Emerging Pandemic Diseases: How We Got to COVID-19.

Infectious diseases prevalent in humans and animals are caused by pathogens that once emerged from other animal hosts. In addition to these established infections, new infectious diseases periodically emerge. In extreme cases they may cause pandemics such as COVID-19; in other cases, dead-end infections or smaller epidemics result. Established diseases may also re-emerge, for example by extending geographically or by becoming more transmissible or more pathogenic. Disease emergence reflects dynamic balances and imbalances, within complex globally distributed ecosystems comprising humans, animals, pathogens, and the environment. Understanding these variables is a necessary step in controlling future devastating disease emergences.

Four ways blue foods can help achieve food system ambitions across nations.

Blue foods, sourced in aquatic environments, are important for the economies, livelihoods, nutritional security and cultures of people in many nations. They are often nutrient rich1, generate lower emissions and impacts on land and water than many terrestrial meats2, and contribute to the health3, wellbeing and livelihoods of many rural communities4. The Blue Food Assessment recently evaluated nutritional, environmental, economic and justice dimensions of blue foods globally. Here we integrate these findings and translate them into four policy objectives to help realize the contributions that blue foods can make to national food systems around the world: ensuring supplies of critical nutrients, providing healthy alternatives to terrestrial meat, reducing dietary environmental footprints and safeguarding blue food contributions to nutrition, just economies and livelihoods under a changing climate. To account for how context-specific environmental, socio-economic and cultural aspects affect this contribution, we assess the relevance of each policy objective for individual countries, and examine associated co-benefits and trade-offs at national and international scales. We find that in many African and South American nations, facilitating consumption of culturally relevant blue food, especially among nutritionally vulnerable population segments, could address vitamin B12 and omega-3 deficiencies. Meanwhile, in many global North nations, cardiovascular disease rates and large greenhouse gas footprints from ruminant meat intake could be lowered through moderate consumption of seafood with low environmental impact. The analytical framework we provide also identifies countries with high future risk, for whom climate adaptation of blue food systems will be particularly important. Overall the framework helps decision makers to assess the blue food policy objectives most relevant to their geographies, and to compare and contrast the benefits and trade-offs associated with pursuing these objectives.

Smoke-free law compliance and predictive factors in Ethiopia: observational assessment of public places and workplaces.

OBJECTIVES: The primary objective of this observational study was to assess the status of public place and workplace compliance with smoke-free provisions in Ethiopia. METHODS: This study was conducted in four regions of Ethiopia (Oromia; Sidama; Harari; and Southern Nations, Nationalities, and Peoples' Region) from September to October 2021. Data were collected using a standardised smoke-free checklist. Χ2 tests were used to assess the association between categorical variables and the smoke-free status. Multivariable binary logistic regression analysis was used to identify factors associated with the presence of at least one person actively smoking. RESULTS: Approximately 97% (95% CI 93.1%, 98.8%) of government buildings, 92.5% (95% CI 85.7%, 96.2%) of educational institutions, 89.8% (95% CI 86.3%, 92.5%) of bars, restaurants and cafés, 88.4% (95% CI 82.9%, 92.3%) of food establishments and 84.0% of hotels (95% CI 79.5%, 87.6%) were non-compliant with the tobacco control law. Overall, only 12.3% of sites met the requirements of the current smoke-free law. The multivariable logistic regression models showed that transit facilities (adjusted OR (AOR)=26.66 (95% CI 7.53, 94.41)) and being located in the Harari region (AOR=4.14 (95% CI 2.30, 7.45)) were strongly associated with the presence of active smoking observed during the site visit. CONCLUSION: This study indicated that public place and workplace non-compliance level was very high in all sites. This calls for more effective implementation of complete smoke-free provisions across all government buildings and institutions in all regions, such as public educational campaigns about the laws and enforcement action for non-compliance. Furthermore, all regional states should adopt Federal Proclamation 1112/2019.

The impact of green-listed companies on rural ecological environments in China: A spatial heterogeneity and empirical analysis.

