Planning, implementing and governing systems-based co-creation: the DISCOVER framework.

BACKGROUND: Increasingly, public health faces challenges requiring complex, multifaceted and multi-sectoral responses. This calls for systems-based approaches that facilitate the kind of collective and collaborative thinking and working required to address complexity. While the literature on systems thinking, system dynamics and the associated methodologies is extensive, there remains little clear guidance on how to plan, govern and implement participatory systems approaches within a co-creation process. METHODS: We used a three-step process to develop DISCOVER, a framework for implementing, and governing systems-based co-creation: Stage 1: We conducted a literature analysis of key texts to identify well-documented methods and phases for co-creation using a systems approach, as well as areas where gaps existed. Stage 2: We looked for the most appropriate methods and approaches to fill the gaps in the knowledge production chain. Stage 3: We developed the framework, identifying how the different tools and approaches fit together end-to-end, from sampling and recruiting participants all the way through to responding with an action plan. RESULTS: We devised DISCOVER to help guide researchers and stakeholders to collectively respond to complex social, health and wider problems. DISCOVER is a strategic research planning and governance framework that provides an actionable, systematic way to conceptualise complex problems and move from evidence to action, using systems approaches and co-creation. In this article, we introduce the eight-step framework and provide an illustrative case study showcasing its potential. The framework integrates complementary approaches and methods from social network analysis, systems thinking and co-creation literature. The eight steps are followed sequentially but can overlap. CONCLUSIONS: DISCOVER increases rigour and transparency in system approaches to tackling complex issues going from planning to action. It is being piloted in environmental health research but may be suitable to address other complex challenges and could be incorporated into research proposals and protocols for future projects.

Scoping review on the link between economic growth, decent work, and early childhood caries.

BACKGROUND: Early Childhood Caries (ECC) is a prevalent chronic non-communicable disease that affects millions of young children globally, with profound implications for their well-being and oral health. This paper explores the associations between ECC and the targets of the Sustainable Development Goal 8 (SDG 8). METHODS: The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to economic growth, decent work sustained economic growth, higher levels of productivity and technological innovation, entrepreneurship, job creation, and efforts to eradicate forced labor, slavery, and human trafficking and ECC all of which are the targets of the SDG8. Only English language publications, and publications that were analytical in design were included. Studies that solely examined ECC prevalence without reference to SDG8 goals were excluded. RESULTS: The initial search yielded 761 articles. After removing duplicates and ineligible manuscripts, 84 were screened. However, none of the identified studies provided data on the association between decent work, economic growth-related factors, and ECC. CONCLUSIONS: This scoping review found no English publication on the associations between SDG8 and ECC despite the plausibility for this link. This data gap can hinder policymaking and resource allocation for oral health programs. Further research should explore the complex relationship between economic growth, decent work and ECC to provide additional evidence for better policy formulation and ECC control globally.

The process of developing and implementing health and nursing policy: Implications of research and opportunities to influence.

AIM: To provide insight into the process of developing health and nursing policy and how that process can be influenced by both researchers and nursing leaders. BACKGROUND: Nurses care for people across the life course from birth to death, in our communities, hospitals, care homes and schools. They have unique insight into how people live their lives and how this affects their health. Despite being well placed to influence health policy, nurses often fail to capitalise on this. At the same time, academics often struggle to identify the policy implications of their research resulting in further missed opportunities to use policy influence. SOURCES OF EVIDENCE: Classical policy theory, which is predominantly drawn from economics and public administration together with a range of contemporary nursing and health policy studies, is used in this paper to discuss the policy process and opportunities to influence. DISCUSSION: Researchers need to focus on realistic policy suggestions that aim to raise awareness, highlight policy problems or set the agenda. In turn, nursing leaders, from National Nursing Associations, need to harness evidence to support their efforts to influence policy. In terms of influence, a range of approaches exist, and each lends itself to different parts of the policy cycle. CONCLUSION: The role nurses can play in health policy is not well developed in many countries. Nursing researchers and leaders are well placed to influence policy but must do so in a clear and pragmatic way recognising that policymakers make decisions despite being faced with conflicting evidence, competing demands and economic imperatives. IMPLICATIONS FOR NURSING PRACTICE: Recognising that nurses can offer much in terms of policy development, the paper argues that a pragmatic approach based on different forms of influence at different stages is likely to be most successful. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The evidence reviewed in this paper suggests that nursing academics and leaders need to identify realistic policy interventions when examining their own empirical work or identifying ways to individually or collectively influence policymakers.

