Search

Background: A voluntary National Healthy Food and Drink Policy (the Policy) was introduced in public hospitals in New Zealand in 2016. This study assessed the changes in implementation of the Policy and its impact on providing healthier food and drinks for staff and visitors in four district health boards between 1 and 5 years after the initial Policy introduction. Methods: Repeat, cross-sectional audits were undertaken at the same eight sites in four district health boards between April and August 2017 and again between January and September 2021. In 2017, there were 74 retail settings audited (and 99 in 2021), comprising 27 (34 in 2021) serviced food outlets and 47 (65 in 2021) vending machines. The Policy's traffic light criteria were used to classify 2652 items in 2017 and 3928 items in 2021. The primary outcome was alignment with the Policy guidance on the proportions of red, amber and green foods and drinks (≥ 55% green 'healthy' items and 0% red 'unhealthy' items). Results: The distribution of the classification of items as red, amber and green changed from 2017 to 2021 (p < 0.001) overall and in serviced food outlets (p < 0.001) and vending machines (p < 0.001). In 2021, green items were a higher proportion of available items (20.7%, n = 815) compared to 2017 (14.0%, n = 371), as were amber items (49.8%, n = 1957) compared to 2017 (29.2%, n = 775). Fewer items were classified as red in 2021 (29.4%, n = 1156) than in 2017 (56.8%, n = 1506). Mixed dishes were the most prevalent green items in both years, representing 11.4% (n = 446) of all items in 2021 and 5.5% (n = 145) in 2017. Fewer red packaged snacks (11.6%, n = 457 vs 22.5%, n = 598) and red cold drinks (5.2%, n = 205 vs 12.5%, n = 331) were available in 2021 compared to 2017. However, at either time, no organisation or setting met the criteria for alignment with the Policy (≥ 55% green items, 0% red items). Conclusions: Introduction of the Policy improved the relative healthiness of food and drinks available, but the proportion of red items remained high. More dedicated support is required to fully implement the Policy. [ABSTRACT FROM AUTHOR]

