Adoption Of Policies Research Articles

P-2202. Immune response after hepatitis B vaccination among healthcare providers in Uzbekistan

Abstract Background About 2.5 million people in Uzbekistan have Hepatitis B virus (HBV). Mass HBV vaccination of healthcare providers was conducted in 2015 and 2022. Post-vaccination immunity testing was never performed. We aimed to estimate post-vaccination immune response and determine associated factors.Table 1.HBV tests and intepretation Methods We conducted a cross-sectional study in Tashkent in 2023. Participants were randomly-selected from a database of providers vaccinated in the 2015 and 2022 campaigns. Interviews and blood collection for hepatitis B surface antigen, anti-HBs, and core antigen testing was performed at the workplace (Table 1). We assessed differences in mean titers using the Kruskal-Wallis test and factors associated with protective immune response (anti-HBs ≥10mIU/mL) using multivariable Poisson regression expressed as adjusted prevalence ratios (aPR).Table 2.Characteristics of healthcare providers vaccinated against HBV, Uzbekistan Results Of 334 participants, 61% were vaccinated in 2015 and 39% in 2022 (Table 2). Average age was 40 years old (interquartile range:35–49 years), 87% were female, 52% were nurses, 53% worked in hospitals, and 9% had current or past HBV infection. Among those without prior infection (n=303), 71% had protective titers. Three-quarters (72%) had completed the entire 3-dose course, 21% had 2 doses, and 7% 1 dose; 41% followed recommended intervals between doses. Mean immune titers differed by age (68 mIU/mL among 19–32-year-olds vs 31 mIU/mL among >42-year-olds, p=0.021). The proportion with protective immunity did not differ by year vaccinated (70% in 2015 vs 71% in 2022), dose number (72% for those with 3 doses vs 67% with ≤2) or dose intervals (74% followed recommendation and 69% didn’t). Nurses and laboratorians were more likely than physicians to have protective immunity (aPR=1.11, 95% confidence intervals [CI]: 1.00–1.24, p=0.042 and aPR=1.13, CI:1.04–1.22, p=0.003, respectively), and primary care workers were less likely than hospital workers to be protected (aPR=0.91, CI:0.87-0.98, p=0.009) (Figure 1).Figure 1.Forest plot of factors associated with protective immunity following HBV vaccination among healthcare providers in Uzbekistan Conclusion A high proportion of healthcare providers remained unprotected after HBV vaccination in Uzbekistan, especially hospital workers and physicians. Strategies to increase compliance with vaccination schedules are needed. Adoption of post-vaccination immunity testing policy can identify providers that may require revaccination. Disclosures All Authors: No reported disclosures

Renewable Energy Policies in the USA: A Comparative Study of Selected States

Policies concerning renewable energy transition are the primary responsibilities of individual states in the United States. This article aims to provide a comprehensive evaluation of state-level renewable energy policies, focusing on identifying key factors driving successful energy transitions and offering actionable insights for policymakers. The research investigates: What are the critical indicators and strategies contributing to an effective renewable energy transition at the state level? To ensure meaningful comparisons, states were selected based on top and bottom performance across various energy parameters, including renewable energy share, solar and wind capacity, electricity costs, and policy adoption (RPS, EERS, and net metering). A rubric, structured around environmental, institutional, social, and techno-economic criteria, was developed to measure policy effectiveness across 15 indicators. Scores for each state were weighted based on their contextual relevance, determined through consultations with energy professionals and the adaptation of existing weighting frameworks. Washington state emerges as the frontrunner, achieving the highest scores for both weighted and unweighted transition performance, closely followed by California. Conversely, Kentucky, Texas, and Florida exhibit the lowest scores. A correlation analysis reveals relationships among performance indicators, such as the impact of stakeholder diversity on energy equity and the link between policy integration and energy demand. This study provides a roadmap for prioritizing renewable policy integration, showing how technology and policy drivers collectively influence the rate of energy transitions. It offers essential insights for shaping state-level renewable energy policies, fostering partnerships, and steering states toward a greener and more resilient energy future.