Based on the panel data of 22 inland provinces in China from 2010 to 2020, this study constructs and measures the level of rural ecological environment in China. The impact of the financial performance of green-listed companies on the rural ecological environment and its moderating and threshold effects are analyzed. The following conclusions are drawn: (1) During 2010-2020, China's rural ecological environment shows a trend of "fluctuating-decreasing-rising" with significant regional non-equilibrium characteristics. (2) The financial performance of green-listed companies has a significantly negative impact on rural ecology. This negative impact has a crucial heterogeneous feature, with a more significant negative impact in areas with a higher rural ecological environment index and less substantial performance in regions with a lower rural ecological environment index. (3) There is a significant positive moderating effect of education level and digitalization on the relationship between the financial performance of green-listed companies on the level of rural ecological development. As moderating variables, the digitalization and education level weakens the negative impact of green-listed companies' performance on the ecological environment. The positive impact of the financial performance of green-listed companies on the development level of the rural ecological environment is more vital in areas with higher per capita education levels and digitalization in rural areas. (4) There is a significant threshold effect on the financial performance of green-listed companies on the level of rural ecological development. When the financial performance of green-listed companies exceeds a particular threshold value, the impact of the financial performance of green-listed companies on the development level of the rural ecological environment is significantly positive. Based on the above findings, this paper puts forward corresponding countermeasure suggestions.

Exploring the uptake of advanced digital technologies in environmental assessment practice - Experiences from Austria and Germany.

Environmental assessment (EA) evaluates the environmental impacts of proposed projects, plans or policies to inform decision making. While several studies have highlighted the potential and opportunities of digitalisation for EA, few have explored practitioners' perceptions using a mixed methods approach in order to discover concerns and risks identified by EA of novel technological approaches. In addition, this initial exploratory study examines the perception of benefits and contributions to quality and effectiveness of advanced digital approaches, such as the introduction of artificial intelligence, in EA practice. The research process was based on focus group discussions and exploratory interviews with EA consultants, environmental authorities, researchers, environmental associations and NGOs. Relevant technologies were identified from the existing scientific literature and their applicability, benefits and use were discussed in context of real-world experience made by the practitioner. It became evident that the majority of practitioners in the field of EA in Austria and Germany are not familiar with advanced digital approaches and tools. While other planning disciplines are exploiting the potential of advanced digital tools, EA practitioners still share concerns about data quality, security, legal uncertainties, but also skills and know-how. The study identifies a gap and a need for training and confidence building. It aims to contribute to the promotion of inter- & transdisciplinary exchange involving the wider EA community.

Does Matrilineality Reduce Gender Inequality in Environmental and Social Impact Assessment (ESIA) Public Participation? Some Evidence from Malawi.

This paper reports on Environmental and Social Impact Assessment (ESIA) public participation in Malawi with a focus on the role of women from matrilineal and patrilineal marriage systems. Six rural ESIA projects are explored of which three are in areas of patrilineal and three are in areas of matrilineal systems. Participation space was found to be consistently dominated by men, with no obvious differences between both systems. The key reasons are likely to be lower educational and social status of women in rural areas throughout the country. This is associated with a number of challenges, including chronic poverty and food insecurity. Affirmative action is needed to achieve a better representation of women in ESIA processes.

Health-Oriented Environmental Categories, Individual Health Environments, and the Concept of Environment in Public Health.

The term 'environment' is not uniformly defined in the public health sciences, which causes crucial inconsistencies in research, health policy, and practice. As we shall indicate, this is somewhat entangled with diverging pathogenic and salutogenic perspectives (research and policy priorities) concerning environmental health. We emphasise two distinct concepts of environment in use by the World Health Organisation. One significant way these concepts differ concerns whether the social environment is included. Divergence on this matter has profound consequences for the understanding of health and disease, for measures derived from that understanding targeting health promotion and disease prevention, and consequently, for epistemic structures and concept development in scientific practice. We hope to improve the given situation in public health by uncovering these differences and by developing a fruitful way of thinking about environment. Firstly, we side with the salutogenic conception of environment as a health resource (as well as a source of health risks). Secondly, we subdivide the concept of environment into four health-oriented environmental categories (viz., natural, built-material, socio-cultural, and psychosocial) and we link these with other theoretical notions proposed in the health sciences literature. Thirdly, we propose that in public health 'environment' should be understood as consisting of all extrinsic factors that influence or are influenced by the health, well-being, and development of an individual. Consequently, none of the four categories should be excluded from the concept of environment. We point out the practical relevance and fruitfulness of the conception of environment as a health source and frame this in causal terms, representing individual health environments as causal networks. Throughout, we side with the view that for the design of human health-promoting settings, increased attention and consideration of environmental resources of salutogenic potential is particularly pressing.

