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Urinary tract infections (UTIs) make up a significant proportion of the global burden of disease in vulnerable groups and tend to substantially impair the quality of life of those affected, making timely detection of UTIs a priority for public health. However, economic and societal barriers drastically reduce accessibility of traditional lab-based testing methods for critical patient groups in low-resource areas, negatively affecting their overall healthcare outcomes. As a result, cellulose-based materials such as paper and thread have garnered significant interest among researchers as substrates for so-called frugal analytical devices which leverage the material’s portability and adaptability for facile and reproducible diagnoses of UTIs. Although the field may be only in its infancy, strategies aimed at commercial penetration can appreciably increase access to more healthcare options for at-risk people. In this review, we catalogue recent advances in devices that use cellulose-based materials as the primary housing or medium for UTI detection and chart out trends in the field. We also explore different modalities employed for detection, with particular emphasis on their ability to be ported onto discreet casings such as sanitary products. Graphical abstract

The entire world seems to have responded to COVID-19 pandemic in a knee-jerk manner with a short mindset without building on the existing strengths of public health infrastructure. National governments cannot be blamed for this as we are dealing with a crisis that comes once in a lifetime. Realising this, the Organized Medicine Academic Guild (OMAG) an association of major health associations in this country has suggested measures for long-term solutions to COVID-19-like pandemics in the form of a policy paper by OMAG.

There is widespread acknowledgement of the presence of vitamin D deficiency in the community and the pressing need to address this. From a public health perspective, emphasis has been placed on addressing vitamin D deficiency through dietary means. However, naturally rich food sources of vitamin D are few and infrequently consumed, and nutrition survey data from various countries have indicated that habitual vitamin D intakes in the community are much lower than the current vitamin D dietary guidelines. This review will briefly overview the extent of vitamin D deficiency within the community, its causes, and how our food chain, once its embraces the evidence-based practise of food fortification and potentially biofortification, can cater for meeting the dietary vitamin D needs of the community. Finally, international authorities, briefed with establishing vitamin D dietary guidelines over the past decade, have struggled with uncertainties and gaps in our understanding of the relative contribution of sunshine and diet to vitamin D status and vitamin D requirements for health maintenance. The review will also consider how emerging evidence of a possible minimal-risk UVB radiation exposure relative to skin cancer that also enables vitamin D production could greatly inform future vitamin D dietary guidelines.

Food-borne infections are major causes of public health concern in developing and developed countries. During the past decade, the Institut Hospitalo-Universitaire Méditerranée Infection has conducted or been involved in multiple investigations that aimed at identifying the sources and strains responsible for food-borne diseases and therefore at improving the understanding, diagnosis, prevention and control of these infections. Investigations were conducted in the Mediterranean area and in sub-Saharan Africa on more than 15 food-borne agents, 17 food products and 14 antibiotic resistance-associated genes. Multiple sources, including unexpected ones, and pathogens, including emerging ones, were involved. Travelling in developing countries and zoonoses are major contributors to food-borne infections, while food-borne transmission of resistance-associated genes is increasingly reported. However, risk factors and pathogens associated with food-borne infections likely remain untapped and must be more extensively investigated, monitored and regularly reassessed. Diagnostic tests based on new technologies and real-time surveillance tools based on microbiology laboratory data are promising approaches to detect known food-borne infections and decipher new ones. Studies of the microbiota and its relationships with dietary patterns are also worth being conducted. Keywords: Africa, bacteria, food, food-borne, fungus, IHU Mediterranée Infection, infections, Mediterranean Basin, virus, zoonosis

Automatic segmentation of bones in computed tomography (CT) images is used for instance in beam hardening correction algorithms where it improves the accuracy of resulting CT numbers. Of special interest are pelvic bones, which—because of their strong attenuation—affect the accuracy of brachytherapy in this region. This work evaluated the performance of the JJ2016 algorithm with the performance of MK2014v2 and JS2018 algorithms; all these algorithms were developed by authors. Visual comparison, and, in the latter case, also Dice similarity coefficients derived from the ground truth were used. It was found that the 3D-based JJ2016 performed better than the 2D-based MK2014v2, mainly because of the more accurate hole filling that benefitted from information in adjacent slices. The neural network-based JS2018 outperformed both traditional algorithms. It was, however, limited to the resolution of 1283 owing to the limited amount of memory in the graphical processing unit (GPU). Funding: VetenskapsradetSwedish Research Council [VR-NT 2016-05033]

