Associations of U.S. state-level COVID-19 policies intensity with cannabis sharing behaviors in 2020.

BACKGROUND: Cannabis use before the COVID-19 pandemic for many involved sharing prepared cannabis for inhalation, practices that were less prevalent during the pandemic. State-level COVID-19 containment policies may have influenced this decrease. This study examined the extent to which the intensity of state-level COVID-19 policies were associated with individual-level cannabis sharing. Findings have the potential to guide harm reduction policies for future respiratory pandemics and seasonal respiratory virus waves. METHODS: This study used cross-sectional individual-level data from the COVID-19 Cannabis Study, an anonymous U.S.-based web survey on cannabis use disseminated during the early phase of the pandemic (Full sample N = 1,883). We combined individual-level data with state-level policy data from Kaiser Family Foundation's State COVID-19 Data and Policy Actions for three time-points from June to August 2020 that overlapped with the survey period. Cannabis sharing was dichotomized as any versus no sharing. We adapted a previously published coding framework to score the intensity of COVID-19 policies implemented in each U.S. state and averaged the policy score across the time period. We then used Poisson regression models to quantify the associations of the average state-level COVID-19 policy score with cannabis sharing during the pandemic. RESULTS: Participants (n = 925) reporting using inhalation as a mode for cannabis use were included in this analysis. Most respondents were male (64.1%), non-Hispanic White (54.3%), with a mean age of 33.7 years (SD 8.8). A large proportion (74.9%) reported sharing cannabis during the pandemic. Those who shared cannabis more commonly lived in states with a lower average policy score (16.7, IQR 12.3-21.5) compared to those who did not share (18.6, IQR 15.3-25.3). In adjusted models, the prevalence ratio of any cannabis sharing per every 5-unit increase in the average COVID-19 policy score was 0.97 (95% CI 0.93, 1.01). CONCLUSIONS: Fewer individuals shared cannabis in states with more intense COVID-19 containment policies compared to those in states with less intense policies. Individuals who use cannabis may be willing to make changes to their behavior and may further benefit from specific and directed public health messaging to avoid sharing during respiratory infection outbreaks.

Engaging with immigrant students' voices in the school environment: an analysis of policy documents through school websites.

BACKGROUND: For students to feel happy and supported in school, it is important that their views are taken seriously and integrated into school policies. However, limited information is available how the voices of immigrant students are considered in European school contexts. This study generated evidence from written documents to ascertain how student voice practices are described at school websites. METHODS: Between 2 March and 8 April 2021, we reviewed the policy documents publicly available on school websites. The schools located in areas of high immigration in six European countries: Austria, England, Finland, Germany, Romania, and Switzerland. The READ approach was used to guide the steps in the document analysis in the context of policy studies (1) ready the materials, 2) data extraction, 3) data analysis, 4) distil the findings). A combination of qualitative and quantitative approaches with descriptive statistics (n, %, Mean, SD, range) was used for analysis. RESULTS: A total of 412 documents (305 schools) were extracted. Based on reviewing school websites, reviewers'strongly agreed' in seven documents (2%) that information related to seeking student voices could be easily found. On the contrary, in 247 documents (60%), reviewers strongly indicated that information related to seeking student voices was missing. No clear characteristics could be specified to identify those schools were hearing students' voices is well documented. The most common documents including statements related to student voice were anti-bullying or violence prevention strategies (75/412) and mission statements (72/412). CONCLUSIONS: Our document analysis based on publicly accessible school websites suggest that student voices are less frequently described in school written policy documents. Our findings provide a baseline to further monitor activities, not only at school level but also to any governmental and local authorities whose intention is to serve the public and openly share their values and practices with community members. A deeper understanding is further needed about how listening to student voices is realized in daily school practices.

Causes and outcomes of at-risk underperforming pharmacy students: implications for policy and practice.