Background: Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments. Objectives: This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches. Data sources: Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020. Methods: Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments. Results: A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public–private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public–private partnership approaches. Conclusion: From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. Limitations: This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest. Future work: Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporting policy characteristics in evaluations, for supporting evaluations of real-world policies equitably across geographic regions, for capturing equity dimensions in policy evaluations, and for guideline development for quality and risk of bias of policy evaluations. Study registration: This study is registered as PROSPERO CRD42020170963. Funding: This award project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information. Plain language summary: Poor diet is a leading cause of death, globally, including in the United Kingdom. It also causes many types of illness and is one of the biggest drains on the United Kingdom National Health Service budget. Governments act in various ways to promote healthy diets by improving food environments: these are the physical and social surroundings that influence what and how much people eat. Some actions are regulated by government, for example, to control food production, marketing and promotions. Other actions are led by, or with, food businesses, making voluntary changes to the foods they produce, for example, by reducing salt content; this can be done by businesses alone or in partnership with government (referred to as 'public–private partnerships'). The six reviews of published research look at whether, and how, these actions to improve diets work, and whether they can provide value for money. Most regulations appear to be effective at supporting better diets. However, voluntary changes led by businesses had limited success. There were not many evaluations that assessed the effectiveness of public–private partnerships. Of those that did, partnerships with the food industry had limited effectiveness, resulting in largely unchanged outcomes. When looking at how these actions improve diets, we found that clear leadership, public support for the policy, the use of the best evidence and of local expertise helped with getting actions implemented. Factors that appear to make it harder to implement policy actions include a lack of evidence specific to the context, conflicting beliefs about what works, limited human or financial resources, lack of engagement by key people. Although the findings may help us to think about the ways forward to improve diets, more research is needed to understand whether actions to reduce diet-related ill health work, and provide value for money. Scientific summary: Background: Unhealthy diets are now estimated to be responsible for more deaths than any other risk globally, including in England. Dietary factors underpin many of the major chronic diseases currently faced by the population and are estimated both to be the largest contributor to overall disease and to have the highest impact on the NHS budget. It is in this context that the English government has implemented a range of population interventions to promote healthy diets by improving food environments. These range from public–private partnerships (PPPs) and voluntary programmes to regulatory policies, aiming to reduce ingredients like sodium and sugars in foods through interventions, such as reformulation, advertising reduction/bans and labelling. Governance arrangements in policy are broadly defined here as whether or not a policy intervention is voluntary, PPP or government led. Governance is a key overlooked mechanism in these interventions, and also in reviews of policy responses, and it is a fundamental part of the context, which is insufficiently discussed. It is essential to understand how governance arrangements in policy have an impact on effectiveness, by understanding what factors relating to interventions, providers, populations and settings affect the implementation of such population interventions to improve diet. Aims: This study, cost-effectiveness and policy processes of population interventions to improve diet with a focus on governance, and with a view to informing the most effective responses to unhealthy diets, formulating implications for diets in England. Research questions: How are regulatory interventions, voluntary approaches and PPPs to improve diet assumed to work in theory? What regulatory interventions, voluntary approaches and PPPs to improve diet, and reduce inequalities in diet improvement, have been evaluated? What factors relating to interventions, providers, populations and settings affect implementation of such population interventions to improve diet? Have such population interventions improved process, impact (intermediate and distal) and cost outcomes? Are there any reported unanticipated effects of such population interventions? What is the cost-effectiveness of such population interventions? How can the findings of the evidence review be translated into recommendations for improved interventions? Methods: This evidence synthesis consists of six individual evidence syntheses based on a common systematic literature search [see Figure A (Figure 2 in main text)]. The evidence syntheses consisted of a systematic evidence map of primary research, an overview of reviews on the effectiveness of regulatory, voluntary and PPP approaches, two systematic reviews on the effectiveness of PPPs, and voluntary approaches by private actors to fill gaps in the overview of review, as well as another systematic review on the cost-effectiveness of regulatory, voluntary and PPP approaches, and a qualitative evidence synthesis of the policy process. FIGURE A Relationships between review outputs. We ran searches of real-world evaluations of policies (defined as evaluations conducted while the policy was adopted or implemented, or as part of a state or national public consultation) aiming to improve diets by targeting the food environments, and published between 2010 and 2020, across 14 databases in November 2020. Records were uploaded to the Evidence for Policy and Practice Information-Reviewer Web for the removal of duplicates, screening, as well as part of the data extractions for the different reviews of the series. About 12% of titles and abstracts and 33% of full texts eligible for the overarching project were screened by at least two reviewers independently. The remainder were screened by one reviewer after reaching a 90% agreement rate, except for those excluded because they were not about real-world policy (all were checked by a second reviewer). Disagreements were discussed with a third reviewer. Depending on the review, data were either extracted by one reviewer and checked by another or extracted by two independent reviewers. The specific methods and results for each review are presented in their respective chapters. All papers included in one of the four effectiveness or cost-effectiveness reviews were independently critically appraised by two reviewers. The quality of evidence syntheses in the overview of reviews was appraised using the checklist by the Scottish Intercollegiate Guidelines Network. For the systematic reviews of PPP evaluations and of voluntary approaches, study quality was assessed using a modified version of the Newcastle–Ottawa Scale for cross-sectional studies. The review of voluntary approaches included 10 single cross-sectional studies and 5 repeat cross-sectional studies, all about food items, advertising material and other non-human 'participants'. The studies in the PPP review consisted of two single cross-sectional studies, nine repeat cross-sectional studies, one interrupted time series and five policy document analyses; five of which involved human participants. The quality of the cost-effectiveness analyses was assessed with Drummond's 10-criteria checklist version 2015. For the policy process review, their contributions were moderated on the basis of three criteria: relevance, rigour and richness. Data for the five reviews that used quantitative data were synthesised using narrative approaches since they were not suitable for statistical pooling techniques, such as meta-analysis. In the systematic reviews and overview of reviews about effectiveness, we also used an effect direction plot to represent the summary findings graphically. We had planned to use the Grading of Recommendations, Assessment, Development and Evaluation approach in the three reviews about effectiveness but did not for different reasons explained in the respective chapters. Data in the qualitative review about policy process were analysed using a thematic analysis. Results: Literature search and screening for the overarching project: A total of 38,209 records were retrieved from the databases; 27,887 remained after removing duplicates and had their title and abstract screened against the eligibility criteria. Of these, 1859 met the criteria and had their full text screened, resulting in 500 records included. In parallel, 72 additional full texts were retrieved by screening websites and reference lists. Of these, 33 met the eligibility criteria, contributing to a total of 533 publications: 483 reporting on primary research evaluations and 50 on evidence syntheses. All 483 primary studies were included in the evidence map. All evidence syntheses were screened for inclusion in the overview of reviews. Of the 483 publications on primary research, all those assessing the effectiveness of PPPs (n = 18) were considered for the systematic review on the latter, and all those assessing the cost-effectiveness of policies (n = 4) were included in the systematic review on the latter. For the systematic review of the effectiveness of voluntary approaches by private actors, given the high number of potential primary studies (n = 186), only those comparing outcomes between participants and non-participants (NP) in the policies and that were published in journals in the most recent 4 years (2017–20) were considered (n = 15). Lastly, the review of policy process included both primary studies and evidence syntheses of both qualitative and mixed-methods design that assessed factors influencing policy development or implementation. Again, due to their high number (n = 87), only those published in 2019 and 2020 were considered (n = 33). Systematic evidence map: We found imbalances across the 483 included studies, suggesting that policy evaluations are conducted and published inequitably across the world both in terms of quantity and quality. Though 70 countries were represented overall, 81% of publications focused on only 12 countries (USA, UK, Australia, Canada, Mexico, Brazil, Chile, France, Spain, Denmark, New Zealand and South Africa), and 30% included the USA. Few evaluations were found about Africa, Central and South Asia, and the Middle East. Inequities were also detected in the study designs, with the most quantitative robust methods mainly documenting the abovementioned 12 dominant countries. Few publications reported on PPPs (n = 31), and only one assessed the development of voluntary policies led by the public and private sectors each. Using a generous interpretation of the PROGRESS-Plus equity dimensions, we found that not only 50% of publications assessing policy effectiveness did not compare outcomes by any equity domain, but that the proportion of those doing so has decreased over time. Age was the most frequently assessed dimension, while occupation, religion and culture, social capital and disability were barely considered. Overview of reviews: An overview of reviews of 11 systematic reviews was conducted to review the effectiveness of policies by governance approach. Three additional systematic reviews were considered for addressing questions about equity. The 11 systematic reviews primarily assessed regulatory policies (especially taxation) and a few voluntary approaches by the public sector, food retailers and restaurant chains. No PPP was included, and few regulatory and voluntary initiatives could be directly compared. Overall, the results suggest that, except for salt-related taxes, most regulatory approaches designed to improve health, consumer behaviour (e.g. food intake, purchases), and food environment outcomes were effective. These mainly consisted of trans-fat bans, taxes on sugar-sweetened beverages (SSBs) and non-essential foods (except for salt intake), and front-of-pack labelling (FOPL). Effects for voluntary approaches by public and private actors were also generally positive for salt and trans-fat reformulation (but regulatory trans-fat bans were more promising), labelling on products and supermarket shelves, and changing defaults in children's menus in restaurants, although some of them relied on single cross-sectional studies in the USA. Results for voluntary menu labelling and multicomponent commitments by large retail chains were mixed. The findings by PROGRESS-Plus categories indicate a lack of reporting of outcomes in systematic reviews for population groups that are prone to health inequalities: overall, evidence on equity is patchy, incomplete, mainly inconsistent and largely relies on single studies (although some evaluations had large samples) rather than aggregated bodies of evidence. Review of PPPs: This systematic review aimed to complement the overview of reviews by assessing the effectiveness of PPPs targeting the food environment since the overview of reviews did not include data on the latter. We reviewed 17 studies evaluating seven PPPs to improve population diets and food environments. Five involved humans or data about human behaviours (sales and purchases) using cross-sectional design (single or repeat) or intermittent time series, seven assessed food products or labelling practices (all single and repeat cross-sectional), and five examined policy content and progress using documents. Overall, studies found that partnerships with the food industry to improve diets via reformulation or other changes to the environment have limited effect at achieving this aim. Review of voluntary approaches by private actors: This systematic review aimed to complement the overview of reviews by assessing the effectiveness of voluntary approaches by private actors between participants and NPs. Sixteen studies evaluating nine voluntary approaches were included. Policies were mainly about advertising and marketing control, reformulation, and the retail and catering sectors. All were cross-sectional: nine single and seven post–post. All measured effects or associations on the food environment, such as product or advertising characteristics using cross-sectional designs. None evaluated humans. When comparing the commitment's participants to NPs, the direction of effect or of association for most outcomes was either inconclusive or worse for participants. There is no evidence to suggest that policies designed as voluntary approaches led by commercial actors are effective at reducing advertising and other promotion of unhealthy products to children, improving the nutritional composition of food and beverages, encouraging calorie menu labelling in chain restaurants, or reducing marketing targeting children on food packages. Review of cost-effectiveness: Four studies of the cost-effectiveness of real-world policies to promote healthy diets were identified. Two studies suggested positive impacts for the fiscal measure of the Mexican SSB tax, and one for the voluntary government-led Health Star Rating FOPL intervention in Australia. The fourth one showed a lack of effectiveness and cost–benefit for the PPP intervention to reduce salt consumption in England as part of the Public Health Responsibility Deal. There is a pressing need to build on the extensive literature on the effectiveness of interventions with high-quality evidence on cost-effectiveness, to support meaningful action to tackle the scourge of diet-related ill health. Review of the policy process: We included 33 papers studying the policy process (factors shaping from design to implementation) of regulatory, voluntary and PPP approaches. The studies on regulatory policy processes highlighted key enabling factors, including clear leadership; policy entrepreneurs, champions and strategists; policy supporters' coalitions; the active use of best evidence and local expertise; institutional and financial capacity; and harnessing focusing events. They also pointed to impeding factors, including practical considerations often around policy implementation and the generation of context-specific evidence; differing ideological positions; capacity constraints; the role of evidence; lack of key stakeholder engagement, and the deployment by the food and beverage industry of frames and framing strategies to ultimately oppose a policy process. This review also advanced the understanding of phenomena and mechanisms underpinning the policy process for improving diet, in particular how large food and beverage industries have become legitimate actors in policy interventions to improve diets. Conclusion: To our knowledge, this is the first review of real-world evaluations of policies to improve food environments. From the available evidence reviewed, regulatory appears to be the most effective approach, and voluntary industry approaches and PPPs have limited effectiveness. The geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations should be redressed. Food policy should be designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. The role and interests of policy stakeholders, and the accepted legitimacy of corporate actors in food policy, should be critically interrogated with healthy diets for the population as the first priority. Implications for future work: Implications for public health policy include prioritising structural changes through regulation as they are found to be the most effective approach to improve the food environment; expanding geographical representation of the evidence, capturing dimensions of health equity as policy outcomes; taking a systems approach across policies to improve food environments. Implications for future policy evaluations include developing guidance for appraising risk of bias and quality of non-clinical studies and for reporting policy characteristics in evaluations. Implications for future research and research funding include conducting studies on the role of corporate actors in food policy, conducting evaluations of real-world policies equitably across geographic regions, capturing equity dimensions in policy evaluations, and developing guidelines for quality and risk of bias of policy evaluations. Study registration: This study is registered as PROSPERO CRD42020170963. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information. [ABSTRACT FROM AUTHOR]

Introduction: Euthanasia, which allows individuals with an incurable disease to end their lives in an honourable way, is a long-debated practice. It is related to various issues such as culture, philosophy, religion, ethics, public value, and efficient use of health resources. While some advocate for the right of individuals to choose euthanasia, others criticize it on ethical, legal, and religious grounds. Methods: In this study bibliometric analysis was used and the data were obtained from the Web of Science Core Collection database on July 26, 2024. Only English publications and articles were included using keywords such as "euthanasia," "end-of-life decisions," "medical assistance in dying," "physician-assisted death," and "physician-assisted suicide" without time restrictions. VOSviewer software was used to create network and density graphs, and SciMAT software was used to create strategic diagrams.Results: A total of 2,230 studies published between 1980 and 2024 were analyzed. The author with the most publications is Deliens, L, with 86 studies. The majority of studies were published in the USA, Netherlands, and Canada (692, 336, 225 respectively). The most frequently used keywords are euthanasia, palliative care, and ethics. The highest number of publications (149) was in the year 2021. In the strategic diagram for the first period (between 1980 and 2001), the themes of care and ethics were prominent, while for the second period (between 2002 and 2024), the clusters of nurse and shared decision-making were notable. Conclusion: After its legalization in the Netherlands, euthanasia has been accepted and implemented in some countries over the years, with variations in scope. Some countries, like the Netherlands and Belgium, also accept health problems related to old age and mental illness as euthanasia requests. The discussion around euthanasia often revolves around the principles of medical ethics, including autonomy, beneficence, non-maleficence, and justice. Studies have focused on the role of physicians and nurses in the process, as well as end-of-life decision-making by patients. Recently, Canada defined the role of nurses in the euthanasia process, marking a significant development.

