Stress, interpersonal and inter-role conflicts, and psychological health conditions among nurses: vicious and virtuous circles within and beyond the wards.

BACKGROUND: The increasing costs of nurses' occupational-stress, conflicts, and violence within healthcare services have raised international interest. Yet, research/interventions should consider that perceived stress and conflicts- but also potential resources- within the wards can crossover the healthcare settings, impacting nurses' private lives and viceversa, potentially creating vicious circles exacerbating stress, conflicts/violence or, conversely, virtuous circles of psychological/relational wellbeing. Based on the Demands-Resources-and-Individual-Effects (DRIVE) Nurses Model, and responding to the need to go in-depth into this complex dynamic, this study aims to explore potential vicious circles featured by the negative effects of the interplay (main/mediating effects) between perceived stressors in nursing linked to interpersonal conflicts (Conflicts-with-Physicians, Peers, Supervisors, Patients/their families), work-family inter-role conflicts (Work-Family/Family-Work-Conflicts), and work-related stress (Effort-Reward-Imbalance) on nurses' psychological/relational health (Anxiety, Depression, Somatization, Interpersonal-Sensitivity, Hostility). The potential moderating role of work-resources (Job-Control, Social-Support, Job-Satisfaction) in breaking vicious circles/promoting virtuous circles was also explored. METHOD: The STROBE Checklist was used to report this cross-sectional multi-centre study. Overall, 265 nurses completed self-report questionnaires. Main/mediating/moderating hypotheses were tested by using Correlational-Analyses and Hayes-PROCESS-tool. RESULTS: Data confirmed the hypothesized detrimental vicious circles (main/mediating effects), impairing nurses' psychological health conditions at individual level (Anxiety, Depression, Somatization), but also at relational level (Hostility and Interpersonal-Sensitivity). The moderating role of all work resources was fully supported. CONCLUSION: Findings could be used to implement interventions/practices to effectively prevent the maintenance/exacerbation of vicious circles and promote psychological/relational wellbeing in healthcare settings and beyond.

Impact of war-associated factors on spread of sexually transmitted infections: a systemic review.

Introduction: Statistical data indicate a link between war and the spread of sexually transmitted infections (STIs), then it is necessary to carefully analyze the factors that directly affect the identified pattern in order to overcome this problem. Therefore, the purpose of the study was to systematically analyze the factors that influence the spread of STIs during war. Methods: The study included all original research articles and meta-analyses on the impact of war on the spread of sexually transmitted infections that met the following eligibility criteria: (1) articles published exclusively in English; (2) articles published in the period 2013-2023; (3) studies with quantitative, qualitative or mixed design. The search for relevant literature was conducted using four databases: PubMed, Embase, Web of Science, and Ebsco. Results: The articles selected for our systematic review had different research designs and were mainly published as original studies (n = 8) and literature reviews (n = 6). As a result of the evaluation of the selected articles for the systematic review, the authors identified migration, a decrease in access to health care, difficult access to contraception, sexual violence as the most frequent factors directly affecting the spread of STIs during the war. Conclusion: This systematic review systematizes data on the impact of hostilities on the spread of STIs and outlines the main factors that contribute to the dissemination of pathogens far beyond the territory at the epicenter of the conflict.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023479808, CRD42023479808.

The MCM2-7 Complex: Roles beyond DNA Unwinding.

The MCM2-7 complex is a hexameric protein complex that serves as a DNA helicase. It unwinds the DNA double helix during DNA replication, thereby providing the single-stranded replication template. In recent years, it has become clear that the MCM2-7 complex has additional functions that extend well beyond its role in DNA replication. Through physical and functional interactions with different pathways, it impacts other nuclear events and activities, including folding of the genome, histone inheritance, chromosome segregation, DNA damage sensing and repair, and gene transcription. Collectively, the diverse roles of the MCM2-7 complex suggest it plays a critical role in maintaining genome integrity by integrating the regulation of DNA replication with other pathways in the nucleus.

