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This article analyses high staff circulation in the government health services in Balochistan, Pakistan. The analysis is based on literature review, a small pilot study and authors' experience in the province. The article notes that high staff turnover and, more specifically, circulation are context specific. (DSE/DÜI)

Background: In 1997 there was a major reform of the government run urban health insurance system in China. The principal aims of the reform were to widen coverage of health insurance for the urban employed and contain medical costs. Following this reform there has been a transition from the dual system of the Government Insurance Scheme ( GIS) and Labour Insurance Scheme ( LIS) to the new Urban Employee Basic Health Insurance Scheme ( BHIS). Methods: This paper uses data from the National Health Services Surveys of 1998 and 2003 to examine the impact of the reform on population coverage. Particular attention is paid to coverage in terms of gender, age, employment status, and income levels. Following a description of the data between the two years, the paper will discuss the relationship between the insurance reform and the growing inequities in population coverage. Results: An examination of the data reveals a number of key points: a) The overall coverage of the newly established scheme has decreased from 1998 to 2003. b) The proportion of the urban population without any type of health insurance arrangement remained almost the same between 1998 and 2003 in spite of the aim of the 1997 reform to increase the population coverage. c) Higher levels of participation in mainstream insurance schemes ( i. e. GIS-LIS and BHIS) were identified among older age groups, males and high income groups. In some cases, the inequities in the system are increasing. d) There has been an increase in coverage of the urban population by non-mainstream health insurance schemes, including non-commercial and commercial ones. The paper discusses three important issues in relation to urban insurance coverage: institutional diversity in the forms of insurance, labour force policy and the non-mainstream forms of commercial and non-commercial forms of insurance. Conclusion: The paper concludes that the huge economic development and expansion has not resulted in a reduced disparity in health insurance coverage, and that limited cross-group ...

BACKGROUND: Governmental debate in Ireland on the de facto decriminalisation of cannabis and legalisation for medical use is ongoing. A cannabis-based medicinal product (Sativex®) has recently been granted market authorisation in Ireland. This unique study aimed to investigate Irish general practitioner (GP) attitudes toward decriminalisation of cannabis and assess levels of support for use of cannabis for therapeutic purposes (CTP). METHODS: General practitioners in the Irish College of General Practitioner (ICGP) database were invited to complete an online survey. Anonymous data yielded descriptive statistics (frequencies, percentages) to summarise participant demographic information and agreement with attitudinal statements. Chi-square tests and multi-nominal logistic regression were included. RESULTS: The response rate was 15% (n = 565) which is similar to other Irish national GP attitudinal surveys. Over half of Irish GPs did not support the decriminalisation of cannabis (56.8%). In terms of gender, a significantly higher proportion of males compared with females (40.6 vs. 15%; p < 0.0001) agreed or strongly agreed with this drug policy approach. A higher percentage of GPs with advanced addiction specialist training (level 2) agreed/strongly agreed that cannabis should be decriminalised (54.1 vs. 31.5%; p = 0.021). Over 80% of both genders supported the view that cannabis use has a significant effect on patients' mental health and increases the risk of schizophrenia (77.3%). Over half of Irish GPs supported the legalisation of cannabis for medical use (58.6%). A higher percentage of those who were level 1-trained (trained in addiction treatment but not to an advanced level) agreed/strongly agreed cannabis should be legalised for medical use (p = 0.003). Over 60% agreed that cannabis can have a role in palliative care, pain management and treatment of multiple sclerosis (MS). In the regression response predicator analysis, females were 66.2% less likely to agree that cannabis should be decriminalised, 42.5% less likely to agree that cannabis should be legalised for medical use and 59.8 and 37.6% less likely to agree that cannabis has a role in palliative care and in the treatment of multiple sclerosis (respectively) than males. CONCLUSIONS: The majority of Irish GPs do not support the present Irish governmental drug policy of decriminalisation of cannabis but do support the legalisation of cannabis for therapeutic purposes. Male GPs and those with higher levels of addiction training are more likely to support a more liberal drug policy approach to cannabis for personal use. A clear majority of GPs expressed significant concerns regarding both the mental and physical health risks of cannabis use. Ongoing research into the health and other effects of drug policy changes on cannabis use is required.

AbstractBackgroundCulinary nutrition education can support improved diet‐related health and wellbeing. This pre‐post pilot study aimed to assess feasibility and acceptability of an eight‐session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild‐to‐moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness.MethodParticipants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality.ResultsSix of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess.ConclusionsFindings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild‐to‐moderate intellectual disability.

