Meeting report describing assessment protocols for a lagoon ecosystem on the East coast of India

Over the last 15 years, Uganda has achieved spectacular economic growth, thanks to the introduction of an enabling macro-economic environment and political stability. However, this economic growth has only recently manifested itself due to the fact that tremendous damage was done in the 1970s and early 1980s. Many Ugandans are still confronted with poverty, hunger, ill health and illiteracy, and a continuing deterioration of the ecosystems on which the country's largely rural population depends.

In 2015, total production of electricity was 28 ktoe of which 46.4 came from fossil fuels and 42.8 per cent from hydro sources.

This report seeks to investigate the financial standards and further to consider to what extent they currently relate to sustainable development, how they can support and solidify the various G20 policy commitments and the evolving country-level regulations and industry activities in a way that builds on the synergies that already exist.

Background: Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors. Methods: A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and reference-list checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting. Results: A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology (n = 38; e.g. electronic prescribing), organizational (n = 16; e.g. guidelines, policies, and procedures), personnel (n = 13; e.g. staff education), pharmacy (n = 9; e.g. clinical pharmacy service), hazard and risk analysis (n = 8; e.g. error detection tools), and multifactorial (n = 18; e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies (>90%) demonstrated a reduction in medication errors. A similar median reduction of 50-70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors. Conclusion: While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice

Responding to United Nations Environment Programme Governing Council decision 27/2 and United Nations Environment Assembly (UNEA) 1 resolution 1/ 4, United Nations Environment Programme is ready to launch its new study called: Strengthening the Science-Policy Interface: A gap analysis. The world is increasingly faced with environmental challenges which are exacerbated by an absence of coordination among different actors around the globe. In a global political context where scientific evidence is not often understood or used by policy-makers, there is a growing disconnect that has emerged, which not only dismisses but excludes opportunities for collaboration. Science and policy are at a crossroads. The interface needs to be framed by an effective and efficient governance structure to promote better interaction between the two. This inter can be facilitated by operational knowledge from non-state actors. A dynamic science-policy interface can be a core instrument to support well-informed decision making on the environment while also engaging the right actors in achieving the Sustainable Development Goals. This report aims to identify new ways to improve the science-policy interface by: Providing a summary of the characteristics of an effective science-policy interface. Identifying the gaps found in practice in science-policy interfaces. Providing practical steps that the Member States and international organizations can take to fill these gaps The report addresses the existing gap in collaboration between scientists and policymakers, and how closing it could protect this planet and its people. It also suggests that non-state actors can be more closely involved in policy design. This might include businesses, city networks and non-governmental organizations who understand what’s involved in implementing specific policies. Finally, it highlights the importance of making high-quality scientific data readily available to the right people. United Nations Environment programme hopes that scientists, policy makers and decision makers from industry and civil society, will use the new tools and approaches in this report to create a better future for all of us. The report was launched during the Science Policy Business Forum, held in Nairobi from the 2nd to the 3rd of December 2017. The key findings will be presented to the Member States during the 4th Global authors meeting of the Global Environment Outlook-6, taking place from the 19th to the 23rd of February 2018 in Singapore.

BACKGROUND: Indigenous Australians experience high rates of chronic conditions. It is often asserted Indigenous Australians have low adherence to medication; however there has not been a comprehensive examination of the evidence. This systematic literature review presents data from studies of Indigenous Australians on adherence rates and identifies supporting factors and impediments from the perspective of health professionals and patients. METHODS: Search strategies were used to identify literature in electronic databases and websites. The following databases were searched: Scopus, Medline, CINAHL Plus, PsycINFO, Academic Search Premier, Cochrane Library, Trove, Indigenous Health infonet and Grey Lit.org . Articles in English, reporting original data on adherence to long-term, self-administered medicines in Australia's Indigenous populations were included. Data were extracted into a standard template and a quality assessment was undertaken. RESULTS: Forty-seven articles met inclusion criteria. Varied study methodologies prevented the use of meta-analysis. KEY FINDINGS: health professionals believe adherence is a significant problem for Indigenous Australians; however, adherence rates are rarely measured. Health professionals and patients often reported the same barriers and facilitators, providing a framework for improvement. CONCLUSIONS: There is no evidence that medication adherence amongst Indigenous Australians is lower than for the general population. Nevertheless, the heavy burden of morbidity and mortality faced by Indigenous Australians with chronic conditions could be alleviated by enhancing medication adherence. Some evidence supports strategies to improve adherence, including the use of dose administration aids. This evidence should be used by clinicians when prescribing, and to implement and evaluate programs using standard measures to quantify adherence, to drive improvement in health outcomes.

