Public Education Campaigns Research Articles

Factors influencing household energy choices in the Kumasi Metropolitan area of Ghana

Reforms in the energy sector are expected to bring about essential efciency gains, which could result in energy diversifcation and welfare improvements among households. However, there are other unintended social and environmental consequences associated with the process. One signifcant social concern is the likely impact on how low-income families access new energy. The study used a cross-sectional design to undertake a comparative analysis of domestic energy choices. Data was collected from 405 households’ decision makers. An interview schedule and a guide were used for the data collection. The results showed that modern fuels are by far the most predominant source of energy for high and medium class residential households in Kumasi. However, residents in low-class areas preferred to use biomass fuel as their primary energy choice. Contextual variations revealed that general factors such as afordability and accessibility of energy source were exogenous determinants of energy choice. The fndings of the study also lend support to the energy ladder hypothesis that household income is a signifcant determinant of household energy choice. Further, social and demographic factors are critical determinants of cooking fuel type in residential zones. The study recommends the promotion of modern fuels through developing dependable energy distribution systems, and public education campaigns by the Energy Commission of Ghana.

Abstract A123: Legislation by states and its impact on factors causing divergence in HPV vaccination coverage: Analysis of 2013-2017 National Immunization Survey - Teens (NIS-TEENS)

Abstract Background: Human papilloma virus (HPV) is strongly associated with multiple cancer types, affecting women, men and children of all races, ethnicities and backgrounds. HPV causes more than 30,000 cases of cancer every year and more than 70% of U.S population will experience at-least one HPV infection at some point. School-entry mandates and public health education campaigns though being separate entities, have significantly increased vaccine uptake, reduced disease prevalence and decreased racial disparities in disease rates. Furthermore, improvements in immunization against HPV are not equally distributed across gender, age, demographic and socioeconomic divisions within the recommended group of vaccine recipients. Objectives: To analyze and report the association between state-level policies and HPV vaccination uptake. We further explore predictors of HPV vaccination uptake using Aday & Anderson’s behavioral theory of healthcare utilization. Methods: A repeated cross-sectional survey of NIS-Teens data from 2013-2017 was used for the analysis. Bivariable associations and multivariable ordered logistic regression models were statistically performed using STATA 15/IC & SAS v9.4. Results: HPV vaccination completion rates were 17% higher in teens who lived in states with a legislative mandate irrespective of policy enactment. Relative to males, females had 72% higher odds of uptake. Compared to whites, Non-Hispanic blacks had a 21% lower odds of vaccination uptake. Compared to western region of the US, the north-east region reported 1.47 times higher odds of HPV vaccination. Provider recommendation was also significantly associated with HPV vaccination coverage rates. Conclusion: State legislative mandates had a profound impact of vaccination uptake. Additionally, racial minorities were significantly less likely to receive vaccination. Analysis of statewide adaptation of policy related bills and federal funding on VFC (Vaccine For Children) program could further inform those policy initiatives with the greatest uptake of vaccination. Citation Format: Radhika Ranganathan, Peyin Hung, Swann Arp Adams, Nicole L Hair, Shiba Simon Bailey. Legislation by states and its impact on factors causing divergence in HPV vaccination coverage: Analysis of 2013-2017 National Immunization Survey - Teens (NIS-TEENS) [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A123.

Abstract A022: “Let me smoke that”: Exploring combustible tobacco use and smoking cessation behavior among sexual minority young adult smokers in Washington, D.C.

