Global Alliance to Eliminate Lead Paint - Business Plan

Our first World Ocean Review (WOR) was published more than a year ago. This status report took a comprehensive look at the seas and encapsulated the current state of ocean science. It was read by almost 70,000 people, who either obtained a hard copy in German or English from non-profit organization maribus, or downloaded it as a PDF file from our homepage at www.worldoceanreview.com. Its readers included teachers, students, scientists and interested laypeople. Moreover, the WOR received intense media attention, with TV (e.g. “Tagesschau”, the German evening news), online (e.g. “Spiegel Online” ), radio and print coverage. It was also presented personally to members of parliament in Brussels, and to Federal Chancellor Merkel in Berlin. The feedback we received was all positive, with many people commending its mix of scientific excellence and readability. The original WOR was a world first in that it was comprehensible to all, but also provided a sound basis for media debate, policy developments and lectures. It is maribus’ aim to publish a World Ocean Review each year. The first edition focused on the broad picture, while subsequent WORs will take a more in-depth look at individual aspects of the oceans. Interrelationships which are frequently presented in an abbreviated and simplified form will be thoroughly investigated and presented in all their complexity. Nonetheless the close cooperation between world-leading research scientists and “mare” magazine journalists guarantees that the articles will be straightforward and easily understood by all. They will provide a knowledge base for policy-makers and journalists wishing to hone their awareness of the problems involved. This new report (WOR 2) focuses on fish and their exploitation. Fish have always been a vital source of life for mankind – not only as a food. Fish are still an essential element of the daily diet in most regions of the world. At the same time fisheries provide a livelihood to entire coastal regions and still have great economic clout. All this, however, is in jeopardy and is coming under close scrutiny. Fish stocks are declining worldwide, entire marine regions are considered overfished, and some species are on the Red List of Threatened Species. It is not our intention with this World Ocean Review 2 to press the panic button. But by pointing out the true facts surrounding fish stocks and fisheries we seek to come to grips with an extremely complex situation. Only sound knowledge – not alarmism, nor appeasement – will save these vitally important inhabitants of the world’s oceans.

Atmospheric brown clouds (ABCs) are widespread layers of regional scale plumes of air pollution consisting of a mixture of anthropogenic sulfate, nitrate, organics, black carbon, dust, and fly ash particles. Recent scientific findings suggest that the impacts of ABCs, which include short-lived climate pollutants (SLCPs) such as black carbon and tropospheric ozone, have reached a critical point that raises the need for urgent action. An Atmospheric Brown Clouds (ABC) study published in 2010 (Ramanathan and Xu, 2010) showed that mitigation of all four SLCPs (black carbon, methane, ozone precursors, and HFCs) using maximum available technologies will reduce global warming by 0.6 degree C by 2050. Prompted by this finding and other scientific studies, UNEP commissioned a global assessment of black carbon and tropospheric ozone. The UNEP report was published in 2011. It confirmed the ABC study and suggested that widespread and swift implementation of a small number of already available mitigation measures targeting black carbon and methane emissions will decrease global warming by 0.5 degree C. The report also showed that measures to control SLCPs can prevent crops losses of 30 to 140 million tons and some 0.7 to 4.6 million premature deaths globally. Those regions that cut down significant levels of emissions will benefit most.

Background Improved prevention and management of vascular disease is a global priority. Non-health care professionals (such as, ‘lay health workers’ and ‘peer support workers’) are increasingly being used to offer telephone support alongside that offered by conventional services, to reach disadvantaged populations and to provide more efficient delivery of care. However, questions remain over the impact of such interventions, particularly on a wider range of vascular related conditions (such as, chronic kidney disease), and it is unclear how different types of telephone support impact on outcome. This study assessed the evidence on the effectiveness and cost-effectiveness of telephone self-management interventions led by ‘lay health workers’ and ‘peer support workers’ for patients with vascular disease and long-term conditions associated with vascular disease. Methods Systematic review of randomised controlled trials. Three electronic databases were searched. Two authors independently extracted data according to the Cochrane risk of bias tool. Random effects meta-analysis was used to pool outcome measures. Results Ten studies were included, primarily based in community settings in the United States; with participants who had diabetes; and used ‘peer support workers’ that shared characteristics with patients. The included studies were generally rated at risk of bias, as many methodological criteria were rated as ‘unclear’ because of a lack of information. Overall, peer telephone support was associated with small but significant improvements in self-management behaviour (SMD = 0.19, 95% CI 0.05 to 0.33, I2 = 20.4%) and significant reductions in HbA1c level (SMD = -0.26, 95% CI −0.41 to −0.11, I2 = 47.6%). There was no significant effect on mental health quality of life (SMD = 0.03, 95% CI −0.12 to 0.18, I2 = 0%). Data on health care utilisation were very limited and no studies reported cost effectiveness analyses. Conclusions Positive effects were found for telephone self-management interventions via ‘lay workers’ and ‘peer support workers’ for patients on diabetes control and self-management outcomes, but the overall evidence base was limited in scope and quality. Well designed trials assessing non-healthcare professional delivered telephone support for the prevention and management of vascular disease are needed to identify the content of effective components on health outcomes, and to assess cost effectiveness, to determine if such interventions are potentially useful alternatives to professionally delivered care. Keywords: Self-management support; Chronic care; Non-healthcare professional; Peer; Lay; Telephone; Vascular disease; Chronic kidney disease; Prevention; Management; Patients; Social disadvantage; Health services research; Randomised controlled trial; Review; Meta-analysis

