treatment. This review provides an overview of melanoma biology and the intracellular signalling pathways promoting cell survival, proliferation and adhesion. There is a need to align health and environmental objectives within sustainable development goals 3 (good health and well-being), 13 (climate action) and 15 (life on land) to promote early detection of skin cancer, enhance sun-safe practices, mitigation of environmental factors and advancing the preservation of biodiversity, including medicinal plants. Thus, this review discusses the impact of cytostatic cancer drugs on patients and the environment and examines the potential use of phytochemicals as adjuvant therapy.

The role of primary health care in improving health status, financial protection and health equity in the context of China's health system reform

BACKGROUND

Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity.

METHODS

We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations.

RESULTS

From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density.

CONCLUSIONS

In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.

On the Commemorative Ceremony and Symposium for the 20th Anniversary of Food Safety Commission, Cabinet Office, Government of Japan

Food Safety Commission, Cabinet Office, Government of Japan (FSCJ) was established in 2003 and marked its 20th anniversary in 2023. FSCJ held a commemorative ceremony and symposium to celebrate its 20th anniversary at Mita conference hall (Mita, Minato-ku, Tokyo) on September 1st, 2023, which attracted a total of 164 on-site attendees including six media companies, as well as 460 online viewers. FSCJ Chairperson Dr. YAMAMOTO gave a summary of each session; Session 1 outlined the various future challenges against which risk assessment organizations must prepare. In Session 2, panelists shared information on the development of new evaluation methodologies and international collaborations in order to meet various global demands and issues. In Session 3, the FSCJ introduced its future initiatives and called for international collaboration in sharing information and expertise to address data gaps and emerging issues, to which all panelists expressed their support. The importance of personnel development to tackle these challenges was also raised. In concluding the seminar, Dr. YAMAMOTO expressed that the common understanding gained from this occasion was the most fruitful achievement, owing to the international colleagues who shared their thought-provoking presentations and insights.

Coordinating external assistance for UHC: Pakistan's early experience of the SDG3 GAP

Pakistan is a lower middle-income setting. External assistance for health and development partners play an important role in health sector development. The federal system and health care delivery as a devolved provincial subject warrant regular and effective coordination among federating units and partners. Pakistan was selected as a priority country in 2019 for the implementation of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP). Given the ongoing universal health coverage (UHC) reforms, the country prioritized two SDG3 GAP accelerators, related to primary health care (PHC) and sustainable financing for health (SFH). Eight partner agencies representing PHC and SFH accelerators jointly planned and conducted a 'PHC for UHC mission' to Pakistan in 2021. This mission paved the way for setting up an SDG3 GAP Coordination Committee and a 'PHC Service Delivery and Financing working group', which have been regularly coming together through in-person and virtual meetings; the latter was relatively uncommon previously and this new way of working provided a chance to build rapport, share workplans, identify duplications in technical assistance and jointly gauge governments' priorities. This has shifted the focus of reforms deliberations from 'what' to 'how', enabling joint strategic planning and implementation. The joint work by SDG3 GAP partners with the Ministry of National Health Services Regulation & Coordination linked discussions on health financing and service delivery reforms for the first time, and has contributed to advocacy, analysis, strategic policy dialogue, institutional strengthening and implementation of UHC reforms, with a focus on PHC. Even though joint work by SDG3 GAP partners undoubtedly shows the potential for better alignment and collaboration, translation of the commitment to better collaboration into concrete impact has been the result of committed and engaged staff members, rather than institutionalized change, which will require strong incentives for collaboration.

