Related Policies Research Articles

1.Y.2. Children’s mental health problems explode. Can exposome research offer a solution?

Abstract Background A week-long, multidisciplinary workshop at the Lorentz Institute explored the expectations of exposome research on child health. Exposome research investigates how combined exposures affect health. Currently we see an increase in adolescent mental health problems in Europe. We explore at the workshop if and how exposome research can be part of the solution to tackle this health issue. Findings The workshop aims were to analyze how monitoring data from exposome research can be best used for improving health policy in relation to improving (environmental) health policy in relation to children’s health. By taking a deep dive into solution-finding, we explored creative solutions to better utilize existing exposome data from digital data platforms, such as cohort data. And to facilitate working across disciplines using innovative tools of working transdisciplinary across research, policymakers and other professionals. Furthermore, we study how to enhance, harmonize and interpretation of data on child health. Furthermore, we look how child health depends not only on the quality of a healthcare system, but also on the magnitude of negative or positive influencing factors, such as social and environmental factors. Identifying such stressors and reducing their impact through adequate policies can improve child health on local, national, or even global scales. One innovative way of identifying such stressors is the exposome approach. The exposome approach is the characterization of the non-genetic drivers of health and disease. The exposome comprises aspects of the Built environment (characteristics of where we live); the Social environment (with whom we interact, social networks and income); the Physio-Chemical environment (chemical and environmental factors exposure) and the Lifestyle/Food environment (what we eat, how much we exercise) over the entire life-course. Workshop aims: - Provide a background on the urgency of adolescent mental health problems in Europe. - Compare approaches of stakeholders and researchers: stakeholders’ input from the practical field can shape the approach of the research process. The second benefit is to derive implications for creating effective interventions and policies to prevent adverse effects of environmental exposures and to foster positive health in children and later in life. - Explore existing interventions on child health for issues, experiences and possible solutions to the governance and organization of health adaptation in urban and social planning. - How to act in the process of research to intervention to public policies. The workshop consists of three short presentations followed by interactive panel discussions. We end with the audience actively engaging in the debate, as well as entering their questions. The workshop will end by identifying the current and future necessary roles, responsibilities, capacities of the public health researchers, policymakers, and professionals for child health protection in complicated exposure settings. Key messages • Child mental health issues are increasing in an unexplainable way. • Engaging stakeholders into an exposome research process can help to form a child health strategy in Europe.

3.I. Scientific session: Increasing EU preparedness and improving European Vaccination Beyond COVID-19: the EUVABECO approach

Abstract This workshop provides a platform for delegates to enhance their understanding of the interdisciplinary approach developed in the European Vaccination Beyond COVID-19 (EUVABECO) project, funded under the European Commission’s EU4Health programme. The project is to build and validate implementation plans for EU Member States (MS) to equip them with operational and technical tools to enhance vaccination practices both in routine vaccination and in case of future outbreaks. Validation will be based on innovative practices that emerged in the context of the COVID-19 pandemic. Ultimately, EUVABECO will provide MS with robust implementation plans for common tools to support said innovative vaccination practices, thus, enhancing preparedness and increasing resilience against future health threats in Europe and globally. Guided by two chairs, the workshop is structured around five brief interactive presentations to deliver the conceptualisation, methodologies, and early results and vision for vaccination beyond COVID-19. It is designed to highlight how project activities strengthen resilience and increase preparedness against communicable diseases across the EU and beyond its borders, whilst brokering dialogue on related public health priorities. The presentations will focus on: 1. Preparing for future public health crises by fostering a conducive environment. 2. Enhancing preparedness by developing robust implementation plans. 3. An interdisciplinary approach: Exploring the five dimensions (medical/clinical, social, industrial, modelling and forecasting, and digital) of the tools deployed by EUVABECO. 4. The vital role of stakeholders and of the National Immunization Technical Advisory Groups (NITAGs). 5. Future actions and a call for ongoing support and collaboration in a structured manner. The session will also give the opportunity to formally present EUVABECO’s multistakeholder approach and to formally launch the EU Vaccination Stakeholder Forum, where early access will be granted to EU MS for the various resources generate. This will allow the audience to give input about the needs of the broader public health community involved in vaccination across the EU, for the Stakeholder Forum to effectively promote and support: • The scaling up of existing implementation plans within MS; • The development of new implementation plans for additional tools; • Integration between public health and primary care; • Inform the targeted interaction with EU and MS bodies involved in related policies and decision-making. The presentations will be augmented by real-time polling to maximize participant engagement. This approach will maximize interaction whilst eliciting critical insights into stakeholders’ knowledge, attitudes, and practices concerning EUVABECO’s tools and strategies. This type of engagement will ensure effective knowledge transfer and a comprehensive understanding of the project’s objectives and implementation strategies. Key messages • Enhancing vaccination preparedness requires an evidence-based and harmonized set of tools to be deployed across EU MS. EUVABECO will deliver validated implementation plans to achieve this. • An interdisciplinary approach and multistakeholder engagement are critical for evidence-informed decision-making and harmonization to successfully deploy vaccination initiatives across the EU.

