The elimination of industrial trans-fatty acids (i-TFA) is a global public health priority. In Brazil, food regulatory changes were implemented in 2012, limiting the use of TFA-free claims and in 2019, restricting i-TFA content in food. This study analysed i-TFA declarations on labels of packaged foods sold in Brazil in 2010, 2013 and 2020, before, during and after food policy changes. This repeated cross-sectional study analysed labels of packaged foods from an outlet of a large supermarket chain in Brazil (n = 2327 products in 2010; n = 3176 in 2013, n = 4397 in 2020). The i-TFA terms listed in the ingredient list, content of trans-fatty acids (TFA) declared on nutrition information panels (NIPs), and TFA-free claims were examined. Descriptive and comparative analysis over time were conducted using binary and multinomial logistic regressions. The percentage of foods containing potential i-TFA ingredients was 50.6% in 2010, 36.4% in 2013 and 28.5% in 2020. Overall, the likelihood that NIPs declared TFA decreased over time (OR: 0.46; 95%CI: 0.40; 0.53, p < 0.001), but this was not consistent across all food groups and years. The likelihood of using TFA-free claims also decreased (OR: 0.12; 95%CI: 0.10; 0.15, p < 0.001) over time. However, in 2020, 24.1% of foods labelled as containing 0 g TFA in their NIPs still listed ingredients that could be sources of i-TFA. This is the largest study to analyse TFA labelling in Brazil, informing regulatory discussions and offering a basis for assessing compliance with TFA-focused labelling regulations. Our findings suggest that the 2019 regulation on i-TFA restrictions contributed to amplifying and sustaining the impact of the 2012 labelling regulations in reducing i-TFA packaged food sold at the retail level.

How have liberalized drug policies impacted international policing practices across urban and rural jurisdictions? A scoping review.

Co-creating adaptation solutions: A critical review of participatory instruments in climate change adaptation laws and policies

This review provides a summary of the evolving landscape of pediatric lung transplantation highlighting current trends, short and long-term outcomes, ongoing challenges in posttransplant survival, and unique considerations in pediatric populations. The annual volume of pediatric lung transplantation has declined over the past decade due to a decreased need among children with cystic fibrosis. Improvement in survival has paralleled advancements in bridge to transplant strategies, expanding what were once considered contraindications. Despite the ongoing shortage of donor organs, innovations in policy changes, surgical and immunologic strategies, and organ preservation technologies have expanded the donor lung pool. Chronic lung allograft dysfunction (CLAD) remains the primary limitation to long-term survival, with limited management strategies and emerging immunomodulatory therapies offering promise. As survival in pediatric lung transplantation improves, emphasis should shift to long-term outcomes including quality of life and equitable care, development of effective CLAD prevention strategies and pediatric-specific guidelines to optimize long-term survival.

Trends and determinants of childhood anxiety disorders burden in Asia, 1990-2023.

To identify quality-improvement opportunities from the experiences of Black and Latina severe maternal morbidity (SMM) survivors and their families. This study explored the experiences of Black and Latina survivors of SMM through qualitative interviews. A Community Advisory Board of SMM survivors and community representatives guided the study design, recruitment, and analysis. We recruited participants through community outreach and used a trauma-informed approach to interviews. Recruitment concluded after 17 survivors when the team determined through analytic discussion that subsequent interviews reinforced rather than expanded the existing thematic structure. We used reflexive thematic analysis to identify key themes related to prenatal, intrapartum, and postpartum care experiences. The overarching theme of wanting to be seen and heard as a whole person emerged across interviews. Five subthemes characterized the struggles participants faced during and after SMM events: 1) If I Don't Appear a Certain Way, I Won't Get Adequate Care, reflecting experiences of bias and racialized expectations; 2) What Happens Now and What Happens Next?, describing poor communication and uncertainty during care transitions; 3) Advocacy: If I Don't Speak Up, Who Will? If I Do Speak Up, Who Will Hear Me?, highlighting the burden of self-advocacy in clinical settings; 4) Having Another Child at What Cost?, capturing fear and trauma shaping future reproductive decision making; and 5) Long-term Consequences for Mental and Emotional Health, describing persistent psychological effects. Through iterative interpretation and prioritization with the Community Advisory Board, the themes informed multilevel quality-improvement recommendations. These included policy changes such as insurance coverage for doulas and improved parental leave; organizational and clinician-level strategies such as extended perinatal visits, workforce diversity, and training in bias and trauma-informed care; and patient-level supports emphasizing advocacy resources, education, and relationship-centered care. Experiences of SMM survivors and their support persons revealed systemic barriers and a strong desire to be seen and treated as whole persons, with attention to physical, emotional, and mental well-being. Participants highlighted issues such as racial marginalization, clinician biases, and insufficient support and education. These findings align with Community Advisory Board members' experiences and existing research. We offer recommendations, co-developed with the Community Advisory Board, based on these findings to improve care at the policy, organizational, clinician, and patient levels.