Abstract Background A voluntary National Healthy Food and Drink Policy (the Policy) was introduced in public hospitals in New Zealand in 2016. This study assessed the changes in implementation of the Policy and its impact on providing healthier food and drinks for staff and visitors in four district health boards between 1 and 5 years after the initial Policy introduction. Methods Repeat, cross-sectional audits were undertaken at the same eight sites in four district health boards between April and August 2017 and again between January and September 2021. In 2017, there were 74 retail settings audited (and 99 in 2021), comprising 27 (34 in 2021) serviced food outlets and 47 (65 in 2021) vending machines. The Policy’s traffic light criteria were used to classify 2652 items in 2017 and 3928 items in 2021. The primary outcome was alignment with the Policy guidance on the proportions of red, amber and green foods and drinks (≥ 55% green ‘healthy’ items and 0% red ‘unhealthy’ items). Results The distribution of the classification of items as red, amber and green changed from 2017 to 2021 (p

Background: People who interact with healthcare services have an ethical and legal right to control their own lives, to make informed decisions, and to consent to what happens to them. For consent to be considered ethically and legally valid, three key criteria must be met: consent must be given voluntarily; people must be sufficiently informed of all options; and people should have capacity to make the decision to give or withhold their consent. Aim: This study set out to explore, through the use of surveys, the perspectives of patients and public in relation to consent. Method: Surveys were developed for patients and the public and administered paper based (patients) and through social media (public). Results: One hundred and forty surveys were posted to patients, with a 38% response rate; 104 responses were received from the public. Ninety-six percent of patients were satisfied that the decision they made was informed; 100% felt they had made a voluntary decision; 98% felt the clinician seemed knowledgeable about the procedure. What matters most to the public were being informed about the risks associated with the proposed procedure and being assured that whatever choice they make they will receive the best care possible. Conclusions: The results highlight interesting similarities and differences in relation to consent between members of the public thinking about a possible treatment, surgery, or procedure and those patients who have actually been through the process in the past 12 months. Recommendations have been developed on the basis of these findings to co-design improvements in consent practices. [ABSTRACT FROM AUTHOR]