University Students as Change Agents for Health and Sustainability: A Pilot Study on the Effects of a Teaching Kitchen-Based Planetary Health Diet Curriculum

Global dietary habits are one of the main drivers of climate change. At the same time, they contribute to 11 million premature deaths every year. This raises the question of how the urgently needed transformation of food systems can be realized. Regardless of their degree paths, all university students, in their role as potential future experts and leaders in their fields, can serve as important change agents in society. In this paper, we (a) introduce a university curriculum in a teaching kitchen setting that is based on the planetary health diet (PHD) of the EAT-Lancet Commission, (b) investigate its feasibility, and (c) analyze its effects on the planetary health diet literacy of a pilot cohort of university students enrolled in various degree programs. We developed seven flipped classroom teaching kitchen sessions based on social cognitive theory (SCT), each consisting of a one-hour seminar with student presentations on various nutrition- and sustainability-related key topics, followed by corresponding two-hour hands-on cooking classes. To assess feasibility, specific questions from the official teaching evaluation of the University of Göttingen were analyzed. Changes in self-assessed planetary health diet literacy were measured using a pre- and post-survey. During the pilot phase, 26 students successfully completed the course. A total of 25 participants responded to the teaching evaluation and expressed high satisfaction with the course, the learning outcomes, and the level of demand. A total of 26 participants completed the pre- and post-survey. At the post-intervention, the students rated their planetary health diet literacy as 21 to 98% higher than before their course participation. The findings of this pilot study indicate that the curriculum was well-received and feasible with the target group, and they demonstrate that the course participation increased the university students' self-assessed ability to disseminate strategies for more sustainable and healthy diets. Through replication at other universities worldwide, the teaching kitchen-based planetary health diet curriculum might foster a social shift towards healthier and more climate-friendly food systems.

The Role of Artificial Intelligence of Things in Achieving Sustainable Development Goals: State of the Art

With the environmental and societal changes, the achievement of sustainable development goals (SDGs) and the realization of sustainability in general is now more important than ever. Through a bibliometric analysis and scientific mapping analysis, this study aims to explore and provide a review regarding the role of artificial intelligence (AI), the Internet of Things (IoT), and artificial intelligence of things (AIoT) in realizing sustainable development and achieving SDGs. AIoT can be defined as the combination of AI with IoT to create more efficient and data-driven interconnected, intelligent, and autonomous IoT systems and infrastructure that use AI methods and algorithms. The analysis involved 9182 documents from Scopus and Web of Science (WoS) from 1989 to 2022. Descriptive statistics of the related documents and the annual scientific production were explored. The most relevant and impactful authors, articles, outlets, affiliations, countries, and keywords were identified. The most popular topics and research directions throughout the years and the advancement of the field and the research focus were also examined. The study examines the results, discusses the main findings, presents open issues, and suggests new research directions. Based on the results of this study, AIoT emerged as an important contributor in ensuring sustainability and in achieving SDGs.

Strategies and Best Practices That Enhance the Physical Activity Levels of Undergraduate University Students: A Systematic Review

Significant numbers of undergraduate university students are not meeting the physical activity guidelines recommended by the World Health Organisation. These guidelines suggest that university students should aim for 150-300 min of moderate or 75-150 min of vigorous physical activity. Strategic interventions need to be implemented to address this global public health concern. The aim of this study was to review the strategies and best practices to enhance the physical activity levels of undergraduate university students. Utilising the PRISMA guidelines, electronic databases-PubMed, Science Direct, Academic Search Complete, ERIC, Web of Science, CINAHL, SAGE, and SPORTDiscus-were searched between September 2022 and February 2023 using terms and synonyms related to physical activity, strategies, best practices, and undergraduate university students. Studies were critically assessed for their quality using an adapted version of the CASP and RE-AIM frameworks. Eleven articles met the inclusion criteria for the review. The studies reported the use of social media platforms, mobile phone applications, web-based technology, online text messages, in-person classes, and an "exergame" as methods to increase engagement in physical activity. Findings from this review indicated that validated questionnaires emerged as the predominant measurement tool. Furthermore, the frequent use of social network sites served as a best practice for implementing and promoting physical activity interventions. It is recommended that universities promote health-enhancing physical activities based on current trends and strategies, such as technology-based interventions and the use of social media, that are relevant to contemporary university students.