From pollution to prosperity: Investigating the Environmental Kuznets curve and pollution-haven hypothesis in sub-Saharan Africa's industrial sector.

Drivers of environmental change and policy processes are pushing the sub-Saharan African region to do more in the struggle against climate change as the region suffers most from climate change impact. To this end, this study investigates how the interaction effects of a sustainable financing model in energy use influence carbon emissions in Sub-Saharan African economies. It is based on the theory that energy consumption is determined by increased economic financing. Panel data analysis of thirteen countries from 1995 to 2019 is used to explore the interaction effect on CO2 emissions, taking a market-induced energy demand perspective. The study employed the fully modified ordinary least squares technique, removing all heterogeneity effects in a panel estimation. The econometric model was estimated with (and without) the interaction effect. The study finds support for the Pollution-Haven hypothesis and the Environmental Kuznets "inverted U-shaped" Curve Hypothesis in the region. It identifies a long-run relationship between the financial sector, economic activity, and CO2 emissions, with fossil fuel consumption in industrial activities increasing CO2 emissions by about 2.5 times. However, the study also reveals that the interactive effect of financial development can significantly reduce CO2 emissions, providing important implications for policymakers in Africa. The study suggests regulatory incentives to encourage banking credit intermediation for environmentally friendly energy sources. This research makes a valuable contribution to understanding the environmental impact of the financial sector in sub-Saharan Africa, an area that has received limited empirical attention. The findings highlight the relevance of the financial sector for policy formulation in addressing environmental issues in the region.

The Dutch chain approach on pharmaceuticals in water: Stakeholders acting together to reduce the environmental impact of pharmaceuticals.

AIMS: Sewage treatment effluent with pharmaceutical residues is discharged into surface waters, raising societal concerns. The aim of this paper is to describe the Dutch chain approach on medicinal residues in water that has been implemented by the Dutch government. We show how stakeholders from both the health and water sectors have got actively involved. Within this chain approach, source measures as well as end-of-pipe measures are identified and, where feasible and effective, implemented. METHODS: Descriptive paper on the Dutch chain approach. RESULTS: Getting the water and health care sectors to talk with each other instead of about each other was the key accomplishment. Comprehension of each other's viewpoints, terminology, policy goals and span of control, was pivotal in setting shared goals, creating perspective about possible measures and actually taking (joint) action. Together, stakeholders agreed to act within their own possibilities, without pointing at others, and to focus on pragmatic measures. In this article, we provide examples of measures taken, pilot projects performed, and of measures that were not implemented. Besides this, we discuss the most important barriers encountered during this process and how they were overcome. CONCLUSION: The issue of pharmaceuticals in the environment is a wicked problem, which makes it necessary to work together with many stakeholders on possible solutions, avoiding paralysis by complexity. Most importantly, stakeholders need to invest in mutual understanding, keep an open communication, and feel invited to bring in solutions for their part of the chain.

Enhancing Scientific Support for the Stockholm Convention's Implementation: An Analysis of Policy Needs for Scientific Evidence.