Background Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments. Objectives This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches. Data sources Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020. Methods Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments. Results A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public–private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public–private partnership approaches. Conclusion From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. Limitations This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest. Future work Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporting policy characteristics in evaluations, for supporting evaluations of real-world policies equitably across geographic regions, for capturing equity dimensions in policy evaluations, and for guideline development for quality and risk of bias of policy evaluations. Study registration This study is registered as PROSPERO CRD42020170963. Funding This award project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information. Plain language summary Poor diet is a leading cause of death, globally, including in the United Kingdom. It also causes many types of illness and is one of the biggest drains on the United Kingdom National Health Service budget. Governments act in various ways to promote healthy diets by improving food environments: these are the physical and social surroundings that influence what and how much people eat. Some actions are regulated by government, for example, to control food production, marketing and promotions. Other actions are led by, or with, food businesses, making voluntary changes to the foods they produce, for example, by reducing salt content; this can be done by businesses alone or in partnership with government (referred to as ‘public–private partnerships’). The six reviews of published research look at whether, and how, these actions to improve diets work, and whether they can provide value for money. Most regulations appear to be effective at supporting better diets. However, voluntary changes led by businesses had limited success. There were not many evaluations that assessed the effectiveness of public–private partnerships. Of those that did, partnerships with the food industry had limited effectiveness, resulting in largely unchanged outcomes. When looking at how these actions improve diets, we found that clear leadership, public support for the policy, the use of the best evidence and of local expertise helped with getting actions implemented. Factors that appear to make it harder to implement policy actions include a lack of evidence specific to the context, conflicting beliefs about what works, limited human or financial resources, lack of engagement by key people. Although the findings may help us to think about the ways forward to improve diets, more research is needed to understand whether actions to reduce diet-related ill health work, and provide value for money. Scientific summary Background Unhealthy diets are now estimated to be responsible for more deaths than any other risk globally, including in England. Dietary factors underpin many of the major chronic diseases currently faced by the population and are estimated both to be the largest contributor to overall disease and to have the highest impact on the NHS budget. It is in this context that the English government has implemented a range of population interventions to promote healthy diets by improving food environments. These range from public–private partnerships (PPPs) and voluntary programmes to regulatory policies, aiming to reduce ingredients like sodium and sugars in foods through interventions, such as reformulation, advertising reduction/bans and labelling. Governance arrangements in policy are broadly defined here as whether or not a policy intervention is voluntary, PPP or government led. Governance is a key overlooked mechanism in these interventions, and also in reviews of policy responses, and it is a fundamental part of the context, which is insufficiently discussed. It is essential to understand how governance arrangements in policy have an impact on effectiveness, by understanding what factors relating to interventions, providers, populations and settings affect the implementation of such population interventions to improve diet. Aims This study, cost-effectiveness and policy processes of population interventions to improve diet with a focus on governance, and with a view to informing the most effective responses to unhealthy diets, formulating implications for diets in England. Research questions How are regulatory interventions, voluntary approaches and PPPs to improve diet assumed to work in theory? What regulatory interventions, voluntary approaches and PPPs to improve diet, and reduce inequalities in diet improvement, have been evaluated? What factors relating to interventions, providers, populations and settings affect implementation of such population interventions to improve diet? Have such population interventions improved process, impact (intermediate and distal) and cost outcomes? Are there any reported unanticipated effects of such population interventions? What is the cost-effectiveness of such population interventions? How can the findings of the evidence review be translated into recommendations for improved interventions? Methods This evidence synthesis consists of six individual evidence syntheses based on a common systematic literature search [see Figure A (Figure 2 in main text)]. The evidence syntheses consisted of a systematic evidence map of primary research, an overview of reviews on the effectiveness of regulatory, voluntary and PPP approaches, two systematic reviews on the effectiveness of PPPs, and voluntary approaches by private actors to fill gaps in the overview of review, as well as another systematic review on the cost-effectiveness of regulatory, voluntary and PPP approaches, and a qualitative evidence synthesis of the policy process. FIGURE ARelationships between review outputs. We ran searches of real-world evaluations of policies (defined as evaluations conducted while the policy was adopted or implemented, or as part of a state or national public consultation) aiming to improve diets by targeting the food environments, and published between 2010 and 2020, across 14 databases in November 2020. Records were uploaded to the Evidence for Policy and Practice Information-Reviewer Web for the removal of duplicates, screening, as well as part of the data extractions for the different reviews of the series. About 12% of titles and abstracts and 33% of full texts eligible for the overarching project were screened by at least two reviewers independently. The remainder were screened by one reviewer after reaching a 90% agreement rate, except for those excluded because they were not about real-world policy (all were checked by a second reviewer). Disagreements were discussed with a third reviewer. Depending on the review, data were either extracted by one reviewer and checked by another or extracted by two independent reviewers. The specific methods and results for each review are presented in their respective chapters. All papers included in one of the four effectiveness or cost-effectiveness reviews were independently critically appraised by two reviewers. The quality of evidence syntheses in the overview of reviews was appraised using the checklist by the Scottish Intercollegiate Guidelines Network. For the systematic reviews of PPP evaluations and of voluntary approaches, study quality was assessed using a modified version of the Newcastle–Ottawa Scale for cross-sectional studies. The review of voluntary approaches included 10 single cross-sectional studies and 5 repeat cross-sectional studies, all about food items, advertising material and other non-human ‘participants’. The studies in the PPP review consisted of two single cross-sectional studies, nine repeat cross-sectional studies, one interrupted time series and five policy document analyses; five of which involved human participants. The quality of the cost-effectiveness analyses was assessed with Drummond’s 10-criteria checklist version 2015. For the policy process review, their contributions were moderated on the basis of three criteria: relevance, rigour and richness. Data for the five reviews that used quantitative data were synthesised using narrative approaches since they were not suitable for statistical pooling techniques, such as meta-analysis. In the systematic reviews and overview of reviews about effectiveness, we also used an effect direction plot to represent the summary findings graphically. We had planned to use the Grading of Recommendations, Assessment, Development and Evaluation approach in the three reviews about effectiveness but did not for different reasons explained in the respective chapters. Data in the qualitative review about policy process were analysed using a thematic analysis. Results Literature search and screening for the overarching project: A total of 38,209 records were retrieved from the databases; 27,887 remained after removing duplicates and had their title and abstract screened against the eligibility criteria. Of these, 1859 met the criteria and had their full text screened, resulting in 500 records included. In parallel, 72 additional full texts were retrieved by screening websites and reference lists. Of these, 33 met the eligibility criteria, contributing to a total of 533 publications: 483 reporting on primary research evaluations and 50 on evidence syntheses. All 483 primary studies were included in the evidence map. All evidence syntheses were screened for inclusion in the overview of reviews. Of the 483 publications on primary research, all those assessing the effectiveness of PPPs (n = 18) were considered for the systematic review on the latter, and all those assessing the cost-effectiveness of policies (n = 4) were included in the systematic review on the latter. For the systematic review of the effectiveness of voluntary approaches by private actors, given the high number of potential primary studies (n = 186), only those comparing outcomes between participants and non-participants (NP) in the policies and that were published in journals in the most recent 4 years (2017–20) were considered (n = 15). Lastly, the review of policy process included both primary studies and evidence syntheses of both qualitative and mixed-methods design that assessed factors influencing policy development or implementation. Again, due to their high number (n = 87), only those published in 2019 and 2020 were considered (n = 33). Systematic evidence map: We found imbalances across the 483 included studies, suggesting that policy evaluations are conducted and published inequitably across the world both in terms of quantity and quality. Though 70 countries were represented overall, 81% of publications focused on only 12 countries (USA, UK, Australia, Canada, Mexico, Brazil, Chile, France, Spain, Denmark, New Zealand and South Africa), and 30% included the USA. Few evaluations were found about Africa, Central and South Asia, and the Middle East. Inequities were also detected in the study designs, with the most quantitative robust methods mainly documenting the abovementioned 12 dominant countries. Few publications reported on PPPs (n = 31), and only one assessed the development of voluntary policies led by the public and private sectors each. Using a generous interpretation of the PROGRESS-Plus equity dimensions, we found that not only 50% of publications assessing policy effectiveness did not compare outcomes by any equity domain, but that the proportion of those doing so has decreased over time. Age was the most frequently assessed dimension, while occupation, religion and culture, social capital and disability were barely considered. Overview of reviews: An overview of reviews of 11 systematic reviews was conducted to review the effectiveness of policies by governance approach. Three additional systematic reviews were considered for addressing questions about equity. The 11 systematic reviews primarily assessed regulatory policies (especially taxation) and a few voluntary approaches by the public sector, food retailers and restaurant chains. No PPP was included, and few regulatory and voluntary initiatives could be directly compared. Overall, the results suggest that, except for salt-related taxes, most regulatory approaches designed to improve health, consumer behaviour (e.g. food intake, purchases), and food environment outcomes were effective. These mainly consisted of trans-fat bans, taxes on sugar-sweetened beverages (SSBs) and non-essential foods (except for salt intake), and front-of-pack labelling (FOPL). Effects for voluntary approaches by public and private actors were also generally positive for salt and trans-fat reformulation (but regulatory trans-fat bans were more promising), labelling on products and supermarket shelves, and changing defaults in children’s menus in restaurants, although some of them relied on single cross-sectional studies in the USA. Results for voluntary menu labelling and multicomponent commitments by large retail chains were mixed. The findings by PROGRESS-Plus categories indicate a lack of reporting of outcomes in systematic reviews for population groups that are prone to health inequalities: overall, evidence on equity is patchy, incomplete, mainly inconsistent and largely relies on single studies (although some evaluations had large samples) rather than aggregated bodies of evidence. Review of PPPs: This systematic review aimed to complement the overview of reviews by assessing the effectiveness of PPPs targeting the food environment since the overview of reviews did not include data on the latter. We reviewed 17 studies evaluating seven PPPs to improve population diets and food environments. Five involved humans or data about human behaviours (sales and purchases) using cross-sectional design (single or repeat) or intermittent time series, seven assessed food products or labelling practices (all single and repeat cross-sectional), and five examined policy content and progress using documents. Overall, studies found that partnerships with the food industry to improve diets via reformulation or other changes to the environment have limited effect at achieving this aim. Review of voluntary approaches by private actors: This systematic review aimed to complement the overview of reviews by assessing the effectiveness of voluntary approaches by private actors between participants and NPs. Sixteen studies evaluating nine voluntary approaches were included. Policies were mainly about advertising and marketing control, reformulation, and the retail and catering sectors. All were cross-sectional: nine single and seven post–post. All measured effects or associations on the food environment, such as product or advertising characteristics using cross-sectional designs. None evaluated humans. When comparing the commitment’s participants to NPs, the direction of effect or of association for most outcomes was either inconclusive or worse for participants. There is no evidence to suggest that policies designed as voluntary approaches led by commercial actors are effective at reducing advertising and other promotion of unhealthy products to children, improving the nutritional composition of food and beverages, encouraging calorie menu labelling in chain restaurants, or reducing marketing targeting children on food packages. Review of cost-effectiveness: Four studies of the cost-effectiveness of real-world policies to promote healthy diets were identified. Two studies suggested positive impacts for the fiscal measure of the Mexican SSB tax, and one for the voluntary government-led Health Star Rating FOPL intervention in Australia. The fourth one showed a lack of effectiveness and cost–benefit for the PPP intervention to reduce salt consumption in England as part of the Public Health Responsibility Deal. There is a pressing need to build on the extensive literature on the effectiveness of interventions with high-quality evidence on cost-effectiveness, to support meaningful action to tackle the scourge of diet-related ill health. Review of the policy process: We included 33 papers studying the policy process (factors shaping from design to implementation) of regulatory, voluntary and PPP approaches. The studies on regulatory policy processes highlighted key enabling factors, including clear leadership; policy entrepreneurs, champions and strategists; policy supporters’ coalitions; the active use of best evidence and local expertise; institutional and financial capacity; and harnessing focusing events. They also pointed to impeding factors, including practical considerations often around policy implementation and the generation of context-specific evidence; differing ideological positions; capacity constraints; the role of evidence; lack of key stakeholder engagement, and the deployment by the food and beverage industry of frames and framing strategies to ultimately oppose a policy process. This review also advanced the understanding of phenomena and mechanisms underpinning the policy process for improving diet, in particular how large food and beverage industries have become legitimate actors in policy interventions to improve diets. Conclusion To our knowledge, this is the first review of real-world evaluations of policies to improve food environments. From the available evidence reviewed, regulatory appears to be the most effective approach, and voluntary industry approaches and PPPs have limited effectiveness. The geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations should be redressed. Food policy should be designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. The role and interests of policy stakeholders, and the accepted legitimacy of corporate actors in food policy, should be critically interrogated with healthy diets for the population as the first priority. Implications for future work Implications for public health policy include prioritising structural changes through regulation as they are found to be the most effective approach to improve the food environment; expanding geographical representation of the evidence, capturing dimensions of health equity as policy outcomes; taking a systems approach across policies to improve food environments. Implications for future policy evaluations include developing guidance for appraising risk of bias and quality of non-clinical studies and for reporting policy characteristics in evaluations. Implications for future research and research funding include conducting studies on the role of corporate actors in food policy, conducting evaluations of real-world policies equitably across geographic regions, capturing equity dimensions in policy evaluations, and developing guidelines for quality and risk of bias of policy evaluations. Study registration This study is registered as PROSPERO CRD42020170963. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607) and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.

