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Reducing examination table paper (ETP) use may help curb carbon emissions from health care. Six participants applied Glo Germ (DMA International) to their hands before a common physical examination (abdominal, cardiorespiratory, hip and knee) both with and without ETP. After each exam, UV light was shined on the exam table and photographs were taken. The number of hand touches on ETP-covered areas and uncovered areas were tallied and compared using t tests. Despite covering more surface area, participants touched areas without ETP significantly more than ETP-covered areas (P https://doi.org/10.1370/afm.3092, INTRODUCTION Climate change negatively impacts mental health, respiratory and cardiac disease, and quality-adjusted life years. (1) Waste from health care is a major contributor to its negative environmental impact, (2-4) [...]

Introduction In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of [...]

Introduction In accordance with its mandate to provide normative guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations [...]

Introduction In accordance with its mandate to provide normative guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations [...]

Italy’s demographic setting is rapidly evolving and is characterized by a substantial increase in the older population segment. This trend, driven by prolonged life expectancy and declining birth rates, positions Italy as a leader in global aging patterns. The 38th National Congress of the Società Italiana di Geriatria Ospedale e Territorio (SIGOT), held in Rome, underlined the importance of addressing the health needs of this aging population, particularly focusing on preventing sarcopenia and cardiovascular diseases. Recent data challenge the notion of functional decline as an inevitable consequence of aging, highlighting the interplay of genetic, environmental, and lifestyle factors in modulating health outcomes. Sarcopenia, a prevalent condition and biological substrate of frailty, significantly impacts physical function and mortality rates, necessitating behavioral interventions to mitigate its effects. Physical exercise emerges as a key strategy for maintaining cardiovascular health and reducing the risk of arrhythmias, prevalent in older age groups. However, the complex relationship between physical activity intensity, age, and cardiovascular risk underlines the importance of tailored interventions and preliminary screenings. Looking ahead, proactive measures such as enhanced screening, promoting lifelong healthy habits, research and innovation, robust community support systems, and adaptable policies are essential to address the multifaceted challenges posed by an aging population. With this consensus paper, we aimed to summarize the key messages from the three intensive days of the SIGOT National Congress.

These notes and questions have been prepared to promote discussion of the ideas set out in the Clarifying paper, "Living and learning in EcCoWell cities" to be found on the PASCAL International Exchanges (PIE) website. This Discussion Paper sets ten questions for discussion. We are hoping to encourage discussions of these issues around the world.

Big data refers to extremely large data generated at high volume, velocity, variety, and veracity. The nurse scientist is uniquely positioned to leverage big data to suggest novel hypotheses on patient care and the healthcare system. The purpose of this paper is to provide an introductory guide to understanding the use and capability of big data for nurse scientists. Herein, we discuss the practical, ethical, social, and educational implications of using big data in nursing research. Some practical challenges with the use of big data include data accessibility, data quality, missing data, variable data standards, fragmentation of health data, and software considerations. Opposing ethical positions arise with the use of big data, and arguments for and against the use of big data are underpinned by concerns about confidentiality, anonymity, and autonomy. The use of big data has health equity dimensions and addressing equity in data is an ethical imperative. There is a need to incorporate competencies needed to leverage big data for nursing research into advanced nursing educational curricula. Nursing science has a great opportunity to evolve and embrace the potential of big data. Nurse scientists should not be spectators but collaborators and drivers of policy change to better leverage and harness the potential of big data. [ABSTRACT FROM AUTHOR]

Byline: Vanita. Ahuja, Kaushic. Theerth, Rakesh. Garg Abstract, as a form of publication, cannot be valued lightly. In this fast-moving world, a research paper does not exist beyond the abstract [...]

Introduction In accordance with its mandate to provide normative guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers (1) on vaccines and [...]

Health inequities, within and across countries, stand as a critical global challenge of our time. Over 1 billion people face preventable diseases and premature deaths due to limited access to [...]