The Minamata Convention on Mercury is an important advance in global environmental stewardship. This multilateral agreement addresses the devastating effects of mercury through practical actions that will reduce global levels while promoting sustainable development. This booklet is published for information only. It does not substitute the original authentic texts of the Minamata Convention on Mercury as deposited with the Secretary-General of the United Nations acting as the Depositary of the Convention.

Framework and achievements of the current activities of the Waste Management Partnership Area (Chairperson)

This report serves as a national input for Nauru for the 2014 SIDS Conference, the Pacific regional preparatory meeting and the Interregional preparatory meeting. The assessment includes a review of progress and gaps in the implementation of the BPoA and MSI, new and emerging challenges and national policy concerns. This report also includes a brief discussion on linking with global initiatives such as the post-2015 development agenda. This assessment included a national consultative meeting held on 16-18 April 2010 to discuss NSDS progress and new and emerging challenges. The consultative meeting involved stakeholders from government, communities, private entities, non-governmental organizations and others. The inputs from the consultative meeting have been supplemented with information from previous NSDS assessments, the MSI+5 assessment of Nauru, the UNDAF framework for Nauru, the 2012 Nauru MDG report, the Nauru census analysis and interviews with key stakeholders. Progress and gaps in the implementation of the BPoA and MSI were primarily assessed based on the 19 priority themes and means of implementation in the MSI. However, as this assessment is based on national priorities there is not a complete overlap between the MSI themes and the current report. The report highlights a few key achievements and gaps for each sector||it is not an exhaustive list of achievements or gaps.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) among people aged 60 years and above is a growing public health problem. Regular physical activity is one of the key elements in the management of T2DM. Recommendations suggest that older people with T2DM will benefit from regular physical activity for better disease control and delaying complications. Despite the known benefits, many remain sedentary. Hence, this review assessed interventions for promoting physical activity in persons aged 65 years and older with T2DM. METHODS: A literature search was conducted using Ovid MEDLINE, PubMed, EMBASE, SPORTDiscus, and CINAHL databases to retrieve articles published between January 2000 and December 2012. Randomized controlled trials and quasi-experimental designs comparing different strategies to increase physical activity level in persons aged 65 years and older with T2DM were included. The methodological quality of studies was assessed. RESULTS: Twenty-one eligible studies were reviewed, only six studies were rated as good quality and only one study specifically targeted persons aged 65 years and older. Personalized coaching, goal setting, peer support groups, use of technology, and physical activity monitors were proven to increase the level of physical activity. Incorporation of health behavior theories and follow-up supports also were successful strategies. However, the methodological quality and type of interventions promoting physical activity of the included studies in this review varied widely across the eligible studies. CONCLUSION: Strategies that increased level of physical activity in persons with T2DM are evident but most studies focused on middle-aged persons and there was a lack of well-designed trials. Hence, more studies of satisfactory methodological quality with interventions promoting physical activity in older people are required.

A drone is generally thought of as a military weapon or surveillance tool. Commonly referred to as an unmanned aerial vehicle (UAV), unmanned aerial system (UAS) or remotely piloted aircraft (RPA), a drone can also provide a low-cost and low-impact solution to environmental managers working in a variety of ecosystems. Drones used for these purposes are referred to as eco-drones or conservation drones. Their agility and quality imaging abilities make them advantageous as a mapping tool for environmental monitoring, but there are still several challenges and concerns to be surmounted.