Enhancing the Precision of the Self-Compassion Scale Short Form (SCS-SF) with Rasch Methodology

Abstract Objectives Precise measurement of self-compassion is essential for informing well-being–related policies. Traditional assessment methods have led to inconsistencies in the factor structure of self-compassion scales. We used Rasch methodology to enhance measurement precision and assess the psychometric properties of the Self-Compassion Scale Short Form (SCS-SF), including its invariance across Ghana, Germany, India, and New Zealand. Method We employed the Partial Credit Rasch model to analyse responses obtained from 1000 individuals randomly selected (i.e. 250 from each country) from a total convenience sample of 1822 recruited from the general populations of Germany, Ghana, India, and New Zealand. Results The initial identification of local dependency among certain items led to a significant misfitting of the SCS-SF to the Rasch model (χ2 (108) = 260.26, p < 0.001). We addressed this issue by merging locally dependent items, using testlets. The solution with three testlets resulted in optimal fit of the SCS-SF to the Rasch model (χ2 (27) = 23.84, p = 0.64), showing evidence of unidimensionality, strong sample targeting (M = 0.20; SD = 0.72), and good reliability (Person Separation Index = 0.71), including invariance across sociodemographic factors. We then developed ordinal-to-interval conversion tables based on the Rasch model’s person estimates. The SCS-SF showed positive correlations with measures of compassion towards others, optimism, and positive affect, alongside negative associations with psychological distress and negative affect. Conclusions The current study supports the reliability, as well as the structural, convergent, and external validity of the SCS-SF. By employing the ordinal-to-interval conversion tables published here, the precision of the measure is significantly enhanced, offering a robust tool for investigating self-compassion across different cultures.

Being a nurse during an earthquake that affected ten provinces: A qualitative study on experiences and expectations.

This study was conducted to determine the professional experiences and future expectations of nurses working in the most damaged areas during the first two weeks of the 2023 Turkey earthquake. The increase in the frequency and severity of disasters in recent years has strongly shown that nurses must be prepared to respond to all disasters. To prepare for disasters that require a multifaceted approach, the experiences of nurses serving in disasters should not be ignored. A hermeneutic phenomenological approach was used in this research. The study included 18 nurses who worked in the first two weeks of the disaster. Data were collected through semistructured in-depth interviews between April and May 2023. Four themes were identified from the analysis of the data: (1) personal challenges, (2) organizational challenges, (3) nursing during the disaster, and (4) expectations. The results showed that nurses needed psychosocial support intervention skills in disasters and that their psychological preparation and knowledge levels for disasters were insufficient. In addition, the study revealed that organizational preparation was inadequate and that all these factors affected nursing care. The knowledge and skills that nurses need for professional disaster management can be provided by updating undergraduate education, in-service training procedures, and related policies. Considering that ideal disaster management is possible with a multidisciplinary team, it is recommended that national disaster policies be reviewed.

Construction of ESG Performance and Corporate Competitive Advantage: A Case Study of Poly Development Holding Group Co., Ltd.