Applying the Eightfold Path to Morocco's Cabinet Order 2.23.105

ABSTRACTMorocco is fighting its sixth year of drought. As part of its comprehensive response to the drought, the Moroccan cabinet passed order 2.23.105 in December 2023. The new rules require the regulation of well drilling entities. The problem of illegal wells, often dug by farmers who do not know that they need a license, represented a threat to the country's water tables long before the current drought and constitutes a significant barrier towards the adoption of effective Integrated Water Resource Management and Demand Side Management policies. The paper is based on an examination of the current laws including order 2.23.105, by applying the eightfold path of policy analysis, interviews with water officials, and including the views of farmers concerning their efficacy. The paper argues that the state is an essential player in framing an effective response to drought and to climate change. Soil and Water Analysis Tools (SWAT) like ArcSWAT will help improve the state's response and enable it to identify and engage key stakeholders.

Evaluation of a national framework for rational use of medicines in Kazakhstan and its role in improving medicine use practices at the organizational and national levels

BackgroundKazakhstan inherited the Semashko health system model, known for the centralized adoption of rules at the Ministry of Health (MoH) level that regulate the healthcare system. In 2019 MoH established a national framework with indicators aimed at collecting qualitative and quantitative data from healthcare organizations as part of their annual self-evaluation, and biannual external evaluation by the National Research Center for Health Development (NRCHD). The purpose of this study was to pilot the MoH framework on rational use of medicines and evaluate its effects on medicine use practices in health care organizations and at the national level.Materials and methodsThis cross-sectional study was conducted from October to December 2019 at 22 state-owned primary health care organizations (polyclinics) serving adults and children in Astana, Kazakhstan. Data were collected by trained surveyors visiting each organization. Data were converted to numeric values to arrive at compliance scores for each organization and analyzed to assess each organization’s compliance with set indicators.ResultsThe evaluation showed the rational use of medicines was assessed as “excellent” (90% < compliant) in 2 organizations (9% of the sample), “good” (75–89% compliant) in 7 organizations (32%), and “satisfactory” (50–74% compliant) in 13 organizations (59%), with an average compliance rate of 71% across the sample. 22 organization-specific evaluation reports were developed by the evaluator (NRCHD) and sent to health care organizations for corrective actions. Evaluation data triggered two improvements at the national level: correction of the default setting for trade names to international nonproprietary names within the physician ordering feature of the national health information system for medicines, and adoption of a national policy that allowed the exchange of unused stocks of medicines between polyclinics.ConclusionsUsing the national framework allowed the evaluator agency and healthcare organizations to identify organization-specific gaps and triggered improvements in the use of medicines.

New Mexico's aggressive plan to end child food insecurity and hunger through universal school meals policy adoption.

New Mexico's aggressive plan to end child food insecurity and hunger through universal school meals policy adoption.

Mapping the Drivers of Multisectoral Nutrition Governance and Its Link to Nutrition Outcomes in Kenya: A Qualitative Inquiry.

Malnutrition remains a significant public health issue in Kenya. Multisectoral Nutrition Governance (MNG) is increasingly being acknowledged as a catalyst for enhancing nutrition programming and outcomes. Effective MNG establishes policies, systems, and mechanisms that enable coordinated, adequately funded, and sustainable nutrition actions across sectors; however, its understanding and progress assessment remain inadequate. This study aimed to qualitatively assess the status of MNG and propose strategies to strengthen MNG mechanisms for improved nutrition actions and outcomes in Kenya. We hypothesized that effective performance across the MNG domains is associated with effective multisectoral nutrition actions and improved nutrition outcomes. This study used a qualitative design to assess the MNG status over the past 10 years (2012-2023). Nineteen program managers and officers from government and non-governmental institutions implementing nutrition at the national level were included. Data collection was conducted between January and March 2024 through key informant interviews (KIIs). Thematic analysis, guided by both inductive and deductive coding, was carried out using MAXQDA (Maximizing Qualitative Data Analysis) software. The findings indicate progress in strengthening MNG in the previous decade, though gaps persist. The progress was driven by improved political awareness and commitment, the adoption of nutrition policy and planning frameworks, and improved coordination. Constraints that impede MNG progress include inadequate financing and over-reliance on donor funding, limited translation of commitments to actions, lack of unified monitoring and evaluation (M&E) systems and fragmented policies. Strengthening multisectoral M&E systems that allow timely collection and utilization of data, ensuring sustainable financing for nutrition, enhancing accountability mechanisms and improving coherence across sectors are important for further improvement of MNG.

