WHO FCTC Article 14 enforcement in Albania: An urgent issue to tackle.
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SUBMITTER: Mechili EA
PROVIDER: S-EPMC7205049 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
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Project description:AimsTo (1) estimate the number of Parties to the Framework Convention on Tobacco Control (FCTC) providing tobacco dependence treatment in accordance with the recommendations of Article 14 and its guidelines; (2) assess association between provision and countries' income level; and (3) assess progress over time.DesignCross-sectional study.SettingOnline survey from December 2014 to July 2015.ParticipantsContacts in 172 countries were surveyed, representing 169 of the 180 FCTC Parties at the time of the survey.MeasurementsA 26-item questionnaire based on the Article 14 recommendations including tobacco treatment infrastructure and cessation support systems. Progress over time was assessed for those countries that also participated in our 2012 survey and did not change country income level classification.FindingsWe received responses from contacts in 142 countries, an 83% response rate. Overall, 54% of respondents reported that their country had an officially identified person responsible for tobacco dependence treatment, 32% an official national treatment strategy, 40% official national treatment guidelines, 25% a clearly identified budget for treatment, 17% text messaging, 23% free national quitlines and 26% specialized treatment services. Most measures were associated positively and significantly with countries' income level (P < 0.001). Measures not associated significantly with income level included mandatory recording of tobacco use (30% of countries), offering help to health-care workers (HCW) to stop using tobacco (44%), brief advice integrated into existing services (44%), and training HCW to give brief advice (81%). Reporting having an officially identified person responsible for tobacco cessation was the only measure with a statistically significant improvement over time (P = 0.0351).ConclusionFewer than half of countries that are Parties to the Framework Convention on Tobacco Control have implemented the recommendations of Article 14 and its guidelines, and for most measures, provision was greater the higher the country's income. There was little improvement in treatment provision between 2012 and 2015 in all countries.
| S-EPMC5655744 | biostudies-literature
Project description:IntroductionThe exploitation, poor conditions, and precarity in the bidi (hand-rolled leaf cigarette) industry in India make it ripe for the application of the FCTC's Article 17, "Provision of support for economically viable alternative activities". "Bottom-up", participatory approaches give scope to explore bidi rollers' own circumstances, experiences, and aspirations.MethodsA team of six community health volunteers using a participatory research orientation developed a questionnaire-based semi-structured interview tool. Forty-six bidi rolling women were interviewed by pairs of volunteers in two northern Tamil Nadu cities. Two follow-up focus groups were also held. A panel of 11 bidi rollers attended a workshop at which the findings from the interviews and focus groups were presented, further significant points were made and possible alternatives to bidi rolling were discussed.ResultsBidi workers are aware of the adverse impact of their occupation on them and their families, as well as the major risks posed by the product itself for the health of consumers. However, they need alternative livelihoods that offer equivalent remuneration, convenience, and (in some cases) dignity. Alternative livelihoods, and campaigns for better rights for bidi workers while they remain in the industry, serve to undercut industry arguments against tobacco control. Responses need to be diverse and specific to local situations, i.e. "bottom-up" as much as "top-down", which can make the issue of scaling up problematic.ConclusionParticipatory approaches involving bidi workers themselves in discussions about their circumstances and aspirations have opened up new possibilities for alternative livelihoods to tobacco.ImplicationsProgress with the FCTC's Article 17 has generally been slow and has focussed on tobacco cultivation rather than later stages in the production process. The bidi industry in India is ripe for the application of an alternative livelihoods approach. This study is one of the first to use participatory methods to investigate the circumstances, experiences, and aspirations of bidi workers themselves.
| S-EPMC9597000 | biostudies-literature
Project description:There is significant regulatory and economic need to distinguish analytically between tobacco-derived nicotine (TDN) and synthetic nicotine (SyN) in commercial products. Currently, commercial e-liquid and oral pouch products are available that contain tobacco-free nicotine, which could be either extracted from tobacco or synthesized. While tobacco products that contain TDN are regulated by FDA Center for Tobacco Products, those with SyN are currently not in the domain of any regulatory authority. This regulatory difference provides an economic incentive to use or claim the use of SyN to remain on the market without submitting a Premarket Tobacco Product Application. TDN is ~99.3% (S)-nicotine, whereas SyN can vary from racemic (50/50 (R)/(S)) to ≥ 99% (S)-nicotine, i.e., chemically identical to the tobacco-derived compound. Here we report efforts to distinguish between TDN and SyN in various samples by characterizing impurities, (R)/(S)-nicotine enantiomer ratio, (R)/(S)-nornicotine enantiomer ratio, and carbon-14 (14C) content. Only 14C analysis accurately and precisely differentiated TDN (100% 14C) from SyN (35-38% 14C) in all samples tested. 14C quantitation of nicotine samples by accelerator mass spectrometry is a reliable determinate of nicotine source and can be used to identify misbranded product labelled as containing SyN. This is the first report to distinguish natural, bio-based nicotine from synthetic, petroleum-based nicotine across a range of pure nicotine samples and commercial e-liquid products.
