Hasil untuk "Public aspects of medicine"

A. Charkiewicz, W. Omeljaniuk, M. Garley et al.

Mercury is widely used in medicine, agriculture, and industry. Meanwhile, according to the World Health Organization, it has been ranked as one of the ten most hazardous substances in the world, with the Agency for Toxic Substances and Disease Registry ranking it third. It has no known positive functionality in the human body, and even at low concentrations, it can have harmful long-term health effects, seriously affecting the healthcare system as well as posing a serious public health threat. This review focuses on the health effects of mercury and its major sources in the environment. We highlight its major toxic role in almost every possible aspect. Mercury and its forms, even in the smallest doses, cause numerous disorders to the body, including to the nervous system, the respiratory system, and the cardiovascular system. It can cause disorders such as various cancers; endothelial dysfunction; gastric and vascular disorders; liver, kidney, and brain damage; hormonal imbalances, miscarriages, and reproductive disorders; skin lesions; vision damage; and even death. The fact of such widespread use as well as its toxicity to the human body prompts further and in-depth research in populations of both low and moderate exposure. The constant controlling and monitoring of mercury use is a serious public health problem, requiring urgent attention and attentiveness from the governments of all countries and, in the long run, a rapid and concerted response. Thus, it is important to analyze in depth the impact of this highly toxic metal on the human body and to prepare the most precisely targeted public health interventions among all decision- and policy-makers.

Douglas Thaynã Vieira de Souza, Larissa Cristine Franco Geraldo, Deivisson Vianna Dantas dos Santos et al.

Este artigo objetivou conhecer as percepções de estudantes de Medicina sobre o uso pedagógico da série televisiva “Unidade Básica”. Realizaram-se três grupos focais com 16 graduandos que assistiram à série em contexto de ensino, cujas falas foram analisadas segundo a hermenêutica ricoeuriana. Notou-se que “Unidade Básica” se aproxima da realidade brasileira por evidenciar o sistema de saúde nacional e o trabalho na Atenção Básica. Além disso, apontou-se que a série contrapõe certa “doutrinação” exercida pela academia e seu foco nos aspectos biológicos do cuidado em saúde, bem como pelo imaginário social acerca da profissão médica. Para os participantes, o uso do seriado facilitou o aprendizado e ampliou seus conhecimentos sobre a Atenção Básica. Assim, “Unidade Básica” se mostra um recurso útil para a reorientação da formação médica em favor do Sistema Único de Saúde.

Bin Xiao, Lina Fu, Zhe Yang et al.

Abstract Background This umbrella meta-analysis evaluates the effects of probiotics on cognitive function and metabolic health in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) by synthesizing findings from meta-analyses of randomized controlled trials (RCTs), as existing evidence remains inconclusive. Methods A systematic search was conducted in PubMed, Web of Science, and Scopus to identify meta-analyses of RCTs investigating the impact of probiotic supplementation on cognitive function and metabolic biomarkers. The random-effects model was used. Heterogeneity and publication bias were assessed. Results Thirteen meta-analyses, comprising 3910 patients, were included. Probiotics significantly improved cognitive function in AD (SMD = 0.78, 95% CI: 0.33 to 1.23) and MCI (SMD = 0.43, 95% CI: 0.15 to 0.70). Probiotics also increased total antioxidant capacity (SMD = 0.40, 95% CI: 0.11 to 0.70) and reduced MDA (SMD =  − 0.35, 95% CI: − 0.62 to − 0.09) and hs-CRP (SMD =  − 0.59, 95% CI: − 0.87 to − 0.30). Insulin resistance improved, as reflected by decreased HOMA-IR (SMD =  − 0.34, 95% CI: − 0.43 to − 0.26). No significant effects were observed on glutathione, nitric oxide, or lipid profiles. Conclusion Probiotic supplementation appears to enhance cognitive function and metabolic parameters in individuals with MCI and AD, likely through mechanisms involving inflammation reduction, oxidative stress modulation, and improved insulin sensitivity. Further high-quality RCTs are required to validate these findings and determine optimal probiotic formulations.

Aisha Al-Naimi, Khadiga Elsayed, Marwa Alharoon et al.