WOMEN'S ACCESS TO PROPERTY IN BANGLADESH

This paper critically examines the legal, social, and institutional barriers affecting women's access to property in Bangladesh, focusing on the challenges faced by Muslim and Hindu women under personal and statutory laws. The study begins by analyzing the legal framework governing women’s property rights, exploring the interplay between constitutional provisions and personal laws such as the Muslim Personal Law (Shariat) Application Act, 1937, and Hindu inheritance laws. Using India’s Hindu Succession Act, 1956 as a comparative framework, the paper highlights the disparities between Bangladesh and neighboring countries in terms of legal reforms aimed at promoting gender equality in property ownership. The research also discusses key case laws, including Fatema Khatun v. Md. Aminul Haque (1983) and Bipasha Rani Das v. Bharat Chandra Das (1997), to illustrate how the courts have addressed women’s inheritance claims and the limitations of the legal system. The paper concludes with several policy recommendations, including the need for legal reforms to harmonize personal laws with constitutional rights, the adoption of gender-sensitive land policies, and increased awareness and accessibility for women in rural areas. These reforms are essential for ensuring that women in Bangladesh can fully exercise their property rights and for promoting greater gender equality in property ownership. The study also identifies areas for future research, including the impact of international human rights standards on domestic legal reforms and the lived experiences of women in marginalized communities.

Nature-based solutions to address anxiety disorders: A cross-sectional ecological study of green spatial patterns in Taiwan

Air pollution and heat increase the prevalence and risk of anxiety disorders, which are particularly severe under the increasing trends of climate change and urbanization. Well-designed green spaces have mediating effects on the threats posed by environmental deterioration and promote public health. However, previous research has overlooked these effects. This cross-sectional ecological study applied partial least squares structural equation modeling to data from Taiwanese cities and towns to infer the vital influences of and complex relationships among green spatial patterns (i.e., the dispersion, patch area, fragmentation, aggregation, and coverage ratio of green spaces), socioeconomic status (i.e., income and population aging), atmospheric environment (i.e., air pollution and high temperature), and anxiety disorders. The results reveal that minimizing the dispersion of green spaces and maximizing their patch area and coverage ratio are associated with reduced prevalence of anxiety disorders. Air pollution and high temperature mediate the influence of green spatial patterns on anxiety disorders. Population aging, air pollution, and high temperature are factors that increase the prevalence rate of anxiety disorders, whereas income level has a negative effect. This study identified the pathways and influences (i.e., indirect, direct, and total impacts) of green spatial pattern characteristics on anxiety disorders. These findings show that the adoption of effective greening policies may promote the development of healthy cities. Moreover, this study provides a useful methodology for clarifying complex pathways and identifying vital factors that can be applied to future research in health science and policy.

Term Limits in France and the United States: A Comparative History of Policy Debate and Adoption

AbstractThis article seeks to compare the policy histories of the legislative term limits in France and the United States. Both nations debated, initially adopted, and then ultimately rejected imposing term limits during the foundational moments of their democracies. Reemerging in the 1990s in America, proposals to refresh government through such limits have been successful in the states and have failed at the national level. The idea regained prominence in France when Emmanuel Macron supported it during his 2017 presidential election. Although Macron eventually abandoned the proposal, the revival of this debate is an opportunity to draw broad parallels but identify critical differences between the two nations in the philosophical debates over term limits and the ways that leaders have embraced or abandoned them to fulfill their political goals. We show how the idea circulated between the two nations, without a parallel exchange of evidence about its effects.

