Public Perspective Research Articles

The Economic Impact of Obesity in Turkey: A Micro-Costing Analysis.

Turkey currently has the highest obesity prevalence among its European counterparts. 32% and 61% of the population live with obesity and overweight, respectively. Overweight and obesity are linked to non-communicable diseases that incur incremental health and economic costs. The significant public health concern warrants an assessment of the cost of obesity. A micro-costing approach from the public payer perspective was conducted to estimate direct healthcare costs associated with ten obesity-related comorbidities (ORCs) in Turkey. Clinical practice guidelines and a systematic literature review informed ORCs and the respective cost categories. This was subsequently validated by a steering committee comprising seven experts. Seventy public sector physicians were surveyed to estimate healthcare resource use. Unit costs were derived from Social Security Institute's Healthcare Implementation Communique. Cost items were summed to determine the annual cost per patient per ORC, which was validated by the steering committee. Medical inflation was considered in a scenario analysis that varied resource unit costs. Chronic kidney disease, heart failure and type 2 diabetes are the costliest ORCs, incurring an annual cost of 28,600 TRY, 16,639 TRY and 11,993 TRY, respectively. Individuals in Turkey with any ORC triggered direct healthcare costs ranging 1857-28,600 TRY annually. Costs were driven by tertiary care resources arising from treatment-related adverse events, disease complications and inpatient procedures. In the scenario analysis, medical resource unit costs were inflated by 18.7% and 39.4%, triggering an average increase in cost across all ORCs of 1998 TRY and 4210 TRY, respectively. Our findings confirm that obesity and its complications result in significant financial burden to the public healthcare system. By quantifying the burden of obesity across a comprehensive spectrum of ORCs, our study aims to support the economic case for investing in appropriate obesity interventions.

Public and patient perspectives on the use of clinical and administrative health data to identify and contact people at risk of future illness-The case of chronic kidney disease.

For decades, researchers have used linkable administrative health data for evaluating the health care system, subject to local privacy legislation. In Ontario, Canada, the relevant privacy legislation permits some organizations (prescribed entities) to conduct this kind of research but is silent on their ability to identify and contact individuals in those datasets. Following consultation with the Office of the Information and Privacy Commissioner of Ontario, we developed a pilot study to identify and contact by mail a sample of people at high risk for kidney failure within the next 2 years, based on laboratory and administrative data from provincial datasets held by ICES, to ensure they receive needed kidney care. Before proceeding, we conducted six focus groups to understand the acceptability to the public and people living with chronic kidney disease of direct mail outreach to people at high risk of developing kidney failure. While virtually all participants indicated they would likely participate in the study, most felt strongly that the message should come directly from their primary care provider or whoever ordered the laboratory tests, rather than from an unknown organization. If this is not possible, they felt the health care provider should be made aware of the concern related to their kidney health. Most agreed that, if health authorities could identify people at high risk of a treatable life-threatening illness if caught early enough, there is a social responsibility to notify people. While privacy laws allow for free flow of health information among health care providers who provide direct clinical care, the proposed case-finding and outreach falls outside that model. Enabling this kind of information flow will require greater clarity in existing laws or revisions to these laws. This also requires adequate notification and culture change for health care providers and the public around information uses and flows.

Enhancing urban climate resilience: A holistic evaluation of urban forest disservices in the aftermath of typhoons

Ecosystem services associated with urban forests have gained increasing attention, but there has been a relative lack of focus on the corresponding ecosystem disservices, including financial burdens, air pollution, allergens, pests, diseases, and safety concerns. Situated in the northwest Pacific Ocean, Taiwan faces the highest global number of tropical cyclones. Typhoons significantly damage the urban forest ecosystem, especially impacting peripheral residents. Consequently, comprehensive evaluation of urban forest-related policies should also consider disservices induced by natural disasters. Understanding public perspectives on urban forests is crucial for affirming public support, and outcomes of this study can guide government agencies in crafting urban forest planning policies, minimizing risks and casualties during natural disasters. Survey results from Taichung City residents (the second-largest city in Taiwan), highlight key urban forest benefits: shade, picturesque scenery, and stress relief. Disruptions perceived include increased maintenance costs, hazards from broken branches, trunks, and road damage from tree roots. Three prominent ecosystem disservices from natural disasters are identified: power failures, casualties, and property losses from falling branches, and increased cleaning costs. To mitigate disservices and enhance urban forest resilience, recommendations include augmenting the budget for removing unhealthy urban forests, planting structurally stable ones, reinforcing underground cables, and increasing pruning budgets.