Policy changes in opioid agonist therapy and impacts on HIV and hepatitis C prevention in Canadian federal prisons.

Graduated drivers licensing (GDL) programs are being simplified across Canada. In April 2023, Alberta removed advanced road testing for full (Class 5) licenses and lifted previous restrictions on alcohol use, nighttime driving, and passengers for learners (Class 7). As of June 25, 2023, ∼700,000 drivers gained full licensure without advanced testing. New Alberta drivers are younger, less restricted, and have higher motor vehicle collision (MVC) rates than other provinces. We used interrupted time series analysis with publicly available data from January 2022 to January 2025. Negative binomial regression was used to estimate immediate and longer-term effects of the policy change on emergency department (ED) visits due to MVCs, adjusting for age, gender, and seasonality, with subgroup analyses by road user type. Following the changes to GDL programming, drivers and passengers experienced modest increases in visit rates immediately after the intervention (driver IRR: 1.05, 95% CI: 1.00-1.11; passenger IRR: 1.11, 95% CI: 1.02-1.21). Motorcycle drivers showed larger increases, though estimates for motorcycle passengers were imprecise due to small sample size (motorcycle driver IRR: 1.40, 95% CI: 1.09-1.78; motorcycle passenger IRR: 1.49, 95% CI: 0.81-2.73). Removing GDL restrictions in Alberta led to immediate increases in MVC-related ED visits, particularly among motorcycle users, younger age groups, and males. Minimal ongoing trends suggest the effects were largely immediate and no statistically significant lasting impacts are noted. These findings highlight potential safety risks from relaxing licensing restrictions and the need for targeted interventions for high-risk groups as other provinces consider similar policy changes.

Peri-operative medicine is a critical component of contemporary healthcare delivery. Despite significant advancements, peri-operative complications remain a relevant concern. Obtaining reliable risk estimates, identifying potential causes, and studying new interventions, revised policies or implementation of best practices to prevent complications, requires data from a large number of participants. Electronic Patient Record systems offer the opportunity to unlock these data, but the limited standardisation of databases and sharing frameworks available across Europe limit the effective use of the available data. We propose creating a European peri-operative shared data registry with continuous data collection, integrating clinical, bedside monitoring and outcome data in a collaborative network. Such network would facilitate outcomes research, could serve as a platform to optimise clinical practices by fostering quality improvement through benchmarking of care delivered by departments or individual physicians, and could be used to evaluate policy changes. This ESAIC initiative aligns well with the development of the European Health Data Space. This article provides examples of contemporary clinical research and practice evaluation questions to illustrate the need for a European collaborative data-sharing network, highlights inspiring examples of existing data-sharing initiatives and describes a road map to establish such network.

Living donor transplantation is the optimal treatment for end-stage renal disease and end-stage liver disease. For the recipient, the benefits of living donation include improved duration of graft survival compared to deceased donation and avoidance of lengthy waiting time and risks of dialysis. For transplant centers, a robust living donor program results in consistent transplant case volumes, daytime cases and a decreased reliance on potentially unfavorable allocation policy changes. Transplant programs require a playbook of actionable initiatives based on consensus best practices and peer-reviewed data to optimize opportunities to increase living donor evaluation and surgery within current legal and policy frameworks. Strategies to increase center living donor volume include utilization of culturally competent transplant education and outreach, development of living donor champion programs, wider utilization of financial assistance programs available to living donors, increased enrollment in paired donor exchange services and adaptation of modern evidence-based selection and evaluation criteria. Understanding the current landscape of living donor transplantation and exploring areas of innovation is imperative to a center's ability to continue to serve the full spectrum of patients with end stage organ disease to the best of our collective ability.