From Over-Tourism to Under-Tourism via COVID-19: Lessons for Sustainable Tourism Management

With various strains of the novel coronavirus emerging during the last few years, there is a need to reinvent and manage the tourism industry by engaging various stakeholders. Industry and policymakers need to observe the shift and curate tourism-related products and offerings accordingly. In light of the increasing demand for innovations and future directions in the post-COVID-19 period, this article conducts a bibliometric analysis for sustainable tourism studies spanning the years 1990-2021. This paper presents an integrative review of tourism, environment and sustainable tourism to reveal geographical, contextual, and methodological directions for future research. The comprehensive analysis includes contributions on topics and methods, country collaborations, and thematic analysis. The findings are consistent with the Sustainable Development Goals of sustainable production and consumption (SDG-12), with a particular emphasis on sustainable tourism to promote local culture and create jobs (SDG-12.b) and on sustainable growth (SDG-13). The study's findings can be used to inform future policies and directions; for example, the findings indicate that the hospitality industry is facing challenges that necessitate new regulations to address its socioeconomic and environmental impacts.

Health Service Managers' Digital Competencies: A Conceptual Framework

Health service managers play a crucial role in managing and leading in the digital health environment. Development of the health management workforce that is ready to lead and manage digital health transformation requires partnerships across sectors, in not only developing workforce competence but also in developing supportive mechanisms that can translate competencies into practice. A framework presenting a systematic approach in enabling the development of a competent health management workforce in the digital health era has recently been published. The purpose of this paper is to explore and discuss the application of the framework in the Australian context, informed by the findings of a PhD research project that uses an empirically validated four-step approach to confirm the health service management workforce development needs in the digital health context. The PhD project has already confirmed: 1) the paucity of Australian Health Informatics Competency Framework (AHICF) competencies being included in Australian health service management postgraduate program curricula; 2) five key strategies that contribute to developing health management workforce competency and capacity; and 3) seven key factors that enable health management workforce development in the digital health context. Further understanding of the barriers and enablers for health service managers to develop capability and manage in the digital health environment, and the factors that influence digital health policy and practice will be developed, by critically analysing findings from focus group discussions with health managers and semi-structured interviews with digital health leaders, to be completed by May 2023.

Multitask Deep Learning Enabling a Synergy for Cadmium and Methane Mitigation with Biochar Amendments in Paddy Soils

Biochar has demonstrated significant promise in addressing heavy metal contamination and methane (CH4) emissions in paddy soils; however, achieving a synergy between these two goals is challenging due to various variables, including the characteristics of biochar and soil properties that influence biochar's performance. Here, we successfully developed an interpretable multitask deep learning (MTDL) model by employing a tensor tracking paradigm to facilitate parameter sharing between two separate data sets, enabling a synergy between Cd and CH4 mitigation with biochar amendments. The characteristics of biochar contribute similar weightings of 67.9% and 62.5% to Cd and CH4 mitigation, respectively, but their relative importance in determining biochar's performance varies significantly. Notably, this MTDL model excels in custom-tailoring biochar to synergistically mitigate Cd and CH4 in paddy soils across a wide geographic range, surpassing traditional machine learning models. Our findings deepen our understanding of the interactive effects of Cd and CH4 mitigation with biochar amendments in paddy soils, and they also potentially extend the application of artificial intelligence in sustainable environmental remediation, especially when dealing with multiple objectives.

The influencing factors of participation in time banking volunteer service for older adults among university students in Nanjing, China

Objective

This study aims to identify factors influencing university students' participation in time banking volunteer services for older adults and provides evidence to promote the involvement.

Methods

Conducted in November 2022, we utilized a convenience sampling method to recruit students from the School of Aging Service and Management at Nanjing University of Chinese Medicine, China. Data was collected through an online questionnaire focusing on various aspects related to time banking volunteer services for older adults. Factor analysis was employed to extract variables, and logistic regression was applied to identify key determinants.

Results

A significant majority (82.67%) of participants expressed willingness to engage in volunteer services for older adults. Factor analysis uncovered six influential factors explaining 62.55% of the variance. Logistic regression highlighted four key determinants of students' willingness: value judgment (OR = 4.392, CI = 2.897-6.658), social support (OR = 1.262, CI = 0.938-1.975), social influence (OR = 1.777, CI = 1.598-3.799), and socioeconomic conditions (OR = 1.174, CI = 1.891-3.046).

Conclusion

To foster sustainability and continuous time banking among university students majoring in aging service and management, a multifaceted support involving governmental, social, and university is recommended.