| S-EPMC9009602 | biostudies-literature
Project description:Background: Poor medication adherence is still the main cause of antiretroviral therapy (ART) failure among people living with HIV/AIDS (PLWHA). Effective behavioral interventions are needed to improve HIV awareness and medication adherence. Methods: In this retrospective cohort study, we assessed the effect of problem-based learning (PBL) approaches to HIV-related education and adherence outcomes among PLWHA and a college student sample. In our study, compared with 309 demography-matched control participants using conventional counseling methods (109 PLWHA and 200 college students), 321 subjects (111 PLWHA and 210 college students) chose to learn HIV-related knowledge via PBL-integrated methods. Co-primary outcomes were self-administered questionnaire after HIV-related education by all participants and self-reported medication adherence by newly diagnosed PLWHA, measured in terms of the number of missed doses in the past week at each of the seven visits during a 1-year period. Multivariate regression models adjusting different covariates were used to test the robustness of HIV awareness and adherence association. Mediation model was used to investigate the relationship among PBL training, awareness of HIV, and ART adherence. Results: The knowledge scores of participants in the PBL group were higher than those in the controls (P = 0.001), especially the subgroup of newly diagnosed PLWHA in the PBL group (P = 0.001). The HIV-related health scores of the PBL college students were also higher than those of subjects exposed to conventional education (P < 0.001). There was no significant difference between the two by newly diagnosed PLWHA groups in the number of missed doses during the past week at each visit except at the first follow-up visit (P = 0.018). The indirect effect of PBL-integrated education on ART adherence at the 2-week visit through HIV awareness had a point estimate of 0.0349 and a 95% bias-corrected bootstrap confidence interval of 0.0061?0.0874 in newly diagnosed PLWHA. Conclusions: PLWHA and college students using PBL showed improved awareness of HIV and higher levels of recent ART adherence; however, there was no change in long-term ART adherence in newly diagnosed PLWHA.
| S-EPMC6716138 | biostudies-literature
Project description:Background Village doctors are the health “gatekeepers” of rural residents in most developing countries. They undertake a series of strenuous but pivotal missions, including prevention, diagnosis, and treatment of complicated diseases, sanitation services and management, and preventive healthcare and education tasks. Hence, it is of great importance to evaluate the village doctors’ job satisfaction status, which is one of the most important indicators that can reflect the current working state, to provide guidelines for the healthcare policies. Methods Literature search was conducted in 7 authoritative databases, including PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure (CNKI). Experts in the field of social medicine were consulted to achieve supplement and obtain relevant literature. China was selected as a representative of the village doctor system for the in-depth analysis. Building on the previous literature, we modified and proposed a novel strategy that can transform and integrate the outcome indicators to conduct a meta-based and quantitative assessment on job satisfaction. Results A total of 37 publications and 23,595 village doctors were included in this research. The meta-analysis showed that the overall job satisfaction score of village doctors was 3.1858 (total score: 5.00), 95% CI: 2.9675–3.404, which represented the level of “neither satisfied nor dissatisfied.” However, in the subsequent adjustment of publication bias, this score reduced to 2.7579, 95% CI: 2.5254–2.9904, which indicated a direct “dissatisfied” level. To discover the underlying causes, a holistic analysis of each dimension and influencing factors of job satisfaction was conducted, and the results demonstrated that “Financial Rewards” (2.49) was the most important factor causing dissatisfaction among village doctors, followed by “Job Security (2.52)” and “Work Stress (3.05).” Several important themes were also identified and assessed to explore the factors related to this topic. Conclusion This study indicated that there is an urgent need to improve the working status of health workers in rural and remote areas, especially in the middle- and low-income countries. Health policy makers should not only improve the current remuneration and subsidies of village doctors but also guide the professional development and give them more job security to enhance the work stability of this group. More specifically, in the context of the COVID-19 pandemic, further surveys on job satisfaction of village doctors should be carried out to take targeted measures. Systematic review registration [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021289139].