BackgroundThere is limited evidence on preferences for tobacco endgame policies and support levels for them in the Middle East. Further, no studies on the interactive association of sex and tobacco use status with support levels exist to date.ObjectivesTo examine preferred tobacco endgame strategies and levels of support in a Qatari sample.MethodsA convenience sample of adults (N = 372; 73.3% females) completed a cross sectional survey. Preferences for strategies were assessed by demographic variables using chi-square tests and levels of support were compared by sex and tobacco use status while adjusting for other factors using bootstrapped regression.ResultsMales and current tobacco users prefer standardized packages, females prefer nicotine reduction policies, and never tobacco users prefer tax increases, import bans, bans for minors and adults, and flavor bans. Never and past tobacco users reported higher tobacco endgame support relative to current tobacco users. Further, males who never used tobacco or used it in the past reported higher tobacco endgame support than male current users.ConclusionHigh tobacco endgame support level and preferences for a wide range of tobacco endgame policies might be promising indicators for embracing them, especially among never tobacco users and males that do not currently use tobacco in Qatar.

Elaine Aparecida Maldonado Bertacco, Elaine Aparecida Maldonado Bertacco, Luiz Euribel Prestes-Carneiro et al.

IntroductionDengue is a public health challenge worldwide. Brazil registered about 70% of cases in Latin America in 2023; in 2024, the country is experiencing an unprecedented increase in the number of infected individuals. By May 2024, more than 4 million people were infected. Our goal was to: (1) determine the epidemiology of dengue cases and their spatiotemporal distribution and (2) carry out a survey of the storm drains and through a geospatial analysis to determine their possible correlation with cases of dengue in Presidente Prudente, São Paulo, Brazil.MethodsCases and information on the habitat of mosquito in the storm drain underground drainage system from 2020 to 2021 were obtained from public agencies. Larvae, pupae, and Ae. aegypti were identified according to species and described in taxonomic keys. Kernel density maps were constructed.ResultsFrom 1996 to 2023, the prevalence of cases peaked in 2016 and 2019, and in 2023 reached alarming levels, and the city was considered hyperendemic. In 2021, 2,609 cases were registered with 2 clusters of high density. Of 5,492 storm drains analyzed, 18.0% were found to have water, 9.0% had larvae or pupae of Aedes aegypti and 91.0% were classified as dirty or damaged. A direct correlation between the kernel layer of cases in 2021 with the kernel layer of storm drains containing water (r = 0.651) and larvae and pupae (r = 0.576) was found, suggesting that storm drains are risk factors and have an impact on the maintenance of dengue endemicity. The high number of damaged units found demonstrated the lack of storm drain management, compromising the urban drainage system and possibly contributing to dengue outbreaks.ConclusionPolicymakers may use these findings to improve existing dengue control strategies focusing on the control of storm drains and increase local and global perspectives on reducing dengue outbreaks.

Fidelis Atibila, Gill Ten Hoor, Emmanuel Timmy Donkoh et al.

Background. Hypertension (HTN) is a growing public health concern affecting both economically developed and developing nations. In Ghana, HTN significantly impacts morbidity and mortality. Understanding the perspectives of HTN patients regarding its causes and treatment can enhance HTN management. This study explored patient perspectives on HTN in Ghana. Materials and Methods. An exploratory descriptive approach was used, in conducting in-depth interviews and focus group discussions. Purposeful sampling was used to select HTN patients, and thematic content analysis was employed for data analysis. Overall, 14 face-to-face interviews were carried out, and two FGDs were done. The FGD consisted of a total of 15 participants, 8 females and 7 males. Results. Four key perspectives emerged. These include (1) the description of HTN (patients defined HTN as excessive blood); (2) beliefs about the causes of HTN, some attributed HTN to witchcraft, considering it a curse from the gods and traditional medicine was seen as a potential cure; (3) health-seeking behavior, a notable discrepancy exists between patient and medical understandings of HTN, potentially causing healthcare delays; and (4) family support. Recommendation. The misunderstanding of HTN may hinder timely healthcare-seeking and medication adherence, exacerbating HTN-related complications. Addressing these beliefs through community health promotion programs is urgently needed.