Abstract Background: In the U.S., lesbian, gay, bisexual, and transgender individuals (LGBT) are medically underserved, understudied, and are often difficult for researchers to access due in part to risks to participation (i.e., discrimination and stigma). While evidence regarding combustible tobacco use among LGBT adults is relatively underdeveloped, significant health disparities exist in this population. LGBT young adults in particular are nearly twice as likely to use tobacco compared to their heterosexual and cisgender counterparts, indicating that LGBT smokers have higher rates of tobacco-related cancers, including lung cancer. Informed by the Theory of Planned Behavior, this qualitative pilot study explored in depth attitudes, subjective norms, and perceived behavioral control toward combustible tobacco product use and cessation behaviors among a sample of young adult LGB smokers residing in Washington, D.C. Methods: Semistructured face-to-face interviews were conducted with self-identified lesbian (n=1), gay (n=5), and bisexual (n=2) young adult smokers. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis methodology. Digital audio recordings of the interviews were transcribed verbatim and edited to remove identifiers. Results: Participants ranged in age from 18 to 25 (M = 23.25, SD = 2.05). Five participants identified as African American and four identified as male. Three participants reported part-time employment and four reported that they “don’t meet basic expenses”. The mean age for cigarette smoking onset was 15.6. All participants reported menthol cigarette preference, four reported daily menthol cigarette use, and five reported past 30-day little cigar/cigarillo use. Attitudes, subjective norms, and perceived behavioral control toward combustible tobacco use and cessation behaviors fell under the broad themes of individual-level factors (self-image), psychosocial factors (stress and anxiety), socio-cultural factors (pro-smoking social norms), and stage of readiness. Intention to quit smoking in the next six months was low and influenced by pro-smoking attitudes and behaviors in the social environment surrounding LGBT young adults. Conclusions: Study findings contribute to a limited body of research investigating theoretically grounded variables related to combustible tobacco use among sexual minority young adult smokers. Multilevel cessation interventions are needed to address the psychosocial, socioeconomic, and cultural underpinnings of combustible tobacco use by distinct sexual identity. Additionally, study findings suggest opportunities to inform prevention campaigns like “This Free Life,” the Food and Drug Administration’s public education campaign designed to prevent and reduce tobacco use among LGBT young adults. Citation Format: Sabrina L Smiley. “Let me smoke that”: Exploring combustible tobacco use and smoking cessation behavior among sexual minority young adult smokers in Washington, D.C. [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A022.

Factors Associated With Timely Initiation of Breastfeeding and Prelacteal Feeding in North-Central Nigeria

OBJECTIVEDelay in initiation of breastfeeding after birth is associated with the introduction of other feeds. It has been recommended that all women should initiate breastfeeding within the first hour after birth. Early initiation of breastfeeding and exclusive breastfeeding could reasonably reduce neonatal deaths. The aim of this study was to assess the initiation of breastfeeding and prelacteal feeding in Plateau State, Nigeria.MATERIALS AND METHODA cross-sectional design was adopted for the study. A total of 763 women drawn equally from the three senatorial zones of the state voluntarily completed a questionnaire. Results were analyzed using chi-squared statistics and regression analysis.RESULTSFindings show that 33.1% of women initiated breastfeeding in a timely manner. The relationships between the timely initiation of breastfeeding and the use of pain relief, maternal age, maternal employment, economic status, influence of family and friends, and advertisement were found to be statistically significant. Furthermore, 92% gave breast milk for the first feed, while 8% gave infant formula, glucose, herbs, or water. Inadequate breast milk production, delayed initiation of breastfeeding, and health conditions were factors identified as responsible for prelacteal feeding.CONCLUSIONThe proportion of women who initiated feeding in a timely manner was low, which underscores the need to promote and support early initiation of breastfeeding in the state. There is thus a need for a public education campaign, particularly directed at women receiving antenatal care, and focusing on the need for establishing feeding early. Women with health challenges and those with a history of poor milk production may require additional support to breastfeed as recommended.

