From virtually extinct to superabundant in 35 years: establishment, population growth and shifts in management focus of the Swedish wild boar (Sus scrofa) population.

BACKGROUND: The wild boar (Sus scrofa) was extinct in Sweden when a few animals established in the 1970s. Over the past 35 years, the species has made a substantial comeback. In this paper, we analyse wild boar population growth using three indices of population size. We also map the legislative decisions and research prompted by the expanding population. We discuss to what extent, in the eyes of the state, the view of wild boar and the management focus has shifted over time, from a perceived pest (eradication) to scarce (conservation), overabundant (reduction/control) or somewhere in between (sustainable management). RESULTS: Wild boar harvest started in the early 1990s with a few hundred animals annually and peaked at 161,000 in 2020/2021. The distribution now comprises most of southern Sweden. Analyses of harvest and traffic accidents involving wild boar showed that the population grew exponentially until 2010/2011, after which the increase levelled off. Thus, logistic growth models showed the best fit for the full study period. We recorded 38 legislative decisions or commissions to government agencies regarding wild boar. The first decision in 1981 was to eradicate the free-ranging population. In 1987 however, the parliament decided that wild boar is native to Sweden and should be allowed in restricted extent. Later decisions mainly concerned hunting regulations and hunting methods as direct means to increase harvest and regulate the population. Another topic, increasing in importance over time, was to facilitate the use of wild boar meat to indirectly stimulate harvest. A local outbreak of African swine fever in 2023 necessitated a stamping out strategy in the affected area. We found 44 scientific papers regarding the present free-ranging population. Topics include movements and feeding patterns, hunting, reproduction, and population development. CONCLUSIONS: The state historically regarded wild boar as a pest to be eradicated. This changed with the decision that wild boar should be allowed in restricted extent, suggesting a conservation approach. In response to population growth, the focus shifted to means facilitating sustainable management and, lately, reducing growth. The story of wild boar in Sweden illustrates attempts to mitigate conflicts and balance interests in wildlife management.

Beyond surface: Unveiling ecological and economic ramifications of microplastic pollution in the oceans.

Every year, the global production of plastic waste reaches a staggering 400 million metric tons (Mt), precipitating adverse consequences for the environment, food safety, and biodiversity as it degrades into microplastics (MPs). The multifaceted nature of MP pollution, coupled with its intricate physiological impacts, underscores the pressing need for comprehensive policies and legislative frameworks. Such measures, alongside advancements in technology, hold promise in averting ecological catastrophe in the oceans. Mandated legislation represents a pivotal step towards restoring oceanic health and securing the well-being of the planet. This work offers an overview of the policy hurdles, legislative initiatives, and prospective strategies for addressing global pollution due to MP. Additionally, this work explores innovative approaches that yield fresh insights into combating plastic pollution across various sectors. Emphasizing the importance of a global plastics treaty, the article underscores its potential to galvanize collaborative efforts in mitigating MP pollution's deleterious effects on marine ecosystems. Successful implementation of such a treaty could revolutionize the plastics economy, steering it towards a circular, less polluting model operating within planetary boundaries. Failure to act decisively risks exacerbating the scourge of MP pollution and its attendant repercussions on both humanity and the environment. Central to this endeavor are the formulation, content, and execution of the treaty itself, which demand careful consideration. While recognizing that a global plastics treaty is not a panacea, it serves as a mechanism for enhancing plastics governance and elevating global ambitions towards achieving zero plastic pollution by 2040. Adopting a life cycle approach to plastic management allows for a nuanced understanding of possible trade-offs between environmental impact and economic growth, guiding the selection of optimal solutions with socio-economic implications in mind. By embracing a comprehensive strategy that integrates legislative measures and technological innovations, we can substantially reduce the influx of marine plastic litter at its sources, safeguarding the oceans for future generations.

