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The article examines the "policy of a Great power" during the reign of Shinzo Abe: the emergence, main directions and factors influencing its development. The analysis of S. Abe's attempts to get rid of the "post-war system" in domestic politics is given: to revise the pacifist constitution, to carry out vigorous military development and to restructure the national security system. Special attention is paid to the main directions of S. Abe's foreign policy: value diplomacy, global diplomacy and foreign policy towards the United States and China. After the defeat in World War II, Japan quickly turned into a great economic power, but there were no corresponding changes in its political and military status. The Japanese Government seeks to change this situation and turn Japan into a world power with the appropriate economic and military power. The article presents the results of the "Great Power policy" during the reign of S. Abe at home and in the international arena, and also analyzes the factors that influenced its implementation. The author comes to the conclusion that the great-power policy of S. Abe has achieved certain results both within the country and in the international arena. At the same time, it was not possible to revise Article 9 of the Constitution, achieve independence in conducting foreign policy from the United States and effectively restrain China in the region and in the international arena. The strong positions of the Liberal Democratic Party of Japan within the country and the stability of its foreign policy settings give reason to believe that the "Great Power policy" will be continued by the new Prime Minister.

Objectives: To investigate the association between socio-economic factors and the risk of preeclampsia in Sweden, specifically investigating if this relationship is confounded by maternal region of birth. Study design: All singleton births between 1999 and 2009 in an ethnically diverse area in southern Sweden, totaling 46,618 pregnancies, were included in this study. The data on maternal pregnancy outcomes were retrieved from a regional birth register and socio-economic variables from Statistics Sweden. The risk ratios for preeclampsia were calculated for educational level and household disposable income, adjusting for maternal region of birth, maternal age, body mass index, parity, and smoking. Results: Low income levels were associated with a higher risk for preeclampsia, adjusted risk ratio (aRR) = 1.25 (95% confidence interval [CI]: 0.99, 1.59) and aRR = 1.36 (95% CI: 1.10, 1.68) for the two lowest quintiles, respectively, compared to the highest. There was an educational gradient in preeclampsia risk, although not all categories reached statistical significance: aRR = 1.16, (95% CI: 0.89–1.50) for low educational attainment and aRR = 1.23 (95% CI: 1.08, 1.41) for intermediate educational attainment compared to women with highest education. The socio-economic gradient remained after adjusting for region of birth. There was a lower risk for preeclampsia for women born in Asia, aRR = 0.60 (95% CI: 0.47, 0.75), regardless of socio-economic position. Conclusion: An increased risk for preeclampsia was seen for women with measures of lower socio-economic position, even in a universal, government-funded healthcare setting. The relationship was not explained by region of birth, indicating that the excess risk is not due to ethnically differential genetic pre-disposition but rather due to modifiable factors.

The preference for land urbanization of local governments promotes urban sprawl, which leads to the dilemma of land finance dependence (LFD) of local governments and the negative constraints on the ecosystem of urban areas in China. However, how the urban growth boundary (UGB) policy corrects local governments' reliance on land finance has not been discussed in depth. In July 2014, the UGB policy began to be piloted in fourteen cities in China, providing a setting to further reveal the effectiveness of the UGB policy. By constructing an evolutionary game simulation model to clarify the behavioral strategies that local governments tend to adopt in the context of the UGB policy implementation, this study proves that the effective implementation of the UGB policy, by controlling the urban land capacity, can help solve local governments' LFD dilemma in China. The UGB policy consists of a set of technical means and policy tools that controls urban sprawl. It breaks the "unlimited land capacity" situation faced by local governments in China by limiting the urban land capacity within a given period of time, and has become a new solution to the dilemma of LFD. The implementation of the UGB policy highlighted the shortage of urban land, which has led to the increasing cost of land finance for local governments and constraints on local governments' LFD behavior. The shortage has also forced local governments to adjust and optimize their fiscal revenue structure. The UGB policy induced ongoing evolution in the benefit distribution among relevant entities in land finance, motivated local governments and other entities to adjust their primary strategies, and made it possible to address the dilemma of LFD in China.