Information document of the 8th Global Meeting of the Regional Seas Conventions and Action Plans

RSRM 66

Presentataion at the 12th Global Meeting of the Regional Seas Conventions and Action Plans

BACKGROUND: Primary care needs to be strengthened in order to address the many societal challenges. Group practices in primary care foster collaboration with other health care providers, which encourages care co-ordination and leads to a higher quality of primary care. Nursing roles and responsibilities expanded over time and nurses have been found to often provide equal high-quality chronic patient care compared to physicians, even with higher patient satisfaction. Inter-professional collaboration between primary care physicians and nurses is a possible strategy to achieve the desired quality outcomes in a strengthened primary care system. The objective of this research is to synthesize the evidence presented in literature on the impact of collaboration between physicians and nurses on patient outcomes in primary care or in comparable care settings. METHODS: A systematic review of peer-reviewed reviews was performed in four databases: COCHRANE, MEDLINE, EMBASE and CINAHL. All studies from 1970 until May 22 2016 were included in the search strategy. Titles, abstracts and full texts were respectively reviewed. At least two of the three authors independently reviewed each of the 277 abstracts and 58 full texts retrieved in the searches to identify those which contained all the inclusion criteria. Two authors independently appraised the methodological quality of the reviews, using the AMSTAR quality appraisal tool. RESULTS: A total of eleven systematic reviews met all the inclusion criteria and almost fifty different patient outcomes were described. In most reviews, it was concluded that nurses do have added value. Blood pressure, patient satisfaction and hospitalization are patient outcomes where three or more systematic reviews concluded better results when physicians and nurses collaborated, compared to usual care. Colorectal screening, hospital length of stay and health-related quality of life are outcomes where collaboration appeared not to be effective. CONCLUSIONS: Collaboration between physicians and nurses may have a positive impact on a number of patient outcomes and on a variety of pathologies. To address future challenges of primary care, there is a need for more integrated inter-professional collaboration care models with sufficiently educated nurses.

We conducted a systematic review and meta-analysis to determine the effectiveness of healthcare provider-led (HCPs) interventions to support medication adherence in patients with acute coronary syndrome (ACS). A systematic search of Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, IPA, CINAHL, ASSIA, OpenGrey, EthOS, WorldCat and PQDT was undertaken. Interventions were deemed eligible if they included adult ACS patients, were HCP-led, measured medication adherence and randomised participants to parallel groups. Intervention content was coded using the Behaviour Change Technique (BCT) Taxonomy and data were pooled for analysis using random-effects models. Our search identified 8870 records, of which 27 were eligible (23 primary studies). A meta-analysis (n=9735) revealed HCP-led interventions increased the odds of medication adherence by 54% compared to control interventions (k=23, OR 1.54, 95% CI 1.26 to 1.88, I(2)=57.5%). After removing outliers, there was a 41% increase in the odds of medication adherence with moderate heterogeneity (k=21, OR 1.41, 95% CI 1.21 to 1.65, I(2)=35.3%). Interventions that included phone contact yielded (k=12, OR 1.63, 95% CI 1.25 to 2.12, I(2)=32.0%) a larger effect compared to those delivered exclusively in person. A total of 32/93 BCTs were identified across interventions (mean=4.7, SD=2.2) with 'information about health consequences' (BCT 5.1) (19/23) the most common. HCP-led interventions for ACS patients appear to have a small positive impact on medication adherence. While we were able to identify BCTs among interventions, data were insufficient to determine the impact of particular BCTs on study effectiveness. PROSPERO registration number: CRD42016037706

Over 1.2 billion people across the world loose their lives in traffic crashes each year. In Brazil alone this number exceeds 40, 000 per year and continues to grow. This policy brief looks at low speed zones as an important policy and planning solution in the fight against traffic crashes.

Coral reefs constitute an invaluable heritage & a common federating theme for regional cooperation in Western Indian Ocean region due to the connectivity of their marine environments and the ecological and socio-economical services they provide.

目的采用Meta分析系统定量地评价我国高中生与大学生艾滋病健康教育的干预效果,为在学生群体中开展艾滋病健康教育提供科学依据。方法以"艾滋病"、"健康教育"、"大学生"和"高中生"为主题词和关键词联合检索Pub Med、中国知网和万方数据库的相关文献,各数据库检索时间范围限定在2006年1月—2017年6月。对符合纳入排除标准的文献进行质量评价及摘录所需数据,以健康教育前后艾滋病常识得分作为效应值,运用Revman 5.3软件进行Meta分析。结果共纳入19篇合格文献。Meta分析结果显示,健康教育对中学生与大学生艾滋病常识得分影响的标准均数差(Standard Mean Difference,SMD)=1.17(95%CI=0.88～1.47)。结论健康教育对提高我国高中生与大学生艾滋病相关知识的知晓有较好的效果。