Yudelmis Ramírez Duquesne, María Cristina Pérez Guerrero, Esmeralda Calero Yera et al.

La formación de nuevas generaciones para satisfacer las necesidades laborales de la sociedad es una responsabilidad compartida por instituciones educativas y familias. El presente texto responde al objetivo de exponer elementos de la estrategia de formación vocacional que gestiona el Departamento de Ingreso en la Universidad de Ciencias Médicas de Camagüey. Se realizó una investigación descriptiva con enfoque cuanticualitativo, entre septiembre 2018 y junio 2024. La utilización de los métodos teóricos y empíricos permitió la identificación de las insuficiencias que limitaban el desarrollo de formación vocacional. Se elaboró una estrategia a partir del diagnóstico y los intercambios efectuados, desde la Universidad de Ciencias Médicas que involucró las filiales municipales para la ejecución de las actividades de formación vocacional por parte de metodólogos o profesores encargados de la tarea. Se realizaron acciones para despertar los intereses individuales, fomentar el autoconocimiento y facilitar la toma de decisiones en los estudiantes.

Rivka Gelman, Jillian Whelan, Sheree Spiteri et al.

Abstract Background Instilling healthy dietary habits and active play in early childhood is an important public health focus. Interventions supporting the establishment of nutrition and active play behaviours in the first years of life have shown positive outcomes and long-term cost-effectiveness, however, most are research trials, with limited evidence regarding real-world application. Implementation science theories, models and frameworks (TMFs) can guide the process of research translation from trial to real-world intervention. The application of TMFs within nutrition and active play intervention studies in early childhood (< 5 years) is currently unknown. This systematic review identified the use of TMFs and barriers/ enablers associated with intervention adoption, implementation, and sustainability in early childhood nutrition and active play interventions implemented under real-world conditions. Methods Six databases were searched for peer-reviewed publications between 2000–2021. Studies were included if primary outcomes reported improvement in diet, physical activity or sedentary behaviours amongst children aged < 5 years and interventions were delivered under real-world conditions within a community and/or healthcare setting. Two reviewers extracted and evaluated studies, cross checked by a third and verified by all authors. Quality assessment of included studies was completed by two authors using the Mixed Methods Appraisal Tool (MMAT). Results Eleven studies comprising eleven unique interventions were included. Studies represented low, middle and high-income countries, and were conducted across a range of settings. Five TMFs were identified representing four of Nilsen’s implementation model categories, predominantly ‘evaluation models’. Ninety-nine barriers/facilitators were extracted across the three intervention phases—Implementation (n = 33 barriers; 33 facilitators), Sustainability (n = 19 barriers; n = 9 facilitators), Adoption (n = 2 barriers; n = 3 facilitators). Identified barriers/facilitators were mapped to the five domains of the Durlak and DuPre framework, with ‘funding’, ‘compatibility’ and ‘integration of new programming’ common across the three intervention phases. Conclusions Findings demonstrate that there is no systematic application of TMFs in the planning, implementation and/or evaluation of early childhood nutrition and active play interventions in real-world settings, and selective and sporadic application of TMFs occurs across the intervention lifespan. This apparent limited uptake of TMFs is a missed opportunity to enhance real-world implementation success. Trial registration PROSPERO (CRD42021243841).

Rajesh Harsvardhan, Dimpi Singh, S. K. Patnaik et al.