Value co‐creation as a research topic has been a critical proposition of interest to a wide range of disciplines. In recent years, the field of cultural heritage has also developed a range of information practices to promote different forms of value co‐creation. While the body of literature has begun to accumulate, we still lack a comprehensive understanding of conceptual foundations and how value co‐creation is implemented in cultural heritage information practices. This paper conducted a hermeneutic literature review to understand and conceptualize the core aspects of value co‐creation in various cultural heritage information works. In particular, this paper provides a research mapping of the genres of co‐creation in cultural heritage information practices, the actors, and the roles played by the stakeholders. Further, this review provides an overview of the dominant value co‐creation models in the cultural heritage field. It distills the drivers of value co‐creation and the core value consequences that arise from a process perspective. Finally, this paper puts forward a thematic, theoretical, and methodological agenda for future work based on these findings. The review contributes to the literature by proposing an integrated conceptual framework that summarizes the core elements of value co‐creation in cultural heritage information practices. The framework also serves as a call for action, providing a general understanding of the conceptual foundation for future research. [ABSTRACT FROM AUTHOR]

We investigated the performance of attenuated total reflectance-Fourier-transform infrared (ATR-FTIR) spectroscopy to rapidly identify intentional additives in a variety of items commonly handled by consumers and workers. We investigated ortho-phthalate esters, specific alternative plasticizers, and flame retardants in food contact materials and consumer products. We also investigated bisphenol A (BPA) and bisphenol S (BPS) developers in thermal paper purchase receipts. Applications include regulatory compliance screening and product deformulation. We compared FTIR results with mass spectrometry measurements. Samples were analyzed either intact or after a simple liquid-phase extraction using small amounts of nonhalogenated solvents. These methods greatly reduced the time and expense of identifying intentionally added phthalates and other plasticizers compared with more sensitive methods. Similarly, BPA and BPS were readily identified in receipts and organophosphorus flame retardants were identified in child car seats. In some samples, FTIR detected novel or unexpected additives not detected by conventional targeted methods. These approaches are useful for screening diverse product samples for intentional additives with a relatively portable instrument while generating very low volumes of spent solvent., Introduction The Ecology Center of Ann Arbor, Michigan, tests consumer products, publishes reports, and uses the data to engage with product manufacturers, brands, and retailers to eliminate chemical hazards and [...]

Introduction In accordance with its mandate to provide normative guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations [...]

Byline: Georgia. Micha, Eleftheria. Soulioti, Argyro. Fassoulaki Introduction The traditional impact factor measures an article's impact on the academic society. In contrast, https://www.altmetric.com/metrics.com (©Altmetric, London, UK) tracks scholarly outputs' attention [...]

Introduction In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of [...]

Sexual health is fundamental to overall health and well-being, to the dignity of the individual and to the social and economic development of communities and countries. (1) Three decades ago, [...]

BackgroundMethodsResultsDiscussionConclusionsThis paper considers weaknesses in a study by Cohen et al. (2006) on the impacts of community singing on health. These include high demand characteristics, lack of attention to attrition, flawed statistical analysis, and measurement. Nevertheless, the study is uncritically cited, in evidence reviews, with findings taken at face value.Google Scholar, SCOPUS and BASE citation functions for Cohen et al. identified 32 evidence reviews in peer-reviewed journals. Eleven of these reviews, published between 2010 and 2023, focused on creative arts interventions.We demonstrate limitations in the Cohen et al. research which undermine the conclusions they reach regarding the health benefits of group singing. Subsequent evidence reviews take the findings at face value and offer little critical commentary.We consider what is needed to improve evidence reviews in the field of creative arts and health research.A more robust approach is needed in reviewing research evidence in the field of arts and health. The Cohen et al. paper is not suitable for inclusion in future evidence reviews. [ABSTRACT FROM AUTHOR]