The Stockholm Convention is key to addressing the global threats of persistent organic pollutants (POPs) to humanity and the environment. It has been successful in identifying new POPs, but its national implementation remains challenging, particularly by low- and middle-income Parties. Concerted action is needed to assist Parties in implementing the Convention's obligations. This analysis aims to identify and recommend research and scientific support needed for timely implementation of the Convention. We aim this analysis at scientists and experts from a variety of natural and social sciences and from all sectors (academia, civil society, industry, and government institutions), as well as research funding agencies. Further, we provide practical guidance to scientists and experts to promote the visibility and accessibility of their work for the Convention's implementation, followed by recommendations for sustaining scientific support to the Convention. This study is the first of a series on analyzing policy needs for scientific evidence under global governance on chemicals and waste.

What influences the outcome of active disinvestment processes in healthcare? A qualitative interview study on five recent cases of active disinvestment.

BACKGROUND: Recent attempts of active disinvestment (i.e. withdrawal of reimbursement by means of a policy decision) of reimbursed healthcare interventions in the Netherlands have differed in their outcome: some attempts were successful, with interventions actually being disinvested. Other attempts were terminated at some point, implying unsuccessful disinvestment. This study aimed to obtain insight into recent active disinvestment processes, and to explore what aspects affect their outcome. METHODS: Semi-structured interviews were conducted from January to December 2018 with stakeholders (e.g. patients, policymakers, physicians) who were involved in the policy process of five cases for which the full or partial withdrawal of reimbursement was considered in the Netherlands between 2007 and 2017: benzodiazepines, medication for Fabry disease, quit smoking programme, psychoanalytic therapy and maternity care assistance. These cases covered both interventions that were eventually disinvested and interventions for which reimbursement was maintained after consideration. Interviews were transcribed verbatim, double coded and analyzed using thematic analysis. RESULTS: The 37 interviews showed that support for disinvestment from stakeholders, especially from healthcare providers and policymakers, strongly affected the outcome of the disinvestment process. Furthermore, the institutional role of stakeholders as legitimized by the Dutch health insurance system, their financial interests in maintaining or discontinuing reimbursement, and the possibility to relieve the consequences of disinvestment for current patients affected the outcome of the disinvestment process as well. A poor organization of patient groups may make it difficult for patients to exert pressure, which may contribute to successful disinvestment. No evidence was found of a consistent role of the formal Dutch package criteria (i.e. effectiveness, cost-effectiveness, necessity and feasibility) in active disinvestment processes. CONCLUSIONS: Contextual factors as well as the possibility to relieve the consequences of disinvestment for current patients are important determinants of the outcome of active disinvestment processes. These results provide insight into active disinvestment processes and their determinants, and provide guidance to policymakers for a potentially more successful approach for future active disinvestment processes.

Pharmacy premises licensing policy formulation: experience from Ghana.

BACKGROUND: Licences to operate pharmacy premises are issued by statutory regulatory bodies. The Health Institutions and Facilities Act (Act 829) and Health Professions Regulatory Bodies Act (Act 857) regulate pharmacy premises and the business of supplying restricted medicines by retail, respectively, and this could create a potential regulatory overlap for pharmacy practice in Ghana. We theorise that the potential overlap of regulation duties stems from how law-makers framed issues and narratives during the formulation of these Acts. OBJECTIVE: To describe the policy actors involved, framing of narratives and decision-making processes relating to pharmacy premises licensing policy formulation. METHODS: A qualitative study was conducted and data gathered through interviewing eight key informants and reviewing Hansards, reports, bills, memoranda and Acts 829 and 857. Data were analysed to map decision-making venues, processes, actors and narratives. RESULTS: The Ministry of Health drafted the bills in July 2010 with the consensus of internal stakeholders. These were interrogated by the Parliament Select Committee on Health (with legislative power) during separate periods, and decisions made in Parliament to alter propositions of pharmacy premises regulations. Parliamentarians framed pharmacies as health facilities and reassigned their regulation from the Pharmacy Council to a new agency. The Pharmacy Council and the Pharmaceutical Society of Ghana could not participate in the decision-making processes in Parliament to oppose these alterations. The laws' contents rested with parliamentarians as they made decisions in venues restricted to others. Legislative procedure limited participation, although non-legislative actors had some level of influence on the initial content. CONCLUSION: Implementation of these laws would have implications for policy and practice and therefore understanding how the laws were framed and formulated is important for further reforms. We recommend additional research to investigate the impact of the implementation of these Acts on pharmacy practice and business in Ghana and the findings can serve as bargaining information for reforms.