Outdoor smoke-free policies at sports clubs across Europe: Current status, recent evidence, and future challenges.

OBJECTIVE: This commentary emphasizes the importance of implementing outdoor smoke-free policies at sports clubs, particularly highlighting their limited adoption across Europe. The primary aim was to assess the progress made in the Netherlands, explore the strategies employed, and outline future challenges. METHODS: Our methodology involved an examination of national regulations and the voluntary adoption of smoke-free policies at sports clubs throughout Europe. We also assessed the adoption and implementation of these policies using recent evidence, leading to the identification of impending challenges in their implementation across Europe. RESULTS: While only a few European countries currently have national legislation prohibiting outdoor smoking at sports clubs, voluntary initiatives promoting such policies have emerged in various nations. Experiences from the Netherlands have demonstrated the feasibility of implementing outdoor smoke-free policies at sports clubs. To expand these policies across Europe, five key challenges need to be addressed: 1) encouraging smoke-free policies at sports clubs that are less inclined to adopt them, 2) ensuring consistent compliance and enforcement of outdoor smoke-free policies, 3) preventing smoking just outside the sports club, 4) garnering support from various stakeholders to ensure widespread adoption of smoke-free sports clubs, and 5) establishing monitoring and evaluation mechanisms for policy implementation. CONCLUSION: The Dutch experiences serve as a testimony to the feasibility of outdoor smoke-free policies at sports clubs. By addressing the remaining challenges, we can create healthier sports environments for children and take substantial steps towards realizing a smoke-free Europe.

Use of Ecological Theory to Understand the Efficacy and Mechanisms of Multistrain Biological Control.

Since the 1970s, over 6,500 articles have been published about microbial biocontrols and over 200 microbial isolates have been registered for commercial use. However, many of these solutions have seen limited use due to limitations with their in-field efficacy. Even when multiple biocontrol agents are combined to create multistrain biocontrols, the resulting combinations can be less effective than the individual agents. One likely contributor is due to how multistrain microbial biocontrols are created. Multistrain microbial biocontrols are generally produced under controlled settings that are divorced from the ecological conditions they will need to function under. Traditionally, researchers culture, identify, and screen isolates for pathogen suppression traits. Then these researchers will combine the most promising isolates in an attempt to create more effective solutions. This approach, while effective for identifying suppressive isolates and determining the mechanisms of pathogen suppression, does not take into consideration the variability of natural environments, nor the complex ecological interactions that occur between plant hosts, pathogens, and component biocontrol agents, thus limiting the range of circumstances that these multistrain solutions can reliably succeed. To address these limitations, we suggest the application of relevant ecological theory to determine which isolates should be combined to create more reliable multistrain biocontrols. In this synthesis, we build on prior work focused on addressing plant pathogens through the use of multistrain microbial biocontrols, but we argue that viewing this work through the lens of ecology reveals key "design principles" from natural communities that are stable, functioning, and comprise multiple species.

Developing a person-centred care environment aiming to enhance the autonomy of nursing home residents with physical impairments, a descriptive study.

BACKGROUND: Enhancing autonomy is important within the context of the care environment in nursing homes. A nursing home is a place for older adults with physical impairments, who need assistance, to live and where staff work who help them to exercise autonomy. Previous research shows that older adults and staff are influenced by the care environment to apply autonomy-enhancing activities. Therefore, organisational policies regarding the care environment seem promising for enhancing autonomy. The aim is to gain a deeper insight into the development and implementation of organisational policies aimed to enhance the autonomy of older adults with physical impairments. METHODS: A qualitative descriptive design was chosen, using two methods. A document study was conducted on the policies, plans and proceedings in two care organisations. Moreover, interviews were conducted with 17 stakeholders involved in the policies, such as managers and members of the client council. The fragments of the 137 documents and 17 verbatim transcripts were coded and deductively categorised into the seven aspects (i.e., power-sharing, supportive organisational systems, appropriate skill mix, potential for innovation and risk-taking, the physical environment, effective staff relationships and shared decision-making systems) of the key domain care environment, as defined in the person-centred practice (PCP) framework developed by McCormack and McCance. RESULTS: The aspect of power-sharing was used the most in the policies of the two participating organisations. The organisations expected much from the implementation of indirect interventions, such as access to the electronic care plan for residents and the development of staff towards self-managing teams. Less attention was paid to interventions in the physical environment, such as the interior of the building and privacy, and the collaboration processes between staff. CONCLUSIONS: The PCP framework poses that all aspects of the key domain care environment are important to develop a person-centred practice. This is not yet the case in practice and the authors therefore recommend using all seven aspects of the care environment in a balanced combination with the other key domains of the PCP framework to achieve person-centred practice and as a result the enhancement of the autonomy of nursing home residents with physical impairments.