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a well-described intervention for noncompressible torso hemorrhage. Several Canadian centres have included REBOA in their hemorrhagic shock protocols. However, REBOA has known complications and equipoise regarding its use persists. The Canadian Collaborative on Urgent Care Surgery (CANUCS) comprises surgeons who provide acute trauma care and leadership in Canada, with experience in REBOA implementation, use, education and research. Our goal is to provide evidence- and experience-based recommendations regarding institutional implementation of a REBOA program, including multidisciplinary educational programs, attention to device and care pathway logistics, and a robust quality assurance program. This will allow Canadian trauma centres to maximize patient benefits and minimize risks of this potentially life-saving technology., Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a well-described intervention for noncompressible torso hemorrhage. (1-4) International literature has described the indications, technique and outcomes of 7- to 12-French [...]

Reviews have long been recognized as among the most important forms of scientific communication. The rapid growth of the primary literature has further increased the need for reviews to distill and interpret the literature. This review on Reviews and Reviewing: Approaches to Research Synthesis encompasses the evolution of the review literature, taxonomy of review literature, uses and users of reviews, the process of preparing reviews, assessment of review quality and impact, the impact of information technology on the preparation of reviews, and research opportunities for information science related to reviews and reviewing. In addition to providing a synthesis of prior research, this review seeks to identify gaps in the published research and to suggest possible future research directions. [ABSTRACT FROM AUTHOR]

Introduction In accordance with the WHO's mandate to provide guidance to Member States on health policy matters, the organization regularly issues position papers on vaccination, particularly when they relate to [...]

In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines [...]

Introduction In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of [...]

Objective: Media are a main source of medical information for the public, as well as for decision makers. This scenario demands a good selection of stories and correct medical reporting. Design: Our study aimed to analyze if journalistic guidelines or similar documents were already available and whether they provided satisfactory advice for appropriate communication in the field, and to detail recommendations which could become a reference working document. Methodology: Sources for this paper were obtained from PubMed and from websites (and related links) of organizations known to be working in the area of health reporting. Documents providing recommendations for the activity were analyzed and compared through a scheme including nine macro-categories relevant to the selection, verification and building of the story, considering scientific and journalistic issues. The scheme was derived from the most complete document. We then compiled a comprehensive list of recommendations merging the contents of the documents considered and our professional experience. Results: Nine existing guidelines and similar documents representing the worldwide situation were compared. All the documents examined provided interesting indications. Some of these indications shared the basic principles of mainstream journalism (reliability and independence of sources); others were more specific, such as the understanding of the scientific method and its jargon, the need to avoid extrapolations and to understand the difference between "in vitro" and animal studies and clinical trials, statistical parameters, and so on. Most of the topics specific for health communication are concepts which can be grasped only with an adequate scientific background and continuing education. The nature and level of the details provided by these documents vary considerably and in most cases can be fully understood only by experienced journalists with a relevant background. Discussion: Our proposal provides a useful tool listing nearly 70 recommendations ranging from the education of journalists, to all the aspects of selection, understanding and translating of medical and drug information deriving from scientific reports. It is intended for a journalist with a biomedical background, and therefore highlights critical issues without providing detailed descriptions. The proposal endeavors to answer to the main criticisms of medical journalism, particularly the use of sources, the verification of clinical value, the need to follow up on the story. Our work focuses on the prerequisite for a medical journalist to acquire the knowledge that enables him to assess the results of pharmacological and medical research in order to accurately and reliably convey his message to a lay reader. The strength of our working paper derives from the preliminary "benchmarking" of existing documents, as suggested in the literature, but even more so from the concerted effort of the authors, who represent the key stakeholders of the system (researchers, academic teachers, medical journalists and publishers). Conclusion: Our work identifies the major issues entailed in correct health reporting, and constitutes a step forward in overcoming existing barriers between scientists and journalists. The aim is to encourage the mediation of "public-centred" information, which limits the false hopes and expectations that may arise due to communication problems between the two worlds. (Contains 2 tables.)