BACKGROUND: Blood donation is an essential global need far outweighs the available supply, rendering it a scarce and valuable resource. Within India, blood transfusion services hold significant importance and constitute a crucial aspect of the national health-care framework. Voluntary Non-Remunerated Blood Donation (VNRBD) is deemed the safest among the various ways of donating blood. The student population of educational institutions across the country, particularly those who are young and physically fit, represents one of the most promising sources of blood donations. The aim of the study was to evaluate the knowledge, attitudes, and donation practices of medical college students and motivate them to embrace voluntary blood donation as a regular habit. MATERIAL AND METHODS: The Department of Allied Health Science at Dr MGR Educational and Research Institute in Chennai, Tamil Nadu, India, conducted a questionnaire survey from March 2023 to October 2023. Two thousand and two hundred forty students were invited to participate, with 2331 ultimately willing to partake. The gathered data underwent analysis using the SPSS Statistics software, version 20, with a significance level fixed at a P = 5%. RESULTS: The study included 2331 participants, comprising 840 males (36%) and 1491 females (64%). The age range of the participants was between 17 and 25 years, with a mean age of 18.9 ± 1.3 years. Out of 2331 participants, the majority (66.7%) showed sufficient knowledge with 9 or more correct answers, while the rest (33.2%) showed below-average knowledge. CONCLUSION: The Tamil Nadu Health Professions Colleges possess the potential to make a noteworthy impact on the promotion of blood donation. According to a recent survey, students express a keen interest in donating blood if a camp is organized on the campus. By organizing awareness campaigns and conducting informative sessions, the colleges can inspire and motivate more students to donate blood, thereby playing a vital role in saving lives.

Abstract Background Older adults living in nursing home organizations are eager to get voluntary help, however, their past experiences with voluntary services are not satisfactory enough. To better carry out voluntary services and improve the effectiveness of services, it is necessary to have a deeper understanding of the experiences and needs of older adults for voluntary services. Methods The purposive sampling method was used to select 14 older adults from two nursing home organizations in Hangzhou and conduct semi-structured interviews, Collaizzi’s seven-step method was used to analyze the data. Results Older adults in nursing home organizations have both beneficial experiences and unpleasant service experiences in the process of receiving voluntary services; Beneficial experiences include solving problems meeting needs and feeling warmth and care, while unpleasant service experiences include the formality that makes it difficult to benefit truly, lack of organization, regularity, sustainability, and the mismatch between service provision and actual demands. The needs for voluntary services mainly focuses on emotional comfort, Cultural and recreational, and knowledge acquisition. Conclusion Older adults in nursing home organizations have varied voluntary experiences, and their voluntary service needs are diversified. Voluntary service needs of older adults should be accurately assessed, and voluntary service activities should be focused upon.

Background: Older adults living in nursing home organizations are eager to get voluntary help, however, their past experiences with voluntary services are not satisfactory enough. To better carry out voluntary services and improve the effectiveness of services, it is necessary to have a deeper understanding of the experiences and needs of older adults for voluntary services. Methods: The purposive sampling method was used to select 14 older adults from two nursing home organizations in Hangzhou and conduct semi-structured interviews, Collaizzi's seven-step method was used to analyze the data. Results: Older adults in nursing home organizations have both beneficial experiences and unpleasant service experiences in the process of receiving voluntary services; Beneficial experiences include solving problems meeting needs and feeling warmth and care, while unpleasant service experiences include the formality that makes it difficult to benefit truly, lack of organization, regularity, sustainability, and the mismatch between service provision and actual demands. The needs for voluntary services mainly focuses on emotional comfort, Cultural and recreational, and knowledge acquisition. Conclusion: Older adults in nursing home organizations have varied voluntary experiences, and their voluntary service needs are diversified. Voluntary service needs of older adults should be accurately assessed, and voluntary service activities should be focused upon. [ABSTRACT FROM AUTHOR]

With the expansion of competition among organisations, the key factor in their lives is organisational innovation, the proper management of which requires a strategic perspective. In addition, the growth of innovation in the organisation depends on the tacit knowledge of the experts of that organisation. This research empirically investigates the relationship between knowledge sharing and its role in organisational innovation in the Civil Aviation Organization (CAO). In this study, 12 main hypotheses related to knowledge sharing and organisational innovation in the questionnaires were considered and data were collected from 295 managers of CAO, and LISREL was used to validate data and examine the hypothesised relationships. The model presented in this study; Personality, expected results, mental norms, perceived behavioural control, structural characteristics, commitment, trust, organisational culture, organisational environment, information, and communication technology were considered as exogenous variables that will directly affect the voluntary sharing of knowledge and demand-based knowledge. Findings showed that personality, subjective norms, structural characteristics, commitment, trust, organisational culture, organisational environment, information, and communication technology positively influenced voluntary knowledge sharing. Moreover, personality, expected results, perceived behavioural control, structural characteristics, trust, organisational culture, information, and communication technology positively influence demand-based knowledge sharing. Finally, findings showed that voluntary knowledge sharing has a stronger influence on organisational innovation and is more important than demand-based knowledge sharing. The present study highlighted that voluntary and demand-based knowledge sharing significantly and positively influences organisational innovation, and knowledge sharing and organisational innovation appear to be key drivers for gaining competitive advantage. [ABSTRACT FROM AUTHOR]

Considerable debate has focused on whether pre-commitment to a money and/or time limit and adherence to that limit should be mandatory or voluntary. A unique feature of Ontario Lottery and Gaming's player management system (My PlaySmart) provides a middle ground by allowing players to select whether they are permitted to continue playing once their limit is reached (the soft lock option) or whether continued play is not permitted (the hard lock option). We assessed the relative responsible gambling utility of these two options using player account data by comparing play data before and after enrollment. Players who chose the hard lock option decreased their average coin-in, loss per visit, and minutes played per visit. In contrast, soft lock enrollees significantly reduced their coin in (but not to the same extent as those who chose the hard lock option) and increased their visits from pre-enrollment to post-enrollment. The play data for hard and soft lock enrollees was also benchmarked against play of non-enrollees. Results suggest that the soft lock option is relatively ineffective at limiting play, thus adding important knowledge to the ongoing debate about pre-commitment schemes that aim to advance responsible gambling to minimize gambling-related harms. [ABSTRACT FROM AUTHOR]

There has been a lot of discussion on the shift from voluntary to mandatory corporate social responsibility (CSR) and its impacts in different countries across the globe. India is unique in this context as the reporting and expenditure of a certain amount under CSR has been mandated for companies. This article analyzes the changes and responses of Indian businesses post‐2014, when new CSR rules were enacted. The key objectives of this study are to assess the level of awareness and compliance, thematic and geographical focus areas for CSR projects, and drivers and barriers to the adoption of mandatory CSR. We performed a secondary analysis of the data from 60 companies, followed by extensive primary research through in‐person interviews and offline questionnaire responses with 100 key CSR professionals from different companies in India. A key finding from the study is that the awareness of CSR policy and the pool of CSR funds has increased. The policy mandates have been a good driver in improving transparency and reporting quality. However, there is a predominant focus on four thematic areas of education, healthcare, hunger, and poverty alleviation despite the government's efforts to expand in other areas. The geographical spread of expenditure is limited to a few key industrial states in India, limiting CSR's contribution towards national development. The study adds to the CSR literature associated with institutional and stakeholder theories by looking at the response of legally bound organizations toward society and the environment. Finally, the study provides valuable information for governments and regulatory authorities considering the mandatory implementation of CSR expenditure across the globe. [ABSTRACT FROM AUTHOR]

Even with the advantages, carbon taxes are still one of the least effective instruments for climate policy. The purpose of this study is to examine the connection between non-mandatory carbon disclosures specifically in developing countries. This research sample is a green ranking company, and 108 data observations were carried out on 36 selected companies in the year between the Covid-19 out-break 2019-2021. Multiple linear regression testing is carried out to test the alleged hypothesis, by first testing the assumptions. The statistical results support the hypothesis that only legitimacy pressure (media exposure) increases corporate motivation to disclose carbon emissions. This study is novel because, while earlier research has mostly focused on the external factors that drive voluntary disclosure, our findings provide new perspectives and imply that media pressures offer a supplemental explanation for the variation in corporate carbon disclosure propensity that has been largely ignored in the body of existing literature. This suggests for the need to call for holistic mandatory disclosure requirements that encourage companies to participate in climate policy.