This is the final version. Available on open access from Wiley via the DOI in this record. ; As the COVID-19 pandemic continues to affect societies across the world, the ongoing economic and social disruptions are likely to present fundamental challenges for current and future biodiversity conservation. We review the literature for outcomes of past major societal, political, economic and zoonotic perturbations on biodiversity conservation, and demonstrate the complex implications of perturbation events upon conservation efforts. Building on the review findings, we use six in-depth case studies and the emerging literature to identify positive and negative outcomes of the COVID-19 pandemic, known and anticipated, for biodiversity conservation efforts around the world. A number of similarities exist between the current pandemic and past perturbations, with experiences highlighting that the pandemic-induced declines in conservation revenue and capacity, livelihood and trade disruptions are likely to have long-lasting and negative implications for biodiversity and conservation efforts. Yet, the COVID-19 pandemic also brought about a global pause in human movement that is unique in recent history, and may yet foster long-lasting behavioural and societal changes, presenting opportunities to strengthen and advance conservation efforts in the wake of the pandemic. Enhanced collaborations and partnerships at the local level, cross-sectoral engagement, local investment and leadership will all enhance the resilience of conservation efforts in the face of future perturbations. Other actions aimed at enhancing resilience will require fundamental institutional change and extensive government and public engagement and support if they are to be realised. The pandemic has highlighted the inherent vulnerabilities in the social and economic models upon which many conservation efforts are based. In so doing, it presents an opportunity to reconsider the status quo for conservation, and promotes behaviours and actions that are resilient to future perturbation. ; European Union Horizon 2020 ; Natural Environment Research Council (NERC) ; Darwin Initiative ; Fondation Bertarelli ; The Orangutan Project ; Arcus Foundation ; Orangutan Appeal UK ; US Fish and Wildlife Service Great Ape Conservation Fund ; Ocean Parks Conservation Foundation ; European Outdoor Conservation Association and Global Wildlife Conservation

Context. We report the discovery of TOI 263.01 (TIC 120916706), a transiting substellar object (R = 0.87 RJup) orbiting a faint M3.5 V dwarf (V = 18.97) on a 0.56 d orbit. Aims. We setout to determine the nature of the Transiting Exoplanet Survey Satellite (TESS) planet candidate TOI 263.01 using ground-based multicolour transit photometry. The host star is faint, which makes radial-velocity confirmation challenging, but the large transit depth makes the candidate suitable for validation through multicolour photometry. Methods. Our analysis combines three transits observed simultaneously in r′, i′, and zs bands usingthe MuSCAT2 multicolour imager, three LCOGT-observed transit light curves in g′, r′, and i′ bands, a TESS light curve from Sector 3, and a low-resolution spectrum for stellar characterisation observed with the ALFOSC spectrograph. We modelled the light curves with PYTRANSIT using a transit model that includes a physics-based light contamination component, allowing us to estimate the contamination from unresolved sources from the multicolour photometry. Using this information we were able to derive the true planet-star radius ratio marginalised over the contamination allowed by the photometry.Combining this with the stellar radius, we were able to make a reliable estimate of the absolute radius of the object. Results. The ground-based photometry strongly excludes contamination from unresolved sources with a significant colour difference to TOI 263. Furthermore, contamination from sources of the same stellar type as the host is constrained to levels where the true radius ratio posterior has a median of 0.217 and a 99 percentile of0.286. The median and maximum radius ratios correspond to absolute planet radii of 0.87 and 1.41 RJup, respectively,which confirms the substellar nature of the planet candidate. The object is either a giant planetor a brown dwarf (BD) located deep inside the so-called "brown dwarf desert". Both possibilities offer a challenge to current planet/BD formation models and make TOI 263.01 an object that merits in-depth follow-up studies. ; With funding from the Spanish government through the "María de Maeztu Unit of Excellence" accreditation (MDM-2017-0737)

We report the discovery of a Neptune-like planet (LP 714-47 b, P = 4.05204 d, mb = 30.8 ± 1.5Mpdbl, Rb = 4.7 ± 0.3 Rpdbl) located in the "hot Neptune desert". Confirmation of the TESS Object of Interest (TOI 442.01) was achieved with radial-velocity follow-up using CARMENES, ESPRESSO, HIRES, iSHELL, and PFS, as well as from photometric data using TESS, Spitzer, and ground-based photometry from MuSCAT2, TRAPPIST-South, MONET-South, the George Mason University telescope, the Las Cumbres Observatory Global Telescope network, the El Sauce telescope, the TÜBITAK National Observatory, the University of Louisville Manner Telescope, and WASP-South. We also present high-spatial resolution adaptive optics imaging with the Gemini Near-Infrared Imager. The low uncertainties in the mass and radius determination place LP 714-47 b among physically well-characterised planets, allowing for a meaningful comparison with planet structure models. The host star LP 714-47 is a slowly rotating early M dwarf (Teff = 3950 ± 51 K) with a mass of 0.59 ± 0.02Mpdbl and a radius of 0.58 ± 0.02Rpdbl. From long-term photometric monitoring and spectroscopic activity indicators, we determine a stellar rotation period of about 33 d. The stellar activity is also manifested as correlated noise in the radial-velocity data. In the power spectrum of the radial-velocity data, we detect a second signal with a period of 16 days in addition to the four-day signal of the planet. This could be shown to be a harmonic of the stellar rotation period or the signal of a second planet. It may be possible to tell the difference once more TESS data and radial-velocity data are obtained. ; With funding from the Spanish government through the "María de Maeztu Unit of Excellence" accreditation (MDM-2017-0737)

Between September 2017 and February 2018, influenza A(H1N1)pdm09, A(H3N2) and B viruses (mainly B/Yamagata, not included in 2017/18 trivalent vaccines) co-circulated in Europe. Interim results from five European studies indicate that, in all age groups, 2017/18 influenza vaccine effectiveness was 25 to 52% against any influenza, 55 to 68% against influenza A(H1N1)pdm09, -42 to 7% against influenza A(H3N2) and 36 to 54% against influenza B. 2017/18 influenza vaccine should be promoted where influenza still circulates.