National analysis of motorcycle associated injuries and fatalities: Wearing helmet saves lives.

INTRODUCTION: Riding a motorcycle without a helmet represents a public health risk that can result in disabling injuries or death. We aim to provide a comprehensive analysis of the impact of helmet use on motorcycle injuries, injury types, and fatalities, to highlight areas requiring future intervention. METHODS: We performed a retrospective cohort study utilizing the American College of Surgeons Trauma Quality Program Participant Use File between 2017 and 2020 analyzing motorcycle associated injuries and fatalities in adult patients with moderate and severe injury severity score in relation to helmet use. Multivariable regressions were utilized and adjusted for potential confounders. A subset analysis was performed for patients presenting with abbreviated injury scale (AIS) head ≥3 and all other body regions ≤2. RESULTS: 43,225 patients met study criteria, of which 24,389 (56.4%) were helmet users and 18,836 (43.6%) were not. Helmet use was associated with a 35% reduction in the relative risk of expiring in the hospital due to motorcycle-related injuries (aOR 0.65; 95% CI [0.59-0.70]; p < 0.001) and a decreased intensive care unit length of stay (ICU-LOS) by half a day (B = -0.50; 95% CI [-0.77, -0.24]; p < 0.001). CONCLUSION: Motorcycle riders without a helmet had significantly greater odds of increased in-hospital mortality and longer stays in the ICU than those who used a helmet. The results of this nationwide study support the need for continued research exploring the significance of helmet use and interventions aimed at improving helmet usage among motorcyclists. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.

Using a Service Ontology to Understand What Influences Older Adults' Outdoor Physical Activities in Nanjing.

Older adults are not actively participating in outdoor physical activities. An understanding of what factors influence older adults' outdoor physical activities is important for informing interventions. This study aims to examine the potential effect of service ontology on the intention of outdoor physical activities in older adults. Face-to-face surveys were conducted with 421 older adults from eight districts in Nanjing, China. One-way analysis of variance and ordinal logistic regression analysis revealed that seven of the 20 factors have a positive effect on intention of outdoor physical activities, including gender, health self-assessment, family structure, accessibility, exercise instructors, emergency service, and staff in outdoor space. To further improve the intention of outdoor physical activities, governments and service designers should focus on providing age-friendly community infrastructures. Moreover, specific attention should be paid toward older females and people with low-income/poor health conditions, and strategies should also be adopted to significantly improve the quantity and instruction efficiency of exercise instructors.

Information-epidemic co-evolution propagation under policy intervention in multiplex networks.

The emergence of epidemics has seriously threatened the running of human society, such as COVID-19. During the epidemics, some external factors usually have a non-negligible impact on the epidemic transmission. Therefore, we not only consider the interaction between epidemic-related information and infectious diseases, but also the influence of policy interventions on epidemic propagation in this work. We establish a novel model that includes two dynamic processes to explore the co-evolutionary spread of epidemic-related information and infectious diseases under policy intervention, one of which depicts information diffusion about infectious diseases and the other denotes the epidemic transmission. A weighted network is introduced into the epidemic spreading to characterize the impact of policy interventions on social distance between individuals. The dynamic equations are established to describe the proposed model according to the micro-Markov chain (MMC) method. The derived analytical expressions of the epidemic threshold indicate that the network topology, epidemic-related information diffusion and policy intervention all have a direct impact on the epidemic threshold. We use numerical simulation experiments to verify the dynamic equations and epidemic threshold, and further discuss the co-evolution dynamics of the proposed model. Our results show that strengthening epidemic-related information diffusion and policy intervention can significantly inhibit the outbreak and spread of infectious diseases. The current work can provide some valuable references for public health departments to formulate the epidemic prevention and control measures.

Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers: A Serial Survey in Taiwan before and during the Coronavirus Disease 2019 Pandemic.