Closing the Loop: Enhancing Local Monitoring of Child Poverty to Leave No Child Behind

Research on the Leave No One Behind principle of the Sustainable Development Goals (SDGs) within the context of the Agenda 2030 is currently prevalent; however, research on monitoring child poverty at the sub-national (local) level is still limited. This paper addresses this gap by examining indicators developed for monitoring the phenomenon at different territorial levels (global, European, and national) and assessing their territorial transposition locally, using the city of Cadiz, Spain, as a case study. Interviews with local stakeholders reveal that despite the availability and access to related indicators and data, relevant actors must enhance their efforts to utilize such indicators effectively. Based on desktop research and qualitative analysis, the paper delivers recommendations for improving local monitoring of child poverty in Europe and inducing policy changes. This knowledge can inform targeted interventions, policy formulation, and resource allocation to tackle child poverty and promote equitable and inclusive societies.

Integrating the United Nations sustainable development goals into higher education globally: a scoping review

BACKGROUND

In 2015, the United Nations adopted the 2030 Agenda for Sustainable Development, including the 17 Sustainable Development Goals (SDGs). Higher education institutions have a role in raising awareness and building skills among future professionals for implementing the SDGs. This review describes how the SDGs have been integrated into higher education globally.

OBJECTIVES

Determine how have the SDGs been integrated into higher education globally. Describe the differences in the integration of the SDGs in higher education across high-income countries (HICs) and low- and middle-income countries (LMICs).

METHODS

Following a scoping review methodology, we searched Medline, Web of Science, Global Health, and Educational Resources Information Center, as well as websites of key institutions including universities, identifying peer-reviewed articles and grey literature published between September 2015 and December 2021.

RESULTS

We identified 20 articles and 38 grey literature sources. Since 2018, the number of publications about the topic has been increasing. The SDGs were most frequently included in bachelor-level education and disciplines such as engineering and technology; humanities and social sciences; business, administration, and economics. Methods of integrating the SDGs into higher education included workshops, courses, lectures, and other means. Workshops and courses were the most frequent. The methods of integration varied in high-income countries compared to low- and middle-income countries. High-income countries seemed to follow a more academic approach to the SDGs while low- and middle-income countries integrate the SDGs with the aim to solve real-world problems.

CONCLUSION

This study provides examples of progress in integrating the SDGs into higher education. Such progress has been skewed to high-income countries, bachelor-level initiatives, and certain disciplines. To advance the integration of the SDGs, lessons learned from universities globally should be shared broadly, equitable partnerships formed, and students engaged, while simultaneously increasing funding for these processes.

Sustainable preventive integrated child health care: reflections on the importance of multidisciplinary and multisectoral stakeholder engagement

Worldwide, 85% of all children who die are under the age of five. A recent scoping review examining the literature from 2000 to 2021 shows the importance of sustainable integrated preventive child health care for improving child health, enhancing the uptake of preventive child health services, and decreasing health-care costs. In 2022, we organised a stakeholder workshop in Uganda to discuss and contextualise the findings of the scoping review. The workshop took place under the umbrella of the Centre of Excellence for Sustainable Health, a virtual collaborative centre co-hosted by Makerere University in Uganda and Karolinska Institutet in Sweden. The workshop convened multidisciplinary and multisectoral stakeholders, including parents, nurses, paediatricians, nutritionists, village health team members, religious leaders, social workers, teachers, lawyers, health and climate researchers, and representatives from the police, the agricultural sector, the Ministry of Health, the World Health Organization, and other international and national non-governmental organisations, among others. We reflect on the importance of multidisciplinary and multisectoral stakeholder engagement, not only in building bridges between research and practice but also in linking sectors and connecting people for sustainable preventive integrated child health care. Though an important step, this workshop was only a first step; over time, relationships must be nurtured, multisectoral systems built and research and policy closely connected. We hope this workshop will not remain a one-off event but becomes an institutionalised effort that sparks action for sustainable preventive integrated child health care in Kampala and beyond, and sustainable health for all.