OBJECTIVE: This study aimed to understand the key determinants for poor academic performance of students completing a Bachelor of Pharmacy (BPharm), Bachelor of Pharmacy and Management (BPharmMgmt), or Master of Pharmacy (MPharm) degree. METHODS: Data were collected on pharmacy students who had not met academic progression requirements between 2008 and 2018 at The University of Sydney, Australia. This included: age at the start of pharmacy degree; gender; whether they transferred from another university; whether they were a domestic or international student; Australian Tertiary Admissions Rank upon entry, previous studies in biology, chemistry, or mathematics; show cause triggers (units of study failed); number of show causes; students' written show cause responses; weighted average mark at last show cause or graduation; whether they graduated and were a registered pharmacist; and, the number of years they spent studying the degree. Descriptive studies were used to analyse student characteristics using SPSS software, and student self-reported reasons for poor performance were analysed reflexively using thematic analysis procedures using NVivo. RESULTS: This study included 164 pharmacy students enrolled in a BPharm (79.3%, n = 130), BPharmMgmt (1.2%, n = 2), or MPharm (19.5%, n = 32). Of the students, 54% (n = 88) were men, 81% (n = 133) were domestic students, 15% (n = 24) transferred from another degree program, and 38% (n = 62) graduated from the course. Show cause students were less likely to graduate if they transferred from another degree program (P = 0.0002) or failed more than three units of study (UoS; P < 0.0001). The most commonly failed UoS were related to organic or pharmaceutical chemistry, and the top student self-reported reasons for poor performance was stress/anxiety, physical health, and depression. CONCLUSION: Pharmacy schools should aim to address student foundational knowledge in chemistry, identify at-risk students early using pre-subject testing, and provide better services to address student mental health.

Brief interventions 2.0: a new agenda for alcohol policy, practice and research.

BACKGROUND: Alcohol problems are increasing across the world and becoming more complex. Limitations to international evidence and practice mean that the screening and brief intervention paradigm forged in the 1980s is no longer fit for the purpose of informing how conversations about alcohol should take place in healthcare and other services. A new paradigm for brief interventions has been called for. BRIEF INTERVENTIONS 2.0: We must start with a re-appraisal of the roles of alcohol in society now and the damage it does to individual and population health. Industry marketing and older unresolved ideas about alcohol continue to impede honest and thoughtful conversations and perpetuate stigma, stereotypes, and outright fictions. This makes it harder to think about and talk about how alcohol affects health, well-being, and other aspects of life, and how we as a society should respond. To progress, brief interventions should not be restricted only to the self-regulation of one's own drinking. Content can be orientated to the properties of the drug itself and the overlooked problems it causes, the policy issues and the politics of a powerful globalised industry. This entails challenging and reframing stigmatising notions of alcohol problems, and incorporating wider alcohol policy measures and issues that are relevant to how people think about their own and others' drinking. We draw on recent empirical work to examine the implications of this agenda for practitioners and for changing the public conversation on alcohol. CONCLUSION: Against a backdrop of continued financial pressures on health service delivery, this analysis provokes debate and invites new thinking on alcohol. We suggest that the case for advancing brief interventions version 2.0 is both compelling and urgent.

Value per Statistical Life at the Sub-National Level as a Tool for Assessing Public Health and Environmental Problems.

This article aims to estimate the Value per Statistical Life (VSL) and Value per Statistical Life Year (VSLY) at the sub-national level, which can be used to calculate the economic impact of health and environmental problems. We estimate the value of life for Mexico and its 32 states, grouped into 5 regions for 2021. We used the OECD's guidelines on "Mortality Risk Valuation in Environment, Health and Transport Policies," which applies the measure of Willingness to Pay (WTP) and Cost-Benefit Analysis (CBA). Mexico's overall VSL of $2 000 000 USD in 2021 showcases the value placed on human life. The variation in VSL across the 32 states, with Chiapas having the lowest VSL of $400 000 USD and Mexico City boasting the highest VSL of $3 300 000 USD highlights the different levels of regional development and people's willingness to pay to reduce the risk of mortality. Our estimates of VSL and VSLY have the potential to contribute to the evaluation of public policies in the fields of health and the environment. Monetizing human life through these estimates can offer valuable insights to policymakers at both the national and sub-national levels. By quantifying the economic value placed on human life, this paper helps decision-makers prioritize investments, assess the cost-effectiveness of interventions, and allocate resources to maximize societal well-being.