Substantial data supports the use of rapid exome and genome sequencing (rES/rGS) in Neonatal Intensive Care Units (NICU), but fewer studies have examined the impact of rES/rGS in other pediatric critical care units. We evaluated the impact on diagnostic yield and time to diagnosis following a single-center hospital policy change allowing broader, first-line rES/rGS for children in Cardiac and Pediatric Intensive Care Units (CICU, PICU). We conducted retrospective chart review from 1/1/2021-9/15/2024 for children in the CICU and PICU for whom genetic consultation was requested prior to (n = 64) and after (n = 211) the policy change. Exome and genome sequencing (ES/GS), both rapid and non-rapid, was completed in 174 patients, with 146 completing rES/rGS. Overall ES/GS diagnostic yield was 36.5% in the CICU and 31.2% in the PICU. Post-policy change, there were more requested genetics consults, an increase in rES/rGS completed (CICU: 4.8% vs. 56.0%; PICU: 13.6% vs. 88.5%), an increase in diagnoses/year (CICU: 6.0 vs. 14.3; PICU: 6.0 vs. 7.6), and decreased time to diagnosis (CICU: 23 vs. 12 days; PICU: 33 vs. 16 days). We show that changing hospital policy to allow for first-line rES/rGS in the CICU/PICU led to more consults, a higher percentage of patients receiving rES/rGS, a 2.4-fold increase in genetic diagnoses in the CICU, and decreased time to diagnosis in both units.

Policymakers need active citizens' participation to implement meaningful, transparent, and inclusive reforms aimed at ambitious policy changes. However, effective methodologies for ensuring genuine participation, addressing inherent power imbalances, and translating community stakeholder feedback into tangible and lasting policy and project outcomes remain underdeveloped, particularly within the context of housing sustainability and innovation in Ireland. This research addresses this critical gap, employing Participatory Research methods, engaging 28 stakeholders in the Irish social housing sector to inform the implementation of environmental sensor technology to enhance housing sustainability and resilience in the industry. This study details the insights collected from stakeholder engagement, focusing on key concerns, such as data privacy and the diverse needs of residents. It also demonstrates how this input shaped the project's technological design and engagement strategies. The insights shown in this research aim to motivate researchers and policymakers in Ireland to adopt participatory approaches that integrate citizen perspectives into digital innovation and resilience planning. This research also contributes to the field of participatory research methods with a practical approach to meaningfully engaging vulnerable populations and integrating their concerns into technological solutions, demonstrating how participatory frameworks can advance both digital sustainability and housing resilience.

Post-diagnostic support is a critical yet underdeveloped aspect of dementia care, especially for autistic adults who present with distinct cognitive, sensory, and communication needs. Although interventions such as medication management, psychosocial support, environmental modifications, and carer training are known to improve outcomes, their relevance and accessibility for autistic individuals remain poorly understood. As part of the Second International Summit on Intellectual Disability and Dementia, an international working group examined the intersection of autism and dementia with a focus on post-diagnostic care. Drawing on interdisciplinary expertise, the group identified key barriers and opportunities in clinical practice, caregiving, and service delivery. Recommendations are organized across seven areas, including models of post-diagnostic support, caregiving contexts, pharmacological and non-pharmacological interventions, environmental adaptations, and care planning. The discussion emphasizes the complex needs of autistic adults-many of whom have co-occurring intellectual disabilities, psychiatric conditions, or chronic health issues-and the need for individualized approaches that account for sensory sensitivities and communication differences. Existing dementia care frameworks often fail to address these complexities, resulting in significant service gaps. The report calls for urgent investment in research, workforce training, and policy reform to promote equitable, autism-informed post-diagnostic support and improve quality of life for this underserved population.Lay AbstractAutistic adults who develop dementia often experience challenges that are not well addressed by current dementia care systems. After a dementia diagnosis, people may need help with memory, communication, behavior changes, and daily living. For autistic adults, these supports must be adapted to their individual sensory sensitivities, communication styles, and social differences. This article reports on the work of an international group of researchers, clinicians, and advocates who met during the Second International Summit on Intellectual Disability and Dementia. The group examined how post-diagnostic support for autistic adults with dementia could be improved. They reviewed existing evidence, identified key barriers to care, and proposed strategies to strengthen services in areas such as medication use, environmental design, caregiver training, and personalized care planning. The report emphasizes that many autistic adults also have intellectual disabilities, mental health conditions, or long-term physical health issues, which can make care more complex. Current dementia care frameworks often overlook these overlapping needs, resulting in limited or unsuitable supports. The authors call for more research, workforce training, and autism-informed policy changes to ensure that post-diagnostic care is equitable, individualized, and responsive. Enhancing understanding and adapting support can help autistic adults with dementia maintain dignity, comfort, and quality of life.