Renewable energies have been the only sources recording a clear increase in total installed capacity, setting a record in new power capacity in 2020, despite the pandemic. The European Union Green Deal represents a strategy towards a sustainable economic model. In this framework, land-based geothermics has seen very limited development; however, offshore geothermics is almost completely absent in the discussion on energy source alternatives, even though it represents a real challenge for energy transition, including the production of green hydrogen. This article discusses an excursus on the activities carried out on offshore geothermal areas worldwide. We focused on the energy potential capacity of the Marsili volcanic seamount located over the bathial plain of the Tyrrhenian Basin, describing the detailed geological, geochemical, and geophysical investigations that have been carried out on that seamount since the 2000s. All the collected data have shown evidence supporting the existence of an exploitable geothermal system in the Marsili seamount consisting of a reservoir of supercritical geothermal fluids of about 100 km3. We discuss and evaluate the actual consistence of the impacts associated with the occurrence of potential risks. We also describe the necessary further steps towards the pilot well. An important breakthrough in the short-medium term that allows for an exit from the predominance of fossil sources may come from the development of energy production derived from offshore high-enthalpy geothermal fields, especially in areas such as the Southern Tyrrhenian Sea. There is a natural clear predisposition for its exploitation combined with a low ecological footprint, which is the target objective of international agreements in the context of a blue economy strategy.

There is a concerning increase in human immunodeficiency virus (HIV) incidence in eastern Indonesia. HIV testing rates in this area are the lowest in the country. This study aimed to analyze the determinants of HIV testing in the Public Health Centers (PHCs) in eastern Indonesia. A cross-sectional study design was utilized using secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). We focused the survey on eastern Indonesia (Sulawesi, Maluku, and Papua) with PHC settings. After we weighted and removed missing data, we obtained 2118 surveys (425 males and 1693 females aged 14–54 years). Chi-square and binary logistic regression were used to analyze the determinants of HIV testing optimization in eastern Indonesia with a significance level of p < 0.05. The HIV testing coverage at the PHCs in eastern Indonesia was found to be 28.28%. From the survey, we found that respondents from the province of Papua (AOR: 1.45; 95% CI: 1.09–1.91), those who were female (AOR: 2.37; 95% CI: 1.75–3.12), and those with more information on HIV (AOR: 1.88; 95% CI: 1.41–2.51) were more likely to undergo HIV testing at the PHCs. Meanwhile, the wealthiest respondents (AOR: 0.61; 95% CI: 0.42–0.89) and the respondents who engaged in the perpetuation of stigmatization (AOR: 0.65; 95% CI: 0.42–1.02) were less likely to undergo HIV testing at the PHCs. The coverage of HIV testing in eastern Indonesia needs special attention from the Indonesian government. Increasing equity, distributing information regarding HIV and acquired immunodeficiency syndrome (AIDS) through social media, and creating accessible HIV testing in rural areas are vital for developing appropriate interventions.

Waste management (Plastic, PET Bottle, Can, and Glass Bottle, mostly from drink and beverage packages) is an important issue in today's world, as the volume of waste increases daily. This is especially important in developing countries like Nigeria, where there are no strong institutionalized frameworks for waste management, and as a result, increasing waste poses a threat to human well-being. Given the increase in population in these countries, it is necessary to adopt sustainable and practical solutions. Especially in Lagos, where the environmental problem of plastic waste is on the rise. Although the government is making commendable efforts to reduce the increasing volume of plastic waste in the state, they are insufficient, as it has been reported that plastic waste accounts for 15% of total waste volume according to the Lagos state waste characterization index. However, with the rise in various environmental problems caused by plastic waste, this paper proposed combining the extended producer responsibility (EPR) and deposit refund system (DRS) to achieve a high rate of recovery and recycling of waste plastic bottles and sachets. The innovative approach used green technology (vending machine) as well as indigenous knowledge are practical solutions in Lagos state. The paper is also significant because it intends to implement the developed solution in a dense urban and rural setting in Lagos, which can be replicated in other states in Nigeria. Furthermore, the components discussed in this paper are elements that allow the proposed concept to function effectively and efficiently. The proposed concept will serve as a link between Lagos and Nigeria's current linear economy and the future circular economy of plastic production and management.