Access of older people to primary health care in low and middle-income countries: A systematic scoping review.

INTRODUCTION: Ensuring access for older people to Primary Health Care (PHC) is vital to achieve universal health coverage, improve health outcomes, and health-system performance. However, older people living in Low-and Middle-Income Countries (LMICs) face barriers constraining their timely access to appropriate care. This review aims to summarize the nature and breadth of literature examining older people's experiences with access to PHC in LMICs, and access barriers and enablers. METHODS: Guided by Arksey and O'Malley's framework, four databases [CINAHL, Cochrane, PubMed, and Embase] were systematically searched for all types of peer-reviewed articles published between 2002 and 2023, in any language but with English or French abstract. Gray literature presenting empirical data was also included by searching the United Nations, World Health Organization, and HelpAge websites. Data were independently screened and extracted. RESULTS: Of 1165 identified records, 30 are included. Data were generated mostly in Brazil (50%) and through studies adopting quantitative designs (80%). Older people's experiences varied across countries and were shaped by several access barriers and enablers classified according to the Patient-Centered Access to Healthcare framework, featuring the characteristics of the care delivery system at the supply side and older people's attributes from the demand side. The review identifies that most access barriers and enablers pertain to the availability and accommodation dimension, followed by the appropriateness, affordability, acceptability, and approachability of services. Socio-economic level and need perception were the most reported characteristics that affected older people's access to PHC. CONCLUSIONS: Older people's experiences with PHC access varied according to local contexts, socioeconomic variables, and the provision of public or private health services. Results inform policymakers and PHC practitioners to generate policies and services that are evidence-based and responsive to older people's needs. Identified knowledge gaps highlight the need for research to further understand older people's access to PHC in different LMICs.

Governance for planetary health equity-the Planetary Health Equity Hothouse project.

BACKGROUND: Planetary health equity (PHE) is defined here as equitable good health in a stable Earth system. PHE is arguably in crisis. Human-made climate change is damaging global populations through hotter temperatures, wildfires, and more severe and frequent storms, flooding, and landslides. A tsunami of health inequities will result from this, as pre-existing health conditions and inequities in living and working conditions ensure that socially disadvantaged groups and people in low-income and middle-income countries are disproportionately affected by climate change. Despite evidence of these massive challenges and multiple calls to action, why has there been so little effective remedial action? And more importantly, how can we overcome this failure? To answer these questions, this panel discusses new research for understanding the conditions that enable coherent governance to improve planetary health equity outcomes. METHODS: The panel draws on emerging research from the Planetary Health Equity Hothouse. With perspectives from political economy, public health, policy studies, and systems science, we present new conceptual thinking and empirics around the complexities, dynamics, and trajectories of the global consumptogenic system in the 21st century, with a focus on the intersections between climate change and social and health inequities. The research examines mechanisms via which the global political economy creates planetary health inequities; identifies policy that optimises the climate, social, and health equity outcomes of mitigation actions; and discusses how governance for planetary health equity must evolve into the future, focusing on the structural, institutional, and ideational factors that advance action to promote PHE outcomes. FINDINGS: The global consumptogenic system of institutions, actors, norms, policies, and commercial activities that incentivise excessive production and consumption of fossil fuel-reliant goods and services with negative environmental, social, and health effects lies at the heart of the PHE crisis. Using network analysis, we show that the global PHE governance architecture is highly centralised and dominated by economic governance organisations. We also discuss a new Planetary Health Equity Impact Assessment tool to assess the PHE effects of existing policy and business practices within the consumptogenic system. An initial assessment of the mitigation sections of national governments' Nationally Determined Contribution reports to the UN Framework Convention on Climate Change shows a dominance of economic language and issues. This highlights a missed opportunity for mitigation policy to be inclusive of social and health matters. Finally, we present new conceptual understandings of multilevel governance coherence and relevant strategies to advance PHE focused action. INTERPRETATION: The major contribution from research on governance for planetary health equity lies in detailing the what, who, and how of effective governance that advances health, social equity, and the environment in an interconnected way, helping to shift institutional norms and behaviours towards principles of fairness, sustainability, and human wellbeing. Crucially, it provides strategies for socially oriented actors, including governments, civil society, and international organisations to change the consumptogenic system and advance action for PHE. FUNDING: Australian Research Council.