Policy Actors' Perceptions of Conflicts of Interest and Alcohol Industry Engagement in UK Policy Processes.

BACKGROUND: Alcohol industry organisations occupy a prominent position in UK alcohol policy, but their involvement has been contested by public health bodies on the basis that a conflict of interest (COI) exists between their economic objectives and those of public health. There are ongoing debates in the research literature about how to conceptualise COI and mitigate this in health research and practise. However, less attention has been paid to these issues in relation to the alcohol industry specifically. This article explores similarities and differences in beliefs among alcohol policy actors regarding COI and the implications of engagement with the alcohol industry in the context of UK public health policy. METHODS: Semi-structured interviews with a range of policy actors (n=26) including medical professionals, parliamentarians, civil servants, academic researchers, health campaigners, and alcohol industry representatives. Interviews with alcohol industry representatives were supplemented with an analysis of industry responses to a public consultation. All data was thematically coded using NVivo software. RESULTS: Two competing "coalitions" were identified, expressing beliefs about COI linked to alcohol industry engagement. Both divergent and convergent beliefs were expressed by the two coalitions in relation to the type of industry actor, form of engagement, the policy issue under discussion and the stage of policy process. CONCLUSION: Alcohol policy is a complex and contested space in which policy actors have differing, nuanced and contingent understandings of COI and identify varying risks associated with alcohol industry engagement. In identifying the areas of convergence and diversion in both understanding and evaluation of COI in alcohol-specific settings, these findings will assist both decision-makers and non-governmental actors in developing policies and guidelines to manage potential COI in future.

The Overlooked Contributors to Climate and Biodiversity Crises: Military Operations and Wars.

The military-industrial complex, military operations, and wars are major contributors to exacerbating both climate change and biodiversity crises. However, their environmental impacts are often shadowed due to national security reasons. The current paper aims to go through the devastating impacts of military operations and wars on climate change and biodiversity loss and challenges that hinder the inclusion of military-related activities into environmental crisis mitigation efforts. The information blind spot induced by concerns about national security reasons jeopardizes the efforts to involve the military-industrial complex and military operations in the global climate and biodiversity agendas. Besides that, many military-related challenges, such as specificity of operational requirements and lifecycles, dependence on fossil fuels, complex supply change, inadequate civilian technologies and innovations, and requirements of structural changes, can hinder emission reduction. Meanwhile, wars and conflicts not only threaten to drain all human and material resources available to tackle environmental problems but also inflict long-lasting destructions, pains, and trauma that can lead to hatred and distrust among nations and parties. With the rising hatred and distrust, global agreement and commitment to address climate change and biodiversity will hardly be achieved. Thus, promoting peace is the humanistic and planetary conscience.

Building a decision-support tool to inform sustainability approaches under complexity: Case study on managing wild ruminants.

In wildlife management, differing perspectives among stakeholders generate conflicts about how to achieve disparate sustainability goals that include ecological, economic, and sociocultural dimensions. To mitigate such conflicts, decisions regarding wildlife management must be taken thoughtfully. To our knowledge, there exists no integrative modeling framework to inform these decisions, considering all dimensions of sustainability. We constructed a decision-support tool based on stakeholder workshops and a Bayesian decision network to inform management of wild ruminants in the federal state of Lower Austria. We use collaborative decision analysis to compare resource allocations while accounting for trade-offs among dimensions of sustainability. The tool is designed for application by non-technical users across diverse decision-making contexts with particular sets of wildlife management actions, objectives, and uncertainties. Our tool represents an important step toward developing and evaluating a transparent and replicable approach for mitigating wildlife-based conflicts in Europe and beyond.

Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review.

Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.

Parent-child attachment mediates the association between parental conflict perceptions and suicide intention: a cross-sectional survey among middle school students in China.