BACKGROUND: Female genital mutilation (FGM) is a traditional harmful practice affecting 200 million women and girls globally. Health complications of FGM occur immediately and over time, and are associated with healthcare costs that are poorly understood. Quantifying the global FGM-related burden is essential for supporting programmes and policies for prevention and mitigation. METHODS: Health complications of FGM are derived from a meta-analysis and stratified by acute, uro-gynaecological, obstetric and psychological/sexual. Treatment costs are calculated from national cohort models of 27 high-burden countries over 30 years. Savings associated with full/partial abandonment are compared with a current incidence reference scenario, assuming no changes in FGM practices. RESULTS: Our model projects an increasing burden of FGM due to population growth. As a reference scenario assuming no change in practices, prevalent cases in 27 countries will rise from 119.4 million (2018) to 205.8 million (2047). Full abandonment could reduce this to 80.0 million (2047), while partial abandonment is insufficient to reduce cases. Current incidence economic burden is US$1.4 billion/year, rising to US$2.1 billion/year in 2047. Full abandonment would reduce the future burden to US$0.8 billion/year by 2047. CONCLUSION: FGM is a human rights violation, a public health issue and a substantial economic burden that can be avoided through effective prevention strategies. While decreasing trends are observed in some countries, these trends are variable and not consistently observed across settings. Additional resources are needed to prevent FGM to avoid human suffering and growing costs. The findings of this study warrant increased political commitment and investment in the abandonment of FGM.

BACKGROUND: The aim of this work was to develop a National Evaluation Framework to facilitate the standardization of delivery, quality, reporting, and evaluation of diabetes education and support programs delivered throughout Australia through the National Diabetes Services Scheme (NDSS). The NDSS is funded by the Australian Government, and provides access to diabetes information, education, support, and subsidized product across diverse settings in each state and territory of Australia through seven independent service-providers. This article reports the approach undertaken to develop the Framework. METHODS: A participatory approach was undertaken, focused on adopting nationally consistent outcomes and indicators, nominating objectives and measurement tools, specifying evaluation processes, and developing quality standards. Existing programs were classified based on related, overarching indicators enabling the adoption of a tiered system of evaluation. RESULTS: Two outcomes (i.e., improved clinical, reduced cost) and four indicators (i.e., improved knowledge and understanding, self-management, self-determination, psychosocial adjustment) were adopted from the Eigenmann and Colagiuri national consensus position statement for diabetes education. This allowed for the identification of objectives (i.e., improved empowerment, reduced distress, autonomy supportive program delivery, consumer satisfaction) and related measurement instruments. Programs were categorized as comprehensive, topic-specific, or basic education, with comprehensive programs allocated to receive the highest-level of evaluation. Eight quality standards were developed, with existing programs tested against those standards. Based on the results of testing, two comprehensive (OzDAFNE for people with type 1 diabetes, DESMOND for people with type 2 diabetes), and eight topic-specific (CarbSmart, ShopSmart, MonitorSmart, FootSmart, MedSmart, Living with Insulin, Insulin Pump Workshop, Ready Set Go – Let's Move) structured diabetes self-management ...

OBJECTIVE: Evidence of the health and environmental harms of red meat is growing, yet little is known about which harms may be most impactful to include in meat reduction messages. This study examined which harms consumers are most aware of and which most discourage them from wanting to eat red meat. DESIGN: Within-subjects randomized experiment. Participants responded to questions about their awareness of, and perceived discouragement in response to, eight health and eight environmental harms of red meat presented in random order. Discouragement was assessed on a 1-to-5 Likert-type scale. SETTING: Online survey. PARTICIPANTS: 544 US parents. RESULTS: A minority of participants reported awareness that red meat contributes to health harms (ranging from 8% awareness for prostate cancer to 28% for heart disease) or environmental harms (ranging from 13% for water shortages and deforestation to 22% for climate change). Among specific harms, heart disease elicited the most discouragement (mean=2.82 out of 5), followed by early death (mean=2.79) and plants and animals going extinct (mean=2.75), though most harms elicited similar discouragement (range of means, 2.60 to 2.82). In multivariable analyses, participants who were younger, identified as Black, identified as politically liberal, had higher general perceptions that red meat is bad for health, and had higher usual red meat consumption reported being more discouraged from wanting to eat red meat in response to health and environmental harms (all p<0.05). CONCLUSIONS: Messages about a variety of health and environmental harms of red meat could inform consumers and motivate reductions in red meat consumption.