The impact of differing frames on early stages of intersectoral collaboration: the case of the First 1000 Days Initiative in the Western Cape Province.

BACKGROUND: While intersectoral collaboration is considered valuable and important for achieving health outcomes, there are few examples of successes. The literature on intersectoral collaboration suggests that success relies on a shared understanding of what can be achieved collectively and whether stakeholders can agree on mutual goals or acceptable trade-offs. When health systems are faced with negotiating intersectoral responses to complex issues, achieving consensus across sectors can be a challenging and uncertain process. Stakeholders may present divergent framings of the problem based on their disciplinary background, interests and institutional mandates. This raises an important question about how different frames of problems and solutions affect the potential to work across sectors during the initiating phases of the policy process. METHODS: In this paper, this question was addressed through an analysis of the case of the First 1000 Days (FTD) Initiative, an intersectoral approach targeting early childhood in the Western Cape Province of South Africa. We conducted a documentary analysis of 34 policy and other documents on FTD (spanning global, national and subnational spheres) using Schmidt's conceptualisation of policy ideas in order to elicit framings of the policy problem and solutions. RESULTS: We identified three main frames, associated with different sectoral positionings - a biomedical frame, a nurturing care frame and a socioeconomic frame. Anchored in these different frames, ideas of the problem (definition) and appropriate policy solutions engaged with FTD and the task of intersectoral collaboration at different levels, with a variety of (sometimes cross) purposes. CONCLUSIONS: The paper concludes on the importance of principled engagement processes at the beginning of collaborative processes to ensure that different framings are revealed, reflected upon and negotiated in order to arrive at a joint determination of common goals.

How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II.

Health sector strategic plans are health policies outlining health service delivery in low- and middle- income countries, guiding health sectors to meet health needs while maximizing resources. However, little research has explored the formulation of these plans. This study utilized qualitative methods to explore the formulation of Malawi's Health Sector Strategic Plan II, including processes utilized, actors involved, important contextual factors and the use of evidence-based decision-making. Thirteen semi-structured key informant interviews with health policy actors were conducted to explore perceptions and experiences of formulating the policy. Data analysis used an inductive-deductive approach and interpretation of the data was guided by an adapted version of the Walt and Gilson Health Policy Triangle. Our results indicate that HSSP II formulation was complex and inclusive but that the Ministry of Health may have given up ownership of the formulation process to development partners to ensure their continued involvement. Disagreements between actors centered around inclusion of critical services in the Essential Health Package and selection of performance-based financing as purchasing strategy. Resource constraints and the Cashgate Scandal are critical contextual elements influencing the formulation and content of the policy. Evidence-based decision-making contributed to the plan's development despite respondents' divergent opinions regarding evidence availability, quality and the weight that evidence carried. The study raises questions regarding the roles of policy actors during health policy formulation, the inclusivity of health policy processes and their potential influence on government ownership of health policy, as well as the use of evidence in developing health sector strategic plans.

Sector-wide analysis of early childhood development and education in emergencies in Colombia and considerations to strengthen systems globally.

There is an urgent need to strengthen early childhood development and education in emergencies (ECDEiE) globally. Colombia has faced protracted and acute crises for decades. Also, the country has applied a unique approach to holistic and integrated ECDE policy formulation. We argue that these characteristics offer a valuable country-case to identify barriers and levers to the operationalization of ECDEiE. We applied a sector-wide analysis protocol that harmonized components of the Humanitarian Programme Cycle by the Inter-Agency Standing Committee and of a framework to characterize the governance of ECDE systems. The study outlines how the policy and program characteristics identified may represent levers or barriers to the effective operationalization of ECDEiE in Colombia. We discuss how these attributes could be considered in the trans-sectoral dialogue between ECDE and humanitarian actors with the aim of strengthening ECDEiE systems globally.