Introduction: Adolescent suicide is a prevalent issue globally, with various factors contributing to this phenomenon. This study aimed to investigate these factors and their interrelationships to better understand the causes of adolescent suicide and provide evidence for its prevention. Methods: This study conducted among middle school students in Liaoning Province, China, from April to May 2016, A cross-sectional survey was administered to 1,028 students aged 10-19, using instruments such as the Behavior Questionnaire-Revised (SBQ-R), Children's Perception of Interparental Conflict Scale (CPIC), and revised version of Inventory of Parent Attachment (IPPA-R). Result: Binary logistic regression analysis revealed that adolescents aged 15-19, adolescents with strong perceptions of parental conflict were at high risk of suicide intention. Adolescents living in rural areas, adolescents with high mother-child attachment, adolescents with high father-child attachment were at low risk of suicide intention. Furthermore, parent-child attachment played a mediating role between two dimensions of parental conflict perception (resolved situations and response effect) and suicide intention. Discussion: The study concludes that adolescents living in urban areas, older adolescents, adolescents with a high level of parental conflict intensity, and those with low levels of parent-child attachment are at high risk of suicide intention. parent-child attachment played a mediating role between two dimensions of parental conflict perception (resolved situations and response effect) and suicide intention. Interventions aimed at reducing family conflicts and improving parent-child relationships are recommended to decrease the incidence of adolescent suicide.

Women's experiences of trauma-informed care for forced migrants: A qualitative interview study.

Introduction: Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods: This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results: Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions: Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.

Perspectives on non-financial conflicts of interest in health-related journals: A scoping review.

The objective of this scoping review was to systematically review the literature on how non-financial conflicts of interest (nfCOI) are defined and evaluated, and the strategies suggested for their management in health-related and biomedical journals. PubMed, Embase, Scopus and Web of Science were searched for peer reviewed studies published in English between 1970 and December 2023 that addressed at least one of the following: the definition, evaluation, or management of non-financial conflicts of interest. From 658 studies, 190 studies were included in the review. nfCOI were discussed most commonly in empirical (22%; 42/190), theoretical (15%; 29/190) and "other" studies (18%; 34/190) - including commentary, perspective, and opinion articles. nfCOI were addressed frequently in the research domain (36%; 68/190), publication domain (29%; 55/190) and clinical practice domain (17%; 32/190). Attitudes toward nfCOI and their management were divided into two distinct groups. The first larger group claimed that nfCOI were problematic and required some form of management, whereas the second group argued that nfCOI were not problematic, and therefore, did not require management. Despite ongoing debates about the nature, definition, and management of nfCOI, many articles included in this review agreed that serious consideration needs to be given to the prevalence, impact and optimal mitigation of non-financial COI.

Enhancing Research Integrity and Publication Ethics: An Analysis of the Latest International Committee of Medical Journal Editors Recommendations.

In the ever-evolving landscape of biomedical research and publishing, the International Committee of Medical Journal Editors recommendations serve as a critical framework for maintaining ethical standards. By providing a framework that adapts to technological advancements, the International Committee of Medical Journal Editors recommendations actively shape responsible and transparent practices, ensuring the integrity of scientific inquiry and fostering global collaboration in the ever-evolving landscape of medical publishing. This editorial delves into key aspects of the latest changes in the International Committee of Medical Journal Editors recommendations, focusing on authorship, conflict of interest disclosure, data sharing and reproducibility, medical publishing and carbon emissions, the use of artificial intelligence, and the challenges posed by predatory journals within the realm of open access. It emphasizes the importance of new recommendations, which represent a beacon of ethical guidance in the ever-evolving domain of biomedical research and publishing.

Profiles of suicide attempted in children and adolescents.