A comparative meta-analysis of residential green building policies and their impact on overall energy consumption patterns

Data shows residential energy consumption constituting a significant portion of the overall energy end use in the European Union (EU), ranging between 15% and 30%. Furthermore, the EU’s dependency on foreign fossil fuel-based energy imports has been steadily increasing since 1993, constituting approximately 60% of its primary energy. This paper provides an analytical re-view of diverse residential building/energy policies in targeted EU countries, to shed insight on the impact of such policies and measures on energy use and efficiency trends. Accordingly, the adoption of robust residential green and energy efficient building policies in the EU has increased in the past decade. Moreover, data from EU energy efficiency and consumption databases attributes 44% of total energy savings since 2000 to energy upgrades and improvements within the residential sector. Consequently, many EU countries and organizations are continuously evaluating residential building energy consumption patterns to increase the sec-tor’s overall energy performance. To that end, energy efficiency gains in EU households were measured at 1% in 2000 compared to 27.8% in 2016, a 2600% increase. Accordingly, 36 policies have been implemented successfully since 1991 across the EU targeting improvements in residential energy efficiency and reductions in energy use. Moreover, the adoption of National Energy Efficiency Actions Plans (NEEACP) across the EU have been a major driver of energy savings and energy efficiency. Most energy efficiency plans have followed a holistic multi-dimensional approach targeting the following areas, legislative actions, financial incentives, fiscal tax exemptions, and public education and awareness programs and campaigns. These measures and policy instruments have cumulatively generated significant energy savings and measurable improvements in energy performance across the EU since their inception. As a result, EU residential energy consumption trends show a consistent decrease over the past decade. The purpose of this analysis is to explore, examine, and compare the various green building and energy-related policies in the EU, highlighting some of the more robust and progressive aspects of such policies. The paper will also analyze the multiple policies and guidelines across targeted European nations. Lastly, the study will assess the status of green residential building policies in Lebanon, drawing from the comprehensive European measures, in order to recommend a comprehensive set of guidelines to advance energy policies and building practices in the country. Keywords: Building Policies; Residential Energy Patterns; Residential Energy Consumption; Energy Savings

Global Interest in Oral and Maxillofacial Surgery: Analysis of Google Trends Data

Oral and maxillofacial surgery (OMS) has an expansive scope, with myriad diagnoses treated by practicing surgeons. Patients and referring providers are increasingly turning to Web-based sources to find information about clinical conditions before consultations or in conjunction with ongoing care. The purpose of this study was to examine the current trends of public interest of OMS procedures as assessed by online search trends. A cross-sectional study of Internet search data obtained via Google Trends (GT; Alphabet, Mountain View, CA) was conducted. Data were collected using GT for OMS-related search terms between January 2004 and May 2019. The search terms used in the analysis were "wisdom teeth," "TMJ," "dental implants," "jaw surgery," "jaw fracture," "facial trauma," and "facial cosmetic surgery," defined to be the core surgical aspects of OMS based on public awareness campaigns sponsored by the American Association of Oral and Maxillofacial Surgeons.Relative search volumes, trends over time, geographic trends, and seasonal trends were analyzed. For all analyses, P≤.05 was considered significant. Overall search volume trends for OMS procedures showed an increase over time, with seasonal and geographic trends. "Wisdom teeth" was the most searched term and had the greatest increase in search volume over time. "Facial trauma" was the least searched term, with no appreciable trend over time. Geographic search volume was greatest in the United States. Seasonal changes were most apparent with searches for "wisdom teeth" and "jaw surgery." Analysis of GT data shows substantial interest in core OMS procedures, with seasonal variations noted for certain areas of practice (third molars and jaw surgery) and consistent interest in other areas (facial cosmetic surgery, dental implant reconstruction, and temporomandibular disorders).The use of GT data may be a powerful tool for predicting demand for OMS services and for public education campaigns.