Waste metrics in the framework of circular economy

There are several sustainability issues that the linear economy of today's society cannot adequately tackle (i.e. resource depletion, waste treatment, etc.). As a result, the scientific community and policymakers give high priority to the implementation of the circular economy concept. The sustainable development goals of the United Nations are in line with the European Union's (EU) commitment to a smooth transition to a circular economy. Circular business models require a shift in technical elements involving R strategies to replace traditional business models (i.e. reuse, reduce, recycle, etc.). Monitoring circular economy to provide quantifiable, measurable data is necessary for a successful transition. Monitoring tools (i.e. Key Performance Indicators, quality protocols) enable decision-makers to measure circular economy performance and identify circularity's advantages and disadvantages. To stimulate the adoption of a circularity model addressing critical issues of excessive waste production and resource use, this mini review aims to address the literature gap of waste metrics in the framework of circular economy and offer insights on circular economy indicators to aid for a seamless transition to a more sustainable society. For this purpose, Preferred Reporting Items for Systematic Reviews and Meta-Analysis method was chosen to assess literature. The authors collected and analysed data from 101 records, 70 articles and 31 reports related to the topic under consideration. Through the literature review, it is obvious that moving away from linear production model frequently leads to the development of new internal capabilities along the value chain and, eventually, high efficiency that reduces costs, increasing productivity, encourages brand names, minimizes threats, creates new products and fulfils regulations and green consumer expectations.

Repercussions of Hydroelectricity use on Carbon Emissions in Bangladesh: Evidence using Novel Fourier-Bootstrapped ARDL and Fourier-Gradual Shift Causality analyses

Bangladesh has recently pledged at the 26th Conference of Parties (COP26) to reduce its carbon dioxide emission figures by 22% at the end of 2030. However, since this South Asian country has always turned to fossil fuels for electricity generation purposes, achieving this emission reduction goal is a challenging task for the Bangladesh government. Nevertheless, considering the negative environmental implications associated with the generation and consumption of unclean energy, particularly electricity, it is critically important for Bangladesh to expedite the process of clean transformation of its traditional pollution-intensive power system. Hence, the objective of this study is to dissect the repercussions of hydroelectricity use on Bangladesh's fossil fuel consumption-related carbon dioxide As opposed to the traditional method of quantifying environmental quality using total carbon dioxide emissions, this study considers Bangladesh's annual carbon dioxide emissions generated from the combustion of gas, oil, and coal. Besides, novel Fourier-based econometric methods that effectively handle structural break problems in data are utilized in this study. Based on the results, it is found that up-scaling hydroelectricity consumption levels exert emission-inhibiting effects while greater economic globalization activities are witnessed to boost the emissions. More importantly, hydroelectricity consumption and economic globalization are observed to jointly curb fossil fuel consumption-based emissions of carbon dioxide. Additionally, the results verify the environmental Kuznets curve hypothesis for Bangladesh. Furthermore, financial sector development is found to be effective in reducing the natural gas consumption-related carbon dioxide emissions while urbanization is held responsible for amplifying emissions generated from all three types of fossil fuels. Therefore, considering these findings, the Bangladesh government needs to particularly emphasize scaling up production and consumption of hydroelectricity to decarbonize its economy.

Harbingers of Hope: Scientists and the Pursuit of World Peace

The ongoing wars in many regions-such as the conflict between Israel and Hamas-as well as the effects of war on communities, social services, and mental health are covered in this special editorial. This article emphasizes the need for international efforts to promote peace, offer humanitarian aid, and address the mental health challenges faced by individuals and communities affected by war and violence.

Safe Today, Unsafe Tomorrow: Tanzanian Households Experience Variability in Drinking Water Quality

Measuring Escherichia coli in a single-grab sample of stored drinking water is often used to characterize drinking water quality. However, if water quality exhibits variability temporally, then one-time measurement schemes may be insufficient to adequately characterize the quality of water that people consume. This study uses longitudinal data collected from 193 households in peri-urban Tanzania to assess variability in stored water quality and to characterize uncertainty with different data collection schemes. Households were visited 5 times over the course of a year. At each visit, information was collected on water management practices, and a sample of stored drinking water was collected for E. coli enumeration. Water quality was poor for households, with 80% having highly contaminated (>100 CFU per 100 mL) water during at least one visit. There was substantial variability of water quality for households, with only 3% of households having the same category (low, medium, or high) of water quality for all five visits. These data suggest a single sample would inaccurately characterize a household's drinking water quality over the course of a year and lead to misestimates of population level access to safe drinking water.