Cerium oxide nanoparticles with integrated gadolinium have been proved to be useful as contrast agents in magnetic resonance imaging. Of question is their performance in dual-energy computed tomography. The aims of this work are to determine (1) the relation between the computed tomography number and the concentration of the I, Gd or Ce contrast agent and (2) under what conditions it is possible to resolve the type of contrast agent. Hounsfield values of iodoacetic acid, gadolinium acetate and cerium acetate dissolved in water at molar concentrations of 10, 50 and 100 mM were measured in a water phantom using the Siemens SOMATOM Definition Force scanner; gadolinium- and cerium acetate were used as substitutes for the gadolinium-integrated cerium oxide nanoparticles. The relation between the molar concentration of the I, Gd or Ce contrast agent and the Hounsfield value was linear. Concentrations had to be sufficiently high to resolve the contrast agents. Funding: VetenskapsradetSwedish Research Council [VR-NT 2016-05033]

This paper discusses the ways in which 2009 novel swine‐origin influenza A (H1N1) was announced and resonated with current pandemic anxieties. In particular, the US Centers for Disease Control and Prevention (CDC) are used as a lens through which recent pandemic anxieties can be analysed and understood. This entails a closer look at the securitisation of public health and the challenges and struggles this may have caused within public health agencies. In that light, CDC' formal entanglement with global health security and its announcement of the H1N1 pandemic are interpreted, followed by an ethnographically informed focus on various people who were engaged in the H1N1 emergency response and their practices and practical struggles in the face of pandemic anxiety.

BackgroundUnidentified depression in primary care is a public health concern, globally. There is a need for brief, valid and easily administered tools in primary care.AimsTo estimate reliability and validity of the newly developed Primary care Screening Questionnaire for Depression (PSQ4D), a four-item tool, with ‘yes’ or ‘no’ options.MethodPSQ4D was administered verbally (time required, n=827) in six primary care settings in Kerala, India. A psychiatrist evaluated each patient on the same day, using ICD-10 Diagnostic Criteria for Research, based on unstructured clinical interview.ResultsThe Cronbach's alpha for internal consistency reliability was 0.80; kappa coefficient for test-retest reliability was 0.9 and that for interrater reliability was 0.72. At a score ≥2, sensitivity was 0.96, specificity was 0.87, positive predictive value was 0.74, negative predictive value was 0.98, positive likelihood ratio was 7.4 and negative likelihood ratio was 0.05.ConclusionsWhen physician administered, PSQ4D has good reliability. At a cut-off score of ≥2, it has high sensitivity and specificity to identify depressive disorder in primary care.

BackgroundThe psychiatric health burden of prisoners is substantial. However, there is a lack of high-quality studies of psychiatric disorders among young adults with a high risk of reoffending.AimsTo investigate the lifetime prevalence of psychiatric disorders and use of mental health services among young male violent offenders and the impact of childhood-onset conduct disorder (COCD).MethodA nationally representative cohort (n = 270, age 18–25) of male offenders was followed back in medical records and clinically assessed by gold standard methods. Lifetime prevalences are presented together with odds ratios (ORs) as risk estimates in relation to COCD.ResultsPrevious use of psychiatric services among the participants was high but their lifetime psychiatric morbidity was even higher, with 93% meeting criteria for at least one Axis I disorder. The COCD group was overrepresented in most clinical categories and carried five times higher odds (OR = 5.1, 95% CI 2.0–12.8) of a psychotic disorder, three times higher odds (OR = 3.2, 95% CI 1.2–8.5) of a substance use disorder and two times higher odds of a mood disorder (OR = 2.3, 95% CI 1.3–4.0) or anxiety disorder (OR = 2.0, 95% CI 1.1–3.5).ConclusionsThe mental health burden is substantial among young violent offenders, and COCD is an important indicator of future mental health problems which must be a priority for public health efforts.