In recent years, the attention to Environmental, Social, and Governance (ESG) issues has been increasing, accompanied by the enrichment and improvement of related policy systems. The advantages brought to enterprises by corresponding ESG policies have gradually become evident. Therefore, this paper takes the development of Poly Development Group from 2021 to 2023 as a sample to study the advantages that enterprises have gained in response to ESG-related policies. Through the analysis of existing data, it is found that the advantages established by ESG for enterprises mainly include: (1) enhancing corporate economic benefits, (2) reducing corporate operating risks, and (3) promoting corporate innovation and development. Based on these findings, it is proposed to accelerate the improvement of the ESG-related policy system, increase the attention of enterprises to ESG performance and disclosure, and contribute to the construction of a favorable development ecosystem for both academia and industry, thereby effectively improving production and development efficiency.

Nonmedical cannabis legalization policy in Canada: Has commercialization been a pivotal mistake for public health?

AbstractCanada implemented the legalization of nonmedical cannabis use and supply in 2018. Initial blueprints for the legalization policy framework emphasized public health protection as a priority principle and objective, including related policy design parameters and regulatory restrictions (e.g., strict access and distribution control, advertisement/promotion ban, etc.) also as informed by adverse experiences from alcohol/tobacco control. Conversely, Canada's present legalization ecology is characterized by increasingly far‐reaching commercialization; this includes an extensive for‐profit cannabis production and retail industry producing large sales volumes that centrally include high‐risk cannabis products, with many public health‐oriented provisions hollowed out or circumvented in practice. While key cannabis‐related health problem indicators have increased through legalization, mounting evidence suggests that these adverse outcome dynamics, to a crucial extent, have been accelerated by commercialization aspects of legalization. Meanwhile, since legalization the cannabis industry has pushed for further rollbacks of public health‐oriented restrictions for benefits of increased competitiveness. Using the Canadian case study, we focus on the possible pitfalls and adverse effects of commercialization dynamics for public health‐oriented cannabis legalization. Also since commercialization‐related developments and outcomes are hard to reverse, we urge jurisdictions planning cannabis legalization reforms to carefully take consider related evidence and dynamics when assembling their legalization policy frameworks.

Punishment or reward? Environmental information disclosure in Chinese listed companies based on evolutionary game systems

AbstractIn February 2022, the Chinese government implemented a mandatory environmental information disclosure policy for publicly traded corporations. To assess the factors influencing environmental information disclosure, we developed a tripartite evolutionary game system model based on strategic interactions between the government, enterprises and the public. Afterwards, we conducted a simulation to examine the systemic interaction equilibrium among the parties involved. Additionally, we assessed critical factor changes in decision‐making for three stakeholders: initial strategy selection, related policy subsidies, regulatory penalties and public incentives. Incorporating Gaussian white noise into the evolutionary game model enhances the realism of simulations, allowing for a more accurate representation of how random disturbances affect decision‐making among the government, the public and enterprises. The study reveals that the active participation of the public in information disclosure activities has a certain degree of substitution effect on the government's choice to regulate high‐quality information disclosure by enterprises actively. The penalty mechanism is more effective than the subsidy mechanism. The public's decision‐making process is susceptible to the direct economic benefits that enterprises can gain from disclosing low‐quality environmental information.

Linguistic Diversities in Nepal: A Glimpse of Past and Present

Nepal is known m as a multilingual nation; however, language policies and statistics of languages spoken in Nepal showed the challenges to maintain linguistic diversities in Nepal. In this context, aim of this study is to outline the language policies of Nepal. Constitutional provisions and arguments of the participants were analyzed with geographical and historical contexts. The study also presents the current population census and highlights the statistics of languages on the basis of mother tongue, second language and ancestor language. Government reports, law and rules related language policies, published between 1950 to 2013 were analyzed with the opinions and perceptions of the participants. Throughout history, the language politics in Nepal has undergone significant shifts and changes due to various political transformations. Current statistics of languages show that it is difficult to preserve minority languages because he numbers of speakers is very low. Except that lack of sufficient resource mobilization on the preservation of minority languages, confusing government policies, socio economic and cultural shift of the respected language community creates problems to sustain minorities language in Nepal. Finding of this study can be apply to formulate the policies and programs related to the preservation and promotion of endangered language because the study analyzes the present linguistic polices and statistics of the language spoken in Nepal.