Contractualizing Environmental Protection: Public and Private International Law Perspectives in Azerbaijan’s Post-conflict Reconstruction

Contractualizing Environmental Protection: Public and Private International Law Perspectives in Azerbaijan’s Post-conflict Reconstruction

A public administration perspective on wind power development: decision-making logic of local government officials

ABSTRACT Onshore wind power has experienced decades of controversies and conflicts between national policies and ambitions for development and local government and community opposition. This discrepancy has spurred extensive studies on economic, socio-cultural and environmental variables of (lack of) social acceptance. To understand controversies surrounding wind power development there is a need to investigate how decision-making is shaped by various factors in local governments affected by wind power. This paper develops a public administration perspective related to key assumptions of social acceptance theory and examines how different factors interact and mutually affect each other in local decision-making logic. We suggest an integrated analytical model that delineates three types of decision-making logic among local government officials: a logic of consequences, a logic of trajectory and a logic of appropriateness. As such we highlight the importance of public administration decision-making as a pivotal component of wind power development. This study is informed by interviews with municipal political and administrative leaders in Norway. The analysis shows that local decision-making logic is shaped by a reciprocation between considerations of socio-economic benefits (consequences), by past procedural experiences with energy development (trajectory) and by linkages to community, place and nature (appropriateness).

Cost-effectiveness analysis of hospital treatment volume and survival outcomes in endometrial cancer in Japan.

Hospital treatment volume affects survival in patients with endometrial cancer; notably, initial treatment at high-volume centers improves survival outcomes. Our study assessed the effect of hospital treatment volume on cost-effectiveness and survival outcomes in patients with endometrial cancer in Japan. A decision-analytic model was evaluated using the following variables and their impact on cost-effectiveness: 1) hospital treatment volume (low-, intermediate-, and high-volume centers) and 2) postoperative recurrent risk factors based on pathological findings (high- and intermediate-risk or low-risk). Data were obtained from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Japanese Diagnosis Procedure Combination database. Quality-adjusted life years (QALY) was used as a measure of effectiveness. The model was built from a public healthcare perspective and the impact of uncertainty was assessed using sensitivity analyses. A base-case analysis showed that the incremental cost-effectiveness ratio at high-volume centers was below a willingness-to-pay (WTP) threshold of ¥5,000,000 with a maximum of ¥3,777,830/4.28 QALY for the high- and intermediate-risk group, and ¥2,316,695/4.57 QALY for the low-risk group. Treatment at the high-volume centers showed better efficiency and cost-effectiveness in both strategies compared to intermediate- or low-volume centers. Sensitivity analyses showed that the model outcome was robust to changes in input values. With the WTP threshold, treatment at high-volume centers remained cost-effective in at least 73.6% and 78.2% of iterations for high- and intermediate-risk, and low-risk groups, respectively. Treatment at high-volume centers is the most cost-effective strategy for guiding treatment centralization in patients with endometrial cancer.

Middle Class African American Parents’ Aspirations for Rigor and Reading Curriculum During the Pandemic Era in Detroit Schools

This community-based research study examined the perspectives of African American parents of middle-class economic status who participated in a social network pertaining to school choice decisions during the pandemic era of virtual schooling. Their residency and school choices emerged against the grain of urban schools that have racially charged histories and decades of residential mobility trends. I examined parents’ aspirations for academic rigor and perspectives of literacy practices at select schools as well as public school district official perspectives of supporting the enrollment process and attracting families to the district. Parent interview and survey data revealed confidence in public, private, and charter school selections prior to enrolling, but uncertainty with the virtual literacy curriculum once enrolled in school. School district official interviews revealed enhanced awareness of parents’ concerns surrounding school choice and need to be proactive to the needs of middle-class families.