Recognized for conducting cutting-edge science in the field of radiation health effects research, the Department of Energy's (DOE) Russian Health Studies Program has continued to generate excitement and enthusiasm throughout its 23-year mission to assess worker and public health risks from radiation exposure resulting from nuclear weapons production activities in the former Soviet Union. The three goals of the Program are to: (1) clarify the relationship between health effects and chronic, low-to-medium dose radiation exposure; (2) estimate the cancer risks from exposure to gamma, neutron, and alpha radiation; and (3) provide information to the national and international organizations that determine radiation protection standards and practices. Research sponsored by DOE's Russian Health Studies Program is conducted under the authority of the Joint Coordinating Committee for Radiation Effects Research (JCCRER), a bi-national committee representing Federal agencies in the United States and the Russian Federation. Signed in 1994, the JCCRER Agreement established the legal basis for the collaborative research between USA and Russian scientists to determine the risks associated with working at or living near Russian former nuclear weapons production sites. The products of the Program are peer-reviewed publications on cancer risk estimates from worker and community exposure to ionizing radiation following the production of nuclear weapons in Russia. The scientific return on investment has been substantial. Through 31 December 2015, JCCRER researchers have published 299 peer-reviewed publications. To date, the research has focused on the Mayak Production Association (Mayak) in Ozersk, Russia, which is the site of the first Soviet nuclear weapons production facility, and people in surrounding communities along the Techa River. There are five current projects in the Russian Health Studies Program: two radiation epidemiology studies; two historical dose reconstruction studies and a worker biorepository. National and international standard-setting organizations use cancer risk estimates computed from epidemiological and historical dose reconstruction studies to validate or revise radiation protection standards. An overview of the most important research results will be presented.

Health risks from air pollutants are evaluated by comparing chronic (i.e., an average over 1 yr or greater) or acute (typically 1-hr) exposure estimates with chemical- and duration-specific reference values or standards. When estimating long-term pollutant concentrations via exposure modeling, facility-level annual average emission rates are readily available as model inputs for most air pollutants. In contrast, there are far fewer facility-level hour-by-hour emission rates available for many of these same pollutants. In this report, we first analyze hour-by-hour emission rates for total reduced sulfur (TRS) compounds from eight kraft pulp mill operations. This data set is used to demonstrate discrepancies between estimating exposure based on a single TRS emission rate that has been calculated as the mean of all operating hours of the year, as opposed to reported hourly emission rates. A similar analysis is then performed using reported hourly emission rates for sulfur dioxide (SO2) and oxides of nitrogen (NOx) from three power generating units from a U.S. power plant. Results demonstrate greater variability at kraft pulp mill operations, with ratios of reported hourly to average hourly TRS emissions ranging from less than 1 to greater than 160 during routine facility operations. Thus, if fluctuations in hourly emission rates are not accounted for, over- or underestimates of hourly exposure, and thus acute health risk, may occur. In addition to this analysis, we also demonstrate an additional challenge when assessing health risk based on hourly exposures: the lack of human health reference values based on 1-hr exposures. Implications: Largely due to the lack of reported hourly emission rate data for many air pollutants, an hourly average emission rate (calculated from an annual emission rate) is often used when modeling the potential for acute health risk. We calculated ratios between reported hourly and hourly average emission rates from pulp and paper mills and a U.S. power plant to demonstrate that if not considered, hourly fluctuations in emissions could result in an over- or underestimation of exposure and risk. We also demonstrate the lack of 1-hr human health reference values meant to be protective of the general population, including children.