Introduction: The safety of patients in health-care systems has long been a concern, but despite many positive changes in practice, health systems, and regulations, the desired level of safety remains unachieved. The competency of health-care leaders to create positive work environments and manage constant change is essential to the success of teams and organizations. The need for great leadership in health care has always been imperative; however, throughout the industry's recent transformation, it has been vital. Faced with enormous amounts of change, today's leaders must be capable of serving their teams while adapting to the evolving landscape and leading us into the future. Aim: The aim of this study was to identify the leadership style of nurse managers and ascertain the influence of leadership style on patient safety culture, organizational citizenship behavior, and job satisfaction so as to suggest an evidence-based feed forward for preparing guidelines for training of nurse managers working in a superspecialty tertiary health-care teaching institute in Northern India. Objectives: The objectives of this study were as follows – (1) to identify the leadership style of nurse managers based on full-range leadership model using the prevalidated tool, (2) to ascertain the influence of leadership style on patient safety culture using the prevalidated tool, (3) to assess the influence of leadership style on organizational citizenship behavior and job satisfaction using the prevalidated tool, and (4) to suggest an evidence-based feed forward for preparing guidelines for training of nurse managers working in a superspecialty health-care teaching institute in India using analysis of data thus obtained. Methodology: This was an analytical study. Results: (1) In the study, it was thus found that as transformational and transactional leadership behavior increases, patient safety culture, organizational citizenship behavior, and job satisfaction also increase; (2) on the other hand, patient safety culture, organizational citizenship behavior, and job satisfaction decrease as laissez-faire leadership behavior increases. Conclusion: Staff nurse under the leadership of their managers provides exemplary care and shares professional knowledge as well as provides direction and support to practice best patient care through policy development.

Ace Vo, Youyou Tao, Yan Li et al.

BackgroundWith the increased availability of data, a growing number of studies have been conducted to address the impact of social determinants of health (SDOH) factors on population health outcomes. However, such an impact is either examined at the county level or the state level in the United States. The results of analysis at lower administrative levels would be useful for local policy makers to make informed health policy decisions. ObjectiveThis study aimed to investigate the ecological association between SDOH factors and population health outcomes at the census tract level and the city level. The findings of this study can be applied to support local policy makers in efforts to improve population health, enhance the quality of care, and reduce health inequity. MethodsThis ecological analysis was conducted based on 29,126 census tracts in 499 cities across all 50 states in the United States. These cities were grouped into 5 categories based on their population density and political affiliation. Feature selection was applied to reduce the number of SDOH variables from 148 to 9. A linear mixed-effects model was then applied to account for the fixed effect and random effects of SDOH variables at both the census tract level and the city level. ResultsThe finding reveals that all 9 selected SDOH variables had a statistically significant impact on population health outcomes for ≥2 city groups classified by population density and political affiliation; however, the magnitude of the impact varied among the different groups. The results also show that 4 SDOH risk factors, namely, asthma, kidney disease, smoking, and food stamps, significantly affect population health outcomes in all groups (P<.01 or P<.001). The group differences in health outcomes for the 4 factors were further assessed using a predictive margin analysis. ConclusionsThe analysis reveals that population density and political affiliation are effective delineations for separating how the SDOH affects health outcomes. In addition, different SDOH risk factors have varied effects on health outcomes among different city groups but similar effects within city groups. Our study has 2 policy implications. First, cities in different groups should prioritize different resources for SDOH risk mitigation to maximize health outcomes. Second, cities in the same group can share knowledge and enable more effective SDOH-enabled policy transfers for population health.

Disha Ali, Asfawesen Gebre-Yohannes Woldegiorgis, M. Tilaye et al.

Private health care facilities working in partnership with the public health sector is one option to create sustainable health systems and ensure health and well-being for all in low-income countries. As the second-most populous country in Africa with a rapidly growing economy, demand for health services in Ethiopia is increasing and one-quarter of its health facilities are privately owned. The Private Health Sector Program (PHSP), funded by the United States Agency for International Development, implemented a series of public–private partnership in health projects from 2004 to 2020 to address several public health priorities, including tuberculosis, malaria, HIV/AIDS, and family planning. We assessed PHSP’s performance in leadership and governance, access to medicines, health management information systems, human resources, service provision, and finance. The World Health Organization’s health systems strengthening framework, which is organized around six health system building blocks, guided the assessment. We conducted 50 key informant interviews and a health facility assessment at 106 private health facilities supported by the PHSP to evaluate its performance. All six building blocks were addressed by the program and key informants shared that several policy and strategic changes were conducive to supporting the functioning of private health facilities. The provision of free medicines from the public pharmaceutical logistics system, relaxation of strict regulatory policies that restricted service provision through the private sector, training of private providers, and public–private mix guidelines developed for tuberculosis, malaria, and reproductive, maternal, newborn, child, and adolescent health helped increase the use of services at health facilities. Some challenges and threats to sustainability remain, including fragile partnerships between public and private bodies, resource constraints, mistrust between the public and private sectors, limited incentives for the private sector, and oversight of the quality of services. To continue with gains in the policy environment, service accessibility, and other aspects of the health system, the government and international communities must work collaboratively to address public–private partnerships in health areas that can be strengthened. Future efforts should emphasize a mechanism to ensure that the private sector is capable, incentivized, and supervised to deliver continuous, high-quality and equitable services.