PURPOSE: To report the prevalence of preschool myopia after implementing a policy intervention promoting outdoor activities and the secular trend of myopia before and during the coronavirus disease 2019 (COVID-19) pandemic in a Taiwan preschool population. DESIGN: Repeated countywide population-based, cross-sectional surveys based on the Yilan Myopia Prevention and Vision Improvement Program (YMVIP). PARTICIPANTS: Among 23 930 kindergarteners 5 to 6 years of age from 7 school-year cohorts in Yilan County from 2014 through 2020, a total of 21 761 children (90.9%) were included for analysis. METHODS: Since launching the YMVIP in August 2014, myopia prevention strategies, such as increasing outdoor activities (2 hours/weekday), have been promoted in all kindergartens, and countywide school-based eye examinations, including cycloplegic autorefraction, and caregiver-administered questionnaires have been carried out annually for all participants. MAIN OUTCOME MEASURES: The prevalence of myopia (spherical equivalent, ≤ -0.5 D in either eye) in each of the 7 school-year cohorts of preschoolers 5 to 6 years of age. RESULTS: The prevalence of myopia continuously decreased for 2 years after implementing the YMVIP: 2014 cohort, 15.5% (95% confidence interval [CI], 14.2%-16.8%); 2015 cohort, 13.5% (95% CI, 12.3%-14.7%); and 2016 cohort, 8.4% (95% CI, 7.4%-9.4%). Subsequent cohorts were exposed maximally to these school-based myopia prevention strategies, and the prevalence of myopia remained relatively stable, between 8.5% and 10.3%, even during the COVID-19 pandemic. Multivariate logistic regression analysis showed a dose-dependent association between the duration of exposure to preventive strategies and the prevalence of myopia (up to 1-year YMVIP exposure, odds ratio, 0.86 [95% CI, 0.74-0.99]; up to 2-year YMVIP exposure, odds ratio, 0.56 [95% CI, 0.50-0.63]) after controlling other myopigenic factors. CONCLUSIONS: This population-based evidence showed high prevalence of preschool myopia and an L-shaped decline after introducing strategies to promote outdoor activities in kindergartens. With undisrupted school-based preventive strategies, the prevalence of myopia can be kept stable, even during the COVID-19 pandemic.

An overview on mechanism, cause, prevention and multi-nation policy level interventions of dietary iron deficiency.

Iron deficiency anemia (IDA) is probably the most ignored situation in the world of malnutrition-largely due to its slow progression. Multiple reasons can be attributed as the cause of IDA, which is not limited to any specific region or population; therefore, making it a matter of global concern. Despite the human body's ability to absorb and conserve iron stores, the gradual loss due to various physiological conditions leads to net deficiency of iron. Countless commercial iron supplements are available, but at given physiological conditions, almost all of these "Bio-not-available" iron forms quite often become ineffective. World Health Organization and other government bodies have jointly developed health advisories and tried to developed nutrition supplements several times in the last two decades. IDA, when combined with other disease conditions, becomes a life-threatening situation. At the same time, an overdose of iron could also be very harmful to the body. Therefore, it is important to deal with this situation with caution. This article covers iron metabolism, available options for iron supplementation, regulatory aspects and strategies to prevent IDA.

Deceleration of Cropland-N2O Emissions in China and Future Mitigation Potentials.

Agricultural soils are the largest anthropogenic emission source of nitrous oxide (N2O). National agricultural policies have been implemented to increase crop yield and reduce nitrogen (N) losses to the environment. However, it is difficult to effectively quantify crop-specific and regional N2O mitigation priorities driven by policies, due to lack of long-term, high-resolution crop-specific activity data, and oversimplified models. Here, we quantify the spatiotemporal changes and key drivers of crop-specific cropland-N2O emissions from China between 1980 and 2017, and future N2O mitigation potentials, using a linear mixed-effect model and survey-based data set of agricultural management measures. Cropland-N2O emissions from China tripled from 102.5 to 315.0 Gg N yr-1 between 1980 and 2017, and decelerated since 1998 mainly driven by country-wide deceleration and decrease in N rate and the changes in sowing structure. About 63% of N2O emissions could be reduced in 2050, primarily in the North China Plain and Northeast China Plain; 83% of which is from the production of maize (33%), vegetables (27%), and fruits (23%). The deceleration of N2O emissions highlights that policy interventions and agronomy practices (i.e., optimizing N rate and sowing structure) are potential pathways for further ambitious N2O mitigation in China and other developing countries.

Prevention and control of non-communicable diseases in iran: the case for Investment.