Nurses leadership in research and policy in Nigeria: A myth or reality?

AIM: This study evaluates nurses' leadership in research and policy formulation in southern Nigeria. BACKGROUND: In Africa and particularly in low- and middle-income countries, expected health information from nurse's leaders is sometimes not available, thereby hindering the attainment of sustainable health. METHODS: This qualitative study used 12 high-ranking nurses leader from primary, secondary and tertiary health care systems in Cross River State, Nigeria. In-depth interview and focus group discussion were used to generate and validate collected data. RESULTS: There was marginal leadership in research and policy formulation. The hindering factors were mainly individual and institutional barriers. CONCLUSION: Nurses effective leadership in research and policy have not yet been actualized. Suggested remedies include mentoring of the mentee in research, provision of designated grants for nursing research, acceptance of nurses as policy formulators rather than implementers among others. The small sample size informs the need for further study throughout the region. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses have the capability to exercise influence directly or indirectly on health care goals. Dereliction in research and policy formulation could hinder the attainment of desired health care reforms due to absence of innovation in nursing practice and management.

The roles of scientific research and stakeholder engagement for evidence-based policy formulation on shipping emissions control in Hong Kong.

Shipping emissions control is critical to air quality management and improved public health for coastal port cities and regions with heavy marine traffic. However, Asian port cities have been slow in introducing regulations on marine fuels for two main reasons - firstly, due to a lack of information and therefore appreciation on the air quality and public health benefits that could be derived; and secondly, due to sensitivity as to whether there may be negative impacts on port competitiveness and trade opposition. Hong Kong, one of the top-ten international container ports in the world, has been proactive in reducing shipping emissions in the past decade. The Ocean Going Vessels Fuel at Berth regulation, enforced since July 2015 in Hong Kong, is the first marine fuel control regulation for ocean going vessels in Asia. This regulation has been adopted nationally by China for its coastal ports, followed by the establishment of domestic emission control areas in its coastal waters that will come into force in 2019. This paper describes the decade-long journey where scientific research led to evidence-based policy changes. New insights and understanding arising from the research enabled cross-sectoral engagement and dialogue among the key stakeholders in government, industry and civil society, which resulted in the political consensus needed for a change in policy and legislation. Similar evidence-based policy formulation, together with public-private sectors dialogue could be useful to other jurisdictions in pursuing a "win-win" path to improve environmental protection and public health through regulating shipping emissions. The same combination of science-to-engagement-to-policy approach could also become part of a knowledge-and-consensus-building process for other environmental policy areas as well.

Formulating policy activities to promote healthy and sustainable diets.

OBJECTIVE: To develop a policy formulation tool for strategically informing food and nutrition policy activities to promote healthy and sustainable diets (HSD). DESIGN: A policy formulation tool consisting of two complementary components was developed. First, a conceptual framework of the environment-public health nutrition relationship was constructed to characterise and conceptualise the food system problem. Second, an 'Orders of Food Systems Change' schema drawing on systems dynamics thinking was developed to identify, assess and propose policy options to redesign food systems. SETTING: Food and nutrition policy activities to promote HSD have been politicised, fragmented and lacking a coherent conceptual and strategic focus to tackle complex food system challenges. RESULTS: The tool's conceptual framework component comprises three integrated dimensions: (i) a structure built around the environment and public health nutrition relationship that is mediated via the food system; (ii) internal mechanisms that operate through system dynamics; and (iii) external interactions that frame its nature and a scope within ecological parameters. The accompanying schema is structured around three orders of change distinguished by contrasting ideological perspectives on the type and extent of change needed to 'solve' the HSD problem. CONCLUSIONS: The conceptual framework's systems analysis of the environment-public health nutrition relationship sets out the food system challenges for HSD. The schema helps account for political realities in policy making and is a key link to operationalise the framework's concepts to actions aimed at redesigning food systems. In combination they provide a policy formulation tool to strategically inform policy activities to redesign food systems and promote HSD.