Impact of a new state law and electronic health record prompt on naloxone prescribing in an academic medical center.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To evaluate the impact of a best-practice advisory (BPA) and South Carolina legislation on naloxone prescribing patterns. The primary objective was to assess the change in naloxone prescription rates following BPA implementation. The secondary objective was to analyze the performance of the BPA. METHODS: Naloxone prescriptions generated before (July 28, 2020, through July 27, 2021) and after (July 28, 2021, through July 28, 2022) BPA implementation were analyzed via retrospective chart review. Lists of patients at risk for opioid overdose and patients for whom the BPA fired were generated for March 2022. The BPA's effectiveness was evaluated based on the proportion of at-risk patients missed by the alert, the frequency with which the BPA resulted in a naloxone prescription, and the reasons for not prescribing naloxone when the BPA fired. RESULTS: Following BPA implementation, there was a significant increase in the average monthly naloxone prescribing rate from 66.1 to 625.5 prescriptions per month. Overall, 2,086 patients were considered at risk for opioid overdose and 1,101 had a BPA alert during March 2022, with 32.7% of BPA alerts resulting in naloxone prescribing. The most common reasons selected for not prescribing naloxone were "patient refusal" and "criteria not met." Only 354 patients (17.1%) at risk for opioid overdose also had a BPA alert. CONCLUSION: State legislation and implementation of the BPA significantly increased naloxone prescribing rates. However, a significant proportion of patients identified as being at risk did not have a BPA alert and most BPA alerts did not result in naloxone prescribing, suggesting a need for improvement of the BPA.

[Disciplinary responsibility of medical workers in medical organizations].

Bringing to disciplinary responsibility of medical workers in the context of reforming the system of personnel training for the medical field, the introduction of digital technologies into the daily activities of a doctor, acquires pronounced specific features. The purpose of the study is to review the current labor legislation regulating labor discipline and identify the grounds for bringing medical workers to disciplinary responsibility in medical organizations.

Attitude of Jordanians towards a new enactment for an opt-out organ donation system: a cross-sectional study.

BACKGROUND: Organ donation entails saving or transforming lives through the provision of organs, either from living donors or deceased individuals. In Jordan, low donation rates are attributed to religious misconceptions, limited education and insufficient awareness of the burden on patients with organ failure. OBJECTIVES: To investigate the attitudes of the Jordanian population towards the practicality and effectiveness of introducing an opt-out organ donation system through legislative measures, with the aim of increasing donation rates. DESIGN: This cross-sectional study used a designed self-administered questionnaire. Data were subsequently analysed using IBM SPSS software. SETTING: The study encompassed all 12 cities located in Jordan. PARTICIPANTS: Data were collected from 1146 Jordanian participants, excluding individuals under the age of 18. RESULTS: Approximately 36.6% reported organ or blood donation while 18.9% participated in awareness campaigns. Many (75.7%) perceived insufficient awareness about the importance of organ donation, and 67.1% noted a scarcity of online donor registration platforms. Only 12.0% of participants discussed organ donation with healthcare providers. As anticipated, only 9.0% were registered donors while 67.7% expressed acceptance of organ donation, with 55.3% willing to enrol in donor programmes. Religion influenced 54.2% of organ donation decisions. There are associations between agreement for a new enactment and prior organ or blood donation or discussions with healthcare providers. However, religion affected willingness to donate organs. Most importantly, refusal to be a donor after death was associated with religion, occupation and awareness levels. CONCLUSION: Despite the population's understanding and support for the concept of organ donation, the willingness towards donating their own organs is limited. To boost organ donation rates and acceptance of the new enactment, we recommend conducting educational campaigns, improving online registration platforms, enhancing healthcare provider engagement, collaborating with religious communities and advocating for supportive policies.

Legislation strengthening Maternal and Perinatal Death Surveillance and Response systems.

Historically, countries have primarily relied on policy rather than legislation to implement Maternal and Perinatal Death Surveillance and Response systems (MPDSR). However, evidence shows significant disparities in how MPDSR is implemented among different countries. In this article, we argue for the importance of establishing MPDSR systems mandated by law and aligned with the country's constitutional provisions, regional and international human rights obligations, and public health commitments. We highlight how a "no blame" approach can be regulated to provide a balance between confidentiality of the system and access to justice and remedies.

Anthropogenic land uses lead to changes in limnological variables in Neotropical streams.