BACKGROUND: Non-communicable diseases are imposing a considerable burden on Iran. This study aims to assess the Return on Investment (ROI) for implementation of Non-communicable diseases (NCDs) prevention program in Iran. METHODS: Four disease groups including cardiovascular diseases, diabetes, cancer, and respiratory diseases were included in our ROI analysis. The study followed four steps: 1) Estimating the total economic burden of NCDs using the Cost-of-Illness approach. 2) Estimating the total costs of implementing clinical and preventive interventions using an ingredient based costing at delivering level and a program costing method at central level.3) Calculating health impacts and economic benefits of interventions using the impact measures of avoided incidence, avoided mortality, healthy life years (HLYs) gained, and avoided direct treatment costs. 4) Calculating the ROI for each intervention in 5- and 15- year time horizons. RESULTS: The total economic burden of NCDs to the Iranian economy was IRR 838.49 trillion per year (2018), which was equivalent to 5% of the country's annual Gross Domestic Product (GDP). The package of NCD will lead to 549 000 deaths averted and 2 370 000 healthy life years gained over 15 years, and, financially, Iranian economy will gain IRR 542.22 trillion over 15 years. The highest ROI was observed for the package of physical activity interventions, followed by the interventions addressing salt, tobacco package and clinical interventions. Conclusions NCDs in Iran are causing a surge in health care costs and are contributing to reduced productivity. Those actions to prevent NCDs in Iran, as well as yielding to a notable health impact, are giving a good economic return to the society. This study underscores an essential need for establishment of a national multi-sectorial NCD coordination mechanism to bring together and strengthen existing cross-agency initiatives on NCDs.

Decoupling between ammonia emission and crop production in China due to policy interventions.

Cropland ammonia (NH3 ) emission is a critical driver triggering haze pollution. Many agricultural policies were enforced in past four decades to improve nitrogen (N) use efficiency while maintaining crop yield. Inadvertent reductions of NH3 emissions, which may be induced by such policies, are not well evaluated. Here, we quantify the China's cropland-NH3 emission change from 1980 to 2050 and its response to policy interventions, using a data-driven model and a survey-based dataset of the fertilization scheme. Cropland-NH3 emission in China doubled from 1.93 to 4.02 Tg NH3 -N in period 1980-1996, and then decreased to 3.50 Tg NH3 -N in 2017. The prevalence of four agricultural policies may avoid ~3.0 Tg NH3 -N in 2017, mainly located in highly fertilized areas. Optimization of fertilizer management and food consumption could mitigate three-quarters of NH3 emission in 2050 and lower NH3 emission intensity (emission divided by crop production) close to the European Union and the United States. Our findings provide an evidence on the decoupling of cropland-NH3 from crop production in China and suggest the need to achieve cropland-NH3  mitigation while sustaining crop yields in other developing economies.

A dynamic model of the opioid drug epidemic with implications for policy.

Background: The U.S. opioid epidemic has caused substantial harm for over 20 years. Policy interventions have had limited impact and sometimes backfired. Experts recommend a systems modeling approach to address the complexities of opioid policymaking.Objectives: Develop a system dynamics simulation model that reflects the complexities and can anticipate intended and unintended intervention effects.Methods: The model was developed from literature review and data gathering. Its outputs, starting in 1990, were compared against 12 historical time series. Four illustrative interventions were simulated for 2020-2030: reducing prescription dosage by 20%, cutting diversion by 30%, increasing addiction treatment from 45% to 65%, and increasing lay naloxone use from 4% to 20%. Sensitivity testing was performed to determine effects of uncertainties. No human subjects were studied.Results: The model fits historical data well with error percentage averaging 9% across 201 data points. Interventions to reduce dosage and diversion reduce the number of persons with opioid use disorder (PWOUD) by 11% and 16%, respectively, but each of these interventions reduces overdoses by only 1%. Boosting treatment reduces overdoses by 3% but increases PWOUD by 1%. Expanding naloxone reduces overdose deaths by 12% but increases PWOUD by 2% and overdoses by 3%. Combining all four interventions reduces PWOUD by 24%, overdoses by 4%, and deaths by 18%. Uncertainties may affect these numerical results, but policy findings are unchanged.Conclusion: No single intervention significantly reduces both PWOUD and overdose deaths, but a combination strategy can do so. Entering the 2020s, only protective measures like naloxone expansion could significantly reduce overdose deaths.