The Effect of Exchange Rate on the Growth of the Nigerian Economy

This study examined the effect of exchange rate on the economic growth of Nigeria. It specifically looked at effect of exchange rate on gross domestic product (GDP), as a proxy of economic growth with interest rate and inflation rate as determinant of exchange rate. Secondary data from the Central Bank of Nigeria Statistical Bulletin were collected for a period of thirty-seven years, 1986 to 2023. Ex-post facto research design was utilized. While some pre and diagnostic tests were carried out to confirm the integrity of the data and their relatedness in both short- and long-term basis, Autoregressive Distributed lag (ARDL) model was employed in the analysis of hypotheses. It was found that while exchange rate and interest rate had significant effect on RGDP, while inflation rate was found to be not significant on RGDP. This implies that exchange rate and interest rate significantly determine economic growth in Nigeria. The study concludes that exchange rate should be handled with utmost concern by experts in the field to avoid unnecessary fluctuations that may inflict unbearable economic consequences on the Nigerian people. The study recommends, among others, the adoption of policies measures that will affect economic growth in Nigeria in such a way that the welfare of the people can be upgraded.

Testing the Multiple Streams Framework in US state legislatures

Despite a robust literature applying the Multiple Streams Framework (MSF) to national government institutions, there remains a dearth of research examining the theory’s explanatory power in US state legislative contexts. This omission is problematic given the critical role state legislatures play in driving policy change in a host of policy domains, including healthcare, emergency preparedness and voting rights policy, to name a few. To fill this gap in the research, this study applies the MSF to the case of climate adaptation policy making in the Massachusetts State Legislature. Using a mixed methods design, it assesses the effect of all three of the MSF’s streams (the problem, politics and policy streams), as well as the concept of policy entrepreneurship on the climate adaptation policy agenda of the Massachusetts State Legislature between the years 2001 and 2020. The findings suggest that agenda activity was largely driven by changes within the political stream, namely the election of a Republican governor. In addition to advancing the MSF by providing one of the most comprehensive quantitative analyses of the framework to date, this article draws on new data from the State House News Service and other sources of state legislative floor debates to present a new methodological approach for measuring agenda change. In this way, the article makes a clear theoretical contribution to the MSF literature as well as providing new analysis of state-level climate adaptation policy adoption.

Subsidy implementation patterns and electric vehicle adoption.

Many local governments provide subsidies to promote electric vehicles (EVs). These subsidies are characterised by different implementation patterns: they are provided by different levels of government, sometimes jointly financed, or retroactively implemented. However, the potential impacts of different subsidy implementation patterns on EV adoption remain unclear. In this study, we analyse the impact of local subsidy implementation patterns on EV adoption. We first propose an analytical model and then verify it empirically using monthly panel data on EV adoption in 132 Chinese cities. We find that municipal subsidies are more effective than both provincial and jointly financed subsidies in promoting EV adoption. Each 10% increase in municipal subsidies (as a share of national subsidies) can promote approximately 1000 more EVs than corresponding provincial subsidies and approximately 965 more EVs than jointly financed subsidies. Retroactive subsidies do not significantly hinder local EV adoption. Our research provides valuable empirical evidence for policymakers to steer toward more synergistic EV adoption policies.

Evaluating the impact of Renewable and Non-Renewable Resources on CO2 Emissions and Sustainability

This study analyzes Pakistan’s energy system, distinguishing between renewable and non-renewable energy sources. We examine energy production decisions as Pakistan’s energy sector faces significant challenges including environmental concerns due to carbon emissions related to nonrenewable energy generation methods using historical data and analytical tools. In essence, we evaluate the relationship between renewable and nonrenewable supplies alongside with GDP, trade, and population quantifies changes in land use and counts related carbon emissions. This analysis will provide valuable insights into the environmental consequences of different energy production methods in Pakistan. Regression analysis will be used in the study to demonstrate how the above-mentioned variables affect CO2 emissions using data from 1990 to 2020. Additionally, methods including ADF-test and ARDL test would be used for accurate results and cater for unit roots and lag variables. According to previous research, non-renewable energy sources directly correlate with CO2 emissions, but renewable energy sources have a negative effect on CO2 emissions. While we can’t be certain of the details until we’ve crunched the figures, we want to contribute to Pakistan’s adoption of wiser energy policies. Consider ways to increase the use of renewable energy, better plan the use of land for sustainable energy projects and reduce carbon emissions in keeping with regional and global environmental objectives. Finding the right course of action for a cleaner, greener energy future is what we’re all about in the end. Essentially, climate change, being a global threat, is becoming a serious threat, so to accommodate this concern, a sustainable approach needs to be studied and applied accordingly.