Technology, transparency, and collaboration/integration: Analysis of digital government problems from public communication perspective during the COVID-19 pandemic in Indonesia

This article aims to analyze the implementation of digital government in handling the Covid-19 Pandemic in Indonesia from a public communication perspective. The three units of analysis that build this article are technology, transparency, and collaboration & integration. A systems approach is used to analyze data collected through searching government policy documents, various relevant webinars, as well as online media reporting data that captures the dynamics of digital governance problems during the year the pandemic lasted. This article finds that the problem of digital government in handling the COVID-19 Pandemic in Indonesia is a complex in terms of technology, transparency, and collaboration/integration. From a public communication and system perspective, the findings of this article in all aspects show a portrait of a digital government system in Indonesia that is not yet robust and adaptive enough.

Exploring the informal learning of zero waste lifestyle in Malaysia with big data analytics

Malaysia's solid waste generation is showing a worrying increasing trend, while public awareness towards achieving zero waste remains low. As a big data resource, social media gives valuable insight into the public's perspective on zero waste and, as such, may be fully utilized as an active informal learning platform to lessen the reliance on formal environmental education. Using big data analytics on Instagram, this study aimed to assess the public knowledge, attitude and practice concerning zero waste lifestyle in Malaysia in order to develop an informal learning strategy on social media. Purposive data sampling was conducted on Phantombuster using zero waste-related Instagram hashtags, which yielded 1723 high engagement posts and 1500 comments from 35 identified hashtags. The recorded posts were analyzed using descriptive statistics and sentiment analysis on Python's TextBlob. A total of 94.3% of posts were published by public and private sector accounts, highlighting their vital role in facilitating active knowledge sharing across the online zero waste communities. The sentiment analysis results indicated 41.3% of comments were fairly positive, while 36.1% were more objective and knowledge oriented, acknowledging the collective individual actions that have initiated influential social change in Malaysia. This study advances the existing literature on zero waste and informal learning by recommending the use of big data analytics on social media in the local context. Only with full commitment from all parties to raising public awareness about waste management will the zero waste nation be realized.

Exploring citizen perceptions and values for a responsible society

AbstractAimsCitizens’ perceived values play a decisive role in shaping a responsive society, driving social and political attitudes and behaviors. Understanding these values, influenced by cultural, historical, and personal experiences, is essential for comprehending public perspectives on social, economic, and ecological aspects crucial for sustainable societies. This study investigates perceived values as indicators of citizens’ potential civic engagement, mainly contributing to societal development.Materials and methodsFor the purpose of this study, we analyzed 1012 cases from the European Value Survey/World Value Survey data set of the Republic of Macedonia. In addition to the exploratory factor analysis and cluster analysis, we employed XGBoost regression, coupled with SHAP analysis, offering a transparent exploration of the significance of citizens’ perceived values, while emphasizing their role in motivating social responsibility and duty.ResultsWe identified 12 factors and categorized Macedonian citizens into 4 clusters. Through the SHAP feature importance method, we determined that perceptions of gender stereotypes, trust in people, civil rights, and job equality strongly influence the idea of social responsibility.ConclusionsOur findings offer pathways to promote individual accountability and increased participation in societal actions, fostering greater advocacy and policy changes for a responsible, engaged, and sustainable society.

Navigating vulnerability markets and bug bounty programs: A public policy perspective

Navigating vulnerability markets and bug bounty programs: A public policy perspective

Smart cities at the intersection of public governance paradigms for sustainability

As a research domain, the smart city keeps growing, despite the remaining contradictions and ambiguity related to its conceptual aspects. We propose to dig deeper into the complex socio-technical nature of the smart city and examine the concept through the lens of different public governance paradigms, therefore aligning it with the sustainability outcomes. Embracing interrelated dimensions of humans, technologies and organisations, the smart city can be viewed through the intersection of public governance paradigms (digital governance, collaborative governance and networks). The case of the smart city initiative of Tampere in Finland serves as an empirical illustration of how the proposed conceptual model might be applied in practice. Providing a novel approach to the smart city from a public management perspective, this model would allow policymakers to acquire a more comprehensive understanding of smart city governance and its multi-dimensional outcomes, in terms of social, environmental and economic sustainability. This approach enables the unlocking of the potential to generate multiple values for each group of actors and ensure more effective integration of smart initiatives, policies and projects, based on the public governance paradigms.