Exposure to GLP-1 Receptor Agonist and Bariatric Surgery Use on Obesity Policy Support.

Glucagon-like-peptide-1 receptor agonists (GLP-1s) are a newer class of obesity medications that have garnered significant attention by the public and media. Media reports suggest that medical interventions such as GLP-1s are often perceived as weight loss "shortcuts." The present experimental research tested the effect of exposure to medical weight loss interventions on GLP-1 policy support, dependent on body mass index. A sample of 440 participants (Mage = 37, SD = 12.6) were randomly assigned to read about a woman who lost 15% of her body weight either with a GLP-1, bariatric surgery, or diet/exercise. Participants reported on beliefs that the woman took a weight loss "shortcut" and support for three policies expanding GLP-1 coverage. Exposure to a woman who lost weight with GLP-1 or bariatric surgery (vs. diet/exercise) led to higher GLP-1 policy support. However, such exposure was also indirectly associated with lower policy support, partially mediated by weight loss "shortcut" beliefs. This study provides evidence that exposure to medical weight loss interventions leads to higher GLP-1 policy support. Exposure may also, indirectly, lead to lower policy support due to beliefs that such interventions are shortcuts. Findings have implications for policymakers who are interested in how perceptions of medical weight loss interventions influence support for obesity treatments and related health policies.

The basic income for care leavers in Wales pilot evaluation: Protocol of a quasi-experimental evaluation.

This study will evaluate the Basic Income for Care Leavers in Wales pilot (BIP), which is the most generous basic income scheme in the world. A cohort of care-experienced young people who become aged 18 during a 12-month enrolment period (July 2022-June 2023) are receiving £1,600 (before tax) per month for two years, and the Welsh Government intends this to have a range of benefits. This evaluation will examine the impact of BIP, the implementation of the pilot and how it is experienced, and its value for money. The study is a theory-based quasi-experimental evaluation, and the design and methods are informed by ongoing co-production with care-experienced young people. We will estimate the impact of BIP on participants using self-reported survey data and routinely collected administrative data. This will include outcomes across a range of domains, including psychological wellbeing, physical and mental health, financial impact, education, training and volunteering. Comparisons between temporal (Welsh) and geographical (English, using administrative data) controls will be done using coarsened exact matching and difference in differences analysis. The process evaluation will examine how BIP is implemented and experienced, primarily through monitoring data (quantitative) and interview, observational, and focus group data (qualitative). The economic evaluation will take a public sector and a societal perspective to identify, measure and value the costs and outcomes of BIP, and to synthesise the evidence to inform a social cost-benefit analysis at 24 months post-intervention. BIP is unusual in that it targets a wide range of outcomes and is available to an entire national cohort of participants. The evaluation also has several practical constraints. Therefore, the study will use a range of methods and triangulate between different analyses to assess how successful it is. Findings will inform policy in relation to care leavers, social security and basic income studies worldwide.

Methods, Progress and Challenges in Global Monitoring of Carbon Emissions from Biomass Combustion

Global biomass burning represents a significant source of carbon emissions, exerting a substantial influence on the global carbon cycle and climate change. As global carbon emissions become increasingly concerning, accurately quantifying the carbon emissions from biomass burning has emerged as a pivotal and challenging area of scientific research. This paper presents a comprehensive review of the primary monitoring techniques for carbon emissions from biomass burning, encompassing both bottom-up and top-down approaches. It examines the current status and limitations of these techniques in practice. The bottom-up method primarily employs terrestrial ecosystem models, emission inventory methods, and fire radiation power (FRP) techniques, which rely on the integration of fire activity data and emission factors to estimate carbon emissions. The top-down method employs atmospheric observation data and atmospheric chemical transport models to invert carbon emission fluxes. Both methods continue to face significant challenges, such as limited satellite resolution affecting data accuracy, uncertainties in emission factors in regions lacking ground validation, and difficulties in model optimization due to the complexity of atmospheric processes. In light of these considerations, this paper explores the prospective evolution of carbon emission monitoring technology for biomass burning, with a particular emphasis on the significance of high-precision estimation methodologies, technological advancements in satellite remote sensing, and the optimization of global emission inventories. This study aims to provide a forward-looking perspective on the evolution of carbon emission monitoring from biomass burning, offering a valuable reference point for related scientific research and policy formulation.