Carmen Vargas, Jill Whelan , Julie Brimblecombe et al.

Collaboration between community members, researchers, and policy makers drives efforts to solve complex health problems such as obesity, alcohol misuse, and type 2 diabetes. Community participation is essential to ensure the optimal design, implementation and evaluation of resulting initiatives. The terms ‘co-creation’, ‘co-design’ and ‘co-production’ have been used interchangeably to describe the development of initiatives involving multiple stakeholders. While commonalities exist across these concepts, they have essential distinctions for public health, particularly related to the role of stakeholders and the extent and timing of their engagement. We summarise these similarities and differences drawing from the cross-disciplinary literature, including public administration and governance, service management, design, marketing and public health. Co-creation is an overarching guiding principle encompassing co-design and co-production. A clear definition of these terms clarifies aspects of participatory action research for community-based public health initiatives.

YunTao Luo, Jinghua Wang, Minmin Zhang et al.

Before public health emergencies became a major challenge worldwide, the scope of laboratory management was only related to developing, maintaining, improving, and sustaining the quality of accurate laboratory results for improved clinical outcomes. Indeed, quality management is an especially important aspect and has achieved great milestones during the development of clinical laboratories.

Rodrigo M. Carrillo-Larco, Wilmer Cristobal Guzman-Vilca, Antonio Bernabe-Ortiz

ABSTRACT: Background: While there is a growing interest in antihypertensive medication rates among people with hypertension in low- and middle-income countries, little has been described about antihypertensive medication rates among eligible people based on the absolute cardiovascular risk approach. Following the risk-based approach, we described the proportion of eligible people receiving antihypertensive medication in Peru. Methods: Analysis of six (2015-2020) national health surveys. Absolute cardiovascular risk was computed with the 2019 WHO cardiovascular risk charts and based on local guidelines. Antihypertensive treatment allocation based on the absolute cardiovascular risk was defined using the Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings and the HEARTS guidelines by the WHO; we also followed the recommendations by local guidelines. Results: There were 120,059 people. Overall, according to the local guidelines the 17.9% of the population would be eligible for antihypertensive medication while this estimate was 8.1% based on the WHO guidelines. At the national level, depending on the guidelines, we observed a steady trend of eligible people receiving antihypertension medication (e.g., men, local guidelines), a decreasing trend (e.g., men, <60, local guidelines) or an increasing trend (e.g., men, ≥60, local guidelines). At the sub-national level, seventeen regions showed an increasing antihypertensive treatment rate based on the local guidelines; when based on the WHO guidelines, eleven regions showed a decreasing rate. Conclusions: Peru needs to define a tool for surveillance of absolute cardiovascular risk and to monitor antihypertensive treatment allocation among high-risk people. Funding: Wellcome Trust (214185/Z/18/Z).

Akanksha Gupta, Sanjay Kumar, Ravinder Kumar et al.

Abstract Wuhan, a city of China, is the epicenter for the pandemic outbreak of coronavirus disease‐2019 (COVID‐19). It has become a severe public health challenge to the world and established a public health emergency of international worry. This infectious disease has pulled down the economy of almost all top developed nations. The coronaviruses (CoVs) known for various epidemics caused time to time. Infectious diseases such as severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), followed by COVID‐19, are all coronaviruses led outbreaks that scourged the history of mankind. CoVs evolved themselves to more infectious, transmissible, and more pandemic with time. To prevent the spread of the SARS‐CoV‐2, many countries have ordered the complete lockdown to combat the outbreak. This paper briefly discussed the historical background of CoVs and the evolution of human coronaviruses (HCoVs), the case studies and the development of their antiviral medications. The viral infection encountered with present‐day challenges and futuristic approaches with the help of nanotechnology to minimize the spread of infectious viruses. The antiviral drugs and their clinical advances, along with herbal medicines for viral inhibition and immunity boosters, are described. Elaboration of tables related to CoVs for the compilation of the literature has been adopted for the better understanding.