The purpose of this study was to test whether the web version is an alternative to the paper version of the short version of the World Health Organization Quality of Life assessment (WHOQOL-BREF). Two studies were conducted. Study 1 used crossover self-controlled trials with 80 participants to compare the web and paper versions and to determine the test-retest reliability of the web version. Study 2 used data from 1,016 web participants to analyze the internal consistency and concurrent and construct validity of the web version. The correlations of domain scores between the web and paper versions ranged from 0.71 to 0.85. Dependent t tests showed no significant differences in domain scores between these two versions. The intra-class correlation coefficients (ICC) for test-retest reliability of web version ranged from 0.79 to 0.91. The Cronbach's alpha for internal consistency reliability ranged from 0.60 to 0.83. Multiple regression models indicated that the web version has good concurrent validity. Confirmatory factor analysis (CFA) for the second-order hierarchical factor model also supported the construct validity of the web version. The web version of the WHOQOL-BREF can be the alternative to the paper version for health-related quality of life (HR-QOL) evaluation.

In this editorial we describe the clinician/administrator/researcher experience of frustration or confusion around how to effectively advocate for policy change in health care. By the end of the piece the reader will (a) understand the importance of health professionals' advocacy; (b) know how to use policy papers to advocate; and (c) understand how policy organizations use policy papers. We also discuss the National Academies of Medicine, Science, & Engineering High Quality Primary Care report as an example of a policy paper, introduce our new coeditors for the Policy and Management Department, and describe the Collaborative Family Health Care Association's new policy principles., I (Jodi Polaha) recently got an e-mail from a colleague with the subject line 'Re: Fw: High-Quality Primary Care Should Be Available to Every Individual in the U.S.' The body [...]

Byline: Yaxin. Zhang, Guan. Jiang Background: There have been several papers published about pemphigus. Bibliometric analysis is useful in determining the most significant research in a certain topic. By bibliometric [...]

Normative leadership is a core function of the World Health Organization's (WHO) mandate, as outlined in its founding principles. (1) This leadership role is realized by developing evidence-based and ethically [...]

In accordance with its mandate to provide guidance to Member States on health policy matters, WHO regularly issues position papers on vaccines against diseases that have an international public health [...]

Author(s): Lesley Rees [sup.1] , Joseph Flynn [sup.2] [sup.3] Author Affiliations: (1) grid.83440.3b, 0000000121901201, Pediatric Nephrology, UCL Great Ormond Street Institute of Child Health, UCL, , London, UK (2) grid.240741.4, [...]

BackgroundAmerican Indian and Alaska Native youth research has rarely included young people from within these populations as co-designers. In addition to the lack of youth involvement, most findings focus on presenting statistics around disparity vs. focusing on this population's unique strengths and resiliency. The research design of this protocol aims to fill this gap in the current literature.MethodsTo address this discrepancy, a multipronged approach to youth and young adult participatory research was implemented. These prongs included a virtual gathering where the Nominal Group Technique was conducted and an assembly of a Youth Research Design Team. Lastly, the research team will implement a protocol developed by the Research Design Team. The Research Design Team plans to conduct qualitative interviews and distribute a web-based quantitative survey with a raffle as respondent compensation. This protocol is a preliminary phase to developing a wellbeing measure for AIAN youth.DiscussionHaving an operationalized definition of wellness from AIAN youth will fill a gap in the current body of research with optimism that this will lead to additional studies exploring the AIAN youth voice.

Background: A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process.Objective: The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training.Method: The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine.Results: First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice.Conclusion: Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies.

Addendum to Pneumococcal conjugate vaccines in infants and children under 5 years of age: WHO position paper--February 2019 Introduction In accordance with its mandate to provide guidance to Member States [...]

Byline: Prakash. Tandon 'In many general surgical works today the diagnosis of primary brain stem injury amounts to pronouncement of death sentence' (Kalyanaraman and Ramamurthi 1969) It is interesting that [...]