Assessing the implementation of physical activity-promoting public policies in the Republic of Ireland: a study using the Physical Activity Environment Policy Index (PA-EPI).

BACKGROUND: Government policy can promote physical activity (PA) as part of a multilevel systems-based approach. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework which assesses the implementation of government policy by drawing on the experience of national stakeholders. This study is the first to assess the extent of policy implementation in the Republic of Ireland using the PA-EPI tool, and to provide information on how policy implementation can be improved, with the intention of maximizing its impact on population levels of PA. METHODS: This mixed-methods research study, comprising eight steps, was carried out in 2022. Information documenting the evidence for implementation of PA policy, across all 45 PA-EPI indicators, was collected via systematic document analysis, and validated via survey and interview with government officials. Thirty-two nongovernment stakeholders rated this evidence on a five-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identified and prioritized critical implementation gaps. RESULTS: Of the 45 PA-EPI indicators, one received an implementation rating of 'none/very little', 25 received a rating of 'low' and 19 received a 'medium' rating. No indicator was rated as fully implemented. The indicators that received the highest level of implementation related to sustained mass media campaigns promoting PA and PA monitoring. Ten priority recommendations were developed. CONCLUSIONS: This study reveals substantial implementation gaps for PA policy in the Republic of Ireland. It provides recommendations for policy action to address these gaps. In time, studies utilizing the PA-EPI will enable cross-country comparison and benchmarking of PA policy implementation, incentivizing improved PA policy creation and implementation.

Upscaling the remediation of acidic landscapes - the coastal floodplain prioritisation method.

Over 24 million hectares of the world's coastal floodplains are underlain by acid sulfate soils (ASS). Drainage of these sediments has led to widespread environmental degradation, raising serious health concerns. To date, onsite rehabilitation has been complicated by differing stakeholder priorities, with resources often allocated to sites with more vocal proponents rather than those exposed to more significant environmental impacts. To address this issue, this paper introduces the Coastal Floodplain Prioritisation (CFP) Method; a novel, data driven and spatially explicit multi-criteria assessment that ranks floodplain catchment areas according to their risk of transferring acidic drainage waters to an estuary. Results can be used to prioritise where remediation actions are likely to have the greatest benefit. The method was applied across six different estuaries in south-east Australia, with major field campaigns undertaken at each site. Within each estuary, the largest acid fluxes and impacts are identified with relevant mitigation measures provided. On a catchment scale, the results reflect the broader hydrogeomorphic characteristics of each estuary, including the historic acid formation conditions and recent anthropogenic drainage activities. Low-lying backswamps were identified as the highest risk zones within each estuary. These areas are also the most vulnerable to sea level rise. Reinstatement of tidal inundation to these backswamps effectively remediates acid sulfate soil discharges and provides a nature-based solution for adaptation to sea level rise with a range of co-benefits to encourage further investment.

Assessing the energy recovery potential at district metered areas inlets of water supply systems: A Spanish case study.