Recovery preparedness of global air transport influenced by COVID-19 pandemic: Policy intervention analysis.

The outbreak of COVID-19 constitutes an unprecedented disruption globally, in which risk management framework is on top priority in many countries. Travel restriction and home/office quarantine are some frequently utilized non-pharmaceutical interventions, which bring the worst crisis of airline industry compared with other transport modes. Therefore, the post-recovery of global air transport is extremely important, which is full of uncertainty but rare to be studied. The explicit/implicit interacted factors generate difficulties in drawing insights into the complicated relationship and policy intervention assessment. In this paper, a Causal Bayesian Network (CBN) is utilized for the modelling of the post-recovery behaviour, in which parameters are synthesized from expert knowledge, open-source information and interviews from travellers. The tendency of public policy in reaction to COVID-19 is analyzed, whilst sensitivity analysis and forward/backward belief propagation analysis are conducted. Results show the feasibility and scalability of this model. On condition that no effective health intervention method (vaccine, medicine) will be available soon, it is predicted that nearly 120 days from May 22, 2020, would be spent for the number of commercial flights to recover back to 58.52%-60.39% on different interventions. This intervention analysis framework is of high potential in the decision making of recovery preparedness and risk management for building the new normal of global air transport.

Pandemic waves and the time after Covid-19 - Consequences for the transport sector.

This paper discusses the dual role of the transport sector in the Covid-19 pandemic: spreading the virus around the world and being most negatively impacted by the pandemic. This paper describes and analyzes the following: (a) actions taken by the governments and international community in order to control the spreading and to alleviate negative economic impacts including massive fiscal and monetary stimulus funding; (b) detailed discussions on the impacts of the pandemic on air transport, rail and bus transport, and urban transit, and major countries' responses to reduce the negative effects; (c) discussions on the positive effects of the pandemic on the environment and climate change by suggesting policy measures in order to make it sustainable over the long term. Finally, the paper addresses social acceptance issue of the behavioral changes necessary in the post-pandemic world, in particular reflecting historical experience of the Spanish flu case. We end the paper with some observations and discussion of the normative issues for a sustainable development of the transport sector.

The effects of nudging and pricing on healthy food purchasing behavior in a virtual supermarket setting: a randomized experiment.

BACKGROUND: Evidence on what strategies - or combination of strategies - are most effective and equitable in promoting healthier diets is needed. This study examined the efficacy of nudging and pricing strategies on increasing healthy food purchases and the potential differential effect by socio-economic position (SEP) among Dutch adults in a virtual supermarket. METHODS: A randomized study design was conducted within a virtual supermarket (SN VirtuMart). Participants were exposed to five within-subject study conditions (control, nudging, pricing, price salience and price salience with nudging) and randomized to one of three between-subject study arms (a 25% price increase on unhealthy products, a 25% discount on healthy products, or a 25% price increase and discount). In total, 455 participants of low and high SEP (using either education or income as proxy) were randomized to conduct their weekly shopping in a virtual supermarket for five consecutive weeks. The primary outcome included the percentage of healthy purchases. Data were analyzed using linear mixed models. RESULTS: In total, 346 (76%) adults completed all five shops within the SN VirtuMart. Median age was 32.5, 49.2% had high education and 32.8% had high income. Out of the 12 conditions, four conditions were statistically significantly different from the control condition. Nudging and non-salient pricing strategies alone did not statistically significantly increase healthy food purchases, whereas a combination of salient price increases and discounts led to an increase in the percentage of healthy food purchases (B 4.5, 95%CI 2.6; 6.4). Combining salient pricing and nudging strategies led to increases in the percentage of healthy products in all three pricing arms, with largest effects found in the combined price increase and discount arm (B = 4.0, 95%CI = 2.0; 6.0). Effects were not modified by SEP. CONCLUSIONS: Combining health-related price increases and discounts and combining these salient pricing strategies with nudges in a supermarket setting seems to stimulate healthy food purchases for both low and high SEP populations. However, further research in real-world settings is needed. TRIAL REGISTRATION: This randomized trial ( NTR7293 ) was registered in the Dutch trial registry ( www.trialregister.nl ).