The consequences of untreated perinatal mental health conditions are well-established, yet fewer than one in five women experiencing perinatal mental health distress receive treatment. Although recommendations for evidence-based treatment are increasingly widespread, patients and providers still face substantial hurdles to accessing needed services. This study sought to update the literature with a report on providers' perceptions of the demand for and accessibility of mental health services for women in the perinatal period with the goal of pinpointing areas where quality improvement should be implemented. An eight-item, mixed-methods (i.e., open choice, multiple choice, and open response) questionnaire assessing perceptions of patients' access and barriers to care was sent in a department-wide email at a large academic medical center. Forty-six providers completed the survey (n = 18 physicians, n = 14 nurse midwives, n = 13 advanced practitioner nurses, n = 2 other providers). Providers reported pervasive barriers to perinatal mental healthcare and that only occasionally are their perinatal patients able to access appropriate mental healthcare. The findings contribute to the growing body of knowledge regarding access to mental healthcare, ultimately aiming to improve the overall well-being of women during the perinatal period. The study emphasizes the ongoing critical need for researchers and the healthcare system to recognize and address the persistent challenges faced by obstetric providers, highlighting the pervasive nature of issues in accessing quality perinatal healthcare and underscoring the importance of acknowledging these challenges for justifying increased clinical access, rigorous intervention studies, and policy change.

To (1) explore the experiences and perceptions of older adults accessing an Australian Government Home Care Package (HCP), (2) understand how recipients prioritise their package expenditure, (3) understand the value that recipients place on food and nutrition services, and (4) understand the barriers and facilitators to spending on these services. Semi-structured interviews were conducted with 15 HCP recipients aged 65 years or older located across Australia. Transcripts were analysed using Braun and Clarke's six-phase reflexive thematic analysis. Four themes were developed from 15 interviews: (1) Care, By Name or By Nature; (2) We Know What We Need, Just Listen; (3) The Struggles of Prioritising and Spending; and (4) Nutritional (Im)Balance. Participants experienced a lack of person-centred care in the HCP program, making it difficult to obtain services that met their care needs and preferences. For many, their package budget was insufficient, causing recipients to compromise on services required for safe, independent living. Nutrition was important to HCP recipients but was often not their main priority when prioritising their limited package funding. Nutrition was valued by HCP recipients but often deprioritised for more immediate care needs. It is apparent that changes to home care programs are required so recipients are at the centre of their care and have access to resources to help maintain their nutritional health and remain living independently at home. These insights can inform program and policy changes to better support older adults to age-in-place.

Variations in Nurse Practitioner full practice authority in the United States: Difference in difference analysis of access and health Performance at a national level.

Age of Entry into Early Intervention: Influence of the COVID-19 Pandemic, Telehealth, and Other Factors.

The historiography of energy and industrialization characterizes the nineteenth century as the age of coal. Wood is rather seen as a pre-modern energy source. In line with this, the historiography on wood and forests focuses on the eighteenth century and the pioneering role of German foresters in determining sustainable management practices. Recently, historians have argued that wood remained a more important staple of industry in the nineteenth and twentieth centuries than is often acknowledged. This raises the question how forestry economists and experts reacted to the rise of coal and industrialization. So far it has not been studied if these changes led to pessimism about the future of forests, new economic ideas or management practices, or changes in ownership structure or tariff policies. Focusing on Germany between 1850 and 1900, this paper uses forestry journals and handbooks to argue that foresters remained optimistic about future demand for timber, but strongly disagreed about economic questions regarding rotation periods, land use and the role of forests in the national economy.

Climate change and food policy interventions: Implications for the yield response of arable crops in Nigeria

North African countries are increasingly facing climate change, natural resource degradation, and food crises. Algerian regions such as Laghouat are one of the hotspots where problems such as soil degradation, desertification, and water scarcity are experienced. Current agricultural production systems are not responding to future needs and are inadequate to address these problems. Agroecology emerges as a promising alternative that can respond to growing future needs by providing resilient and sustainable production systems. This study investigates the factors affecting farmers’ adaptation to agroecology in Laghouat, Algeria, using Elinor Ostrom’s Social Ecological Systems Framework (SESF). We apply our mixed-methods methodology in the field to systematically examine the complex relationships of the system, resource systems and, governance, and actors. Our findings suggest that the negative impacts of unsustainable agricultural practices, combined with climate change and misguided policies, are leading to a problematic trend that results in a system that is losing its resilience and sustainability and is becoming increasingly vulnerable. However, the study also highlights that farmer training, incentives to support the adoption of environmentally friendly practices, and strong social networks can significantly increase the transition to sustainable agroecology. These insights underline the need for integrated and collaborative strategies to achieve sustainable soil management, and hence more resilient agricultural system. • Agroecology can induce sustainable agricultural land management and improve soil health in a systematic manner. • Transdisciplinary approach helps understand SES by integrating social, ecological and economic aspects of soil and land use. • Participatory and site-specific methodology has been developed to implement Social Ecological Systems framework.