The energy required for various processes in the water cycle can have significant economic and environmental impacts. Therefore, efficient energy management in urban water supply systems is crucial for a sustainable operation. By installing energy recovery technologies in these facilities, it is possible to reap the benefits of the infrastructure design by saving energy. In this study, a new methodology to assess the energy recovery at the inlets of district metered areas is presented, considering the city of Murcia (Spain) as case study. This methodology is based on creating a detailed model of city water supply system and calibrating such model with an experimental campaign of measurements. Then, the assessment of the hydraulic potential recovery is analysed through two different energy estimators, one considering the minimum available net head and the other assuming a variable net head. Results show that there are several points where turbines could be installed, most of them recovering in between 1000-5000 kWh, which could be used to cover the yearly energy consumption of about 24-120 m2 of a school or 10-50 traffic lights of such area. Moreover, in some points it could be recovered up to 14500 kWh. Even though these values are not high, the energy recovered could be used for self-consumption of nearby electrical loads, at the time that reduces the pressure in the system, thus leading to leak reductions. Moreover, this kind of energy recovery does not reduce the potential of other proposals for upstream energy recovery, such as replacing pressure reduction valves with turbines instead. The scripts developed to apply the proposed methodology are available in EPANET-Octave file exchange for the researcher community.

Sustainability in practice: ScotGEM (Scottish Graduate Entry Medicine) students' quality improvement projects in primary care - reducing the environmental impact of health care.

INTRODUCTION: ScotGEM is the first graduate entry medical degree course in Scotland. Students are viewed as 'Agents of Change', embedded in clinical practice and communities and, as such, are able to facilitate change. The Quality Improvement Projects presented demonstrate the commitment of the students (and their host practices) to improving the sustainability of health care. METHODS: The selected projects illustrated use of a Quality Improvement methodology: identifying areas of need; working with key stakeholders; collecting and analysing data; testing change; modifying changes; and re-testing. The overall aims are to improve the quality and sustainability of the healthcare setting and, ultimately, patient health. The duration of the projects vary from a few weeks to many months. RESULTS: Demonstrated through a collection of posters (some of which are published and award winning) from numerous projects. Examples include demonstrating a reduction in waste, a reduction in use of inhalers with high greenhouse gas emissions, and changes to consulting such as use of video consulting to the benefit of patients and the environment. The combined environmental impact of this educational intervention will be arranged via thematic analysis and the value of student agency will be considered. DISCUSSION: This collection of projects, many of which are based in rural settings, will demonstrate the innovative ways in which medical education can work with practices and communities to reduce the impact of health care on the environment.

Citizen science in monitoring food environments: a qualitative collective case study of stakeholders' experiences during the Local Environment Action on Food project in Alberta, Canada.

BACKGROUND: Citizen science bears potential to build a comprehensive view of global food environments and create a broader discussion about how to improve them. Despite its potential, citizen science has not been fully utilised in food environment research. Thus, we sought to explore stakeholders' experiences of the Local Environment Action on Food (LEAF) project, a community-based intervention that employs a citizen science approach to monitoring food environments. METHODS: We used a qualitative collective case study design to explore citizen science through the LEAF process in seven communities in Alberta, Canada. Data generating strategies included semi-structured interviews with citizen scientists (n = 26), document review of communities' Mini Nutrition Report Cards (n = 7), and researcher observation. Data were analyzed in a multi-phase process, using Charmaz's constant comparison analysis strategy. RESULTS: Analysis revealed two main themes: relationship building and process factors. Communities used three interconnected strategies, engaging the right people, treading lightly, and reaching a consensus, to navigate the vital but challenging relationship building process. Process factors, which were influences on the LEAF process and relationship building, included the local context, flexibility in the LEAF process, and turnover among LEAF community groups. CONCLUSION: Citizen science through the LEAF project supported the creation and application of food environment evidence: it enabled residents to collect and interpret local food environment data, develop realistic recommendations for change, and provided them with an evidence-based advocacy tool to support the implementation of these recommendations. We recommend a web application that enables independent community food environment assessments. Such a tool could stimulate and sustain citizen involvement in food environment efforts, helping to build the necessary evidence base and promote the creation of healthy food environments.

A participatory practice study for the improvement of sub-regional health vulnerabilities: a qualitative study.