Understanding right-wing populists’ anti-abortion politics in Turkey: The symbolic violence of the state

This study investigates how symbolic violence is shaping anti-abortion stances associated with legitimising right-wing populist policies. The prominent questions are as follows: What are the institutional and politico-administrative mechanisms that are impacting anti-abortion politics in terms of material and symbolic violence? How and to what extent does anti-abortion politics influence the interplay between symbolic and material state violence? The study argues that reproduction-centred policies and material and symbolic violence have intensified through anti-abortion politics in the discursive context of the social reproduction crisis in Turkey. It explores the institutional actions and the legitimation mechanisms of anti-abortion policies in relation to the penetration of right-wing populist politics after the authoritarian turn of 2010. This qualitative case study uses critical discourse analysis. It interprets the public speeches of representatives of the government and documentary data concerning the ruling party’s programmes, development plans and relevant legislation. The research provides a gendered perspective on the anti-abortion policies that anchor right-wing populism in terms of the crisis of social reproduction. It also contributes to critical state theory and pre-existing feminist scholarship on right-wing populism.

Free sugars in the Canadian diet: a research summary and future directions for food policy.

Until recently, most dietary guidelines and related food policies in Canada focused on total sugars, but recent evidence suggests that free sugars are of greater public health concern. Starting in 2017, our research group received federal funding to fill critical gaps related to free sugars and health. In this commentary, we describe our work related to tracking free sugars in the Canadian food supply and simulating the diet and health impacts of product reformulation. We then summarize how our work has influenced policymaking in Canada with examples of our knowledge translation efforts, and provide a future research and policy agenda based on our findings. Overall, there is significant room for Canadian food policies to target free sugars reductions in food and diets to address overconsumption of this nutrient of public health concern.

Carbon Sequestration by Preparing Recycled Cement, Recycled Aggregates, and Recycled Concrete from Construction and Demolition (C&D) Wastes

As the world’s largest producer of construction waste, China’s recycling and related policies are of the biggest concern to the world. However, the effective disposal and reuse of this waste has become an important issue since currently China still has a very low recycling ratio compared to developed countries, and most of the waste concrete was only simply broken and used as low-grade recycled aggregates for subgrade cushion, cement stabilized crushed stone, and filler wall. In this paper, a concrete cycle model focusing on how to effectively recycle and utilize waste concrete is put forward to prepare high quality recycled concrete, especially through a series of technical means, such as effective separation, carbon sequestration, and reactivation. Producing high quality recycled concrete can not only replace traditional concrete but also effectively reduce the consumption and waste of raw materials. What’s more, the calculation results show a potential of significantly carbon sink; for every ton of recycled cement produced, the CO2 emission could be reduced by 0.35–0.77 tons compared to ordinary Portland cement, corresponding to a reduction of 47%–94%; and for every ton of recycled concrete produced, the CO2 emission could be reduced by 0.186 tons compared to normal concrete. A yearly CO2 sequestration of 1.4–3.08 gigatonnes could happen if the ordinary Portland cement could be replaced by the recycled cement around the world. Taking the currently accumulated construction and demolition (C&D) wastes globally, the production of recycled cement, recycled aggregates, and recycled concrete could induce a significant carbon sink in the world.