Prevalence of undetected hypertension and its association with socio-demographic and non-communicable diseases risk factors in Brunei Darussalam

This study estimated the prevalence of undetected, untreated and uncontrolled hypertension in Brunei Darussalam and the associations with socio-demographic and non-communicable diseases (NCDs) risk factors. Participants were aged 18–69 years old from the national NCDs and risk factors survey in Brunei Darussalam, conducted from August 2015 to April 2016. Multiple logistic regression was applied to estimate the associations of undetected, untreated and uncontrolled hypertension with socio-demographic and NCDs risk factors. The crude prevalence of hypertension was estimated to be 40.4% [95% confidence interval (CI) = 37.2–43.6] in men and 32.3% (95% CI = 29.6–35.0) in women. Multivariable adjustment using logistic regression found that those who were currently married [odds ratio (OR) = 0.34, p < 0.001], have family history of hypertension (OR = 0.43, p < 0.001), reported buying food with low salt content (OR = 0.67, p = 0.039) and diabetic (OR = 0.28, p < 0.001) were found to be significantly less likely to have undetected hypertension. Amongst those who were previously diagnosed with hypertension, younger age groups, tobacco use and having no other NCDs diagnosis were found to have significantly higher odds of having untreated hypertension. Amongst those who were on antihypertensive treatment, having body mass index (BMI) 30 kg/m2 and above was significantly associated with lower odds of uncontrolled hypertension. More than one-third (35.8%) of the adult population in Brunei Darussalam were found to have hypertension. Among them, over one-quarter (28.6%) of hypertension cases were not previously detected. Amongst those previously diagnosed with hypertension, more than one-third (35.1%) were not treated or on antihypertensive medication. Screening for hypertension should be emphasised in public health education and media campaigns so that hypertension can be detected and treated earlier.

Micromapping of Thalassemia and Hemoglobinopathies Among Laos, Khmer, Suay and Yer Ethnic Groups Residing in Lower Northeastern Thailand

Northeastern (NE) Thailand is one of the areas with a prevalence of thalassemias and hemoglobinopathies. Data on the prevalence of the diseases in minorities in the region has been limited. This study aimed to survey the thalassemias and hemoglobinopathies that take into account ethnicity. Four ethnic groups, including Laos (n = 162), Khmer (n = 145), Suay (n = 134), and Yer (n = 101) inhabiting the lower region of NE Thailand, were selected to represent the study populations. The results demonstrated that an extremely high prevalence of Hb E (HBB: c.79G>A) (>50.0%) was observed in the Khmer, Suay and Yer ethnic groups. The highest prevalence of α+-thalassemia (α+-thal) [–α3.7 (rightward)] deletion was found in the Khmer ethnic group (48.28%). The –α4.2 (leftward) deletion (α+-thal) was restricted to the Yer ethnic group. Yer and Suay had a high incidence of Hb Constant Spring (Hb CS; HBA2: c.427T>C) as well as Hb Paksé (HBA2: c.429A>T). As the prevalence of α0-thalassemia (α0-thal) is relatively high in Suay (7.46%), couples who are members of Suay ethnic population should be urged to undergo hematological screening before planning a pregnancy to control the Hb Bart’s hydrops fetalis. Micromapping of thalassemias and hemoglobinopathies herein described will be helpful in genetic counseling and public education campaigns, which should be carried out in appropriate languages, with exhibitions at the village levels. This information will be of benefit for the long-term effort to reduce the burden of severe thalassemia disease in the region.

Genotype-Phenotype Correlation of β-Thalassemia in Malaysian Population: Toward Effective Genetic Counseling

Effective prevention of β-thalassemia (β-thal) requires strategies to detect at-risk couples. This is the first study attempting to assess the prevalence of silent β-thal carriers in the Malaysian population. Hematological and clinical parameters were evaluated in healthy blood donors and patients with β-thal trait, Hb E (HBB: c.79G>A)/β-thal and β-thal major (β-TM). β-Globin gene sequencing was carried out for 52 healthy blood donors, 48 patients with Hb E/β-thal, 34 patients with β-TM and 38 patients with β-thal trait. The prevalence of silent β-thal carrier phenotypes found in 25.0% of healthy Malaysian blood donors indicates the need for clinician’s awareness of this type in evaluating β-thal in Malaysia. Patients with β-TM present at a significantly younger age at initial diagnosis and require more blood transfusions compared to those with Hb E/β-thal. The time at which genomic DNA was extracted after blood collection, particularly from patients with β-TM and Hb E/β-thal, was found to be an important determinant of the quality of the results of the β-globin sequencing. Public education and communication campaigns are recommended as apparently healthy individuals have few or no symptoms and normal or borderline hematological parameters. β-Globin gene mutation characterization and screening for silent β-thal carriers in regions prevalent with β-thal are recommended to develop more effective genetic counseling and management of β-thal.