BACKGROUND: This study aimed to explore the experiences of the residents of Samho-dong with the health environment in the local community, and their in-depth opinions on health promotion using a photovoice methodology. Alternatives to improve health among the residents of Samho-dong were also discussed with the local residents, with the aim of translating suggestions from the discussion into practice. METHODS: A total of 195 photographs taken by the 15 participants over the course of 7 weeks were collected, along with 96 photovoice activity logs and transcription data from 5 rounds of focus group discussions. The photovoice activity logs consisted of the photographer's name, the dates photos were taken, and a series of responses to the following SHOWeD questions: "What do you SEE here?", "What is really HAPPENING?", "How does this situation or scenario affect OUR lives/health?", "WHY does this problem or strength Exist?", "What can we DO about it?". Direct content analysis was used for analysis. RESULTS: The analysis yielded a total of 247 semantic units, which were categorized into the themes, "the good, but insufficiency, living environment in Samho-dong," "the health environment in Samho-dong needs improvement," "small efforts to improve Samho-dong," and "points of improvement for a better Samho-dong". Samho-dong was found to have a poorer walking and transportation infrastructure than other regions, even though it was a town with a large elderly population. The dark streets in the residential complex made participants hesitate to engage in afternoon activities, and the insufficient traffic environment made it difficult to live a natural daily life by solving food, clothing, and shelter. Participants have made various attempts to solve areas that need improvement in the Samho-dong, which has led to actual improvement. It was analyzed that in order to make Samho-dong better, it was necessary to improve the perception of residents in Samho-dong and cooperate with the local community. CONCLUSIONS: This study was significant in that it enabled the in-depth exploration and identification of areas of improvement from the participants' perception of their health environment, considering that as residents, they are the direct stakeholders of the community health environment.

Incorporating environmental and sustainability considerations into health technology assessment and clinical and public health guidelines: a scoping review.

Healthcare systems account for a substantial proportion of global carbon emissions and contribute to wider environmental degradation. This scoping review aimed to summarize the evidence currently available on incorporation of environmental and sustainability considerations into health technology assessments (HTAs) and guidelines to support the National In stitute for Health and Care Excellence and analogous bodies in other jurisdictions developing theirown methods and processes. Overall, 7,653 articles were identified, of which 24 were included in this review and split into three key areas - HTA (10 studies), healthcare guidelines (4 studies), and food and dietary guidelines (10 studies). Methodological reviews discussed the pros and cons of different approaches to integrate environmental considerations into HTAs, including adjustments to conventional cost-utility analysis (CUA), cost-benefit analysis, and multicriteria decision analysis. The case studies illustrated the challenges of putting this into practice, such as lack of disaggregated data to evaluate the impact of single technologies and difficulty in conducting thorough life cycle assessments that consider the full environmental effects. Evidence was scant on the incorporation of environmental impacts in clinical practice and public health guidelines. Food and dietary guidelines used adapted CUA based on life cycle assessments, simulation modeling, and qualitative judgments made by expert panels. There is uncertainty on how HTA and guideline committees will handle trade-offs between health and environment, especially when balancing environmental harms that fall largely on society with health benefits for individuals. Further research is warranted to enable integration of environmental considerations into HTA and clinical and public health guidelines.

Risk of air and surface contamination of SARS-CoV-2 in isolation wards and its relationship with patient and environmental characteristics.

Air and surface contamination of the SARS-CoV-2 have been reported by multiple studies. However, the evidence is limited for the change of environmental contamination of this virus in the surrounding of patients with COVID-19 at different time points during the course of disease and under different conditions of the patients. Therefore, this study aims to understand the risk factors associated with the appearance of SARS-CoV-2 through the period when the patients were staying in the isolation wards. In this study, COVID-19 patients admitted to the isolation wards were followed up for up to 10 days for daily collection of air and surface samples in their surroundings. The positivity rate of the environmental samples at different locations was plotted, and multiple multi-level mixed-effect logistic regressions were used to examine the association between the positivity of environmental samples and their daily health conditions and environmental factors. It found 6.6 % of surface samples (133/2031 samples) and 2.1 % of air samples (22/1075 samples) were positive, and the positivity rate reached to peak during 2-3 days after admission to the ward. The virus was more likely to present at bedrail, patients' personal items and medical equipment, while less likely to be detected in the air outside the range of 2 m from the patients. It also revealed that higher positivity rate is associated with lower environmental temperature, fever and cough at the day of sampling, lower Ct values of latest test for respiratory tract samples, and pre-existing respiratory or cardiovascular conditions. The finding can be used to guide the hospital infection control strategies by identifying high-risk areas and patients. Extra personal hygiene precautions and equipment for continuously environmental disinfection can be used for these high-risk areas and patients to reduce the risk of hospital infection.