Nursing students' and educators' perspectives on sustainability and climate change: An integrative review

AIM

To identify and synthesize research on the awareness, attitudes and action related to sustainability and climate change from the perspective of nursing students and educators globally.

DESIGN

Integrative review.

METHODS

The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal Tool. A deductive content analysis based on Elo and Kyngäs' methodology was employed.

DATA SOURCES

CINAHL, MEDLINE, EMBASE, Web of Science, British Education Index, GreenFILE and Scopus were searched up to the 8th November 2022.

RESULTS

Thirty-two studies were included in the review. Two studies included nursing educators in their samples, the rest focused solely on students. Findings suggest that whilst some students were aware of sustainability issues and felt that nurses have a responsibility to mitigate climate change, others showed limited awareness and believed that nurses have more important priorities. A global interest was seen among students for increased curricular content related to sustainability and climate change. Waste management and education of others were suggested actions students can take; however, barriers included lack of confidence and limited power.

CONCLUSION

There is a need for sustainability education within nursing curricula, accompanied by student support.

IMPLICATIONS FOR THE PROFESSION

The review acts as a starting point to make sustainable healthcare and climate change mitigation integral aspects of nursing.

IMPACT

Sustainability education within nursing curricula can positively impact on sustainable healthcare and climate change mitigation. More research is needed on the perspectives of nursing educators.

REPORTING METHOD

The review is reported according to the PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Helping the World Achieve Sustainable Development Goals: The Role of PNPs and Pediatric-Focused Providers

In 2015 the United Nations created the Agenda for Sustainable Development and a list of 17 sustainable development goals (SDGs) for 2030. This year is the halfway mark toward meeting the goals, and the results reported by the World Health Organization in 2023 are not as positive as hoped, as progress has stagnated. The third SDG primarily focuses on the health and well-being of all ages to prevent unavoidable deaths in children aged < 5 years. Pediatric nurse practitioners are uniquely positioned to support programs building toward the health and well-being of children. Becoming aware of opportunities will help pediatric nurse practitioners use their voices toward success in meeting the SDGs.

Reductions in Children's Blood Lead Levels from a Drinking-Water Intervention in Madagascar, Sub-Saharan Africa

One in three children globally is estimated to have blood lead levels (BLL) at or above the BLL reference value of 5 μg/dL with increased burden falling on low- and middle-income countries (LMIC). Within developed countries, aqueous lead is the predominant exposure route. However, aqueous lead exposure is rarely examined in the LMIC, leaving a gap in the literature that ignores a potentially significant route of exposure. Furthermore, limited lead-based remediation efforts around consumer products have been examined. This study investigates the importance of lead exposure from the water supply through a case study in Toamasina, Madagascar. The project measured aqueous lead and BLL of children pre- and postremediation efforts (i.e., removal of leaded pump components in hand pumps) to verify the impact of aqueous lead exposure within this community. Removal of the leaded pump components (i.e., piston and foot valves) and replacement with nonleaded components decreased aqueous lead levels below the World Health Organization provisional guideline of 10 μg/L in all but 4% of pumps tested. Measured BLL concentrations indicated a statistically significant decrease in BLL from pre- to postremediation. Furthermore, the remediation resulted in a decrease in BLL for 87% of children with the greatest changes in BLL observed for children with the highest preremediation concentrations. These findings point to a need for greater consideration of lead in drinking and cooking waters as an important exposure route in LMIC.

Urban Sanitation: New Terminology for Globally Relevant Solutions?