Kağıt endüstrisi; ülkemizde ve dünyada kişi başına kağıt tüketiminin artmasıyla birlikte büyüyen ve ürün çeşitliliği olan potansiyel bir sektördür. Yapılan bu araştırma ile iş sağlığı ve güvenliği kavramı irdelenerek, son dönemde kağıt sektöründe meydana gelen iş kazaları ve meslek hastalıklarının nedenleri araştırılarak çözüm önerileri geliştirilmiştir.6331 sayılı İş Sağlığı ve Güvenliği Kanununun yürürlüğe girmesi ile birlikte, iş sağlığı ve güvenliği alanında iş kazası ve meslek hastalıklarının gerçekleşmesini önlemeye yönelik bir yaklaşım yasal olarak benimsenmiştir. Aile, Çalışma ve Sosyal Hizmetler Bakanlığı Rehberlik ve Teftiş Başkanlığınca, iş yerlerindeki çalışma ortamının sağlıklı ve güvenli olup olmadığının, iş kazalarını önlemeye yardımcı olan önlemlerin alınıp alınmadığının tespit edilmesi ve varsa uygunsuzlukların giderilmesi amacıyla denetimler yapılmaktadır.Yapılan bu çalışmada, 7 ilde yer alan kağıt ve kağıt ürünleri imalatı yapan 106 iş yerinde, 2014 yılında yapılan denetim verileri derlenerek ve tespit edilen temel riskler sınıflandırılarak denetimlerin iş yeri üzerindeki olumlu etkileri araştırılmıştır. Sektördeki işletmeler için tehlikelerin belirlenerek alınabilecek önlemlerin değerlendirilmesi, pratik ve yol gösterici çözümlerin oluşturulması hedeflenmiştir. Çalışma sonucunda, yapılan proaktif denetimlerin kağıt ürünü imal eden iş yerlerinde yüksek oranda iyileşme sağladığı görülmüştür. Considering modern-day demands with the regard of the varieties and in vast amount of manufacturing, paper industry is a potential sector that grows with the increasing consumption of paper per person. With this thesis, the concept of occupational health and safety has been studied and the solutions of occupational accidents and diseases have been investigated and solution proposals have been developed in the paper industry. With come out of the Occupational Health and Safety Law (6331), an approach to prevent the occurrence of occupational accidents and diseases in the field of occupational health and safety has been legally adopted. By the Head of Guidance and Inspection within the Ministry of Family, Labour and Social Services, inspections are carried out that whether or not exist of health and safety in workplaces, precautions to prevent occupational accidents and eliminated non-conformities. In this study, the positive effects of the inspections on the workplace were investigated by compiling the inspection data in 2014 and the main risks classificated in 106 workplaces manufacturing paper and paper products in 7 provinces. It is aimed to determine the hazards for the workplaces in the sector and to evaluate the precautions that can be taken and to create practical and guiding solutions. Conclusion of the study, it has been observed that proactive inspections have improved greatly in the paper industry workplaces. 88

Epidemics such as viral haemorrhagic fevers, severe acute respiratory syndrome, Middle East respiratory syndrome coronavirus or yet unknown ones have few chances of disappearing. Globalization, worldwide travel, climate change, social conflicts and wars, among others, are likely to favor the emergence of epidemics. Preparedness of hospitals to prevent the spread of these outbreaks is among the prioritized political programmes of many countries. The EuroNHID network has in the past drawn a map of features and equipment of hospitals across Europe to take care of highly contagious patients. We update the data regarding isolation capabilities and recommendations, with an emphasis on Mediterranean countries., peer-reviewed

The United States Department of Health and Human Services (HHS) is fully committed to the development of medical countermeasures to address national security threats from chemical, biological, radiological, and nuclear agents. Through the Public Health Emergency Medical Countermeasures Enterprise, HHS has launched and managed a multi-agency, comprehensive effort to develop and operationalize medical countermeasures. Within HHS, development of medical countermeasures includes the National Institutes of Health (NIH), (led by the National Institute of Allergy and Infectious Diseases), the Office of the Assistant Secretary of Preparedness and Response/Biomedical Advanced Research and Development Authority (BARDA); with the Division of Medical Countermeasure Strategy and Requirements, the Centers for Disease Control and Prevention, and the Food and Drug Administration as primary partners in this endeavor. This paper describes various programs and coordinating efforts of BARDA and NIH for the development of medical countermeasures for radiological and nuclear threats.

The public health and medical response to a radiological or nuclear incident requires the capability to sort, assess, treat, triage and to ultimately discharge, refer or transport people to their next step in medical care. The size of the incident and scarcity of resources at the location of each medical decision point will determine how patients are triaged and treated. This will be a rapidly evolving situation impacting medical responders at regional, national and international levels. As capabilities, diagnostics and medical countermeasures improve, a dynamic system-based approach is needed to plan for and manage the incident, and to adapt effectively in real time. In that the concepts and terms can be unfamiliar and possibly confusing, resources and a concept of operations must be considered well in advance. An essential underlying tenet is that medical evaluation and care will be managed by healthcare professionals with biodosimetry assays providing critical supporting data.