The environmental impact of buying groceries online/offline pre and during COVID-19. Any changes?

COVID-19 has represented a watershed in people's lifestyle. One important consequence has been the change in how people buy groceries online/offline that represent the most frequent shopping-related trip any household performs. Since this has substantially different transport and environmental implications, it is crucial to investigate what are the COVID-19-induced variations. This paper estimates both travel and environmental impacts grocery channel choice implies by comparing, in a diachronic fashion, the pre and during COVID-19 situation in Norway, considering alternative scenarios describing different service configurations for each channel considered. Stated preferences are used to estimate market shares for grocery purchase distinguishing between different channels: in-store, home delivery and click&pick. The robust comparative analysis between the two time periods is guaranteed by the use of the same methodological approach in the same geographical context. Results show that total emissions are lower during the pandemic and adopting a free delivery strategy not only increases home delivery market shares but also produces the lowest level of CO2 emissions regardless of COVID-19. The results obtained are particularly relevant in the "new normal" the world is experiencing both from a public policymaking perspective, when promoting transport-related interventions to curb emissions, and from a private standpoint, when customising market strategies to increase sales and profits.

The Lawn as a Social and Cultural Phenomenon in Perth, Western Australia

Lawns, introduced in Australia through English colonial heritage, dominate public spaces in cities, serving various ecosystem functions. Australian lawns consist of non-native grasses that differ from native original vegetation and require intensive management and maintenance. This study explores public perspectives on urban lawns in Perth, Western Australia, an area largely overlooked in ecological and social research in the context of Australia compared to Europe and North America. This paper presents empirical research on public perceptions of urban lawns and alternatives in Perth, Western Australia. The study explores social values and preferences regarding traditional lawns and new options, considering visual appearance, uses, and maintenance. Findings from an online questionnaire, involving 171 respondents, identified seven categories based on a content analysis of lawn definitions: flat area; ground covered by grass; maintained; non-native vegetation; open space; recreational space; and turf grass. The results revealed that respondents most value lawns for aesthetics, cooling and recreation (exercises, walking pets, as a transit area, passive recreation, and social gatherings). At the same time, participants demonstrated an environmental awareness of lawns and the necessity of revisiting the existing planning and maintenance routine based on irrigation and intensive mowing by considering several alternative solutions. While valuing new solutions such as Scaevola patches in dedicated areas and “weedy lawns”, participants still preferred alternatives closest in appearance to a conventional lawn (e.g., lawn grass with Dichondra and lawn grass with clover). The study emphasizes the need for a ‘blended model’ of urban lawns, combining durability with heat-resistant, biodiverse vegetation to address social values and environmental concerns.

Public perspectives on the use of different data types for prediction in healthcare.

Understand public comfort with the use of different data types for predictive models. We analyzed data from a national survey of US adults (n = 1436) fielded from November to December 2021. For three categories of data (identified using factor analysis), we use descriptive statistics to capture comfort level. Public comfort with data use for prediction is low. For 13 of 15 data types, most respondents were uncomfortable with that data being used for prediction. In factor analysis, 15 types of data grouped into three categories based on public comfort: (1) personal characteristic data, (2) health-related data, and (3) sensitive data. Mean comfort was highest for health-related data (2.45, SD 0.84, range 1-4), followed by personal characteristic data (2.36, SD 0.94), and sensitive data (1.88, SD 0.77). Across these categories, we observe a statistically significant positive relationship between trust in health systems' use of patient information and comfort with data use for prediction. Although public trust is recognized as important for the sustainable expansion of predictive tools, current policy does not reflect public concerns. Low comfort with data use for prediction should be addressed in order to prevent potential negative impacts on trust in healthcare. Our results provide empirical evidence on public perspectives, which are important for shaping the use of predictive models. Findings demonstrate a need for realignment of policy around the sensitivity of non-clinical data categories.