The most important Public policy debates today surround the use of euthanasia to end the sufferings of terminally ill patients. This debate revolves around one of the most important aspects which is, the right to a dignified life, and it is the central concern for one and all. This research paper is an attempt to analyze the legal issues involved in legalizing euthanasia and the consequences thereof. The research paper will also focus on the role played by the judiciary in India related to euthanasia. [ABSTRACT FROM AUTHOR]

Aristotle's account of voluntariness (to hekousion) lacks a sufficiently precise positive definition of 'voluntary'. This is a problem: in Aristotle's ethics, voluntariness is an important and unifying joint between psychological (character) and practical matters (action). I contend that Aristotle implicitly defines voluntariness as positive causal relation to an agent's desire, where one's character is the state of one's faculty of desire. Since desires always have particular ends (final causes), a voluntary action is one which originates in the agent's desire for that action's end. Using this interpretation, I answer questions about 'mixed' actions, culpable ignorance, and non-voluntariness. Without this interpretation, these questions cannot be systematically answered. [ABSTRACT FROM AUTHOR]

This report, signed by >170 scholars, clinicians, and researchers in palliative care and related fields, refutes the claims made by the previously published Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability. That report attempted to argue that structural vulnerability was not a concern in the provision of assisted dying (AD) by a selective review of evidence in medical literature and population studies. It claimed that palliative care has its own safety concerns, and that "misuse" of palliative care led to reports of wrongful death. We and our signatories do not feel that the conclusions reached are supported by the evidence provided in the contested report. The latter concluded that the logical policy response would be to address the root causes of structural vulnerability rather than restrict access to AD. Our report, endorsed by an international community of palliative care professionals, believes that public policy should aim to reduce structural vulnerability and, at the same time, respond to evidence-based cautions about AD given the potential harm. [ABSTRACT FROM AUTHOR]

Purpose: Over the past decade, digital labor platforms (DLP) have emerged as a new trend and are major components of the platform economy. Crowdsourcing is being used in an innovative way to allow firms to outsource tasks to individuals with access to DLP. Apart from paid crowdsourcing, unpaid crowdsourcing has also emerged, where crowdsourced volunteers are recruited to contribute to crowdsourcing tasks available on the platform. Integrating perspectives from the public services motivation, uses and gratification theory and self-determination theory, this paper investigates the motives and underlying needs behind participation in the crowdsourcing of translation tasks. Design/methodology/approach: Interviews were conducted with 21 volunteer crowdsourced volunteers from a voluntary global crowdsourcing community to understand the factors driving them to spend time and effort contributing to the community. Content analysis methods were utilized to analyze the text data. Findings: The results indicated that the autonomy, competence and relatedness needs were the underlying needs of the crowdsourced volunteers. Furthermore, we found diverse motives consisting of both intrinsic and extrinsic motivations driving users to contribute voluntarily. Originality: While prior research efforts have clarified many issues related to participation in DLP, the reasons behind volunteers' participation in DLP are still unexplored. The findings of the present study contribute to a better understanding of the motives underlying volunteers’ participation in the crowdsourcing tasks on DLP.

OBJECTIVES: This study aimed to estimate the average individual effect of the company-level Norwegian Agreement on a More Inclusive Working Life (IA Agreement) on individuals’ (i) sustained return to work after a sickness absence (SA) episode, and (ii) recurrent SA. METHODS: Using register data, 79 253 men and 94 914 women born in Norway 1967–1976 were followed for one year between 2005 and 2010 after returning to work from an SA episode (>16 days). Weighted Cox proportional hazard models analysed time to first exit from work by companies’ IA status (IA/non-IA). Weighted cumulative incidence differences between IA and non-IA groups with 95% bootstrapped confidence intervals (CI) were calculated for the competing events of full SA, graded (

Background. The purpose of this study was to identify the level of utilization of tubal ligation among women attending the MCH clinic at Ruhoko Health Centre IV Ibanda District and the factors that may influence the utilization of such contraceptive methods. Methodology: I carried out a cross-sectional study and I used a pretested questionnaire to collect data from 52 respondents. Collected data was entered into IBM SPSS 25.0 for data analysis chi-square test was done to determine factors associated with the use of ligation. Results were presented in tables and charts. Results: The study findings on socio-demographic factors found that the majority (75%) of respondents were aged >30 years, most (54%) of respondents reported that the distance to the health facility was too far for them and the prevalence of tubal ligation was low (32.7%). Factors associated with low use of tubal ligation were; the mother’s age ≥ 30 years and a current number of children ≥4. i.e. (X2=10.71; p=0.001) and (X2=97.47; P=

The independent review of children's social care (2022) has proposed a radical reset of England's children's services, shifting a remote, assessment heavy system towards one that works alongside communities to help prevent statutory interventions. However, notions around the harnessing of community resources to deliver Early Help are often underpinned by assumptions regarding the voluntary, community and social enterprise (VCSE) sector and the ease with which such organizations can be integrated into preventative strategies. This paper reports findings from embedded research within a unitary authority in Southwest England during remodelling of its Early Help service to work more collaboratively with local VCSE organizations. The study generated data from ethnographic observations, semi‐structured interviews and focus groups with 95 participants, including local parents, service providers, VCSE organizations and Council leaders. The findings illustrate that families value the compassionate, responsive and flexible support available within many VCSE settings. However, differences in practice cultures, regulatory pressures on statutory providers, the need to (re)build trust in communities and sensitivities around power‐sharing and resourcing meant negotiating VCSE sector integration was fraught with complexities. Few studies have gained such privileged access to a Local Authority's remodelling of Early Help services, and this paper has significant insights for the debates surrounding the independent review of children's social care (2022) and its recommendation to bring services 'closer to communities'. [ABSTRACT FROM AUTHOR]

In light of the gravity of environmental issues, this study investigates the influence of competitive advantage and stakeholder pressure on voluntary environmental disclosures, together with the "certification" mediating variable. The research questions and hypotheses were developed based on the essence of stakeholder and legitimacy theory, within the compass of the resource-based view. Data were collected from numerous listed manufacturing organizations and analyzed following the deductive approach. Structural equation modeling was used to test the hypotheses. The results show that competitive advantage influences and smoothens the attainment of environmental certificates, leading to an impression on voluntary environmental disclosures. The evidence from the study also demystifies the dominance of competitive advantage over environmental disclosures. Furthermore, the associated effect of certification upon environmental disclosure is also established and found worthy. Other factors were not found to be significant. Finally, the study also provides various insightful policy suggestions to the wide range of stakeholders. Plain Language Summary: Perceived Pressures and Motivations forEnvironmental Disclosures: The Role of Certification The main objective of this study is to find out the motivation of voluntary environmental disclosure. This study also justifies the role of authorized certifications as a mediating variable between environmental disclosure and motivation factors. According to the stakeholder theory, legitimacy theory and resource-based view, this paper identified two motivation factors such as pressures and competitive advantage. Applying structural equation model on data set gathered from the listed Bangladeshi companies, the study revealed competitive advantage as a significant motivation factor of environmental disclosure while stakeholder's pressure proved insignificant. Moreover, the study also found significant relationship of acquiring certificates from authorized organisations to receive competitive advantage. [ABSTRACT FROM AUTHOR]

Investors have a finite capacity to organize all information they receive from financial disclosures. Under rational inattention, we show that investor processing capacity affects the probability of disclosure. Our main result is that the likelihood of disclosure is inverse-U shaped in investor attention. For low levels of attention, more attention facilitates communication and increases disclosure; for high levels of attention, more attention better identifies, and therefore deters, unfavorable voluntary disclosures. We provide empirical evidence that the relationship between investor attention and management forecast follows the predictions of the theory, using institutional ownership as a proxy for investor attention as well as exogenous shocks to fund manager distraction. JEL Classifications: D83; G14; M4. [ABSTRACT FROM AUTHOR]