Streams are vulnerable to anthropogenic impacts, such as changes in land use, which reflect on water quality and can be evaluated by abiotic variables. In this context, the aims were to compare the abiotic values recorded in streams of different land use categories with the limits established by National legislation, and to analyze changes in abiotic variables in response to different land use impacts. Thus, 17 streams located in southern Brazil were sampled and grouped into urban, rural, and protected areas (PA) categories. The results showed the major impacts in urban streams. However, some variables in rural streams and PA also exceeded local legislation limits. Conductivity, total dissolved solids, salinity, ammoniacal nitrogen and coliforms were significantly higher in the urban streams. Contrary to expectations, the highest levels of manganese were found in PA streams. The relationship between abiotic variables and land uses suggests possible contamination by sewage in urban streams and by pesticides in rural streams. The abiotic similarity between rural and PA streams indicates that the conservation of these water bodies is ineffective. We suggest the monitoring of these environments and measures to mitigate the impacts to seek the restoration of ecosystem services and the well-being of human populations.

Recent State Legislative Attempts to Restructure Public Health Authority: The Good, The Bad, and The Way Forward.

The COVID-19 pandemic spurred legal and policy attacks against foundational public health authorities. Act for Public Health - a partnership of public health law organizations - has tracked legislative activity since January 2021. This article describes that activity, highlighting 2023 bills primarily related to vaccine requirements and policy innovations undertaken in the wake of the pandemic. Finally, we preview a legal framework for more equitable and effective public health authority.

Education, organizational changes, and enforcement challenges of the 2019 flavored tobacco sales restriction in Massachusetts.

OBJECTIVES: In November 2019, the Massachusetts legislature passed An Act Modernizing Tobacco Control and became the first state to restrict retail sales of all flavored (including menthol) cigarettes, e-cigarettes, and other tobacco products (the Act). Additional tobacco control policies and health insurance coverage for tobacco treatment were included as part of the Act. Implementation of these policies occurred between November 2019 and June 2020. This study explored challenges and facilitators during the implementation of the Act experienced by public health officials, school personnel, and healthcare providers. METHODS: We conducted in-depth interviews with a purposive sample of 9 public health officials and advocates, 9 school personnel, and 8 healthcare providers from March to December 2021. We conducted thematic analysis of interview transcripts using inductive codes of key themes emerging from the interviews. RESULTS: Interviewees highlighted three key themes that impacted the implementation of the Act: 1) Education of those impacted by the Act, 2) Organizational-level changes to incorporate the Act, and 3) Enforcement challenges. Examples of challenges to the implementation of the Act included COVID-19 pandemic restrictions, navigating tobacco industry tactics around naming flavors, and confusion regarding health insurance coverage for tobacco use cessation programs. Examples of facilitators were enforcement leading to retailer compliance, committed advocacy efforts of leadership/champions, and strong coordination within and between organizations. CONCLUSIONS: These findings of Massachusetts's experience in policy implementation can inform the preparation to implement similar tobacco control policies in other states.

The association between county ordinances allowing off-road vehicles on public roads and crash rates.

BACKGROUND: Legislative bodies across the country have increasingly allowed off-road vehicles (ORVs) including all-terrain vehicles (ATVs) and utility task vehicles (UTVs) on public roads, an environment for which they are not designed. In 2004, Iowa gave individual counties the discretion to pass ordinances allowing ORVs on public roadways. The objective of this study was to evaluate the relationship between the passage of ORV ordinances and ORV crash rates, especially on public roads. METHODS: An Iowa ORV roadway ordinance database and an Iowa ORV crash database (2002-2018) for all 99 counties were compiled. Crashes for which county location could not be determined were excluded. Utilizing a zero-inflated Poisson model, correcting for background crash frequency trends and population, investigators compared the relative rates of crashes after ordinance passage to time points before ordinance implementation and to counties without such ordinances. Sub-analyses, including that focused on more recent years (2008-2018), were also performed. RESULTS: Forty-five county ORV roadway ordinances went into effect between 2011 and 2018 and 2,347 crashes (69%) met inclusion criteria. Adjusted for year, there was a 58% greater ORV crash rate in counties after passing an ORV roadway ordinance (incidence rate ratio (IRR) 1.58, 95% CI 1.32-1.90). Roadway crashes (n = 834) increased 48% after ordinance passage (IRR 1.48, 95% CI 1.14-1.94). This roadway crash association remained statistically significant when analysis was limited to the years 2008-2018 (IRR 1.39, CI 1.06-1.83, n = 544); to ATV crashes only (IRR 1.70, CI 1.20-2.40, n = 683); and to ATV crashes excluding counties with UTV-only ordinances (IRR 1.74, CI 1.40-2.15, n = 2,011). CONCLUSIONS: ORV roadway and total crashes increased significantly after implementation of county ordinances allowing ORVs on public roadways and when compared to counties without such ordinances. It is likely that these increased crashes have resulted in more injuries and possibly deaths. Results from this study may help inform policymakers as they consider legislation regarding ORV usage on public roads.