Health system strengthening is key to achieving universal health coverage, a target of the sustainable development goals. For policy-makers to effectively focus health system strengthening efforts and translate them into [...]

Context.--Controversies and uncertainty persist in prostate cancer grading. Objective.--To update grading recommendations. Data Sources.--Critical review of the literature along with pathology and clinician surveys. Conclusions.--Percent Gleason pattern 4 (%GP4) is as follows: (1) report %GP4 in needle biopsy with Grade Groups (GrGp) 2 and 3, and in needle biopsy on other parts (jars) of lower grade in cases with at least 1 part showing Gleason score (GS) 4 + 4 = 8; and (2) report %GP4: less than 5% or less than 10% and 10% increments thereafter. Tertiary grade patterns are as follows: (1) replace 'tertiary grade pattern' in radical prostatectomy (RP) with 'minor tertiary pattern 5 (TP5),' and only use in RP with GrGp 2 or 3 with less than 5% Gleason pattern 5; and (2) minor TP5 is noted along with the GS, with the GrGp based on the GS. Global score and magnetic resonance imaging (MRI)targeted biopsies are as follows: (1) when multiple undesignated cores are taken from a single MRI-targeted lesion, an overall grade for that lesion is given as if all the involved cores were one long core; and (2) if providing a global score, when different scores are found in the standard and the MRI-targeted biopsy, give a single global score (factoring both the systematic standard and the MRI-targeted positive cores). Grade Groups are as follows: (1) Grade Groups (GrGp) is the terminology adopted by major world organizations; and (2) retain GS 3 + 5 = 8 in GrGp 4. Cribriform carcinoma is as follows: (1) report the presence or absence of cribriform glands in biopsy and RP with Gleason pattern 4 carcinoma. Intraductal carcinoma (IDC-P) is as follows: (1) report IDC-P in biopsy and RP; (2) use criteria based on dense cribriform glands (>50% of the gland is composed of epithelium relative to luminal spaces) and/or solid nests and/or marked pleomorphism/necrosis; (3) it is not necessary to perform basal cell immunostains on biopsy and RP to identify IDC-P if the results would not change the overall (highest) GS/GrGp part per case; (4) do not include IDC-P in determining the final GS/GrGp on biopsy and/or RP; and (5) 'atypical intraductal proliferation (AIP)' is preferred for an intraductal proliferation of prostatic secretory cells which shows a greater degree of architectural complexity and/or cytological atypia than typical high-grade prostatic intraepithelial neoplasia, yet falling short of the strict diagnostic threshold for IDC-P. Molecular testing is as follows: (1) Ki67 is not ready for routine clinical use; (2) additional studies of active surveillance cohorts are needed to establish the utility of PTEN in this setting; and (3) dedicated studies of RNA-based assays in active surveillance populations are needed to substantiate the utility of these expensive tests in this setting. Artificial intelligence and novel grading schema are as follows: (1) incorporating reactive stromal grade, percent GP4, minor tertiary GP5, and cribriform/intraductal carcinoma are not ready for adoption in current practice. doi: 10.5858/arpa.2020-0015-RA, Originally proposed by Donald Gleason in 1966, the Gleason grading system has evolved with several important modifications in the past 2 decades. (1-5) Cumulatively, Gleason pattern 3 has been narrowed [...]