Moving Upstream: The Effect of Tobacco Clean Air Restrictions on Educational Inequalities in Smoking Among Young Adults.

Education affords a range of direct and indirect benefits that promote longer and healthier lives and stratify health lifestyles. We use tobacco clean air policies to examine whether policies that apply universally-interventions that bypass individuals' unequal access and ability to employ flexible resources to avoid health hazards-have an effect on educational inequalities in health behaviors. We test theoretically informed but competing hypotheses that these policies either amplify or attenuate the association between education and smoking behavior. Our results provide evidence that interventions that move upstream to apply universally regardless of individual educational attainment-here, tobacco clean air policies-are particularly effective among young adults with the lowest levels of parental or individual educational attainment. These findings provide important evidence that upstream approaches may disrupt persistent educational inequalities in health behaviors. In doing so, they provide opportunities to intervene on behaviors in early adulthood that contribute to disparities in morbidity and mortality later in the life course. These findings also help assuage concerns that tobacco clean air policies increase educational inequalities in smoking by stigmatizing those with the fewest resources.

[Cancer epidemics and the cancer prevention and control strategies in the United States: a review study].

In the past two decades,the United States made an impressed progress in the prevention and control of cancer that the overall morbidity and mortality of cancer had shown a downward trend, while China had seen an opposite trend. Cancer, one of the major public health concerns in China, has imposed an enormous burden onthe society and individuals. Therefore,in order to scientifically formulate cancer prevention and control policies, it is essential to make a comprehensive understanding of the practical experience in the field of cancer prevention and control from the United States. This article reviews the relevant literature on cancer trends as well as the prevention and control strategies in the United States,depictsthe cancer epidemic situation in the United States in the past 30 years, and summarizes the influencing factors, strategies and intervention experiences that lead to the improvement of cancer epidemic. It highlights the policy support, surveillance and intervention adopted by the United States for the cancer prevention and control. This article is expected to provide some implications and reference for the cancer prevention and control in China.

How does 'park and ride' perform? An evaluation using longitudinal data.

The efficiency of park and ride (PnR) lots has not been investigated in serious depth in prior literature. This study examines the effect of various factors on the utilization rate of PnR lots with panel Tobit models. The examined factors consist of land use features, roadway design features, transit ridership, sociodemographic attributes, travel characteristics, policy tools, gasoline prices, and weather conditions. The data is drawn from PnR lots in King County, Washington. Results show that: (1) degree of mixed land use, road density, employment density, percentages of people aged between 18 and 34 and people over 65, the percentage of white people, the percentage of poor people, and transit ridership are positively associated with the utilization rate of PnR lots; (2) the percentage of drive lanes in total roadway miles, the percentage of males, and the mode share percentage of driving are negatively correlated with the utilization rate of PnR lots; (3) various policy interventions, including countermeasures for preserving transit after the economic recession, congestion reduction charge, and bus-rail integration, are all positively correlated with the utilization rate of PnR lots. Contextualized to US cities, PnR is a practical way to attract bus riders, especially young adults, senior citizens, and low-income people to public transit. Dense urban development is encouraged for the full utilization of PnR lots. Additionally, the integration between bus and rail appears to be an effective policy tool to promote PnR utilization.

The spillover effect of midwife attrition from the Nigerian midwives service scheme.

BACKGROUND: The Nigerian Midwives Service Scheme (MSS) increased use of antenatal services at rural public sector clinics. However, it is unclear if women who would not have otherwise sought care, or those who would have sought care in rural private sector clinics caused this change. Additionally, it is also unclear if the reported midwife attrition was associated with a spillover of the scheme's effect on urban areas. We sought to answer these two questions using data from two nationally representative surveys. METHODS: We used an interrupted time series model to assess trends in the use of obstetric (i.e. antenatal and delivery) services among rural and urban respondents in the 2008 and 2013 Nigerian demographic and health surveys. RESULTS: We found that the MSS led to a 5-percentage point increase in the use of antenatal services at rural public sector clinics, corroborating findings from a previous study. This change was driven by women who would not have sought care otherwise. We also found that there was a 4-percentage point increase in the use of delivery services at urban public sector clinics, and a concurrent 4-percentage point decrease in urban home deliveries. These changes are most likely explained by midwives' attrition and exemplify a spillover of the scheme's effect. CONCLUSION: Midwife attrition from the Nigerian MSS was associated with a spillover of the scheme's effect on the use of delivery services, on urban areas.