Moral courage of emergency nurses in care-limited environments: A mixed-methods study.

BACKGROUND: Professional ethics in nursing exist to guide care and allow for decision-making to be patient-centered. In the current medicolegal landscape post-Roe and in light of bans on gender-affirming care, the decision-making processes of emergency nurses in the clinical environment of care as informed by both professional and personal ethics are an important area of inquiry. AIM: The aim of this study was to examine the contribution of moral courage to decision-making by emergency nurses. RESEARCH DESIGN: A mixed-methods exploratory sequential approach was used, using a standard demographics form and the Nurses Moral Courage Scale to collect quantitative data. These data were used to inform an interview guide for qualitative data collection. Situational analysis was used to analyze the interview data. ETHICAL CONSIDERATIONS: Prior to recruitment, this study was reviewed and approved by the University of Massachusetts IRB (#00003909). Participants were provided with an informed consent document at the time of registration and at the time of interview; participants provided both signed consent and verbal assent. Participants were assigned study codes to maintain anonymity and data were maintained in a secure University cloud. PARTICIPANTS AND RESEARCH CONTEXT: US-based emergency nurses working in environments with care limitations. RESULTS: 70% of respondents reported that they would speak up if they were aware of a situation that was ethically challenging. Respondents reported that it was fairly easy or very easy to defend their values when addressing ancillary staff, coworkers, authorities outside the organization, patients, and patient families. Respondents reported challenges in defending their professional values to charge nurses, physicians, or administrators. In response to a serious ethical problem, 65.8% of respondents answered that they would bring up the problem for discussion, 21.1% would file an internal report, and 13.2% would report externally. Interview participants reported significant social and professional barriers to acting in response to an ethical violation. Willingness to act centered on personal values and not professional codes of ethics. CONCLUSIONS: While emergency nurses in this study reported high perceived levels of moral courage, they also reported low willingness to act directly, citing burnout and significant social and professional barriers. Adherence to professional codes of ethics is not the primary driver of moral courage.

Comprehensive Review of Aflatoxin and Ochratoxin A Dynamics: Emergence, Toxicological Impact, and Advanced Control Strategies.

Filamentous fungi exhibit remarkable adaptability to diverse substrates and can synthesize a plethora of secondary metabolites. These metabolites, produced in response to environmental stimuli, not only confer selective advantages but also encompass potentially deleterious mycotoxins. Mycotoxins, exemplified by those originating from Alternaria, Aspergillus, Penicillium, and Fusarium species, represent challenging hazards to both human and animal health, thus warranting stringent regulatory control. Despite regulatory frameworks, mycotoxin contamination remains a pressing global challenge, particularly within cereal-based matrices and their derived by-products, integral components of animal diets. Strategies aimed at mitigating mycotoxin contamination encompass multifaceted approaches, including biological control modalities, detoxification procedures, and innovative interventions like essential oils. However, hurdles persist, underscoring the imperative for innovative interventions. This review elucidated the prevalence, health ramifications, regulatory paradigms, and evolving preventive strategies about two prominent mycotoxins, aflatoxins and ochratoxin A. Furthermore, it explored the emergence of new fungal species, and biocontrol methods using lactic acid bacteria and essential mustard oil, emphasizing their efficacy in mitigating fungal spoilage and mycotoxin production. Through an integrative examination of these facets, this review endeavored to furnish a comprehensive understanding of the multifaceted challenges posed by mycotoxin contamination and the emergent strategies poised to ameliorate its impact on food and feed safety.