SYNOPSIS: Extant accounting research based on data from the United States, Europe, and Australia finds that increases in carbon emissions are associated with lower firm value. However, recent research indicates that investor perspectives on corporate social responsibility (CSR) in other parts of the world differ from those of Western investors. This study investigates whether increases in carbon emissions, as one indicator of poor CSR performance, are also associated with a lower firm value in Taiwan. Using carbon disclosure data from Taiwanese-listed companies between 2012 and 2016, we find that firm value is positively associated with carbon emissions, which contrasts with the findings of extant research. Likewise, firm value is not associated with a combined measure of financial information and carbon emissions in Taiwan. Our findings suggest that international generalizations of the findings of the extant research on the relationship between carbon emissions and firm value should be undertaken with caution. JEL Classifications: G32; M4; M48; Q56. [ABSTRACT FROM AUTHOR]

Measuring the will of the perpetrator at the time of withdrawing from committing a crime in proportion to whether it is voluntary or involuntary is one of the most important topics of attempt of crime since the main core of renunciation is the spiritual element, which cannot be easily understood. Therefore, it is necessary to make a fine distinction between voluntary and involuntary withdrawal by codification. Finally, in this article, by using the descriptive-analytical and library method, it was found that there are two types of withdrawal criteria for the existence of conditions beyond the perpetrator's will. The first category is human obstacles, which are either third parties or victims, and the second category is non-human obstacles, which are either indirect obstacles or direct obstacles related to crime. In the first type, withdrawal is involuntary, and in the second type, indirect obstacles are voluntary withdrawal, and in direct obstacles, involuntary withdrawal. The American Criminal Law has regulated voluntary withdrawal by adding the phrase "full intent to withdraw" and specifying conditions such as the presence of a third party, the severity of the crime or the victim's resistance, or changing the criminal purpose of voluntary withdrawal. In contrast, Iran's approach is only accepting the principle of withdrawal without stating the rules. Therefore, it seems that the American approach in expressing the rules is considered more efficient. However, the attention of the two criminal systems to the development of the circle of renunciation to prevent the crime or sometimes the irreparable damages of the total crime and to encourage the criminals to avoid committing the crime seems to be considered.

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Medical Assistance in Dying (MAID) and palliative care often have an antagonistic relationship in jurisdictions where both are legal, but the early ethical and legal history of palliative care closely mirrors that of MAID in important ways. Palliative practices that are commonplace today were considered homicide or "medically assisted death" in most jurisdictions until quite recently. Moreover, while many patients request MAID today for reasons that are criticized as "ableist," the same rationale is accepted without comment or judgment when used to justify withdrawal of life support or a discontinuation of life-prolonging therapies. Concerns about factors that undermine autonomous decisions for MAID would apply equally to routine palliative care practices. By the same token, palliative care exists because no field in medicine is able to fix every problem it encounters. It is ironic, therefore, that some palliative care providers oppose MAID with the hubristic argument that we can relieve all forms of suffering. Palliative care providers may choose not to participate in MAID, but palliative care and MAID do not have to be mutually exclusive and are often complementary and synergistic for patients and families. [ABSTRACT FROM AUTHOR]

State and local governments have implemented voluntary and mandatory programs to conserve and protect natural resources in and around urban developments. Even though the long-term environmental benefits are apparent, convincing homeowners to adopt sustainable landscapes with less water and chemical use is challenging. An important consideration from the successful policy implementation point of view is that homeowners have different environmental attitudes, which can be the determining factor that influences their adoption intentions of sustainable landscaping practices. This study assesses whether homeowners' environmental attitude is a statistically significant predictor of sustainable landscape adoption intention. Moreover, homeowners' perception of the effectiveness of the voluntary environmental programs may be influenced by their environmental attitudes and impose mediating effects on sustainable landscape adoption intentions. We also examine whether homeowners' perceived effectiveness of voluntary environmental programs has a mediating effect on the adoption decision. The Value-Belief-Norm hierarchical model framework is utilized to examine both effects. The results revealed that homeowners' pro-environmental attitudes influence their perceived effectiveness of voluntary programs and their sustainable landscape adoption intentions. The combined influence accounts for 13.6% of homeowners' adoption intention. Homeowners' personal norms also affect their perceived effectiveness of voluntary programs (9% variance explained), and the mediating effect of the perceived effectiveness of voluntary programs has an amplifying effect and positively influences the adoption intention. The implications for policymakers in the realm of landscape conservation programs are discussed. [ABSTRACT FROM AUTHOR]

A decline in the monarch butterfly population led the U.S. Fish and Wildlife Service to acknowledge monarchs should be listed under the 1973 Endangered Species Act. This research evaluates farmer interest in restoring monarch habitat on their non‐cropped acres to help circumvent such a listing. Results suggest that efforts to promote habitat restoration on non‐cropped acres should focus on voluntary participation and make programs as easy as possible through design and technical assistance. The results also suggest that even a successful program can only provide a small fraction of the habitat needed to meet current restoration goals. [ABSTRACT FROM AUTHOR]

This paper describes and analyses the financing arrangements of Edinburgh's Burgh churches from the time of the Reformation to the enactment of the Church of Scotland (Property and Endowments) Act 1925. Deploying financial and demographic data it offers a preliminary economic commentary on two key episodes in Edinburgh's nineteenth century ecclesiastical history – the Voluntary revolt against the Annuity Tax of the 1830s, and the 1843 Disruption – thereby enriching existing narratives of the period through a calibration of the financial impact of both events on the Burgh's revenues. [ABSTRACT FROM AUTHOR]

Background: Voluntary medical male circumcision (VMMC) is a strategy used to try to limit new human immunodeficiency virus (HIV) infections, as it has the potential to reduce HIV and/or AIDS transmission from women to men by up to 60%. However, in spite of efforts by the Ministry of Health and Social Services, only a few men in Namibia have been circumcised. The objective of this study was to explore and describe the facilitators of, and barriers to, medical male circumcision for HIV prevention in Kavango East, Namibia. Methods: A qualitative, explorative, descriptive and contextual design was employed. The accessible population in this study comprised 18 health professionals who were selected for the study using a purposive sampling technique. Results: Participants reported numerous barriers to VMMC in Namibia. Barriers to VMMC included ‘myths’ and misconceptions attached to VMMC, age limitations, fear of pain and stigma associated with HIV, small VMMC team and long distances from health facilities. Facilitators to VMMC included family support, having experienced genital sores and genital warts or phimosis and paraphimosis. Conclusion: The study revealed that a number of barriers must be overcome before VMMC before the desired number of men take advantage of VMMC. Multiple factors act as constraints to VMMC, including fear, myths and misconceptions, small VMMC teams and the long distance between clients’ homes and VMMC services. Contribution: The study’s findings can be used to develop targeted interventions and strategies that can be used by VMMC providers to address the identified barriers.

No abstract available.

Background: Blood transfusion plays a significant role in maternal and child-care interventions, as well as by saving lives following natural disasters. Ignorance and fear among the general population in Namibia limit the numbers of blood donors, leaving the Namibian Blood Transfusion Services (NAMBTS) with insufficient donations for hospital patients. A review of the literature did not disclose publications on the factors that contribute to the low number of blood donors in Namibia, despite the urgent need for an increased pool of blood donors. Aim: The aim was to explore and describe the factors contributing to the low number of blood donors among the employed residents of the Oshatumba village, Oshana Region, Namibia. Settings: Interviews were conducted at a peri-urban village located in the eastern part of the Oshakati District in the Oshana Region. Methods: A qualitative methodology utilising explorative, descriptive and contextual strategies. Data were collected by means of individual, in-depth, semi-structured interviews with 15 participants, who were selected through convenience sampling. Results: The study discovered three themes: (1) the concept of blood donation; (2) factors contributing to low blood donations and (3) practical suggestions to increase the low uptake of blood donations. Conclusion: The findings of this study revealed that individual health status, religious beliefs and misconceptions associated with blood donations are among the factors that cause a low level of blood donations. Contribution: The research findings can be used to develop strategies and targeted interventions to increase the number of blood donors.