Purpose: This article provides an overview of five papers appearing together on the topic of 'Advances in Specific Language Impairment Research and Intervention,' which was the 2019 program in an ongoing series of research symposia presented at the Annual Convention of the American Speech-Language-Hearing Association. Method: The article provides a historical context for the set of papers, then a short summation of each paper's content, followed by the identification of overarching themes and working conclusions. Results: Each paper provides summations of empirical results, and some papers provide new empirical evidence. Conclusion: The papers collectively highlight six points: (a) Children with specific language impairment (SLI) are likely to be unidentified among their age peers. (b) There is great need for better identification of children with SLI across developmental levels. (c) Progress is evident toward a better understanding of causal pathways, as examined across different research designs involving comparison of children with typical language acquisition to children with SLI and other possibly co-occurring atypical conditions. (d) Measuring multiple dimensions of language brings enhanced informativeness, with differing outcomes for differing dimensions. (e) Replicated research findings require precision of methods in order to reduce unexplained error variance especially when defining groups. (f) Accurate identification of children with SLI is the first step toward a sound treatment plan for SLI and reading disorders as well. Presentation Video: https://doi.org/10.23641/asha. 13063721, Under the leadership of Margaret Rogers, Chief Staff Officer for Science and Research at the American Speech-Language-Hearing Association (ASHA), there is an annual research forum offered at the time of [...]

The purpose of this American Council on Science and Health report is to review issues and sources of uncertainty affecting assessment of potential health risks related to drinking water in the United States. Some background is included on how these issues arose, as is a review of the 1999 National Research Council report (with references to an updated version), to formulate a position based on the current science concerning how much of a risk of adverse health effects actually exists from arsenic in drinking water in the United States. ACSH concludes that there is clear evidence that chronic exposure to inorganic arsenic at concentrations of at least several hundred micrograms per liter may cause: (1) cancer of skin, bladder, lung (and possibly several other internal organs, including kidney, liver, and prostate), and (2) noncancer effects, including classic cutaneous manifestations that are distinctive and characteristic of chronic arsenic poisoning (diffuse or spotted hyperpigmentation and palmar-plantar hyperkeratoses). Noncancer effects may be multisystemic, with some evidence of peripheral vascular, cardiovascular, and cerebrovascular disease, diabetes, and adverse reproductive outcomes. Further study is needed to know if beneficial effects of arsenic in animal studies apply to humans. ACSH concludes that there is little, if any, evidence of a detrimental health effect in humans from inorganic arsenic in drinking water at the current maximum contaminant level (MCL) of 50 microg/L or below, either in the United States or elsewhere. As noted in the 1999 NRC report, "No human studies of sufficient statistical power or scope have examined whether consumption of arsenic in drinking water at the current MCL results in an increased incidence of cancer or noncancer effects" (NRC, 1999, p. 7). Based on our review, described in this article, ACSH finds that the limitations of the epidemiological data available and the state-of-the-science on the mode-of-action of arsenic toxicity, including can cer, are inadequate to support the conclusion that there are adverse health effects in the United States from arsenic in drinking water at or below the limit of 50 microg/L., (Copyright 2002 Elsevier Science (USA))

The U.S. healthcare system struggles to provide adequate language assistance to medical practitioners and patients. As a result, health providers and patients rely on ad hoc interpreters, including children, to communicate. Bilingual children who regularly interpret for others, whom we refer to as child language brokers, are important linguistic and cultural conduits for their communities and bridge language differences in vital contexts, such as health and medical settings. In this paper, we explore the experiences of 17 adolescent language brokers and consider the settings, tasks, and people they engage with when language brokering for health. Findings illustrate that child language brokering is a real and important component for immigrant family health, that child language brokering for health is not a uniform experience, and that language brokering for health can sometimes have severe ramifications.

The general goal of this discussion paper is to contribute toward the further harmonization of human health risk assessment. It first discusses the development of a formal, harmonized set of assessment factors. The status quo with regard to assessment factors is reviewed, that is, the type of factors to be identified, the range of values assigned, as well as the presence or absence of a scientific basis for these values. Options are presented for a set of default values and probabilistic distributions for assessment factors based on the state of the art. Methods of combining default values or probabilistic distributions of assessment factors are also described. Second, the effect parameter, the no-observed-adverse-effect level (NOAEL), is discussed. This NOAEL as selected from the toxicological database may be a poor substitute for the unknown, true no-adverse-effect level (NAEL). New developments are presented with respect to the estimation of the NAEL. The already widely discussed Benchmark Dose concept can be extended to obtain an uncertainty distribution of the Critical Effect Dose (CED). This CED distribution can be combined with estimated uncertainty distributions for assessment factors. In this way the full distribution of the Human Limit Value will be derived and not only a point estimate, whereas information on dose-response relations is taken into account. Finally, a strategy is proposed for implementation of the new developments into human health risk assessments.