Water fluoridation between public health and public law: an assessment of regulations across countries and their preventive medicine implications.

Among health professionals and health policymakers concern is growing as to the difficulty of balancing the prevention of dental caries through cost-effective interventions and the need to limit unnecessary exposure of the population, and especially children, to environmental chemicals. In this respect, the use of water fluoridation to prevent tooth decay epitomizes the dilemma by raising questions relevant to both public health and public law, ranging from the balance of public health and medical self-determination, the division of powers between local or national authorities over water fluoridation, and the need to avoid the adverse effects of socioeconomic inequalities as well as both under- and over-exposure. We carried out a narrative review by searching the relevant literature about the laws and rules related to drinking water fluoridation at the community level in the US, UK, and Europe, in order to discuss how the issue is handled from both a public health and public law perspective. Sources of data for this review were the biomedical and legal literature retrieved by searching online databases, and websites of public health and legal institutions. We found that water fluoridation is still largely adopted throughout the US, while in the UK and particularly in the European Union only a minor part of the population is subject to it. In addition, the recommended and maximum allowed amounts of fluoride in drinking water are being adapted to the public health recommendations and the new regulations, within an evolving evaluation of the epidemiologic evidence and the risk assessment currently in progress by two major regulatory agencies, the US National Toxicology Program - NTP and the European Food Safety Authority - EFSA. Under a comparative public law perspective, the three investigated legislations are facing a reassessment of their policies and regulations, to allow for effective and safe public health measures in the field of water fluoridation and more generally for a preferred use of topical fluoride for caries prevention. A consistent trend across these legislations is the choice to centralize at the national level regulatory and management issues related to water fluoridation, and to carefully balance benefits for dental caries prevention in children and the potential risks of systemic overexposure associated with excess fluoride intake, by promptly responding to the evolving indications by the scientific community and the public health professionals.

From KMS Fusion to HB11 Energy and Xcimer Energy, a personal 50 year IFE perspective

Shortly after the laser was invented in 1960, scientists sought to use it for thermonuclear fusion. By 1963, Livermore had a classified laser inertial confinement fusion (ICF) program and leaders predicted scientific breakeven by 1973. In 1974, KMS Fusion, Inc. announced thermonuclear neutrons from a laser target and promised grid electricity within 10 years. Private capital was attracted, but the data fell far short of the optimistic simulations. Magnetic fusion energy has had civilian funding (DOE), while ICF has primarily received military funding (DOE Defense Programs and now NNSA). As bigger lasers have been built and better simulations performed, optimism about ICF breakeven has waxed and waned. The achievement of ignition and gain on NIF has validated ICF's scientific basis, and the DOE and venture capital funded private companies are again interested in inertial fusion energy (IFE). The new DOE Milestone-Based Fusion Development Program is creating public–private partnerships to accelerate progress toward fusion pilot plants. ARPA-E, DOE INFUSE, and DOE IFE STAR are also building a U.S. IFE program within DOE. The U.S. leads in ICF, but developing IFE is an international competition. Private companies are leading the way. HB11 Energy Pty Ltd. is pursuing the aneutronic proton–boron fuel cycle. Xcimer Energy is developing a disruptive IFE technology to achieve high laser energies at dramatically lower costs. This 50-year perspective discusses where the U.S. IFE program is headed and promising strategies for progress in establishing an effective U.S. IFE program from both public and private perspectives.

