ASEAN countries' environmental policies for the Sustainable Development Goals (SDGs).

This study's objective is to examine how ASEAN countries reported their environment-related policies for the Sustainable Development Goals (SDGs) in their Voluntary National Reviews (VNRs), and a dataset of their environmental policies was developed. This is a necessary first step in analyzing the reasons for insufficient progress on the environmental dimension of the SDGs, since policies are key means of implementation. Previous studies of SDG progress and VNRs examined many aspects such as achievement levels, indicators, data, governance, and VNR preparation procedures, but surprisingly, there has been little discussion of countries' actual policy efforts. Progress on the SDGs' environmental dimensions is widely considered insufficient, including in Asia. This study showed that insufficient progress on the environmental dimension of the SDGs is not due to a lack of environmental policies or a lower prioritization of policies for environmental SDG targets. ASEAN countries included almost 600 concrete environment-related policies in their VNRs, widely distributed among most SDGs, accounting for about 40 percent of their total reported SDG-related policies. The number of environmental policies was not closely related to GDP, GDP per capita, or VNR date. Many policies appeared substantial, including national action plans, strategies, laws, and regulations, not just small projects or programs. However, some major existing environmental policies, for example on air pollution, were usually not included in the VNRs. Further research is needed to explore other possible factors such as insufficient policy implementation or effectiveness, which this study could not examine. This study's environmental policy dataset provides the necessary baseline for future research on policy implementation and effectiveness, especially to help future studies identify ASEAN countries' environmental policies in specific areas such as climate, energy, or water. This will also facilitate comparative analysis. Supplementary Information: The online version contains supplementary material available at 10.1007/s10668-022-02514-0.

Low back pain in a natural disaster.

UNLABELLED: Low back pain is usually self-limited. The transition from acute to chronic LBP is influenced by physical and psychological factors. Identification of all contributing factors, in a mass emergency setting, differentiating primary and secondary life-threatening forms of LBP, is the best approach for success. Aims of the present report were to estimate the prevalence of LBP in population afferent to four advanced medical presidiums (AMPs) during postseismic emergency period and to evaluate frequency of use, types of pain killers administered to patients and short-term efficacy of them. METHODS: Study was carried out in four AMPs during the first 5 weeks after the earthquake. Site, type of eventual trauma, pain intensity during LBP episode by Verbal Numerical Rating Scale (vNRS) were registered. Diagnosis of primary or secondary LBP was made on the basis of clinical features and therapeutic treatment was also analyzed. RESULTS: The prevalence of acute LBP was 4.9% (95%, IC 3.7 to 6.4), among 958 first accesses to AMP, representing 14.1% (95%, IC 10.8 to 18.3) of cases on the total of 322 patients treated for all pain conditions. Episodes of relapsed LBP in chronic pre-existing LBP represented the 40% (n = 19) of cases, while the first episode was present in 60% of patients (n = 28). Pain treatment was effective with a significant reduction in vNRS in short term evaluation. CONCLUSIONS: The emotional stress induced by natural disaster tends to heighten norepinephrine and sympathetic nervous system activity, which may further amplify nociception through peripheral or central mechanisms that result in consistent prevalence of primary NSLBP and become potential risk factor for pain chronicization.

The role of context in identifying linkages between SDG 2 (food) and SDG 6 (water).