Informal gold mining in Colombia: baseline 2012

Background and Aims Despite well documented disparities in health and healthcare in rural communities, evidence in relation to quality improvement (QI) interventions in those settings is still lacking. The main goals of this work were to assess the effectiveness of QI strategies designed to improve diabetes care in rural areas, and identify characteristics associated with greater success. Methods We conducted a systematic review and meta-analysis. Systematic electronic searches were conducted in MEDLINE, EMBASE, CINAHL, and 12 additional bibliographic sources. Experimental studies carried out in the OECD member countries assessing the effectiveness of QI interventions aiming to improve diabetes care in rural areas were included. The effect of the interventions and their impact on glycated hemoglobin was pooled using a random-effects meta-analysis. Results Twenty-six studies assessing the effectiveness of twenty QI interventions were included. Interventions targeted patients (45%), clinicians (5%), the health system (15%), or several targets (35%), and consisted of the implementation of one or multiple QI strategies. Most of the interventions produced a positive impact on processes of care or diabetes self-management, but a lower effect on health outcomes was observed. Interventions with multiple strategies and targeting the health system and/or clinicians were more likely to be effective. Six QI interventions were included in the meta-analysis (1,496 patients), which showed a significant reduction in overall glycated hemoglobin of 0.41 points from baseline in those patients receiving the interventions (95% CI -0.75% to -0.07%). Conclusions This work identified several characteristics associated with successful interventions to improve the quality of diabetes care in rural areas. Efforts to improve diabetes care in rural communities should focus on interventions with multiple strategies targeted at clinicians and/or the health system, rather than on traditional patient-oriented interventions.

Objectives To identify effective interventions to increase organ donor registration and improve knowledge about organ donation among ethnic minorities in North America and the UK. Design Systematic review. Data Sources MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane Central searched up to November 2012, together with four trials databases and the grey literature. Review methods A systematic search followed by assessment of eligibility and quality. An interpretive and thematic approach to synthesis was undertaken. This examined the nature and delivery of interventions in relation to a range of outcomes: verified registration, changing knowledge and a measured shift towards greater readiness. Results 18 studies were included in the review, comprising educational and mass media interventions. Mass media interventions alone reported no significant change in the intention or willingness to register. Educational interventions either alone or combined with mass media approaches were more effective in increasing registration rates, with a strong interpersonal component and an immediate opportunity to register identified as important characteristics in successful change. Conclusions Effective interventions need to be matched to the populations’ stage of readiness to register. Measured outcomes should include registration and shifts along the pathway towards this behavioural outcome.

INTRODUCTION: Mobile phone text messaging is emerging as an important tool in the care of people living with HIV; however, reports diverge on its efficacy in improving adherence to antiretroviral therapy (ART), and little is known about which patient groups may benefit most from phone-based adherence interventions. We will conduct an individual patient data meta-analysis to investigate the overall and subgroup effects of text messaging in three recently published text-messaging randomised controlled trials. METHODS AND ANALYSIS: Data from two Kenyan and one Cameroonian trial will be verified, reformatted and merged. We will determine pooled effect sizes for text messaging versus standard care for improving adherence to ART using individual patient random-effects meta-analysis. We will test for the interaction effects of age, gender, level of education and duration on ART. Sensitivity analyses will be conducted with regard to thresholds for adherence, methods of handling missing data and fixed-effects meta-analysis. Only anonymised data will be collected from the individual studies. ETHICS AND DISSEMINATION: Ethical approval was obtained for the individual studies. The results of this paper will be disseminated as peer-reviewed publications, at conferences and as part of a doctoral thesis. This individual patient data meta-analysis may provide important insights into the effects of text messaging on ART adherence in different subpopulations, with important implications for programme implementation involving such interventions and future research.

Objective. To determine the effects of multidisciplinary home rehabilitation (MHR) on functional and quality of life (QOL) outcomes following hip fracture surgery. Methods. Systematic review methodology suggested by Cochrane Collboration was adopted. Reviewers independently searched the literature, selected the studies, extracted data, and performed critical appraisal of studies. Summary of the results of included studies was provided. Results. Five studies were included. Over the short-term, functional status and lower extremity strength were better in the MHR group compared to the no treatment group (NT). Over the long-term, the MHR group showed greater improvements in balance confidence, functional status, and lower extremity muscle strength compared to NT group, whereas the effect on QOL and mobility was inconsistent across the studies. Several methodological issues related to study design were noted across the studies. Conclusion. The MHR was found to be more effective compared to the NT in improving functional status and lower extremity strength in patients with hip fracture surgery. Results of this review do not make a strong case for MHR due to high risk of bias in the included studies. Further research is required to accurately characterize the types of disciplines involved in MHR and frequency and dosage of intervention.