Age-inclusive Arctic outdoor spaces: a policy review in four Nordic countries.

In the last decade, policy strategies were adopted in response to population ageing in the Nordic countries. Governmental actions have to be evaluated in terms of their efficacy. The objective of this article is to identify and review the policies related to age-inclusive outdoor spaces in the Arctic regions of Nordic countries. Our analysis focuses on central government white papers that address the older adults in Finland, Norway, Sweden, and Iceland. A review of such policy documents provides insights into the predominant understandings of older adults and healthy ageing. Moreover, such analysis may identify "blind spots" in the national policies, especially regarding the sparsely researched northernmost and rural Arctic territories. Our results demonstrate how the older populations in the Nordic Arctic and their access to outdoor spaces are addressed in the policy documents. We found that with few exceptions, the older people of the rural Arctic is strikingly absent in the Nordic national governmental papers. Moreover, access to outdoor spaces is mentioned in general terms, and specific challenges of the rural Arctic context, such as the harsh climate, long winters and geographical distances are not addressed. The noticed omissions might be the result of "urban-rural", "south-north", "indoor-outdoor", and "generalisation" biases.

Understanding the legacies of shocks on health system performance: Exploring Ireland's management of recent crises and its implications for policy.

This paper contrasts the Irish experience of the 2008 economic crisis and the Covid-19 pandemic, and the health system responses to these shocks, from the perspective of health system leaders working across both time periods. Based on semi-structured interviews with seven senior national and international officials, the research presented here forms the qualitative component of RESTORE, a five-year research project examining health system resilience and reform, funded through the Health Research Board's Research Leader Award in Ireland. Findings indicate that the financial crisis deeply impacted the Irish health system in relation to infrastructure and capacity, service delivery and workforce. Due to these legacy issues, Ireland's health system was in a relatively weak position when faced with the Covid-19 pandemic but the system proved adaptive and innovative during this time. Furthermore, the pandemic proved to be a catalyst for positive change, providing opportunities for long-term reform, alongside an immediate response to the crisis. This was facilitated by increased funding, a devolution in decision-making structures and a political commitment to the health system. Exploring lessons from the Irish response to these crises provides a case study for developing appropriate policy responses around financing and resource allocation, fostering support for healthcare among political leaders and policy makers, and preparing for future shocks. Furthermore, examining these experiences facilitates understanding around the impact of each crisis on the health system, exploring options for addressing legacy issues and considering practical steps to improve health system performance.

The effectiveness of emerging markets' legal structure in explaining financial development.

This article examines the role of legal structure in explaining financial development in twenty-three emerging markets, which has not been explored in institutional economics literature before. This study relied on Pedroni, and Kao cointegration tests, which is followed by the renowned panel cointegration technique. The results of the Pedroni and Kao cointegration tests show that the variables understudy is cointegrated in the long-run. These findings are confirmed by the panel cointegration showing that legal structure (LS) has positive impact on financial development (FIND) in long-run that support Law and Finance, and New Institutional Economics theories in emerging markets. This study is the first to directly examine the long-run impact of LS on FIND in emerging markets, and the result remains consistent across alternative measure of FIND. The findings of this study have important policy implications for emerging markets. Policymakers should focus on creating a legal environment that is conducive to financial development. This includes strengthening the legal framework, improving regulatory regimes, and promoting market autonomy. Additionally, policymakers should work to attract foreign investment, which can help spur economic growth and development in emerging markets. The findings of the study are consistent across battery of robustness testing.