The Sustainable Development Goals (SDGs) of the United Nation's Agenda 2030 are formulated to promote the development of integrated, multisectoral policies that explicitly consider linkages across SDGs. Although multiple recent studies have tried to identify linkages across SDGs, the role of contextual factors in identifying SDG linkages is neither well described nor understood. For the case of SDG 2 and SDG 6, this study aims to (i) identify linkages-at country and SDG target level-through the application of various quantitative and qualitative identification methods, and (ii) explore contextual factors to explain the differences across identified linkages. Hereto, we first conducted a text analysis of 195 Voluntary National Reviews (VNRs) reported by 159 countries from 2016 to 2020. Next, we synthesized linkages reported by previous qualitative studies and conducted a quantitative (correlation) analysis on the UN's SDG database. Last, we compared identified linkages across methods, paying special attention to the role of context. From the text analysis, we identified 221 country-specific linkages between 25 SDG target pairs and observed that countries increasingly report SDG linkages in their VNRs over time. Comparing text analysis, existing qualitative studies, and our quantitative correlation analysis, we found substantial differences between the number and nature of linkages identified. These differences can be explained in part by methodological considerations, but to a significant extent also by contextual factors, such as project design, technology application, phase of interventions, and project scale. We conclude by discussing the strengths and limitations of the methods involved, and suggestions for future studies. Supplementary Information: The online version contains supplementary material available at 10.1007/s11625-022-01158-3.

Laparoscopic surgery for benign adnexal conditions under spinal anaesthesia: Towards a multidisciplinary minimally invasive approach.

BACKGROUND: Laparoscopic gynaecological surgery is commonly performed under general anaesthesia with endotracheal intubation. In general surgery, locoregional anaesthesia was applied to laparoscopic procedures, increasing minimally invasive surgery advantages. AIMS: To assess and compare postoperative pain after laparoscopic adnexal procedures for benign conditions under spinal anaesthesia (SA) versus general anaesthesia (GA). Furthermore, anaesthesiologic, surgical and clinical data were evaluated in both groups. MATERIALS AND METHODS: This is a prospective cohort study performed in a tertiary level referral centre for minimally invasive gynaecological surgery (Gynaecology and Human Reproduction Physiopathology, University of Bologna). Women scheduled for adnexal laparoscopic surgery for benign conditions between February and May 2019 were assigned to receive either SA or GA with endotracheal intubation. A sample size of 13 women per group was needed to detect a 2-point difference in pain scores. MAIN FINDINGS: 13 women were enrolled in the SA arm, 15 in the GA arm. In the SA cohort, the most common intraoperative adverse event was shoulder pain, reported by 3/12 women. At 1, 8, 12, 24 and 48 h after surgery pain was significantly lower in the SA arm (p < .05). Patients submitted to SA experienced no need for opioid drugs administration, unlike those receiving GA. Patients' mobilization and return of bowel function were noted significantly earlier in the SA group (p < .05). CONCLUSIONS: SA is a feasible, safe and effective anaesthesiologic technique for laparoscopic gynaecological procedures for benign conditions, allowing a better control of postoperative pain. Women undergoing SA achieve earlier mobilization and bowel canalization. During the Covid-19 pandemics, SA could be useful in reducing the need for invasive procedures on respiratory tract.

Safety and efficacy of balloon kyphoplasty at 4 or more levels in a single anesthetic session.

OBJECTIVE In this case series, the authors evaluated the safety of balloon kyphoplasty at 4 or more vertebral levels in a single anesthetic session. The current standard is that no more than 3 levels should be cemented at one time because of a perceived risk of increased complications. METHODS A retrospective chart review was performed for 19 consecutive patients who underwent ≥ 4-level balloon kyphoplasty between July 1, 2011, and December 31, 2015. Outcomes documented included kyphoplasty-associated complications and incidences of subsequent vertebral fracture. RESULTS Nineteen patients aged 22 to 95 years (mean 66.1 years, median 66 years; 53% male, 47% female) had 4 or more vertebrae cemented during the same procedure (mean 4.6 levels [62 thoracic, 29 lumbar]). No postoperative anesthetic complication, infection, extensive blood loss, symptomatic cement leakage, pneumothorax, or new-onset anemia was observed. Five patients experienced new compression fracture within a mean of 278 days postoperatively. One patient with metastatic cancer suffered bilateral pulmonary embolism 19 days after surgery, but no evidence of cement in the pulmonary vasculature was found. CONCLUSIONS In this case series, kyphoplasty performed on 4 or more vertebral levels was not found to increase risk to patient safety, and it might decrease unnecessary risks associated with multiple operations. Also, morbidity associated with leaving some fractures untreated because of an unfounded fear of increased risk of complications might be decreased by treating 4 or more levels in the same anesthetic session.