Chair's Summary

This report has been prepared by the Trade, Policy and Planning Unit of the United Nations Environment Programme. It is a key component of the Green Economy and Trade Opportunities Project. It aims to: Identify a range of international trade opportunities in various key economic sectors associated with the transition to a green economy||Identify policies and measures that may act as facilitators and overcome hindrances to seizing trade opportunities arising from the transition to a green economy||and Assist governments, the private sector and other stakeholders to build capacity to take advantage of sustainable trade opportunities at the national, regional or international level.

Introduction: There is a need to develop new, more cost-effective models of healthcare and in this vein there is a considerable international interest in exploiting the potential offered by major developments in health information technologies (HITs). Very substantial investments are, as a result, now being made globally, but these still probably only represent a fraction of the investments needed if healthcare is to make the transition from the paper to the digital era. Investing greater resources is, however, inherently challenging and unpopular at a time of financial austerity and this is furthermore complicated by the thus far variable evidence of health benefits and demonstrable short-term to medium-term returns associated with investments in HITs. Objectives: Building on our related systematic overviews investigating the impact of HITs, we now seek to estimate the cost-effectiveness of HITs and as a secondary aim to identify potentially transferable lessons in relation to how to realise returns on investments in these technologies. Methods: We will conduct a systematic review to identify the empirical evidence base surrounding the return on investments from implementing HITs. Two reviewers will independently search major international databases for published, unpublished and on-going experimental and quasi-experimental studies of interest published during the period 1990-2013. These searches of bibliographic databases will be supplemented by contacting an international panel of experts. There will be no restriction on the language of publication of studies. Studies will be critically appraised using the Critical Appraisal Skills Programme (CASP) Economic Evaluations checklist. In view of the anticipated heterogeneity in intervention investigated, study design and health system contexts, we will undertake a descriptive, narrative and interpretative synthesis of data. Ethics and dissemination: Ethical approval is not required. Results: These will be presented in one manuscript. The protocol is registered with the International Prospective Register for Systematic Reviews (PROSPERO) CRD42013005294.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic metabolic disease characterized by hyperglycemia and cardiovascular risks. Without proper treatment, T2DM can lead to long-term complications. Diabetes self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs for T2DM patients can help to successfully improve patient health behaviors and health-related outcomes. Theories can help to specify key determinants of the target behaviors and behavior change strategies required to arrive at the desired health outcomes, which can then be translated into specific behavioral techniques or strategies that patients can learn to apply in their daily life. From previous reviews of a wide range of online diabetes self-management tools and programs, it appears that it is still unclear which behavioral change techniques (BCTs) are primarily used and are most effective when it comes to improving diabetes self-management behaviors and related health outcomes. OBJECTIVE: We set out to identify which BCTs are being applied in online self-management programs for T2DM and whether there is indication of their effectiveness in relation to predefined health outcomes. METHODS: Articles were systematically searched and screened on the mentioned use of 40 BCTs, which were then linked to reported statistically significant improvements in study outcomes. RESULTS: We found 13 randomized controlled trials reporting on 8 online self-management interventions for T2DM. The BCTs used were feedback on performance, providing information on consequences of behavior, barrier identification/problem solving, and self-monitoring of behavior. These BCTs were also linked to positive outcomes for health behavior change, psychological well-being, or clinical parameters. CONCLUSIONS: A relatively small number of theory-based online self-management support programs for T2DM have been reported using only a select number of BCTs. The development of future online self-management interventions should be based on the use of theories and BCTs and should be reported accurately.

This publication presents the latest available data on the extent of unregistered children and assesses progress to date in increasing birth registration rates worldwide. Download (English) Download (French)

This publication outlines a possible process and poses questions that countries may wish to consider as they develop integrated national waste management strategies. It outlines the reasons for a national waste management strategy and explores the challenges and opportunities waste management presents to governments and communities. It also deals with concepts and principles related to waste management and takes account of major considerations influencing policy choices involved in the process of strategy development, monitoring, and implementation. Finally, this document defines the actions a country can take in order to develop a strategy, then to implement, review and update it.