A Case Study of Ergonomic Risk Assessment in Slovakia with Respect to EU Standard.

Attention on work-related musculoskeletal disorders (WMSDs) involves statistical surveys showing an increasing trend in the incidence of WMSDs. Technological development has led to new tools and methods for the assessment of physical load at work. These methods are mostly based on the direct sensing of appropriate parameters, which allows more precise quantification. The aim of this paper is to compare several commonly used methods in Slovakia for the assessment of ergonomic risk reflecting current EU and Slovak legislative regulations. A Captiv wireless sensory system was used at a car headlight quality control assembly workplace for sensing, data acquisition and data processing. During the evaluation of postures and movements at work, we discovered differences in the applicable standards: Decree 542/2007 Coll. (Slovak Legislation), the STN EN 1005-4+A1, and the French standards default in the Captiv system. Standards define the thresholds for hazardous postures with significant differences in several evaluated body segments, which affects the final evaluation of the measurements. Our experience from applying improved risk assessment methodology may have an impact on Slovak industrial workplaces. It was confirmed that there is a need to create uniform standards for the ergonomic risk assessment of body posture, including a detailed description of the threshold values for individual body segments.

[Translated article] Implementation of a traceability and safe drug preparation system in a clean room.

OBJECTIVE: To describe the process of implementing a traceability and safe manufacturing system in the clean room of a pharmacy service to increase patient safety, in accordance with current legislation. METHODS: The process was carried out between September 2021 and July 2022. The software program integrated all the recommended stages of the manufacturing process outlined in the "Good Practices Guide for Medication Preparation in Pharmacy Services" (GBPP). The following sections were parameterised in the software program: personnel, facilities, equipment, starting materials, packaging materials, standardised work procedures, and quality controls. RESULTS: A total of 50 users, 4 elaboration areas and 113 equipments were included. 435 components were parameterized (195 raw materials and 240 pharmaceutical specialties), 54 packaging materials, 376 standardised work procedures (123 of them corresponding to sterile medicines and 253 to non-sterile medicines, of which 52 non-sterile were dangerous), in addition, 17 were high risk, 327 medium risk, and 32 low risk, and 13 quality controls. CONCLUSIONS: The computerization of the production process has allowed the implementation of a traceability and secure manufacturing system in a controlled environment in accordance with current legislation.

Core Legal Challenges for Medical 3D Printing in the EU.

3D printing has been adopted into routine use for certain medical applications, but more widespread usage has been hindered by, among other things, unclear legislation. We performed an analysis, using legal doctrinal study and legal informatics, of relevant EU legislation and case law in four issues relevant to medical 3D printing (excluding bioprinting or pharmacoprinting): pre-market approval, post-market liability, intellectual property rights, and data protection. Several gaps and uncertainties in the current legislation and interpretations were identified. In particular, we regard the current EU regulatory framework to be quite limiting and inflexible, exemplifying a cautionary approach common in EU law. Though the need to establish high safety standards in order to protect patients as a disadvantaged population is understood, both legal uncertainties and overregulation are seen as harmful to innovation. Hence, more adaptive legislation is called for to ensure continuous innovation efforts and enhanced patient outcomes.

Increasing Risks to the Health of the Invertebrates-Balancing between Harm and Benefit.

The article discusses the issue of extensive use of detergents and sanitizers in the time of new challenges associated with the COVID-19 (SARS-CoV-2) pandemic. These agents could pose threats to the existence of free-living invertebrates as essential components of the ecosystem. The biological effects of the mentioned classes of substances, their metabolites, and combined effects in the mixture have not been studied enough. The main challenges in trying to balance the threats and benefits of using such substances are the lack of knowledge of the biological effects of these products, the gaps in testing invertebrates' responses, and changes in environment-related regulations to minimize risks to animals and humans. Numerous studies in this field still leave research gaps, particularly concerning the combined toxicity of well-known and widely used disinfectants, surfactants, and heavy metals, posing potential future challenges. Additionally, the review identified the need for additional testing of invertebrates for their sensitivity to disinfectants and surfactants of different compositions, including improved (non-invasive) methods, studies for early life stages, and comparative studies of species resilience.

Road safety implications of the partial legalisation of cannabis in Germany: protocol for a quasi-experimental study.