Ideas and Methods of Cognitive Science in the Studies of International Relations and Foreign Policy

International studies have recently witnessed a renaissance of interest in the study of decision-making patterns related to the influence of individual and group actors and the resulting need to understand their deep psychology, the nature of their incentives and motivations. Such studies update the application of behavioral and cognitive sciences in the field of international relations and foreign policy, and encourage the adaptation of the methodology of specialized disciplines to solve complex socio-political problems. The present paper is an attempt to inventory key research subject areas and related literature, as well as to demonstrate the application of existing theories to the analysis of current political issues.

Construction, assessment, and protection of green infrastructure networks from a dynamic perspective: A case study of Dalian City, Liaoning Province, China

The green infrastructure (GI) network, an important nature-based solution (NBS) strategy, is pivotal for sustainable urban development. However, current research perspectives focus on constructing a static GI network, and research on evaluating and protecting GI networks in the context of spatiotemporal changes has been limited. This research aims to comprehensively characterise the spatio-temporal changes in the GI network and protect its efficiency. We selected Dalian City as a case study and applied the Future Land-use Simulation (FLUS) model to predict its land use for 2030 and 2040. Based on predicted and historical land-use data, the 1990–2040 GI network of Dalian City was constructed utilising the Integrated valuation of ecosystem services and trade-offs (InVEST), morphological spatial pattern analysis (MSPA) and minimum cumulative resistance (MCR) model, while its spatiotemporal changes were evaluated. The results revealed that the hub area exhibited positive growth over time, whereas the link lengths showed an opposite trend. Furthermore, the overall position of the GI network shifted toward the southwest. The flatness indicator detected that the direction of the GI network shape gradually became less pronounced. Consequently, the structure of the GI network shifted from multi-centre to mono-centre. Additionally, priority protection for hubs is mainly in the northeast, while links are primarily in the coastal regions. The urgency of protection for both increases over time. This research developed a dynamic GI network construction and assessment method, providing a scientific basis and reference for future rational GI network planning, ecological protection planning, and related land policy formulation.

A Guideline for Local Elderly Policy Development in Thailand

In previous local elder policy research, most studies were fragmented with only some subjects or some steps in the policy process and attention to the local policy process not included explicitly. This article aims to analyze Thai local elderly policy formulation, implementation and evaluation and to propose guidelines for Thai local elderly policy development. This was a qualitative study. Data were collected using in-depth interviews with 40 key informants from 5 local case studies and 8 national organizations, as well as observations and documentary studies. Data were analyzed using thematic analysis and analytic induction. For the policy content dimensions, the guidelines of policy content development of the case studies aim to make senior citizens happy, self-sufficient, and physically and mentally healthy. The means to achieve this are comprised of the following:1) an economic, career, and income stability dimension; 2) a health dimension; and 3) a social dimension. For the policy process dimensions, the guideline of policy formulation comprises of the following: the related national policy dimension, including developing the mindset of policy actors, developing the content of policies with clarity that is up-to-date and congruent with key agreements or related principles, and developing a participation process and communication of the policy. The local policy dimension is locally aged society strategic planning based on strategic management and objectives and key results (OKRs) derived from the results of data analysis, integration of public policy theory, resource-based view in strategic management theory, and objective and key results to reduce the limitations of the public policy theory and model. This comprises developing policy actors’ mindsets, competencies, and motivations, collecting information, creating participation for analyzing and formulating direction, and making local elderly society strategic plans. The guidelines of policy implementation comprise the following: creating knowledge and understanding, organizing a central organization, implementing a strategic plan, formulating strategies for implementing and integrating amicable coordination of networks, seeking and allocating tangible and intangible resources, developing competencies of local government personnel, network partners, and target groups, creating and developing a culture supporting the aged society, and creating internal and external motivation. The guidelines of policy evaluation comprise the following: the development of the evaluation competency, the growth and ethical mindset, and the development of a participatory local policy evaluation system. Based on the results of this study, the guidelines focus on the intangible resources, the internal motivation, the mindset of policy actors, the coordination and strength of networks, and the upper-level policy factors.