OBJECTIVE: Suicide attempt (SA) is the strongest predictive variable for completed suicide. The Department of Cauca in Colombia has an SA rate higher than the national average, but the factors are unknown. The objective was to identify the profiles of SA in children and adolescents of Cauca. METHODS: Cross-sectional study, which included all SA (Event-356) records from the SIVIGILA platform in children under 18 years of age between 2016 and 2019. The authors described the variables and multiple correspondence analysis with the Burt method, according to the completeness of the data to establish the possible SA profiles using STATA 15.1, and R. The Ethics Committee at Universidad del Cauca approved it. RESULTS: The study found 977 SA during this period, 72.4% female, 97.1% adolescent, 74.4% mestizo, 19.3% indigenous, 45.3% resided in municipalities exposed to the armed conflict, 32.3% expressed ideation and previous attempts, and 15.5% prior attempts. The MCA included 810 SA and identified three profiles: "Classic", which had mestizo adolescents with a history of prior SA, mental illness, or psychoactive substance use problems; "Related to the armed conflict", which included female adolescents with a first SA and residents in municipalities exposed to the armed conflict; "Ethnic" represented by male indigenous, with housing in a rural area. CONCLUSION: The SA profiles found in Cauca were "Classic", "Related to the armed conflict", and "Ethnic"; these can be considered to implement prevention strategies from a cross-cultural, mental health, and gender perspective, with the presence of the state in the territories.

When dying does not go well: a qualitative study.

BACKGROUND: Several studies deal with the question of what constitutes a "satisfactory death". A smaller number of studies deal with unsatisfactory dying processes. And only a few shed light on unsatisfactory deaths that take place in hospices and palliative care units, which see themselves as places conducive to a "good" death. What also remains largely undiscussed are the ethical aspects that accompany the observation of an unsatisfactory course of death. METHOD: The research was carried out as an exploratory and qualitative study. The data collection and analysis were based on the methods of the "grounded theory". RESULTS: Notions of a bad death are articulated here, though hardly by the affected persons and their relatives themselves, but rather by the professionals. Principally, descriptions of unsatisfactory dying processes refer to deficient success in symptom control, whereby the principle of autonomy is of particular importance. The focus here is not only on the needs of patients, but also on the needs of staff. The manifestation of such notions is related to the requirements arising from a practice that apparently evokes a need for accountability in the form of communicative reassurance. CONCLUSION: An idealised definition of "dying well" is in danger of losing sight of the contextual specifics of the practice involved, which can lead to ethically problematic situations.

Trauma-informed care for women who are forced migrants: a qualitative study among service providers.

AIMS: The aim was to explore service providers' perspectives on trauma-informed care for women who are forced migrants. METHODS: Service providers (n=32) employed at one of six centres providing trauma-informed care for forced migrants were recruited by way of managers. Audio-recorded and transcribed semi-structured focus group discussions were analysed with systematic text condensation. RESULTS: The analysis revealed exposure to gender-based violence and abuse within patriarchal structures as the main challenges for women. Participants recognised remarkable strength and resilience among women. A range of structural, psychosocial and individual barriers to trauma-informed care were addressed. While trauma-informed care was considered to have the potential to improve the health for many women, participants articulated room for improvement in the competence of service providers and the conditions impacting women's opportunities to access support. CONCLUSIONS: Violence, abuse and oppression against forced migrant women severely impact their health and possibilities of accessing support. Services providing trauma-informed care for forced migrants need to empower women, and carefully consider gender-related aspects impacting women's opportunities to access and utilise trauma-informed care. To ensure that women who need support access it, trauma-informed services should work with outreach efforts, ensure competence development among providers, counteract practical barriers and coordinate with health and social services.

Health transformation toward universal healthcare coverage amidst conflict: examining the impact of international cooperation in Niger.