Vascular surgery's identity

Vascular surgery's identity

The Role of Telehealth in Reducing the Mental Health Burden from COVID-19.

The Role of Telehealth in Reducing the Mental Health Burden from COVID-19.

Differential air temperature cooling performance of urban vegetation types in the tropics

The tendency for cities to be warmer than surrounding rural areas, known as the urban heat island effect, has become a matter of increasing concern, particularly in regions with a hot, humid climate. While urban vegetation may reduce air temperatures, the magnitude of this cooling effect varies between different types of vegetation. In this study we compared the cooling effect of five vegetation types that are commonly encountered in the tropical city of Singapore: grass, shrub, managed trees, managed trees over shrub, and secondary forest. Ambient air temperatures were monitored over 18 months at 88 locations, and analysed in relation to characteristics of the surrounding vegetation. Generalised additive modelling revealed significant temperature reductions associated with increasing cover of managed trees, managed trees over shrubs below, and secondary forest vegetation, with the latter vegetation type having the greatest effect. We conclude that vegetation can significantly ameliorate temperatures in cities with a hot, humid climate, but not all types of vegetation are equally effective. By demonstrating the cooling benefits of secondary forest in densely-populated urban areas, public education and engagement campaigns could help overcome negative perceptions of such vegetation.

Deconstructing match-fixing: a holistic framework for sport integrity policies

On the 1st of September 2019, the Council of Europe Convention against the Manipulation of Sports Competitions entered into force. This official mandate appears to confirm the significance of the issue on the political agenda. For sports governance bodies, the problem is one of the biggest threats against the integrity and sustainability of their industry. Despite this political-institutional situation, the phenomenon still remains under-studied in the academic world and several authors have emphasized the need for more and better empirical research to verify the premises (sometimes unfounded) on which the official preventive narrative of the problem is built. This special issue, Deconstructing Match-fixing, comes to light to address this issue. Systematizing the evidence presented along the contributions, this introductory article attempts to dispel some ‘myths’ in the official preventive narrative, offers some lessons for a better understanding of the phenomenon, and promotes recommendations for establishing more evidence-based public policies and educational campaigns.

Evaluating the impacts of cannabis legalization: The International Cannabis Policy Study

An increasing number of jurisdictions have legalized non-medical cannabis use, including Canada in October 2018 and several US states starting in 2012. The policy measures implemented within these regulated markets differ with respect to product standards, labelling and warnings, public education, retail policies, marketing, and price/taxation. The International Cannabis Policy Study (ICPS) seeks to evaluate the impacts of these policy measures as well as the broader population-level impact of cannabis legalization using a quasi-experimental research design. The objective of this paper is to describe the ICPS conceptual framework, methods, and baseline estimates of cannabis use. The ICPS is a prospective cohort survey conducted with national samples of 16–65-year-olds in Canada and the US. Data are collected via an online survey using the Nielsen Consumer Insights Global Panel. Primary survey domains include: prevalence and patterns of cannabis use; purchasing and price; consumption and product types; commercial retail environment; problematic use and risk behaviours; cannabis knowledge and risk perceptions; and policy-relevant outcomes including exposure to health warnings, public educational campaigns, and advertising and promotion. The first annual wave was conducted in Aug-Oct 2018 with 27,169 respondents in three geographic ‘conditions’: Canada (n = 10,057), US states that had legalized non-medical cannabis (n = 7,398) and US states in which non-medical cannabis was prohibited (n = 9,714). The ICPS indicates substantial differences in cannabis use in jurisdictions with different regulatory frameworks for cannabis. Future waves of the study will examine changes over time in cannabis use and its effects associated with legalization in Canada and additional US states.