Progress toward Sustainable Development Goals for global access to safe sanitation is lagging significantly. In this Feature, we propose that misleading terminology leads to errors of categorization and hinders progress toward sanitation service provision in urban areas. Binary classifications such as "offsite/onsite" and "sewered/nonsewered" do not capture the need for "transport to treatment" or the complexity of urban sanitation and should be discarded. "Fecal sludge management" is used only in the development context of low- or middle-income countries, implying separate solutions for "poor" or "southern" contexts, which is unhelpful. Terminology alone does not solve problems, but rather than using outdated or "special" terminology, we argue that a robust terminology that is globally relevant across low-, middle-, and upper-income contexts is required to overcome increasingly unhelpful assumptions and stereotypes. The use of accurate, technically robust vocabulary and definitions can improve decisions about management and selection of treatment, promote a circular economy, provide a basis for evidence-based science and technology research, and lead to critical shifts and transformations to set policy goals around truly safely managed sanitation. In this Feature, the three current modes of sanitation are defined, examples of misconceptions based on existing terminology are presented, and a new terminology for collection and conveyance is proposed: (I) fully road transported, (II) source-separated mixed transport, (III) mixed transport, and (IV) fully pipe transported.

Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers-A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey

Early initiation of breastfeeding (EIBF) involves feeding a newborn with the mother's breast milk within the first hour of delivery. The prevalence of EIBF in Vietnam has recently shown a downward trend. The present study aimed to demonstrate the current prevalence of EIBF practices and identify factors associated with EIBF among Vietnamese mothers with children under 24 months of age. This study was a secondary analysis of data from the Viet Nam Sustainable Development Goal Indicators on Children and Women (SDGCW) survey 2020-2021. The study participants included 1495 mothers extracted from the SDGCW dataset. Descriptive statistics and logistic regression analyses were performed. The prevalence of EIBF practice was 25.5% among all mothers, 31.9% among vaginal-delivery mothers groups, and 9.0% among cesarean-section mothers groups. Factors negatively associated with EIBF were younger age (0.18 times), cesarean delivery (0.25 times), and absence of skin-to-skin contact with newborns immediately after birth (0.43 times). The prevalence of EIBF among Vietnamese mothers was found to be substantially low, especially among those who underwent cesarean delivery. EIBF should be promoted among younger mothers and those who underwent cesarean delivery.

Creation of Environmentally Friendly Super "Dinitrotoluene Scavenger" Plants

Pervasive environmental contamination due to the uncontrolled dispersal of 2,4-dinitrotoluene (2,4-DNT) represents a substantial global health risk, demanding urgent intervention for the removal of this detrimental compound from affected sites and the promotion of ecological restoration. Conventional methodologies, however, are energy-intensive, susceptible to secondary pollution, and may inadvertently increase carbon emissions. In this study, a 2,4-DNT degradation module is designed, assembled, and validated in rice plants. Consequently, the modified rice plants acquire the ability to counteract the phytotoxicity of 2,4-DNT. The most significant finding of this study is that these modified rice plants can completely degrade 2,4-DNT into innocuous substances and subsequently introduce them into the tricarboxylic acid cycle. Further, research reveals that the modified rice plants enable the rapid phytoremediation of 2,4-DNT-contaminated soil. This innovative, eco-friendly phytoremediation approach for dinitrotoluene-contaminated soil and water demonstrates significant potential across diverse regions, substantially contributing to carbon neutrality and sustainable development objectives by repurposing carbon and energy from organic contaminants.

Substance Use among Emerging Adults during the COVID-19 Pandemic: A Review through the Lens of Sustainable Development Goals

Public health initiatives, including lockdowns to reduce the spread of COVID-19, have resulted in societal stressors like loneliness, job loss, and economic collapse linked to worsening mental health outcomes, such as depression, anxiety, and coping-related substance use. The various psychosocial stressors caused by the pandemic have potentially led to the increased use of substances across the globe, particularly among emerging adults. The current study summarises the literature on substance use among emerging adults during the COVID-19 pandemic. The terms "coronavirus", "COVID-19", "substance use", "substance abuse", "drug use", drug abuse", "emerging adults", and "young adults" were all used in different combinations throughout the search, using the Scopus, PubMed, and JSTOR databases. Using this method, a total of 28 English-language citations published between 2020 and 2023 were obtained. Following a study of the articles mentioned above, 16 papers were removed. The remaining 12 papers were included in this review. Even though substance use dropped when COVID-19 lockdowns began, it rose when restrictions were removed, particularly among those with prior substance use. Studies related to mental health need to assess substance use, as many emerging adults use substances to cope with distress, including isolation and loneliness, which are part of the current mental health crisis among emerging adults.