Introduction: Maddox suggested that there were four convergence subtypes, each driven by a different stimulus. The purpose of this study was to assess the neural correlates for accommodative convergence, proximal convergence (convergence stimulus provided), disparity convergence and voluntary convergence (no specific convergence stimulus provided) using functional magnetic resonance imaging (fMRI). Methods: Ten subjects (mean age = 24.4 years) with normal binocular vision participated. The blood oxygenation level‐dependent (BOLD) signals of the brain from fMRI scans were measured when subjects made vergence eye movements while: (1) alternately viewing letters monocularly where one eye viewed through a −2.00 D lens, (2) alternately viewing Difference of Gaussian targets monocularly at distance and near, (3) viewing random dot stereograms with increasing disparity and (4) voluntarily converging the eyes with binocular viewing. Results: The accommodative convergence paradigm resulted in activation on the right side in the right fusiform cortex and the right middle occipital cortex. The proximal convergence stimulus mainly activated areas in the right occipital lobe. The disparity stimulus activated areas in the left occipital cortex and the left frontal cortex. Finally, the voluntary convergence paradigm resulted in activation primarily in the occipital lobe and mostly bilaterally. Conclusion: The accommodative, proximal, disparity and voluntary convergence paradigms resulted in activation in unique areas in the brain with functional MRI. Activation was found in more areas in the proximal and voluntary conditions compared with the accommodative and disparity conditions. [ABSTRACT FROM AUTHOR]

Background: Voluntary medical male circumcision (VMMC) is a strategy used to try to limit new human immunodeficiency virus (HIV) infections, as it has the potential to reduce HIV and/or AIDS transmission from women to men by up to 60%. However, in spite of efforts by the Ministry of Health and Social Services, only a few men in Namibia have been circumcised. The objective of this study was to explore and describe the facilitators of, and barriers to, medical male circumcision for HIV prevention in Kavango East, Namibia. Methods: A qualitative, explorative, descriptive and contextual design was employed. The accessible population in this study comprised 18 health professionals who were selected for the study using a purposive sampling technique. Results: Participants reported numerous barriers to VMMC in Namibia. Barriers to VMMC included 'myths' and misconceptions attached to VMMC, age limitations, fear of pain and stigma associated with HIV, small VMMC team and long distances from health facilities. Facilitators to VMMC included family support, having experienced genital sores and genital warts or phimosis and paraphimosis. Conclusion: The study revealed that a number of barriers must be overcome before VMMC before the desired number of men take advantage of VMMC. Multiple factors act as constraints to VMMC, including fear, myths and misconceptions, small VMMC teams and the long distance between clients' homes and VMMC services. Contribution: The study's findings can be used to develop targeted interventions and strategies that can be used by VMMC providers to address the identified barriers. [ABSTRACT FROM AUTHOR]

This investigation assessed the physiological effects of voluntary suppression of shivering thermogenesis in response to whole body cooling. Eleven healthy volunteers underwent passive air cooling (10°C), across three visits: NO_SUP, where participants allowed their body to freely regulate against the cold; FULL_SUP, where participants constantly suppressed shivering; INT_SUP, where participants intermittently suppressed shivering (5 min phases), interspersed with 5 min free regulation. Shivering was assessed via electromyography (EMG), mechanomyography (MMG), and whole body oxygen uptake (VO2), whereas body temperature and heat exchange were assessed via skin temperature, rectal temperature, and heat flux sensors. A 29% increase was observed in shivering onset time in the FULL_SUP trial compared with NO_SUP (P = 0.032). Assessing shivering intensity, EMG activity decreased by 29% (P = 0.034), MMG activity decreased by 35% (P = 0.031), whereas no difference was observed in VO2 (P = 0.091) in the FULL_SUP trial compared with NO_SUP. Partitioning the no-suppression and suppression phases of the INT_SUP trial, acute voluntary suppression significantly decreased VO2 (P = 0.001), EMG (P < 0.001), and MMG (P = 0.012) activity compared with the no-suppression phases. Shivering activity was restored in the no-suppression phases, equivalent to that in the NO_SUP trial (P > 0.3). No difference was observed in thermal metrics between conditions up to 60 min (P > 0.4). Humans can both constantly and periodically suppress shivering activity, leading to a delay in shivering onset and a reduction in shivering intensity. Following suppression, regular shivering is resumed. [ABSTRACT FROM AUTHOR]

Background: Blood transfusion plays a significant role in maternal and child-care interventions, as well as by saving lives following natural disasters. Ignorance and fear among the general population in Namibia limit the numbers of blood donors, leaving the Namibian Blood Transfusion Services (NAMBTS) with insufficient donations for hospital patients. A review of the literature did not disclose publications on the factors that contribute to the low number of blood donors in Namibia, despite the urgent need for an increased pool of blood donors. Aim: The aim was to explore and describe the factors contributing to the low number of blood donors among the employed residents of the Oshatumba village, Oshana Region, Namibia. Settings: Interviews were conducted at a peri-urban village located in the eastern part of the Oshakati District in the Oshana Region. Methods: A qualitative methodology utilising explorative, descriptive and contextual strategies. Data were collected by means of individual, in-depth, semi-structured interviews with 15 participants, who were selected through convenience sampling. Results: The study discovered three themes: (1) the concept of blood donation; (2) factors contributing to low blood donations and (3) practical suggestions to increase the low uptake of blood donations. Conclusion: The findings of this study revealed that individual health status, religious beliefs and misconceptions associated with blood donations are among the factors that cause a low level of blood donations. Contribution: The research findings can be used to develop strategies and targeted interventions to increase the number of blood donors. [ABSTRACT FROM AUTHOR]

Mediation, as a completely voluntary and confidential form of Alternative Dispute Resolution (ADR), has today taken an important place in the resolution of disputes around the globe. It provides a neutral and confidential environment in which the parties can openly discuss their views on the underlying dispute. Enhanced communication can lead to resolution that will be satisfactory and acceptable to the parties involved. Mediation usually occurs early in the dispute, and much mediation is completed in one or two meetings. The parties having an equal say in the process and they, not the mediator, decide on the terms of the settlement and the eventual settlement. Therefore, there is no determination of guilt or innocence in the process. The parties may agree to use a set of mediation rules. Such rules usually determine the procedural framework of the mediation. Decades of work by the United Nations Commission on International Trade Law (UNCITRAL) has resulted in UNCITRAL providing states, mediation practitioners, parties to a dispute and mediators with a set of legal documents applicable to the mediation process. The analysis, synthesis, normativism and empiricism used in this paper provides an overview of UNCITRAL's commitment to the adoption of legal rules and the importance that these rules have in implementation, in the form of the convention, model law, rules, explanatory notes and recommendations. The results of the research provide evidence that this commitment is ongoing in order to respond to the changes and innovations that characterize today's disputes. [ABSTRACT FROM AUTHOR]

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The hermeneutical problem of autonomy in Paul Ricoeur's eidetics of the will In Freedom and Nature. The Voluntary and the Involuntary, Ricoeur develops an anthropological analysis of the will on the basis of Husserl's philosophy. In his eidetic phenomenology of the will, Ricoeur argues that the intelligibility of understanding is connected to the relationship between the voluntary and the involuntary. Therefore, the will has to be thought from a hermeneutical and not just from a phenomenological perspective. There are dimensions of affectivity, e.g., the character, life, and the unconscious, that are part of the involuntary and that stand in dialectical tension with the voluntary. Even when it reaches the highest point of the eidetic in the phenomenology of the Orphic consent, the will preserves a minimal margin of freedom, which is expressed in the dimension of hope. Connected to the eidetics, in the empirical approach to the will and autonomy Ricoeur shows that these are not to be sought in a pure logic of self-organization or of internal self- regulation, but in a constant dialectic between an enslaved and guilty will and a capable will that hopes. [ABSTRACT FROM AUTHOR]

According to POJK No 51/POJK.03/2017, since January 2020, public companies are required to prepare a sustainability report (SR). This study aims to examine whether the quality of the sustainability report disclosure (SCR) has a significant association with firm value, and to examine SCR in a mandatory and voluntary context. This study uses a panel data regression method consisting of all publicly listed companies (nonfinancial companies) in Indonesia which published an SR in 2019 and 2020. The results show that there were differences in SCR in the voluntary period (2019) and the mandatory period (2020), and that SCR had a positive association with firm value. [ABSTRACT FROM AUTHOR]