Towards a more inclusive diaspora policy orientation in Africa

Since the declaration of the Diaspora as Africa’s sixth region, a process that began with the adoption of the Protocol on Amendments to the Constitutive Act of the African Union (3q) in 2003, several African nations have responded by making similar declarations, leading to the formulation, adoption and implementation of individual national diaspora policies. The original declaration by the African Union (AU) appears clear in its definition of the categories of people that constitute the African Diaspora. The apparently all-encompassing definition is meant to serve as a model for the states that make up the African Union. However, interaction with some of the national diaspora policies so far drafted and published, indicates that there is a disjunction between the affirmation of the African Union and the selective orientation of the individual African states. This paper, therefore, critically examines the various contradictions between the AU declaration and the diaspora policy orientation of selected African states. The scrutiny is done with a view to highlighting, analysing and recommending new strategies for diaspora policy formulation and revision towards the full realisation of the mutual developmental potential that the initiative of integrating the Diaspora into the institutional frameworks of African states holds.

Selected health characteristics are associated with urban Canadians' acceptability of policies promoting healthier restaurant food environments.

The adoption of policies promoting healthier restaurant food environments is contingent on their acceptability. Limited evidence exists regarding individual characteristics associated with restaurant food environment policy acceptability, especially health-related characteristics. This study examined associations between health characteristics and restaurant food environment policy acceptability among urban Canadians. Links between health characteristics and complete agreement levels with selected policies were examined using data in the cross-sectional Targeting Healthy Eating and Physical Activity survey study, that is, a large pan-Canadian study on policy acceptability. For each policy, several logistic multilevel regression analyses were conducted. Canada's seventeen most populated census metropolitan areas. Urban Canadian adults responded to the survey (n 27 162). Body mass index was not associated with acceptability after adjustments for other health and sociodemographic characteristics were made. Across all policies and analyses, those reporting excellent or very good health statuses were more likely to be in complete agreement with targeted policies than those with good health statuses. For selected policies and analyses, those reporting poor health statuses were also more likely to be in complete agreement than those describing their health status as good. For all policies and analyses, both those consuming restaurant-prepared foods daily and those never consuming these foods were more likely to be in complete agreement than those consuming these foods once per week. More research is needed to explain discrepancies in acceptability according to health characteristics. Bringing this study's findings to the attention of policymakers may help build momentum for policy enactment.

How Populism Replaced Elitism: The Institutional Logic in the Shift of U.S. Trade Policy Under Trump

Since the Ratification of RTAA in 1934, U.S. trade policy has trended toward trade liberalization. However, this trend experienced a significant shift following Donald Trump’s election as president in 2016. This paper analyzes the roles of Congress and the President in shaping trade policy, and by introducing Olson’s collective action theory, examines the logic behind U.S. trade policy formation before and after Trump’s election. The study finds that traditionally, pro-trade groups were able to effectively lobby Congress. In contrast, anti-trade groups struggled to organize effectively due to collective action problem. However, the trade policy formation mechanism underwent a fundamental shift during the Trump administration. By frequently invoking legal provisions such as Section 232, the Trump administration was able to bypass Congress and unilaterally implement protectionist policies, shifting the policymaking authority from Congress to the President, and the primary locus for policy formation from congressional lobbying to presidential elections. In presidential elections, anti-trade groups became highly politically active, forming strong collective action that drove the adoption of protectionist policies. This study provides insights into the institutional logic and political processes behind U.S. trade policy during the Trump era, offering insights into how group political participation influences policymaking.

Bank board diversity and environmental risk management: does critical mass matter in project finance decisions?