BACKGROUND: The implementation of evidence-based approaches by general practitioners (GPs) is new in the primary care setting, and few quantitative studies have evaluated the impact of contextual factors on the attendance of these approaches. METHODS: In total, 892 GPs from 75 community healthcare centers (CHCs) in Shanghai completed our survey. We used logistic regression to analyze factors affecting the number of evidence-based chronic disease programs attended by GPs and whether they had held the lead position in such a program. RESULTS: A total of 346 (38.8%) of the practitioners had never participated in any evidence-based chronic disease prevention (EBCDP) program. The EBCDP interventions in which the GPs had participated were predominantly related to hypertension, diabetes, and cardiovascular disease. However, the proportion of GPs in the lead role was relatively low, between 0.8% (programs involving prevention and control of asthma) and 5.0% (diabetes). Organizational factors and areas were significantly associated with evidence-based practices (EBPs) of the GP, while monthly income and department were the most significantly related to GPs who have the lead role in a program. The results indicated that GPs who had taken the lead position had higher scores for policy and economic impeding factors. GPs who were men, had a higher income, and worked in prevention and healthcare departments and urban areas were more likely to take the lead position. CONCLUSION: Evidence-based programs for chronic diseases should be extended to different types of diseases. Personal, organizational, political, and economic factors and the factors of female sex, lower income, department type, and suburban area environment should be considered to facilitate the translation of evidence to practice.

While One Health initiatives are gaining in popularity, it is unclear if and how they are evaluated when implementation at scale is intended. The main purpose of this scoping review was to describe how One Health initiatives targeting infectious diseases and antimicrobial resistance at a large scale are evaluated. Secondary objectives included identifying the main facilitators and barriers to the implementation and success of these initiatives, and how their impacts were assessed. Twenty-three studies evaluating One Health initiatives were eligible. Most studies included the human (n = 22) and animal (n = 15) sectors; only four included the environment sector. The types of evaluated initiative (non-exclusive) included governance (n = 5), knowledge (n = 6), protection (n = 17), promotion (n = 16), prevention (n = 9), care (n = 8), advocacy (n = 10) and capacity (n = 10). Studies used normative (n = 4) and evaluative (n = 20) approaches to assess the One Health initiatives, the latter including impact (n = 19), implementation (n = 8), and performance (n = 7) analyses. Structural and economic, social, political, communication and coordination-related factors, as well as ontological factors, were identified as both facilitators and barriers for successful One Health initiatives. These results identified a wide range of evaluation methods and indicators used to demonstrate One Health's added values, strengths, and limitations: the inherent complexity of the One Health approach leads to the use of multiple types of evaluation. The strengths and remaining gaps in the evaluation of such initiative highlight the relevance of comprehensive, mixed-method, context-sensitive evaluation frameworks to inform and support the implementation of One Health initiatives by stakeholders in different governance settings.

INTRODUCTION: Buccal midazolam treatment is licensed in the European Union for prolonged acute convulsive seizures in children and adolescents, but the buccal pathway is often hampered by jaw clenching, hypersalivation, or uncontrolled swallowing. Midazolam formulations that are more secure, reliable, and faster for use are needed in the acute setting. Pharmacokinetics and comparative bioavailability of intranasally administered midazolam and two midazolam intravenous solutions administered buccally or intravenously in healthy adults were evaluated. METHODS: In this phase 1, open-label, randomized, single-dose, three-period, three-sequence crossover study, 12 healthy adults (19–41 years) were randomly assigned to receive 2.5 mg midazolam intranasally; 2.5 mg midazolam intravenously; 2.5 mg midazolam buccally. Blood samples were collected for 10 h post dose to determine pharmacokinetic profiles. Adverse events and vital signs were recorded. RESULTS: Intranasal administration of 2.5 mg midazolam demonstrated a more rapid median time to C(max) compared to buccal administration of midazolam (T(max), 12.6 min vs. 45 min; C(max), 38.33 ng/ml vs. 24.97 ng/ml). The antiepileptic effect of intranasal and buccal midazolam treatment lasted less than 4 h and generally did not differ from intravenously administered midazolam. No serious adverse events or deaths were reported, and no treatment-emergent adverse events led to study discontinuation. CONCLUSION: Intranasal administration of midazolam may be a preferable alternative to the currently approve buccal midazolam treatment for prolonged acute convulsive seizures in children and adolescents. TRIAL REGISTRATION: This study is registered at the Chinese Clinical Trial [http://www.chictr.org.cn] (ChiCTR2000032595) on 3 May, 2020.