Could the standardisation of language narrow disparities in achievement in education amongst people of different social class, and within and across ethnicities and genders, and could this have implications for injustices and inequities in wider society? In analysing socio-economic diversity through the lens of its correlation with language, this paper examines how the standardisation of language could be used as a means to reduce such diversity. It examines links between the standardisation of language, and the reduction of inequalities between socio-economic groups, in regard to achievement in education. It also examines the correlation between language and social class, and propensity towards being a perpetrator and/or victim of hostility and violence, as well as their relationship with health and life expectancy etc. The paper further examines the effect of the use of technology and teaching methods on the acquisition of knowledge, and how this impacts upon children of different social class within the learning environment. In order to help address some of these questions, an auto-ethnographic methodology is adopted with the aim of being able to explore, and reflect upon, personal experience, and to be able to weave greater understanding and connections between apparently disparate factors related to diversity, all through the lens of language and its relationship to aspects of culture relating to social class. Amongst its conclusions, the paper argues that the standardisation and enhancement of spoken language would narrow the disparities in academic achievement between socio-economic groups. The paper also argues that in order to challenge inequitable power structures which have arisen from historical injustices, then rather than concentrating on underrepresentation of groups of people within high status positions in society, the focus of diversity should be directed towards challenging the over representation, in a range of settings, of groups of people within low status positions in society.

The long-term consequences of exposure to excess stress, particularly during sensitive developmental windows, on the initiation and progression of many complex, common physical and mental disorders that confer a major global burden of disease are well established. The period of intrauterine life represents among the most sensitive of these windows, at which time the effects of stress may be transmitted inter-generationally from a mother to her as-yet-unborn child. As explicated by the concept of fetal or developmental programming of health and disease susceptibility, a growing body of evidence supports the notion that health and disease susceptibility is determined by the dynamic interplay between genetic makeup and environment, particularly during intrauterine and early postnatal life. Except in extreme cases, an adverse intrauterine exposure may not, per se, 'cause' disease, but, instead, may determine propensity for disease(s) in later life (by shaping phenotypic responsivity to endogenous and exogenous disease-related risk conditions). Accumulating evidence suggests that maternal psychological and social stress during pregnancy represents one such condition that may adversely affect the developing child, with important implications for a diverse range of physical and mental health outcomes. In this paper we review primarily our own contributions to the field of maternal stress during pregnancy and child mental and physical health-related outcomes. We present findings on stress-related maternal-placental-fetal endocrine and immune/inflammatory processes that may mediate the effects of various adverse conditions during pregnancy on the developing human embryo and fetus. We enunciate conceptual and methodological issues related to the assessment of stress during pregnancy and discuss potential mechanisms of intergenerational transmission of the effects of stress. Lastly, we describe on-going research and some future directions of our program.

The financial and economic choices societies make determine whether all individuals can enjoy the right to health. Crises quickly expose the values and interests that drive decisions towards health, as [...]