Optimizing Numeric Pain Rating Scale administration for children: The effects of verbal anchor phrases.

Background: The 0-10 Verbal Numeric Rating Scale (VNRS) is commonly used to obtain self-reports of pain intensity in school-age children, but there is no standard verbal descriptor to define the most severe pain. Aims: The aim of this study was to determine how verbal anchor phrases defining 10/10 on the VNRS are associated with children's reports of pain. Methods and Results: Study 1. Children (N = 131, age 6-11) rated hypothetical pain vignettes using six anchor phrases; scores were compared with criterion ratings. Though expected effects of age and vignette were found, no effects were found for variations in anchors. Study 2. Pediatric nurses (N = 102) were asked how they would instruct a child to use the VNRS. Common themes of "the worst hurt you could ever imagine" and "the worst hurt you have ever had" to define 10/10 were identified. Study 3. Children's hospital patients (N = 27, age 8-14) rated pain from a routine injection using four versions of the VNRS. Differences in ratings ranging from one to seven points on the scale occurred in the scores of 70% of children when the top anchor phrase was changed. Common themes in children's descriptions of 10/10 pain intensity were "hurts really bad" and "hurts very much." Discussion: This research supports attention to the details of instructions that health care professionals use when administering the VNRS. Use of the anchor phrase "the worst hurt you could ever imagine" is recommended for English-speaking, school-age children. Details of administration of the VNRS should be standardized and documented in research reports and in clinical use.

Contexte: L'échelle numérique verbale (ENV) de 0 à 10 est fréquemment utilisée pour l'auto-évaluation de l'intensité de la douleur chez les enfants d'âge scolaire, mais il n'existe pas de descripteur verbal pour définir la douleur la plus aiguë.But: Déterminer de quelle manière les énoncés définissant 10/10 sur l'ENV sont associés à la douleur rapportée par les enfants.Méthodes et résultats: Étude 1. Des enfants (N = 131, âgés de 6 à 11 ans) ont évalué des vignettes représentant une douleur hypothétique à l'aide de six énoncés; les scores obtenus ont été comparés aux évaluations de référence. Bien que les effets attendus en ce qui concerne l'âge et la vignette aient été observés, aucun effet n'a été observé pour les variations dans les énoncés. Étude 2. On a demandé à des infirmières pédiatriques (N = 102) de quelle manière elles enseigneraient à un enfant à utiliser l'ENV. Les thèmes communs de « la pire douleur que tu puisses imaginer ¼ et « la pire douleur que tu aies ressentie ¼ pour définir 10/10 ont été identifiés. Étude 3. Les patients d'un hôpital pour enfants (N = 27, âgés de 8 à 14 ans) ont évalué la douleur d'une injection de routine à l'aide de quatre versions de l'ENV. Des différences dans l'évaluation allant d'un à sept points sur l'échelle sont apparues dans les scores de 70 % des enfants lorsque l'énoncé relatif à la douleur la plus élevée a été modifié. Les thèmes communs dans les descriptions des enfants en ce qui concerne l'intensité de douleur 10/10 étaient « hurts really bad ¼ (fait vraiment mal) and « hurts very much ¼ (fait très mal).Discussion: Cette étude démontre l'importance de porter attention aux détails dans les instructions que les professionnels de la santé utilisent lorsqu'ils ont recours à l'ENV. L'utilisation de l'énoncé « the worst hurt you could ever imagine ¼ (la pire douleur que tu puisses imaginer) est recommandée pour les enfants d'âge scolaire anglophones. Les détails concernant l'utilisation de l'ENV devraient être uniformisés et documentés dans les rapports de recherche ainsi que dans le cadre de leur usage clinique.