The influence of crisis on policy formulation: the case of alcohol regulation in South Africa during COVID-19 (2020-21).

This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol policy reforms in South Africa and other LMICs.

Quantitative evaluation of the medicine innovation policy in China: based on the PMC-Index model.

Introduction: Medicine innovation is crucial in promoting the sustainable development of medicine undertakings, which has significant economic and social benefits. China is the main force in global medicine consumption, with a huge demand for innovative medicines. Thus, the Chinese government releases a series of policies aimed at providing scientific and reasonable guidance for medicine innovation. However, there is inadequate quantitative evaluation and comparison of various medicine innovation policies in the existing studies. Methods: This paper adopts the approach of text mining and the Policy Modeling Consistency Index (PMC-Index) model to construct an evaluation system and then quantitatively evaluates and compares the traditional Chinese medicine innovation policies (TCMIPs), the biological medicine innovation policies (BMIPs), and the multiple medicine innovation policies (MMIPs) in China. Results: The results indicate that: (1) The three types of drug innovation policies have similarities in content and goal through comparative analysis of high-frequency words, while they also have their own characteristics. (2) The average PMC-Index of 29 TCMIPs is 5.77, which has the highest policy bad rate (21%); the average PMC-Index of 12 BMIPs is 6.21, which has the highest policy good rate (92%); moreover, the average PMC-Index of 35 MMIPs is 6.06, which has the highest policy excellence rate (26%). (3) The BMIPs, MMIPs, and TCMIPs have similar scores on policy object, policy orientation, policy timeliness, policy evaluation, and policy accessibility, while they differ significantly mainly on policy nature, incentive method, policy function, policy issuing agency, and policy instrument. Discussion: This study contributes to a comprehensive understanding of medicine innovation policies in China, in order to provide theoretical support for future policy formulation and optimization in the medicine industry. Moreover, we expand the application scenarios of policy diffusion theory.

Mental Health Reform Processes and Service Delivery Shift From the Hospital to the Community in Belgium and Hong Kong.

Aim: We aimed to illustrate and compare the processes of mental health policies aiming at a service delivery shift from the hospital to the community using implementation science, and to identify important implementation strategies. Methods: This study had a comparative case study design. The cases were the Belgian mental health reform, and the person-centered model of mental health in Hong Kong, China. Several documentary sources were reviewed, including the published literature and websites. Data on policy processes were extracted, analyzed using directed content analysis, and categorized into constructs of the conceptual model for evidence-informed policy formulation and implementation arranged for the mental health policy. Results: Several similarities were identified in the strategies for active implementation and dissemination; official staff allocation, and training to the community psychiatric services, an approach to adjust the number of psychiatric hospital beds, and promoting collaboration between health care sectors and social welfare sectors. Under distinct social contexts, differences were found in all processes. Conclusions: Each of the described policy processes can serve as a model for countries in similar social contexts seeking to shift their psychiatric service delivery. Furthermore, our findings suggest widely applicable implementation strategies for policies aiming at a service delivery shift.

Evaluation of a data-driven intelligent waste classification system for scientific management of garbage recycling in a Chinese community.