INTRODUCTION: Germany is reforming its legal approach to cannabis, allowing the possession and cultivation of cannabis for recreational purposes. The objective of this study is to investigate the impact of the policy reform on (1) The prevalence of cannabis use in the general population and (2) Driving under the influence of cannabis (DUIC) among regular users. METHODS AND ANALYSIS: A quasi-experimental research design will be employed, with repeated cross-sectional surveys on self-reported DUIC and cannabis use conducted at three measurement points in Germany (intervention group) and Austria (control group) over a 2-year observation period (2023-2025). Data will be collected from approximately 50 000 individuals aged between 18 years and 64 years. To minimise reporting biases in the measurement of DUIC, we will use direct and indirect assessments via crosswise model and motor vehicle accident data from official statistics. In a difference-in-difference framework, regression analyses and interrupted time series analysis will be carried out for hypothesis testing. ETHICS AND DISSEMINATION: Participants will be informed about voluntary participation, data protection laws and the option to delete data on request. Ethical approval was obtained from the Local Psychological Ethics Committee of the Centre for Psychosocial Medicine in Hamburg, Germany (reference number: 0686). Findings will be disseminated through scientific networks and will be key for a comprehensive evaluation of the cannabis law reform. The findings will facilitate the design and implementation of road safety measures.

Associations between youth suicide rates and state school personnel suicide prevention training requirements.

Objective: As youth spend the majority of their time in school, school personnel suicide prevention training has gained support as an approach to mitigate rising youth suicide rates. This study examined associations between state school personnel suicide prevention training requirements (i.e., mandatory/non-mandatory and annual/not annual), year of legislation enactment (2013 or earlier/2014 or later), and changes in youth suicide rates by state from 2007-09 to 2016-18. Methods: School personnel suicide prevention training requirement data were collected through state-specific Department of Education websites while state-specific youth suicide rates were collected from the Center for Disease Control and Prevention's 2020 National Vital Statistics Report. Data were analyzed using a mixed effects linear regression model. Results: Training is mandated in 40/50 (80 %) states; 19/50 (38 %) require annual training. All states demonstrated increases in youth suicide rates from 2007-09 to 2016-18 (mean increase 3.9/100,000 [sd = 1.8]), but the change did not differ significantly by state requirements for mandatory (p = 0.44) or annual (p = 0.70) training, nor for year of enactment of legislation (p = 0.45). Conclusions: School personnel suicide prevention training requirements were not associated with changes in the youth suicide rate, though study results are limited in that data was not available on how successfully schools implemented the required trainings.

Comparison of Childless and Partnerless Vasectomy Rates Before and After Dobbs v. Jackson Women's Health Organization.

The Supreme Court ruling Dobbs v. Jackson Women's Health Organization (June 2022) overturned federal protection of abortion rights, resulting in significant impact on both male and female reproductive rights and health care delivery. We conducted a retrospective review of all patients who underwent vasectomy at a single academic institution between June 2021 and June 2023. Our objective was to compare the rates of childless and partnerless vasectomies 1 year before and after this ruling, as these men may be more susceptible to postprocedural regret. Of total, 631 men (median age = 39 years, range = 20-70) underwent vasectomy consultation. Total vasectomies pre- and post-Dobbs were 304 (48%) versus 327 (52%). Total childless and partnerless vasectomies pre- and post-Dobbs were 44 (42%) versus 61 (58%) and 43 (46%) versus 50 (54%). Vasectomy completion rate was slightly increased post-Dobbs (90% vs. 88%; p = .240). The post-Dobbs cohort had significantly less children (1.8 vs. 2.0; p = .031). Men in the post-Dobbs era were significantly more likely to be commercially insured (72% vs. 64%) and less likely to be uninsured (1% vs. 6%; p = .002). Men who underwent childless vasectomy were significantly more likely to be younger (36.4 vs. 39.8 years; p < .001). There was a significantly greater proportion of Hispanic and Black men in the partnerless cohort compared to the cohort with partners (24% vs. 19% and 9% vs. 2%; p = .002). In conclusion, patients should be counseled on the permanent nature of this procedure, underscoring need for effective and reversible male contraception.