Many Voices in China’s Legal Profession: Plural Meanings of Weiquan

Figuring prominently in prevailing portraits of activism and political contention in contemporary China are weiquan [rights defense] lawyers. Outside of China, the word weiquan emerged in the early 2000s and had achieved near-hegemonic status by the late 2000s as a descriptive label for a corps of activist lawyers—who numbered between several dozen and several hundred—committed to the cause and mobilizing in pursuit of human rights protections vis-à-vis China’s authoritarian party-state. This article challenges the dominant nomenclature of Chinese activism, in which weiquan in general and weiquan lawyers in particular loom large. A semantic history of the word weiquan, traced through an analysis of four decades of officially sanctioned rights discourse, reveals its politically legitimate origins in the official lexicon of the party-state. Unique survey data collected in 2009 and 2015 demonstrate that Chinese lawyers generally understood the word in terms of the party-state’s official language of rights, disseminated through its ongoing public legal education campaign. Because the officially-sanctioned meaning of weiquan, namely “to protect citizens’ lawful rights and interests,” is consistent with the essential professional responsibility of lawyers, fully half of a sample of almost 1,000 practicing lawyers from across China self-identified as weiquan lawyers. Such a massive population of self-identified weiquan lawyers—approximately 80,000 in 2009 assuming that the sample is at least reasonably representative—makes sense only if local meanings of the term profoundly diverge from its dominant English-language representations. Concluding speculations consider and call for further research on why this word was appropriated and redefined by activist Chinese lawyers in the first place.

COVID-19 control in China during mass population movements at New Year

COVID-19 control in China during mass population movements at New Year

Transport-related walking among young adults: when and why?

BackgroundThe existing smartphones’ technology allows for the objective measurement of a person’s movements at a fine-grained level of geographic and temporal detail, and in doing so, it mitigates the issues associated with self-report biases and lack of spatial details. This study proposes and evaluates the advantages of using a smartphone app for collecting accurate, fine-grained, and objective data on people’s transport-related walking.MethodsA sample of 142 participants (mostly young adults) was recruited in a large Australian university, for whom the app recorded all their travel activities over two weekdays during August–September 2014. We identified eight main activity nodes which operate as transport-related walking generators. We explored the participants’ transport-related walking patterns around and between these activity nodes through the use of di-graphs to better understand patterns of incidental physical activity and opportunities for intervention to increase incidental walking.ResultsWe found that the educational node — in other samples may be represented by the workplace — is as important as the residential node for generating walking trips. We also found that the likelihood of transport-related walking trips is larger during the daytime, whereas at night time walking trips tend to be longer. We also showed that patterns of transport-related walking relate to the presence of ‘chaining’ trips in the afternoon period.ConclusionsThe findings of this study show how the proposed data collection and analytic approach can inform urban design to enhance walkability at locations that are likely to generate walking trips. This study’s insights can help to shape public education and awareness campaigns that aim to encourage walking trips throughout the day by suggesting locations and times of the day when engaging in these forms of exercise is easiest and least intrusive.

Fat taxation in India: A critical appraisal of need, public health impact, and challenges in nationwide implementation.

National Nutritional Monitoring Bureau survey (2017) has found that more than half of the adults in India were overweight and obese. To halt this rising epidemic, development of various policy measures has been suggested in National action plan for prevention and control of noncommunicable diseases. One such measure is the introduction of fat tax which is a surcharge or tax placed on food and beverages containing high amounts of fat. Government of India has made various direct budgetary initiatives for boosting the sectors related to the production of items rich in fat, sugars and salt without realizing the potential public health consequences. Hence, increasing the taxes for unhealthy junk foods should encourage the people to take healthier food options which in turn lead to positive impact on health. However, fat taxationfaced several challenges during implementation in countries like Denmark, Hungary, France and United States. Major challenges were the taxation debate, setting tax limit and encroaching into the autonomy rights of people. Evidences have shown that taxation alone cannot bring down the burden of non-communicable diseases but should be combined with measures like subsidies and access to healthy food items, public health education campaigns and programmes.