How social evaluations shape trust in 45 types of scientists.

Science can offer solutions to a wide range of societal problems. Key to capitalizing on such solutions is the public's trust and willingness to grant influence to scientists in shaping policy. However, previous research on determinants of trust is limited and does not factor in the diversity of scientific occupations. The present study (N = 2,780; U.S. participants) investigated how four well-established dimensions of social evaluations (competence, assertiveness, morality, warmth) shape trust in 45 types of scientists (from agronomists to zoologists). Trust in most scientists was relatively high but varied considerably across occupations. Perceptions of morality and competence emerged as the most important antecedents of trust, in turn predicting the willingness to grant scientists influence in managing societal problems. Importantly, the contribution of morality (but not competence) varied across occupations: Morality was most strongly associated with trust in scientists who work on contentious and polarized issues (e.g., climatologists). Therefore, the diversity of scientific occupations must be taken into account to more precisely map trust, which is important for understanding when scientific solutions find their way to policy.

From theory to practice: Monetary policy transmission and bank risk dynamics.

This paper investigates the relationship between monetary policy and bank risk-taking by introducing a model wherein banks expend a level of costly monitoring effort to select low-risk projects, thereby reducing the risk associated with the loans they grant. The impact of monetary policy on bank risk-taking is examined through both theoretical models and empirical analysis. The paper compares theoretical models with different assumptions, revealing an unambiguous negative effect without the assumption of limited liability for banks, and an ambiguous effect with the assumption of limited liability for banks, influenced by the equity ratio. The empirical model employs unique quarterly data comprising balance sheet information for top-listed banks in the U.S. banking system from 2000 to 2017. The findings indicate that low-interest rates contribute to an increase in bank risk-taking. Moreover, this effect is more pronounced after the financial crisis and weaker before the crisis. Additionally, the impact is evident for undercapitalized banks and more substantial for those financed with a higher proportion of equity.

From pets to parliament: why we chose to shape veterinary policy of the future.

Entering the political arena isn't for everyone, but here the second - and currently only - vet to sit in the House of Lords, Lord Trees, and his parliamentary intern, discuss why contributing to parliamentary business is an exciting and stimulating end and start to their respective careers.

Can Mercury Influence Carbon Dioxide Levels? Implications for the Implementation of the Minamata Convention on Mercury.

The Paris Agreement and the Minamata Convention on Mercury are two of the most important environmental conventions being implemented concurrently, with a focus on reducing carbon and mercury emissions, respectively. The relation between mercury and carbon influences the interactions and outcomes of these two conventions. This perspective investigates the link between mercury and CO2, assessing the consequences and exploring the policy implications of this link. We present scientific evidence showing that mercury and CO2 levels are negatively correlated under natural conditions. As a result of this negative correlation, the CO2 level under the current mercury reduction scenario is predicted to be 2.4-10.1 ppm higher than the no action scenario by 2050, equivalent to 1.0-4.8 years of CO2 increase due to human activity. The underlying causations of this negative correlation are complex and need further research. Economic analysis indicates that there is a trade-off between the benefits and costs of mercury reduction actions. As reducing mercury emission may inadvertently undermine efforts to achieve climate goals, we advocate for devising a coordinated implementation strategy for carbon and mercury conventions to maximize synergies and reduce trade-offs.

Sexually transmitted infections and the HPV-related burden: evolution of Italian epidemiology and policy.