Can E-Commerce Policies Drive Common Wealth Levels —— A Study Based on County-Level Data in China, 2012-2020

Based on national county panel data from 2012 to 2020, this study systematically examines the impact of the comprehensive e-commerce into rural areas demonstration project implemented in rural China on promoting the level of common wealth by applying the multi-period double-difference method (DID). It is found that the e-commerce policy significantly enhances the level of common wealth. Further analysis of the impact mechanism shows that the policy effectively promotes the goal of common prosperity by enhancing the level of rural employment. In addition, the positive effect of the e-commerce policy is strengthened by the increase in the level of local government fiscal expenditure, however, the driving effect of the policy is weakened by the higher level of social consumption. Heterogeneity analyses indicate that the policy's promotional effect is particularly significant in the demonstration counties of the Yangtze River Economic Belt. This paper fills the research gap on the relationship between rural e-commerce policy and the level of common wealth, and provides empirical evidence and policy recommendations for related policy formulation.

Family History of Colorectal Cancer and the Risk of Colorectal Neoplasia: A Systematic Review and Meta-analysis

INTRODUCTION: Though there is enough pooled evidence supporting the positive association between family history of colorectal cancer (CRC) in first-degree relatives (FDRs) and the risk of CRC, synthesized data on its association with the risk of other colorectal neoplasia is lacking. Therefore, we aimed to systematically assess this issue. METHODS: We searched PubMed, Web of Science, and Embase from database inception through May 9, 2024, to identify observational studies investigating the association between family history of CRC in FDRs and the risk of colorectal neoplasia (excepting CRC). Adenoma, non-advanced adenoma (NAA), advanced adenoma (AA), and advanced neoplasia (AN) were further chosen as main outcomes due to data availability. Random-effects model was used for data synthesis. Subgroup meta-analyses were performed to evaluate the robustness of results. RESULTS: Of 5172 initial records screened, 75 studies (with 931,515 participants) were identified for analysis. Family history of CRC in FDRs was associated with increased risk of adenoma (pooled OR 1.67, 95% confidence interval [CI] 1.46–1.91), NAA (pooled OR 1.35, 95% CI 1.21–1.51), AA (pooled OR 1.66, 95% CI 1.46–1.88) and AN (pooled OR 1.58, 95% CI 1.44–1.73). The positive associations persisted in all examined subgroups. The risk of adenoma (pooled OR 4.18, 95% CI 1.76–9.91), AA (pooled OR 2.42, 95% CI 1.72–3.40), and AN (pooled OR 2.00, 95% CI 1.68–2.38) was more evident among individuals with two or more affected FDRs. DISCUSSION: Family history of CRC is associated with increased risk of adenoma, NAA, AA, and AN totally, and in all available subgroups. The findings further strengthen the necessity and importance of an intensified screening strategy to individuals with a positive family history of CRC, which is very useful for related health resource allocation and policy making.

Healthcare Access for Patients With Inflammatory Bowel Disease in the United States: A Survey by the Crohn's & Colitis Foundation.

A prior survey disseminated in 2017 identified that healthcare access barriers exist and significantly affect patients with inflammatory bowel disease (IBD). We sought to identify, through an updated survey, the healthcare access barriers that patients continue to face, with a focus on socioeconomic factors and patient awareness of resources to navigate existing barriers. A 52-question online survey evaluating (1) access to healthcare professionals, medications, and procedures; (2) associated financial challenges; and (3) patient awareness of education and advocacy tools to navigate IBD care barriers, was disseminated through multiple channels to IBD patients and their caregivers. Of the 2281 completed responses, patients on advanced specialty medications, younger than 65 years of age, or on employer insurance experienced significantly greater issues with insurance barriers to accessing medications and coverage of medically necessary tests/treatments. Patients who live in areas of concentrated poverty were more likely to experience poor health outcomes when subjected to step therapy compared to patients who did not. Additionally, patients were more likely to experience one or more financial barriers or trade-offs if the patient used an advanced specialty medicine or lived in an area with concentrated poverty. While there have been significant and numerous advancements in IBD treatments, patients with IBD continue to experience barriers to healthcare access and treatment and financial struggles. Ongoing awareness and advocacy efforts focused on healthcare system reform and related policies to further minimize care disparities and barriers remain vital.