Background/objectives The growing interest of medical community about sarcopenia resulted in the production of several clinical practice guidelines (CPGs), with an unavoidable variability in terms of the overall quality of those publications. Our aim is to evaluate the quality of CPGs on sarcopenia using the AGREE II instrument. Subjects/methods We performed an online literature search for sarcopenia CPGs using different databases. Four independent reviewers evaluated the quality of CPGs using the AGREE II instrument. To classify the quality of each guideline, we defined specific thresholds of final score: high-quality if five or more domains scored >60%; average-quality if three or four domains scored >60%; low-quality if [less than or equal to]2 domains scored >60%. Results Our literature search yielded 315 articles, and after applying exclusion criteria our final analysis included 19 CPGs. The overall quality of CPGs was remarkable, as 13/19 (68.4%) were considered of 'high-quality' CPGs, with more than four domains reached a score higher than 60%. 'Scope and Purpose' and 'Clarity of Presentations' had the best domain results (78.4% and 73.8%, respectively), while the two domains with the lowest scores were 'Rigor of Development' and 'Applicability' (61.5% and 58.7%, respectively). Interobserver variability ranged between moderate (0.624) and fair (0.275). Conclusions Our study showed that the overall quality of CPGs about sarcopenia was noteworthy, as more than two-third of paper obtained a 'high-quality' score. The domain 'applicability' had the lowest score, suggesting that emphasis should be put on possible strategies for helping other doctors to implement guideline recommendations in clinical practice., Author(s): Carmelo Messina [sup.1] [sup.2], Jacopo Antonino Vitale [sup.1], Luigi Pedone [sup.1], Vito Chianca [sup.1], Ilaria Vicentin [sup.3], Domenico Albano [sup.1] [sup.4], Salvatore Gitto [sup.2], Luca Maria Sconfienza [sup.1] [sup.2] [...]

In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines [...]

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition. [ABSTRACT FROM AUTHOR]

Purpose: Greener on the Outside for Prisons (GOOP) is a therapeutic horticulture programme targeting the high levels of complex health and social care needs in prisons in England. The COVID-19 pandemic and resulting lockdowns led to unprecedented disruption in prisons in England. This paper examines the experiences of prisoners both during and post-lockdowns in four prisons, to understand the effects of participation in GOOP on health and wellbeing after the disruption of restrictions, and identify implications for developing this programme further. Design/methodology/approach: The paper is based on original qualitative data gathered from in-depth narrative-based interviews and focus groups with prisoners and staff in four English prisons. Audio data was transcribed and subject to a thematic analysis, drawing from a realist-informed lens. Findings: Thematic analysis revealed five key themes: reimagining the GOOP context; increasing empathy between participants; building sense of coherence; reconnecting with nature and a joined-up connection with provider services. The main arguments centre on horticulture in prisons remaining under-utilised as a means of promoting good health and wellbeing, although there is enthusiasm from staff to provide green spaces for the most vulnerable prisoners and develop a range of mechanisms to connect people in prison with nature. Originality/value: This paper focuses on new knowledge arising from an unprecedented situation in English prisons, from key stakeholders on the frontline of garden activities. Accounts demonstrate the extent of the health and wellbeing benefits of participation in such activities in this challenging environment, which has implications for practice for prisons more widely.

The COVID-19 pandemic has highlighted a major contradiction in contemporary urban planning. This is the relationship between the entrepreneurial modes of urban politics that shape contemporary planning practice and the interrelated dynamics of economic precarity and informalisation of low-income communities that exacerbate contagion, and therefore enable pandemic spread. Through a review of literature on the urban dimensions of COVID-19, and on the historical relationship between pandemics and urban planning, we develop a framework for analysing the debates that are emerging around planning approaches to addressing contemporary pandemic risk in low-income, informalised communities. We argue that post-pandemic debates about urban planning responses are likely to take shape around three discourses that have framed approaches to addressing informalised communities under entrepreneurial urbanism – a revanchist approach based on territorial stigmatisation of spaces of the poor, an incrementalist approach premised on addressing the most immediate drivers of contagion, and a reformist approach that seeks to address the structural conditions that have produced economic precarity and shelter informality. We further argue that any effort to assess the political outfall of the COVID-19 pandemic in a given context needs to take an inter-scalar approach, analysing how debates over informality take shape at the urban and national scales. [ABSTRACT FROM AUTHOR]