Sexually transmitted infections (STIs) are a major public health problem worldwide, with a high prevalence between the ages of 15 and 25 in most Western countries. High notification rates of chlamydia, gonorrhea, and syphilis are reported in the WHO European Region, with differences between countries. In Italy, the total number of STIs alerts increased by 18% from 2020 to 2021. HPV is the most common sexually transmitted infection; globally one in seven women is infected by this virus, and certain sexual behaviors are important risk factors for HPV-related cancers, particularly cervical cancer (CC), anogenital cancers and cancers of the head and neck. The burden of CC is relevant worldwide, in particular in Europe CC is the third leading cause of cancer-related deaths in women aged 15-44. This HPV-related tumor is preventable through a combined strategy of vaccination and screening for precursor lesions. In Italy, the coverage of organized screening varies from region to region and the average HPV vaccination rate is still far from the expected optimal threshold of 95% at the age of 12. To address the challenges of health promotion and HPV prevention, priority actions are needed such as: promoting education and information at every level, from schools to healthcare professionals. In Italy, education of adolescents on sexual and reproductive health, still remains critical, regionally inhomogeneous and much lower than in other European countries. Equitable measures need to be taken, and schools are an important place for health promotion activities.

What Should Prescribers and Policy Makers Know About US Drug Importation?

Drug importation raises several ethical and safety concerns relevant to prescribers and policy makers considering costs and benefits of international medicine importation. This article suggests key points to consider, especially from a policy perspective, when weighing imported medicines' perceived affordability and accessibility against additional resource expenditure needed to assure sufficient regulatory oversight and equitable distribution and to mitigate potential risks of harm to patients.

How Should Critical Medications Be Rationed During Shortages?

When any drug is in short supply, it must be rationed. Recent increases in the frequency of shortages require more rationing by clinicians. Most health systems have policies on managing drug shortages, but transparency of criteria according to which specific scarce medications should be rationed-and by whom-are rare. The COVID-19 pandemic offered several examples of clinical and ethical need to develop and implement clear, fair strategies for distributing medications in short supply. Lessons from the pandemic should inform strategies for managing drug shortages now and in the future.

How COVID-19 is reshaping U.S. national security policy.

In the wake of the COVID-19 pandemic, the United States is actively reshaping parts of its national security enterprise. This article explores the underlying politics, with a specific interest in the context of biosecurity, biodefense, and bioterrorism strategy, programs, and response, as the United States responds to the most significant outbreak of an emerging infectious disease in over a century. How the implicit or tacit failure to recognize the political will and political decision-making connected to warfare and conflict for biological weapons programs in these trends is explored. Securitization of public health has been a focus of the literature over the past half century. This recent trend may represent something of an inverse: an attempt to treat national security interests as public health problems. A hypothesis is that the most significant underrecognized problem associated with COVID-19 is disinformation and the weakening of confidence in institutions, including governments, and how adversaries may exploit that blind spot.

Personalised learning in higher education for health sciences: a scoping review protocol.

BACKGROUND: Personalised learning, an educational approach that tailors teaching and learning to individual needs and preferences, has gained attention in recent years, particularly in higher education. Advances in educational technology have facilitated the implementation of personalised learning in various contexts. Despite its potential benefits, the literature on personalised learning in health sciences higher education remains scattered and heterogeneous. This scoping review aims to identify and map the current literature on personalised learning in health sciences higher education and its definition, implementation strategies, benefits, and limitations. METHODS: A comprehensive search of electronic databases, PubMed, Scopus, Google Scholar, Educational Research Complete, and Journal Storage (JSTOR), will be conducted to identify relevant articles. The search will be limited to articles published in the English language between 2000 and 2023. The search strategy will be designed and adapted for each database using a combination of keywords and subject headings related to personalised learning and health sciences higher education. Eligibility criteria will be applied to screen and select articles. Data extraction and quality assessment will be performed, and thematic synthesis will be used to analyse the extracted data. DISCUSSION: The results of the scoping review will present a comprehensive and coherent overview of the literature on personalised learning in health sciences higher education. Key themes and topics related to personalised learning, its definitions, models, implementation strategies, benefits, and limitations, will be identified. The geographical and temporal distribution of research on personalised learning in health sciences higher education will also be described. This scoping review will provide a structured synthesis of the available evidence on personalised learning in health sciences higher education, highlighting potential gaps and areas for future research. The findings will contribute to ongoing scholarly and policy debates on personalised learning in higher education, informing the development of best practices, guidelines, and future research agendas.