Waste classification management is effective in addressing the increasing waste output and continuous deterioration of environmental conditions. The waste classification behaviour of resident is an important basis for managers to collect and allocate resources. Traditional analysis methods, such as questionnaire, have limitations considering the complexity of individual behaviour. An intelligent waste classification system (IWCS) was applied and studied in a community for 1 year. Time-based data analysis framework was constructed to describe the residents' waste sorting behaviour and evaluate the IWCS. The results showed that residents preferred to use face recognition than other modes of identification. The ratio of waste delivery frequency was 18.34% in the morning and 81.66% in the evening, respectively. The optimal time windows of disposing wastes were from 6:55 to 9:05 in the morning and from 18:05 to 20:55 in the evening which can avoid crowding. The percentage of accuracy of waste disposal increased gradually in a year. The amount of waste disposal was largest on every Sunday. The average accuracy was more than 94% based on monthly data, but the number of participating residents decreased gradually. Therefore, the study demonstrates that IWCS is a potential platform for increasing the accuracy and efficiency of waste disposal and can promote regulations implementation.

Oral Health Statuses of Children and Young Adults with Autism Spectrum Disorder: An Umbrella Review.

This study aimed to comprehensively evaluate the oral health statuses of children and adults within the autism spectrum disorder (ASD) population through an umbrella review approach. The prevalence of dental caries, periodontal disease, and associated variables were investigated across selected studies. A systematic search was conducted across databases including PubMed, Scopus, EMBASE, Science Citation Index, Science Direct, Web of Science, MEDLINE, and Wiley Online Library to identify relevant studies. The assessed variables included dental caries prevalence, periodontal disease prevalence, oral hygiene indicators, and the necessity of dental treatment. The pooled prevalence rates, odds ratios, and standardized mean differences were calculated where applicable. The pooled prevalence of dental caries among ASD individuals ranged from 60.6% to 67.3%, while the periodontal disease prevalence ranged from 59.8% to 69.4%. High rates of dental treatment under general anesthesia were reported. Heterogeneous dental caries and periodontal disease prevalence rates were identified, highlighting the need for collaboration and preventive care. Several studies also reported higher prevalence rates of dental trauma and self-inflicted oral injuries among individuals with ASD. However, the review also identified significant methodological limitations in the included studies, including inconsistency in oral health assessment methods and potential bias. The necessity for targeted policies due to high prevalence rates and the requirement for integrated care systems in high DMFT regions were also observed. The umbrella review synthesized diverse findings, revealing variations in dental caries and periodontal disease prevalence among ASD individuals. This review underscores the need for tailored interventions and policies to address oral health disparities. It highlights the necessity of integrated care systems, methodological improvements, and longitudinal studies to comprehensively address the multifaceted oral health challenges within the ASD population.

Effects of Healthcare Policies and Reforms at the Primary Level in China: From the Evidence of Shenzhen Primary Care Reforms from 2018 to 2019.

Countries worldwide are making efforts to achieve health equity. China focuses on the implementation of the policy goal of "improving the primary level" to eliminate the health equity gap. The main purpose of this study is to examine the effects of the healthcare reforms at the primary level in China and to analyze the key factors that can help to improve their effectiveness. From the perspectives of the policy attention mechanism and public policy analysis, this study will explore primary care reforms from policy formulation to policy implementation on the basis of grounded theory and empirical research on primary care reforms in Shenzhen, China, that was conducted from 2018 to 2019. The present study found that the government pays close attention to the medical level and service level of primary care services at the policy formulation phase but less attention to talent level and information sharing. At the same time, this study combined with empirical data from primary care centers in Shenzhen for the period covering 2018 to 2019 evaluates policy implementation and its effect. Multiple regression analysis revealed that the medical level, talent level, service level, and information sharing helped to develop primary care services and improved health equity. Nevertheless, this study reflects a deviation between policy formulation and policy implementation for the development of primary care policies. Empirical experience shows that the development of talent level and information sharing can significantly promote primary care services and health management. Therefore, this study implies that in the process of promoting the health equity at the primary level, more attention should be paid to the consistency between policy formulation and policy implementation. Additionally, the policy promotion and influence mechanism can be improved, particularly in terms of talent development and information sharing, in order to effectively promote the development of health equity at the primary level.