目的采用Meta分析探讨近十年中国大陆医学生自杀意念发生率,为预防医学生自杀及开展医学生心理健康教育提供参考依据。方法计算机检索Pub Med、CNKI、Wan Fang Data和CBM数据库,搜集2007年1月1日至2017年5月31日发表的有关中国大陆医学生自杀意念的文献,由两名研究者独立进行文献筛选、资料提取和评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。采用亚组分析和Meta回归分析探索异质性来源,并通过敏感性分析探索单个研究对合并效应量的影响。结果共纳入30篇文献,包括58 757名中国大陆医学生,自杀意念发生率介于0.84%41.35%。纳入研究间的异质性较大（I2=99.1%,P0.1）。结论中国大陆医学生的自杀意念发生率相对较高,提示应当对此予以重视并制定相关的...

BACKGROUND: Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended behavior change interventions and how they should be composed is scattered. OBJECTIVE: This comprehensive systematic review aimed to provide an overview of characteristics and effectiveness of blended behavior change interventions for patients with chronic somatic disorders. METHODS: We searched for randomized controlled trials published from 2000 to April 2017 in PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Studies were sorted based on their comparison group. A best-evidence synthesis was conducted to summarize the effectiveness. RESULTS: A total of 25 out of the 29 included studies were of high quality. Most studies (n=21; 72%) compared a blended intervention with no intervention. The majority of interventions focused on changing pain behavior (n=17; 59%), and the other interventions focused on lifestyle change (n=12; 41%). In addition, 26 studies (90%) focused on one type of behavior, whereas 3 studies (10%) focused on multiple behaviors. A total of 23 studies (79%) mentioned a theory as basis for the intervention. The therapeutic guidance in most studies (n=18; 62%) was non face-to-face by using email, phone, or videoconferencing, and in the other studies (partly), it was face-to-face (n=11; 38%). In 26 studies (90%), the online care was provided via a website, and in 3 studies (10%) via an app. In 22 studies (76%), the therapeutic guidance and online care were integrated instead of two separate aspects. A total of 26 outcome measures were included in the evidence synthesis comparing blended interventions with no intervention: for the coping strategy catastrophizing, we found strong evidence for a significant effect. In addition, 1 outcome measure was included in the evidence synthesis comparing blended interventions with face-to-face interventions, but no evidence for a significant effect was found. A total of 6 outcome measures were included in the evidence synthesis comparing blended interventions with online interventions, but no evidence for a significant effect was found. CONCLUSIONS: Blended behavior change interventions for patients with chronic somatic disorders show variety in the type of therapeutic guidance, the type of online care, and how these two delivery modes are integrated. The evidence of the effectiveness of blended interventions is inconsistent and nonsignificant for most outcome measures. Future research should focus on which type of blended intervention works for whom.

OBJECTIVE: To evaluate the clinical efficacy and effectiveness of using 3D printing to develop medical devices across all medical fields. DESIGN: Systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES: PubMed, Web of Science, OVID, IEEE Xplore and Google Scholar. METHODS: A double-blinded review method was used to select all abstracts up to January 2017 that reported on clinical trials of a three-dimensional (3D)-printed medical device. The studies were ranked according to their level of evidence, divided into medical fields based on the International Classification of Diseases chapter divisions and categorised into whether they were used for preoperative planning, aiding surgery or therapy. The Downs and Black Quality Index critical appraisal tool was used to assess the quality of reporting, external validity, risk of bias, risk of confounding and power of each study. RESULTS: Of the 3084 abstracts screened, 350 studies met the inclusion criteria. Oral and maxillofacial surgery contained 58.3% of studies, and 23.7% covered the musculoskeletal system. Only 21 studies were randomised controlled trials (RCTs), and all fitted within these two fields. The majority of RCTs were 3D-printed anatomical models for preoperative planning and guides for aiding surgery. The main benefits of these devices were decreased surgical operation times and increased surgical accuracy. CONCLUSIONS: All medical fields that assessed 3D-printed devices concluded that they were clinically effective. The fields that most rigorously assessed 3D-printed devices were oral and maxillofacial surgery and the musculoskeletal system, both of which concluded that the 3D-printed devices outperformed their conventional comparators. However, the efficacy and effectiveness of 3D-printed devices remain undetermined for the majority of medical fields. 3D-printed devices can play an important role in healthcare, but more rigorous and long-term assessments are needed to determine if 3D-printed devices are clinically relevant before they become part of standard clinical practice.

Presentation at the 13th Global Meeting of the Regional Seas Conventions and Action Plans

Report on the Key Outcomes of the Second IGR for the GPA