Background: Approximately 70% of Sub-Saharan African countries have experienced armed conflicts with significant battle-related fatalities in the past two decades. Niger has witnessed a substantial rise in conflict-affected populations in recent years. In response, international cooperation has aimed to support health transformation in Niger's conflict zones and other conflict-affected areas in Sub-Saharan Africa. This study seeks to review the available evidence on health interventions facilitated by international cooperation in conflict zones, with a focus on Niger. Methods: We conducted a systematic literature review (SLR) adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted from 2000 to 4 September 2022 using MeSH terms and keywords to identify relevant studies and reports in Sub-Saharan Africa and specifically in Niger. Databases such as PubMed (Medline), Google Scholar, Google, and gray literature were utilized. The findings were presented both narratively and through tables and a conceptual framework. Results: Overall, 24 records (10 studies and 14 reports) that highlighted the significant role of international cooperation in promoting health transformation in conflict zones across Sub-Saharan Africa, including Niger, were identified. Major multilateral donors identified were the World Health Organization (WHO), United Nations Children's Fund (UNICEF), United Nations Fund for Population Activities (UNFPA), World Bank, United States Agency for International Development (USAID), European Union, European Commission Humanitarian Aid (ECHO), Global Fund, and Global Alliance for Vaccines and Immunization (GAVI). Most supports targeted maternal, newborn, child, adolescent, and youth health, nutrition, and psycho-social services. Furthermore, interventions were in the form of public health initiatives, mobile clinic implementation, data management, human resource capacity building, health information systems, health logistics, and research funding in conflict zones. Conclusion: This literature review underscores the significant engagement of international cooperation in strengthening and transforming health services in conflict-affected areas across Sub-Saharan Africa, with a particular focus on Niger. However, to optimize the effectiveness of healthcare activities from short- and long-term perspectives, international partners and the Ministry of Public Health need to re-evaluate and reshape their approach to health intervention in conflict zones.

Climate change drove the route shift of the ancient Silk Road in two distinct ways.

Although climate change has convincingly been linked to the evolution of human civilization on different temporal scales, its role in influencing the spatial patterns of ancient civilizations has rarely been investigated. The northward shift of the ancient Silk Road (SR) route from the Tarim Basin (TB) to the Junggar Basin during ∼420-850 CE provides the opportunity to investigate the relationship between climate change and the spatial evolution of human societies. Here, we use a new high-resolution chironomid-based temperature reconstruction from arid China, combined with hydroclimatic and historical datasets, to assess the possible effects of climate fluctuations on the shift of the ancient SR route. We found that a cooling/drying climate in the TB triggered the SR route shift during ∼420-600 CE. However, a warming/wetting climate during ∼600-850 CE did not inhibit this shift, but instead promoted it, because of the favorable climate-induced geopolitical conflicts between the Tubo Kingdom and the Tang Dynasty in the TB. Our findings reveal two distinct ways in which climate change drove the spatial evolution of human civilization, and they demonstrate the flexibility of societal responses to climate change.

The impact of armed conflict on the development and global spread of antibiotic resistance: a systematic review.

BACKGROUND: Scant data are available on the link between armed conflicts and the development and spread of antimicrobial resistance. OBJECTIVES: We performed a systematic review with the aim to summarize the available data on the prevalence and features of antibiotic resistance and the causes of antibiotic resistance development during armed conflicts in the 21st century. METHODS: Data sources: PubMed and SCOPUS databases were searched from 1 January 2000 to 30 November 2023. STUDY ELIGIBILITY CRITERIA: Original articles reporting data on armed conflicts and antimicrobial resistance were included in this systematic review. No attempt was made to obtain information from unpublished studies. No language restriction was applied. Methods of data synthesis: Both quantitative and qualitative information were summarized by means of textual descriptions. PARTICIPANTS: Patients or soldiers deployed in armed conflict zones. TESTS: culture-dependent antibiotic sensitivity testing or molecular detection of the genetic determinants of antibiotic resistance after a confirmed diagnosis of bacterial infection. Assessment of risk of bias: To evaluate the quality of the included studies, we adapted the tool recommended by the Joanna Briggs Institute. RESULTS: Thirty-four studies were identified, published between November 2004 and November 2023. The quality of included studies was high and medium in 47% and 53% of the studies, respectively. The included studies reported high infection and colonization rates of multidrug-resistant bacteria. Studies performed during the Eastern Ukraine conflict reported high rates of New Delhi metallo-ß-lactamase producers. DISCUSSION: Our findings confirm that wars lead to a large pool of multidrug-resistant infections that could potentially spread. Infection control in healthcare facilities in conflict zones and proper antimicrobial stewardship are crucial.