R. Dinis-Oliveira, T. Magalhães

About one-third of adult life is spent in the workplace. The use of psychoactive substances is a major preventable cause of morbidity and mortality. The consumption of psychoactive substances during or outside working hours greatly increases the frequency and severity of labor accidents, as well as the workers’ poor general state of health and productivity, implying higher costs for enterprises. It is the responsibility of organizations to ensure the safety and health of their workers. These cannot be limited to traditional routine clinical exams, as other aspects also have an impact on health. Thus, prevention and intervention in the consumption of psychoactive substances (e.g., ethanol, opioids, central nervous system stimulants or depressants, hallucinogens, Cannabis derivatives, dissociative substances, and inhalants) in labor activity should be considered as an investment of organizations and not as a cost, in view of the professional, personal, and family advantages for workers and employers, with a potential impact on productivity, security, health, and quality of life at work. Despite the extensive literature on the subject, each article generally focuses on one or another aspect of a very specific nature, not tackling the problem in a holistic way by confronting clinical, safety, and legal issues. This article presents a reflection on the legal, laboratorial, clinical, ethical, forensic, and safety concerns related to the consumption of psychoactive substances in the workplace, and can be a cross-cutting contribution to occupational medicine, forensic medicine, and insurance medicine, as well as for entrepreneurs, lawyers, judges, workers, and technicians from the public and private sectors that develop projects in this area. This discussion is based on general principles established internationally and highlights the role of the occupational healthcare system and other decision-making actors in the prevention and supervision of workplace psychoactive consumption.

M. Matlala, A. Gous, J. Meyer et al.

Introduction The World Health Organization identified Pharmaceutical and Therapeutics Committees (PTCs) at district and hospital levels as one of the pivotal models to promote rational use of medicines (RUM). This is endorsed by the Government in South Africa. Formulary development and management is one of the main functions of PTCs. This study aimed to describe the formulary management activities among PTCs in public hospitals in Gauteng Province, South Africa, following initiatives to promote RUM in South Africa. Methods Qualitative, nonparticipatory, observational study, observing 26 PTC meetings. Data were coded and categorized using NVivo9® qualitative data analysis software. Themes and sub-themes were developed. The themes and sub-themes on formulary management are the principal focus of this paper. Results More than half of the observed PTCs reviewed their formulary lists. There was variation in the review process among institutions providing different levels of care. Various aspects were considered for formulary management especially requests for medicines to be added. These included cost considerations (mainly focusing on acquisition costs), evidence-based evaluation of clinical trials, patient safety, clinical experience and changes in the National Essential Medicines List (NEML). The tertiary PTCs mostly dealt with applications for new non-EML medicines, while PTCs in the other hospitals mainly requested removal or addition of EML medicines to the list. Conclusion This is the first study from Gauteng Province, South Africa, reporting on how decisions are actually taken to include or exclude medicines onto formularies within public sector hospitals providing different levels of care. Various approaches are adopted at different levels of care when adding to- or removing medicines from the formulary lists. Future programs should strengthen PTCs in specialized aspects of formulary management. A more structured approach to formulary review at the local PTC level should be encouraged in line with the national approach when reviewing possible additions to the NEML.

S. Prescott, A. Logan, D. Katz

Experts in preventive medicine and public health have long-since recognized that health is more than the absence of disease, and that each person in the ‘waiting room’ and beyond manifests the social/political/economic ecosystems that are part of their total lived experience. The term planetary health—denoting the interconnections between the health of person and place at all scales—emerged from the environmental and preventive health movements of the 1970–1980s. Roused by the 2015 Lancet Commission on Planetary Health report, the term has more recently penetrated mainstream academic and medical discourse. Here, we discuss the relevance of planetary health in the era of personalized medicine, gross environmental concerns, and a crisis of non-communicable diseases. We frame our discourse around high-level wellness—a concept of vitality defined by Halbert L. Dunn (1896–1975); high-level wellness was defined as an integrated method of functioning which is oriented toward maximizing the potential of individuals within the total lived environment. Dunn maintained that high-level wellness is also applicable to organizations, communities, nations, and humankind as a whole—stating further that global high-level wellness is a product of the vitality and sustainability of the Earth’s natural systems. He called for a universal philosophy of living. Researchers and healthcare providers who focus on lifestyle and environmental aspects of health—and understand barriers such as authoritarianism and social dominance orientation—are fundamental to maintaining trans-generational vitality at scales of person, place, and planet.