의료기관 종사자들의 전자의무기록 인증제 시행 목적에 대한 인식

This study was conducted to examine the perceptions of employees at tertiary and general hospitals, which have passed the certification of Electronic Medical Record (EMR) systems, regarding the objectives of the EMR certification program. The study was conducted from the perspectives of the public, medical institutions, and the industry. Data collection spanned from August 1 to October 31, 2022, involving responses from 1,187 employees across 11 or more accredited hospitals. The analysis included descriptive statistics, mean analysis, regression analysis, and Scheffé's analysis to understand the perceptions from the three different perspectives. The results revealed that from the public's perspective, the highest recognition was for “enhanced information security in medical information leading to the prevention of personal data breaches and security incidents” (t=-3.827, p<.01). From the perspective of medical institutions, the highest but not statistically significant recognition was for “improved clinical decision support such as medication warnings and effective history management of medical information, enabling safer and higher quality medical services” (f=-1.612). From the industrial perspective, there was high recognition for “the capability to meet market quality demands due to national recognition of EMR system quality standards” (f=-3.154, p<.01). Linear regression analysis was conducted to identify factors influencing the recognition of the objectives of the EMR certification system. The results showed that the model explained 27.4% of the variance for the public perspective, 26.9% for the medical institution perspective, and 28.6% for the industrial perspective, with all models being significant (P<.05). Following the implementation of the EMR certification system, medical institution employees positively perceived it from the perspectives of the public, medical institutions, and the industry. Future efforts should focus on enhancing system functionality awareness among employees, improving quality, and government and medical institutions should work together to enhance user interoperability of the system.

Cost-effectiveness of weight-management pharmacotherapies in Canada: a societal perspective

ObjectivesThis study aimed to assess the cost-effectiveness of weight-management pharmacotherapies approved by Canada Health, i.e., orlistat, naltrexone 32 mg/bupropion 360 mg (NB-32), liraglutide 3.0 mg and semaglutide 2.4 mg as compared to the current standard of care (SoC).MethodsAnalyses were conducted using a cohort with a mean starting age 50 years, body mass index (BMI) 37.5 kg/m2, and 27.6% having type 2 diabetes. Using treatment-specific changes in surrogate endpoints from the STEP trials (BMI, glycemic, blood pressure, lipids), besides a network meta-analysis, the occurrence of weight-related complications, costs, and quality-adjusted life-years (QALYs) were projected over lifetime.ResultsFrom a societal perspective, at a willingness-to-pay (WTP) threshold of CAD 50 000 per QALY, semaglutide 2.4 mg was the most cost-effective treatment, at an incremental cost-utility ratio (ICUR) of CAD 31 243 and CAD 29 014 per QALY gained versus the next best alternative, i.e., orlistat, and SoC, respectively. Semaglutide 2.4 mg extendedly dominated other pharmacotherapies such as NB-32 or liraglutide 3.0 mg and remained cost-effective both under a public and private payer perspective. Results were robust to sensitivity analyses varying post-treatment catch-up rates, longer treatment durations and using real-world cohort characteristics. Semaglutide 2.4 mg was the preferred intervention, with a likelihood of 70% at a WTP threshold of CAD 50 000 per QALY gained. However, when the modeled benefits of weight-loss on cancer, mortality, cardiovascular disease (CVD) or osteoarthritis surgeries were removed simultaneously, orlistat emerged as the best value for money compared with SoC, with an ICUR of CAD 35 723 per QALY gained.ConclusionSemaglutide 2.4 mg was the most cost-effective treatment alternative compared with D&E or orlistat alone, and extendedly dominated other pharmacotherapies such as NB-32 or liraglutide 3.0 mg. Results were sensitive to the inclusion of the combined benefits of mortality, cancer, CVD, and knee osteoarthritis.

Public Perceptions Can Guide Regulation of Public Facial Recognition

Facial recognition technology is changing how people pass through customs at airports, check in at schools, and move anonymously in public spaces. Yet despite these transformations, its use by the government is largely unregulated. This Article informs the policy and doctrinal debates about facial recognition by presenting a public attitudes perspective. These three novel empirical studies show the nuanced views that Americans hold about government use of facial recognition. The data reveal that people are generally comfortable with the government using facial recognition to investigate serious crimes, enhance the security of controlled spaces like airports and schools, and increase the efficiency of identity verification in some contexts. But people are often not comfortable with casual governmental facial recognition use in public spaces. This pattern of strong comfort for tailored uses persisted even when, in a second study, participants were primed with negative information about the accuracy of facial recognition. Here I explore the implications of these results for both current Fourth Amendment doctrine as well as future legislative reform, promoting a balanced approach that allows tailored use of facial recognition while regulating its purposes.