| S-EPMC9433829 | biostudies-literature
Project description:Coastal organisms reside in highly dynamic habitats. Global climate change is expected to alter not only the mean of the physical conditions experienced but also the frequencies and/or the magnitude of fluctuations of environmental factors. Understanding responses in an ecologically relevant context is essential for formulating management strategies. In particular, there are increasing suggestions that exposure to fluctuations could alleviate the impact of climate change-related stressors by selecting for plasticity that may help acclimatization to future conditions. However, it remains unclear whether the presence of fluctuations alone is sufficient to confer such effects or whether the pattern of the fluctuations matters. Therefore, we investigated the role of frequency and initial conditions of the fluctuations on performance by exposing larval sea urchin Heliocidaris crassispina to either constant or fluctuating pH. Reduced pH alone (pH 7.3 vs 8.0) did not affect larval mortality but reduced the growth of larval arms in the static pH treatments. Changes in morphology could affect the swimming mechanics for these small organisms, and geometric morphometric analysis further suggested an overall shape change such that acidified larvae had more U-shaped bodies and shorter arms, which would help maintain stability in moving water. The relative negative impact of lower pH, computed as log response ratio, on larval arm development was smaller when larvae were exposed to pH fluctuations, especially when the change was less frequent (48- vs 24-h cycle). Furthermore, larvae experiencing an initial pH drop, i.e. those where the cycle started at pH 8.0, were more negatively impacted compared with those kept at an initial pH of 7.3 before the cycling started. Our observations suggest that larval responses to climate change stress could not be easily predicted from mean conditions. Instead, to better predict organismal performance in the future ocean, monitoring and investigation of the role of real-time environmental fluctuations along the dispersive pathway is key.
| S-EPMC7132065 | biostudies-literature
Project description:Energy and protein intakes lower than requirements are associated with worsening health outcomes. Here we set out to evaluate gaps between energy and protein intakes and requirements in older adults in hospitals and in nursing homes (NH). A cross-sectional study included 360 inpatients and residents aged 75 years and older in two acute care wards; i.e., a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), a geriatric rehabilitation unit (GRU), and two NH. Intakes were measured for three days. Requirements were based on French National Health Authority recommendations. Energy and protein intakes were under the minimum requirement of 30 kcal/kg/day and 1.2 g/kg/day in 89.5% and 100% of MCU patients, respectively, 75.5% and 64.2% of GCU patients, 92.7% and 90.9% of GRU patients, and 83.8% and 83.8 of NH residents. Intake-to-requirement gaps were not significantly associated with malnutrition, except in the GCU group where non-malnourished patients had higher energy gaps than malnourished patients. Intakes fell dramatically short of requirements in older adults in both hospital and NH settings irrespective of malnutrition status. A new paradigm based on a patient-centered approach should be developed to adapt meals served in hospital and in NH.
| S-EPMC10421298 | biostudies-literature
Project description:For polar marine mammals, the energetic cost of thermoregulation depends on ambient conditions in the highly variable surrounding environment. Heat conservation strategies used by pinnipeds to reduce total heat loss include small surface area to volume ratios, the ability to limit perfusion and thick subcutaneous blubber layers. There are limits to how cool the skin surface may remain without compromising function, especially during the annual pelage molt, when hair and skin are replaced. To determine if actively molting seals incur higher thermoregulatory costs, surface temperature (ST) and heat flux (HF) were measured in 93 adult female Weddell seals (Leptonychotes weddellii) both prior to and during the active molting period using direct sensors and infrared imaging. Linear mixed-effect models revealed that ST increased significantly with increased ambient temperature and decreased wind speed (contributing 44.6 and 41.7% of the attributed variance, respectively). Seal STs were not impacted by molt status, but were maintained at 11.2?±?0.3°C warmer than the ambient temperature. Infrared imaging results averaged 15.1?±?1.4°C warmer than direct ST measurements. In contrast, HF was significantly higher in seals in early molting stages compared to the pre-molt season ( P?<?0.001) and molt status accounted for 66.5% of the variance in HF. Thermoregulatory costs calculated from estimated basal metabolic rate and measured HF were more than double for molting seals as compared to those in pre-molt. This suggests that perfusion is increased during molt to support follicle development, despite the increased energetic costs associated with higher HF rates. Because ST, HF and thermoregulatory costs are strongly influenced by ambient conditions, molt timing is likely under selective pressure to occur during the warmest period of the year. Shifts in environmental conditions that delay molt phenology or increase HF rates could negatively impact seal populations by further increasing thermoregulatory costs.
| S-EPMC7125049 | biostudies-literature
Project description:This paper introduces a new cross-platform programming framework for developing quantum-accelerated scientific computing applications and executing them on most of today’s cloud-based quantum computers and simulators. It makes use of C++ template meta-programming techniques to implement quantum algorithms as generic, platform-independent expressions, which get automatically synthesized into device-specific compute kernels upon execution. Our software framework supports concurrent and asynchronous execution of multiple quantum kernels via a CUDA-inspired stream concept.
| S-EPMC7304771 | biostudies-literature