BACKGROUND: Expanding availability to naloxone is a core harm reduction strategy in efforts to address the opioid epidemic. In the US, state-level legislation is a prominent mechanism to expand naloxone availability through various venues, such as community pharmacies. This qualitative study aimed to identify and summarize the views of experts on state-level naloxone access laws. METHODS: We conducted a three-round modified-Delphi process using the online ExpertLens platform. Participants included 46 key stakeholders representing various groups (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with expertise naloxone access laws. Participants commented on the effectiveness and implementability of 15 state-level naloxone access laws (NALs). We thematically analyzed participant comments to summarize views on NALs overall and specific types of NAL. RESULTS: Participants commented that the effectiveness of NALs in reducing opioid-related mortality depends on their ability to make sustained, significant impacts on population-level naloxone availability. Participants generally believed that increased naloxone availability does not have appreciable negative impacts on the prevalence of opioid misuse, opioid use disorder (OUD), and non-fatal opioid overdoses. Implementation barriers include stigma among the general public, affordability of naloxone, and reliance on an inequitable healthcare system. CONCLUSIONS: Experts believe NALs that significantly increase naloxone access are associated with less overdose mortality without risking substantial unintended public health outcomes. To maximize impacts, high-value NALs should explicitly counter existing healthcare system inequities, address stigmatization of opioid use and naloxone, maintain reasonable prices for purchasing naloxone, and target settings beyond community pharmacies to distribute naloxone.

BACKGROUND: The effect of the highly contagious coronavirus disease 2019 (COVID-19) began in Wuhan, Hubei Province, China, from which it spread worldwide. In Nigeria, to curb the spread of the virus, the government elected to close public places, halt the general use of public transportation, enforce isolation and manage infected persons. AIM: This study evaluated Nigerian university students' knowledge, attitudes and behaviour (KAB) towards COVID-19. SETTING: This was an online survey of Nigerian university students. METHOD: A cross-sectional study was conducted among 1268 respondents aged 16 to 60 who completed the survey questionnaire. The respondents' demographic data and KAB toward COVID-19 were collected, allocated and scored based on specific stratified divisions. Data were analysed using student's t-test, analysis of variance and logistic regression analysis. RESULTS: The respondents demonstrated good knowledge of COVID-19, with a mean knowledge score of 78.7%; this positively influenced their attitude and behaviour scores (84.1% and 72.3%, respectively). Multiple linear regression analysis showed that 98.9% of the variance associated with poor knowledge is explained by gender (98.9%), age (97.3%), education (97.3%), occupation (97.2%) and marital status (91.4%). CONCLUSION: The respondents had a positive attitude and satisfactory compliance with safety practices required to curb the spread of the virus. Nevertheless, there is a need to intensify health education campaigns targeting all Nigerians, especially the less educated, via community outreach programmes using local languages. CONTRIBUTION: The findings of this study demonstrate the imperative role of the knowledge of COVID-19 in curbing the spread of the infection via improved attitudes and positive behaviours in compliance with safety practices.

BACKGROUND: Sexual assault in South Africa has reached alarming proportions. Mental illness amongst offenders accused of rape is one of the complicating factors. AIM: To describe the sociodemographic, clinical and forensic profile of alleged offenders accused of rape referred to a South African tertiary public psychiatric hospital for forensic evaluation, as well as describe the profile of the reported victims. SETTING: Free State Psychiatric Complex (FSPC) Observation Ward, Bloemfontein, South Africa. METHODS: This cross-sectional retrospective study compiled a sociodemographic, clinical and forensic profile of offenders accused of rape referred to the FSPC for forensic assessment between 2011 and 2015. The study population comprised 159 alleged offenders. Sociodemographic data, mental status, clinical diagnoses, comorbid substance use and forensic outcomes were collected from clinical files. RESULTS: All accused offenders were male with a median age of 30 years. About half obtained primary school level education. Unemployment was common (37.3%) with 40% receiving government grants. Most accused offenders were single (78.0%). Clinically, schizophrenia spectrum and other psychotic disorders were the most common diagnoses (30.8%), followed by intellectual disability (16.3%). Almost a third of the accused offenders did not suffer from any mental illness. Alcohol (20.1%) and cannabis use disorders (12.6%) were dominant comorbidities. After a 30-day evaluation period, 53.2% of alleged offenders were found competent to stand trial. The verdict of criminal responsibility was made for 43.7% of this sample. CONCLUSION: This study contributes data on sociodemographics, psychiatric morbidities and comorbidities and forensic findings amongst alleged offenders of rape referred for forensic assessment.