G. Coleman

Australian society is characterized by a pervasive influence of animals in all aspects of human life. Although most countries use animals as companions, for production and for sport and entertainment, the scale and variety of animals in Australia is unparalleled. For example, companion animal ownership in Australia is among the highest in the world with 62% of households owning a pet (Animal Medicines Australia, 2016). Australia was the highest exporter in the world of beef, lamb, and mutton and goat meat in 2015 (MLA, 2015). Australia also uses kangaroos for human and animal food and deals with pockets of kangaroo overpopulation. Feral dogs, cats, goats, rabbits, and other introduced species pose a threat to wildlife or farming. Although there have been animal welfare concerns expressed by the public in the conventional media and on social media about companion animals, wildlife, animals used in sport and recreation, this chapter will focus on livestock, it being the focus of this book. Although public concerns about livestock animal welfare are well documented in several countries (e.g., European Commission, 2007; Gracia, 2013), there has been an on-going interest in these concerns in Australia (e.g., Parbery and Wilkinson, 2012; Coleman et al., 2015, 2017). These concerns about the livestock industries are not the major drivers of consumer-purchasing decisions because attitudes to livestock welfare is only one of the predictors of purchasing behavior with price, healthiness, and local production being more important for consumers (Coleman et al. 2005; Coleman and Toukhsati 2006). Public attitudes to livestock farming may, however, be a threat to social license to farm (Martin and Shepheard, 2011; Coleman et al., 2015, 2017). An attempt will be made here to tease out some of the possible effects of public concerns about farm animal welfare on the livestock industries in Australia. Suggestions to facilitate discourse among the various stakeholders will be raised with a view to achieving a degree of convergence in opinions and in agreed approaches to livestock farming in the future. The relevance of public attitude to consumption of animal products and to social license to farm will now be discussed in the context of the Australian experience.

C. J. Martin, M. Marengo, Jenia Vassileva et al.

Nuclear medicine (NM) procedures for diagnosis and treatment of disease are performed routinely in hospitals throughout the world. These involve preparation and administration to patients of pharmaceuticals labelled with radioactive material. The International Atomic Energy Agency (IAEA) and the World Health Organisation highlighted the need for improvement in prevention of medical radiation incidents and accidents in the Bonn Call-for-Action in 2012. An IAEA Technical Meeting was held on prevention of unintended exposures and accidents in NM in 2018 to address the issue. Exposures can take place at any time when radioactive material is being produced and used, and the risk continues after procedures have been completed. Thus there is potential for staff or members of the general public to be exposed, as well as patients. This paper sets out guidelines for incident prevention based on presentations and discussions at the meeting, and review of reports from the literature. It deals with potential incidents in in-house radionuclide production, radiopharmaceutical preparation, administration to patients, and following a procedure, as well as aspects in management of radioactive materials. Special attention has been paid to therapeutic procedures, as these have the potential to cause more harm to patients from erroneous administrations, including tissue reactions from extravasation of radiopharmaceutical, and could lead to significant contamination events. Administration of NM therapy is generally contraindicated in pregnancy. Identification of any patient who may be pregnant is crucial and it might be necessary to verify this with a pregnancy test for patients within the age band considered to be fertile. Inclusion of NM therapy incidents in the IAEA automated reporting system SAFRON is recommended. In summary, the paper aims to highlight errors that could occur during different phases of NM procedures in order to aid prevention of incidents. The value of periodic audit in evaluating systems in place on a regular basis is emphasised. Approaches to incident investigation and follow-up are described, and the need to ensure corrective action is taken to address any deficiencies stressed.