Anger regulation in patients with functional neurological disorder: A systematic review.

BACKGROUND: Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND. METHODS: MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340). RESULTS: A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality. CONCLUSIONS: This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND.

Requesting conflicts of interest declarations from the European Medicines Agency: 3-year follow-up status.

AIMS: We have previously described the European Medicines Agency's (EMA) and the US Food and Drug Administration's guidelines, each for a specific psychiatric indication, on how to design pivotal drug trials used in new drug applications. Here, we report on our efforts over 3 years to retrieve conflicts of interest declarations from EMA. We wanted to assess potential internal industry influence judged as the proportion of guideline committee members with industry conflicts of interest. METHODS: We submitted Freedom of Information requests in February 2020 to access EMA's lists of committee members (and their declared conflicts of interest) involved in drafting the 13 'Clinical efficacy and safety' guidelines available on EMA's website pertaining to psychiatric indications. In our request, we did not specify the exact EMA committees. Here, we describe the received documents and report the proportion of members with industry interests (i.e. defined as any financial industry relationship). It is a follow-up paper to our first report (http://doi.org/10.1017/S2045796021000147). RESULTS: After 2 years and 9 months (November 2022), the EMA sent us member lists and corresponding conflicts of interest declarations from the Committee for Medicinal Products for Human use (CHMP) from 2012, 2013 and 2017. These member lists pertained to 3 of the 13 requested guidelines (schizophrenia, depression and autism spectrum disorder). The 10 remaining guidelines were published before 2011 and EMA stated that they needed to require permission from their expert members (with unknown retrieval rate) and foresaw excessive workload and long wait. Therefore, we withdrew our request. The CHMPs from 2012, 2013 and 2017 had from 34 to 36 members; 39%-44% declared any interests and we judged 14%-18% as having industry interests. For the schizophrenia guideline, we identified two members with industry interests to companies who submitted feedback on the guideline. We did not receive declarations from the Central Nervous System (CNS) Working Party, the CHMP appointed expert group responsible for drafting and incorporating feedback into the guidelines. CONCLUSIONS: After almost 3 years, we received information, which only partly addressed our request. We recommend EMA to improve transparency by publishing the author names and their corresponding conflicts of interest declarations directly in the 'Clinical efficacy and safety' guidelines and to not remove conflicts of interest declarations after 1 year from their website to reduce the risk of stealth corporate influence during the development of these influential guidelines.

Assessing territorial space conflicts in the coastal zone of Wenzhou, China: A land-sea interaction perspective.

Territorial space conflicts (TSCs) in coastal zones stem from the intricate interaction between the land-sea dual system, significantly impacting the sustainable development of these areas. To accurately identify TSCs, our study proposed a theoretical framework based on a land-sea interaction perspective. We also assessed TSCs using the territorial space conflicts index and a social network analysis model. We demonstrated the proposed spatial conflicts assessment methodology through a case study of Wenzhou, a typical city on the east coast of China. Our results indicate that the distribution of TSCs gradually decreased from the coastal zone to the inland zone, with significant variation in the distribution of different conflict types across different zones. The findings also reveal that territorial space use had diverse impacts on the space conflict network, making it urgent to take targeted measures. In the future, it is crucial to comprehensively consider the overall pattern and distribution characteristics of current TSCs, as well as the spatial spillover effect of the overall network, to develop targeted coping strategies and regulation mechanisms that promote the integration and high-quality development of coastal territorial space systems. To maintain a sustainable coastal zone process, we proposed a set of optimization paths for alleviating TSCs and promoting the coordinated development of land and sea regions in China based on our study.