Sustainability assessment for the transportation environment of Darjeeling, India.

Darjeeling is an important tourist hill town of West Bengal, India. It suffers from an acute problem of transportation, particularly during its peak tourist seasons due to limited road space, inadequate public transport facilities and indiscriminate use of automobiles. This hill town was originally designed for a population of 10,000, but over the years, it has come face-to-face with rapid urbanization, a rising population of both tourists and residents and intensifying motor vehicle usage. These factors together are posing a threat to its transport environment. This study identifies the Sustainable Transport Indicators (STIs) available in the existing literature to identify the critical stretches using Analytical Hierarchy Process (AHP) based on experts' consensus. It was found that the experts placed emphasis on the mobility of the town, talking about vehicular impact on air pollution and encroachment of roads as the main issues affecting the sustainability of the transport environment. Thereafter, policy-level interventions have been suggested in accordance with the identified sustainability issues. We trust that other tourist hill towns with issues similar to Darjeeling could easily emulate the study methodology to assess their transport environment sustainability, or replicate on the lines of the recommended policy interventions.

Evidence for capitation reform in a New Rural Cooperative Medical Scheme in Pudong New Area, Shanghai: A longitudinal study.

Currently, China has been experiencing rapid growth of medical costs, serious waste of medical resources, increasing disease burden for residents, and a medical insurance fund deficit. Therefore, an urgent problem that needs to be solved is to choose a rational payment for the insurance system. To empirically evaluate the long-term effects of capitation reform in a New Rural Cooperative Medical Scheme in Pudong New Area, we collected and analysed data regarding financing, fund operation, medical service cost, and medical care-seeking behaviour from 2011 to 2015, a duration that includes data before and after reform. The data for financing and behaviours were compared year by year, and the monthly data for inpatient and outpatient costs were evaluated in a retrospective time series study. The capitation reform in Pudong New Area showed strong evidence of the power of medical cost control in the long run, while it was weak in reversing the number of patients flowing into secondary and tertiary hospitals. To make the payment of capitation play a bigger role in cost control in China, a tighter alignment of capitation with the general practitioner system and achieving dual referral is critical for future studies.

Estimating the benefits of public health policies that reduce harmful consumption.

For products such as tobacco and junk food, where policy interventions are often designed to decrease consumption, affected consumers gain utility from improvements in lifetime health and longevity but also lose utility associated with the activity of consuming the product. In the case of anti-smoking policies, even though published estimates of gross health and longevity benefits are up to 900 times higher than the net consumer benefits suggested by a more direct willingness-to-pay estimation approach, there is little recognition in the cost-benefit and cost-effectiveness literature that gross estimates will overstate intrapersonal welfare improvements when utility losses are not netted out. This paper presents a general framework for analyzing policies that are designed to reduce inefficiently high consumption and provides a rule of thumb for the relationship between net and gross consumer welfare effects: where there exists a plausible estimate of the tax that would allow consumers to fully internalize health costs, the ratio of the tax to the per-unit long-term cost can provide an upper bound on the ratio of net to gross benefits.

Testing a policy intervention in the lab: differences between students and non-students in switching bank accounts.

The reliance on student samples has long been a subject of debate in experimental approaches to studying behaviour. We contribute to this discussion by looking at differences in financial behaviour between a student and a non-student sample in three sets of lab experiments conducted in Spain, Germany and Poland (n=857). Participants from both samples switched more often and made better financial decisions after they received a message encouraging them to switch financial service providers. While the size of the effect on switching frequency was comparable between the two samples, the effect on switching quality was significantly stronger on non-students. Further analysis suggests this is due to a better performance of students before the prompt leaving less room for improvement by the reminder. Results suggest that experimental evidence derived from students should be generalized with caution.