Considering tradeoffs in "local" food policies: examples from school feeding programmes

City, national, and multinational governments are increasingly leveraging nutrition programme spending, specifically pursuing policies that require or incentive "local" procurement, to meet a myriad of goals. However, these policies involve tradeoffs that are often not fully considered by government officials, planners, and advocates. This perspective article provides some examples of those tradeoffs from the peer-reviewed literature, which, we argue, are useful to consider in setting school feeding programme policies to achieve sustainability goals.

Factors That Influence the Intention of Smallholder Rice Farmers to Adopt Cleaner Production Practices: An Empirical Study of Precision Agriculture Adoption

Sustainable agriculture is crucial for achieving SDG2 and building a resilient climate-food system. This study provides a nuanced understanding of factors that influence the adoption of precision agriculture technology by Vietnamese smallholder rice farmers as a sustainable agricultural solution. The study's objectives are: (1) to provide a nuanced understanding of factors that influence adoption of precision agriculture technology by Vietnamese smallholder rice farmers; and (2) to identify factors associated with agricultural practice in Vietnam that may impact the adoption of precision agriculture technology. The study conducted 35 semi-structured interviews with smallholder rice farmers and agriculture experts. Data were analyzed using iterative thematic analysis. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was used for empirical analysis. The UTAUT constructs of Performance expectancy, Effort expectancy, Government support, and Social influence were found to be determinants of adoption. Trialability and Observability impact Effort expectancy and Performance expectancy. We also discovered that the performance of agricultural cooperatives and support of lead firms play a crucial role in facilitating agricultural technology adoption by Vietnamese smallholder rice farmers. The results confirm the applicability of UTAUT in defining smallholders' behavioural intention and predicting agricultural technology adoption. The study also provides constructive feedback on the UTAUT model by highlighting the effect of agricultural cooperatives' performance as innovation intermediaries and of the support of lead firms.

Experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management and safe menstrual products in Pakistan

Background

The taboo of menstruation, lack of discussion on puberty, misinformation and poor awareness on menstrual hygiene management and limited access to safe menstrual products can negatively impact the physical and mental health of women and girls residing in low middle income countries.

Aim

The aim of the study was to explore the experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management in Pakistan. Moreover, the study also assessed consumer satisfaction towards locally manufactured organic menstrual products.

Methods

A descriptive cross-sectional study design was used with a sample of 400 women and girls selected through convenience sampling from high schools, universities, outpatient department and gynaecological clinics located in 2 cities, i.e., Islamabad and Rawalpindi, Pakistan. A pre-structured questionnaire was used to explore experiences, awareness, perceptions and attitudes of women and girls towards menstrual hygiene management. Moreover, each respondent was provided with sample of locally designed and manufactured organic menstrual hygiene & wellness kit by a group of women researchers named "FemPure" including organic sanitary pads, feminine wellness mist and feminine wellness wash. The respondents were asked to use the products and a telephonic follow-up was conducted to assess consumer satisfaction for the products after a period of 1 month. Data was analyzed statistically using SPSS 21.

Results

The results of the study reported that 86.2% (n = 345) of the respondents had normal periods. Out of 400 respondents, 58.5% (n = 234) knew about any health conditions related to abnormal menstrual cycle while 88.3% (n = 353) were aware of female menstrual hygiene. Majority of the respondents 78.7% (n = 315) felt ashamed while buying sanitary pads. Out of 400 respondents, 5.4% (n = 22) were interested in getting awareness regarding menstrual hygiene. The results of the study showed that all the respondents (100%, n = 400) were satisfied with FemPure organic menstrual products.

Conclusion

The study concluded that majority of women and girls faced menstrual hygiene issues during and after the cycle and were eager to receive information on MHM and use organic rash free menstrual wellness products which could be ordered via mobile app. The respondents were satisfied after the use of FemPure organic menstrual products.