PurposeThis study investigates the influence of board gender diversity on policy decisions within the banking sector, with a specific focus on the adoption of environmental risk management policies. Drawing on critical mass theory, we provide empirical evidence demonstrating the positive impact of women directors on the implementation of environmental risk management policies aligned with the equator principles (EP) framework.Design/methodology/approachWe analyze data from 540 banks operating in 34 countries over a ten-year period (2013–2022).FindingsOur findings indicate that banks with at least four women directors on their boards are more likely to adopt such policies. Our results remain statistically significant after controlling for endogeneity issues.Practical implicationsThis research advocates for increased female representation on bank boards to foster the adoption of sustainability-focused policies within the banking industry.Originality/valueWe also contribute by providing insights into the role of a diverse board in improving green credit practices among global banks.

Identifying Barriers to the adoption of the Brazilian Digital Governance Policy and the Role of Collaborative Governance

This article aims to identify strategies and barriers to the adoption of Digital Governance by the Brazilian Public Administration based on the Digital Governance Policy, which focuses on access to information, service provision, and social participation. Qualitative exploratory research was conducted through policy analysis and semi-structured interviews carried out with 11 ICT managers from public organizations. Barriers to each Digital Governance strategy were identified, and, based on the literature, they were classified into structural or cultural, individual, organizational, or strategic barriers. Findings show an association between these barriers and Collaborative Governance, which can foster the Digital Governance strategy or hinder it, in case it lacks or is not well implemented. Include something more from the discussion.

Sustainability and Public Management: Focusing on Leadership and on the Development of Competences

Objective: The objective of this study was to investigate the competences associated to the practice of Sustainable Leadership in the city management, having the purpose of identifying pitfalls and proposing strategies for the development of competences that are aligned with the pillars of sustainability. Theoretical Framework: The current research is grounded on Sachs’s (1993) pillars of sustainability, which integrate economic, social and environmental aspects, as well as on competence-based management and sustainable leadership. These theoretical bases guide the analysis and the development of competences associated to the exercise of sustainable leadership by city managers. Method: This is an exploratory and qualitative study, containing semi-structured interviews that have been conducted with eleven city managers, as well as an analysis of institutional norms. The goal was to identify the current situation regarding competences, in order to assess how they are related to sustainability practices and to propose a strategy for the development of such competences. Results and Discussion: The reports demonstrated a lack of competences associated to the practice of sustainable leadership in public city management, and the official documents confirm that there is a need for training that is focused on the development of these strategies, which are essential to promote collective well-being and sustainable practices at the local level. Implications of the study: The study adds to the field when it proposes a practical strategy for training public leaders, influencing in the adoption of sustainable policies and practices. Academically, the study adds to the debate on public city management and sustainability. Originality/Value: This study relates management competences to sustainability in the public sector, providing resources for the development of competences related to sustainable leadership as a key point for the improvement of administrative practices and for guidance on sustainable public policies.

Missing Fundamental Nursing Care: What's the Extent of Missed Oral Care? A Cross-Sectional Study.

The Fundamentals of Care framework emphasizes a patient-centered approach that prioritizes the nurse-patient relationship and care environment to meet patients' basic needs, including oral hygiene. Recognized as crucial for preventing systemic health problems, oral care neglect is a global concern. Studies identify missed oral care as a widespread issue, contributing to significant patient safety risks. This study aimed at measuring missed nursing care occurrence in a Northern Italian university hospital, exploring the association between missed oral care with nursing staff characteristics and oral care policies. A single-center cross-sectional study was conducted according to the STROBE guidelines. Data collection was performed in May 2022 using the MISSCARE survey, a self-administered questionnaire sent by email to 473 nurses from all inpatient units. The degree of implementation of oral care policies was obtained by accessing the Facility Score Sheet data at the department level. Descriptive statistics, chi-square tests, and Fisher tests were conducted using SAS 9.4 and R software. Providing oral care was the third-most missed nursing care after rotating patients every two hours and walking them three times daily. The reasons for missed care included resource shortage and high patient turnover. The Facility Score Sheet data showed a low adoption of oral care policies. No significant associations were found between missed oral care and both nurses' characteristics and oral care policy at the department level. The study confirms highly missed oral care in acute care settings, emphasizing the urgent need for systemic changes via an evidence-based oral care policy and practice implementation. This study was prospectively registered under protocol 293 CE 050/2022 (8 Aril 2022).