Solid organ donation after death in the United States: Data-driven messaging to encourage potential donors.

US deceased donor solid organ transplantation (dd-SOT) depends upon an individual's/family's altruistic willingness to donate organs after death; however, there is a shortage of deceased organ donors in the United States. Informing individuals of their own lifetime risk of needing dd-SOT could reframe the decision-making around organ donation after death. Using United Network for Organ Sharing (UNOS) data (2007-2016), this cross-sectional study identified (1) deceased organ donors, (2) individuals waitlisted for dd-SOT (liver, kidney, pancreas, heart, lung, intestine), and (3) dd-SOT recipients. Using US population projections, life tables, and mortality estimates, we quantified probabilities (Pr) of (1) becoming deceased organ donors, (2) needing dd-SOT, and (3) receiving dd-SOT. Lifetime Pr (per 100000 US population) for males and females of becoming deceased organ donors were 212 and 146, respectively, and of needing dd-SOT were 1323 and 803, respectively. Lifetime Pr of receiving dd-SOT was 50% for males, 48% for females. Over a lifetime, males were 6.2 and females 5.5 times more likely to need dd-SOT than to become deceased organ donors. Organ donation is traditionally contextualized in terms of charity toward others. Our analyses yield a new tool, in the form of quantifying an individual's own likelihood of needing dd-SOT, which may assist with reframing motivations toward deceased donor organ donation.

Widespread illegal sales of antibiotics in Chinese pharmacies \u2013 a nationwide cross-sectional study

BackgroundAccess to antibiotics without a prescription from retail pharmacies has been described as a major contributor to anti-microbial resistance (AMR) globally. In the context of high rates of AMR, the Chinese government has recently introduced strict policies regarding hospital antibiotic use, but the existing ban on antibiotic sales without prescription in retail pharmacies has not been strongly enforced. In 2016, a goal of prescription-only antibiotics by 2020 was announced. The objective of the study was to determine progress towards the 2020 goal, through estimating the proportion of retail pharmacies selling antibiotics without prescription across the three regions of mainland China.MethodsUsing the Simulated Patient method, we conducted a cross-sectional survey across purposively-sampled retail pharmacies in urban and rural areas of 13 provinces in eastern, central and western China. Medical students presented a scenario of a mild upper respiratory tract infection, following a strict three-step protocol. They recorded the pharmacy characteristics, and details of their experience, including at which step antibiotics were offered.ResultsComplete data were obtained from 1106 pharmacies. Antibiotics were obtained in 925 (83.6, 95% CI: 81.5, 85.8%) pharmacies without a prescription, 279 (25.2%) at Stage 1 (symptoms only described), 576 (52.1%) at stage 2 (asked for antibiotics), and 70 (6.3%) at Stage 3 (asked for penicillin or cephalosporins). There were significant differences between provinces, with antibiotic access (at any stage) ranging from 57.0% (57/100) in Zhejiang (81/82) to 98.8% in Guizhou. However, there were no significant differences in access to antibiotics by level of city, county, township or village (P = 0.25), whether the pharmacy was part of a chain or independent (P = 0.23), whether a licensed pharmacist was attending (P = 0.82) or whether there was a sign saying that prescriptions were required for antibiotics (P = 0.19).ConclusionsIt is easy to obtain antibiotics without a prescription in retail pharmacies in China, despite the fact it is against the law. This must be addressed as part of the wider anti-microbial stewardship effort which could include intense enforcement of the existing law, supported by a public education campaign.