O BESITY IS A PUBLIC HEALTH burden associated with a number of adverse health conditions and high health care costs. As an integral part of standard behavior-based therapy, selfmonitoring has been used in many lifestyle intervention programs to address the obesity epidemic. In weight management, self-monitoring usually consists of tracking dietary intake, physical activity, body weight, and/ or other health measurements. Previous research examined the efficacy of dietary self-monitoring on weight management. However, most of those studies addressed self-monitoring using traditional paper methods. The subsequent development and use of advanced technology-based self-monitoring approaches shows promising effects inweight loss.We evaluated the emerging evidence on the efficacy and adherence to different types of dietary self-monitoring, including traditional paper methods, web-based self-monitoring, and the use of mobile devices such as personal digital assistants, wearables, and tablets/mobile smartphones. Motivations and barriers to dietary selfmonitoring are described and strategies to improve adherence are identified. A discussion on future directions of dietary self-monitoring approaches in research and practice is also provided.

Introduction Hantaviruses are maintained by mammalian hosts, such as rodents, and are shed in their excretions. Clinical disease can occur in humans from spillover infection. Brown rats (Rattus norvegicus) are the globally distributed reservoir host of Seoul virus (SEOV). Human cases of SEOV-associated haemorrhagic fever with renal syndrome (SEOV-HFRS)have been reported in Great Britain (GB) since 1977. Methods Brown rats (n=68) were trapped from a variety of peridomestic locations, with a focus on pig farms. Kidney and lung tissues were tested for viral RNA using a pan-hantavirus RT-PCR assay followed by Sanger sequencing and analysis. Results SEOV RNA was detected in 19 per cent (13/68, 95% CI 11 to 30) of rats and all sequences fell within SEOV lineage 9. Twelve sequences were highly similar to each other and to the previously reported GB Humber strain of SEOV (98 per cent). One rat SEOV sequence was more distant. The SEOV prevalence in rats from pig farms was significantly greater (p=0.047) than other sites sampled. No significant sex or age differences were observed among positive and negative rats. Discussion The results from this study suggest that SEOV could be widespread in wild rats in GB and therefore pose a potential risk to public health.

Migration of mineral oil saturated hydrocarbons (MOSH), polyolefin oligomeric saturated hydrocarbons (POSH), and polyalphaolefins (PAO from hot melts) into dry semolina and egg pasta packed in direct contact with virgin paperboard or polypropylene (PP) flexible film was studied. Migration was monitored during shelf life (up to 24 months), through storage in a real supermarket (packs kept on shelves), conditions preventing exchange with the surrounding environment (packs wrapped in aluminium foil), and storage in a warehouse (packs inside of the transport box of corrugated board). Semolina pasta packed in virgin paperboard (without hot melts) had a MOSH content lower than 1.0 mg kg(-1). An increasing contamination with PAO belonging to the adhesives used to close the boxes was detected in egg pasta, wrapped in aluminium (1.5 and 5 mg kg(-1) after 3 and 24 months, respectively). An environmental contribution to total hydrocarbon contamination was observed in egg pasta kept on shelves that, after 3 and 24 months, showed levels of PAO/MOSH < C25 around 3 and 10 mg kg(-1), respectively. The migration of POSH from PP film into egg pasta wrapped in aluminium was around 0.6 mg kg(-1) after 3 months of contact and reached 1.7 mg kg(-1) after 24 months of contact. After 9 months of contact, semolina pasta packed in PP film and stored in the transport box showed that some MOSH migrated into the pasta from the board of the transport box (through the plastic film).

Background A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. Methods The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews. Results The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p

Background: Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems. Objective: To examine the potential of mobile electronic devices compared with paper-based tools in health data collection. Methods: Using data from 961 households from the Rufiji Household and Demographic Survey in Tanzania, the quality and costs of data collected on paper forms and electronic devices were compared. We also documented, using qualitative approaches, field workers, whom we called ‘enumerators’, and households’ members on the use of both methods. Existing administrative records were combined with logistics expenditure measured directly from comparison households to approximate annual costs per 1,000 households surveyed. Results: Errors were detected in 17% (166) of households for the paper records and 2% (15) for the electronic records (p

BackgroundMental disorders of women during the postnatal period are a major public health problem. Compared with women's mental disorders, much less attention has been paid to men's mental disorders in the perinatal period. To date, there have been no reports in the literature describing secular changes of both maternal and paternal hospital admissions for mental disorders over the period covering the year before pregnancy (non-parents), during pregnancy (expectant parents) and up to the first year after birth (parents) based on linked parental data. The co-occurrences of couples' hospital admissions for mental disorders have not previously been investigated.AimsTo describe maternal and paternal hospital admissions for mental disorders before and after birth. To compare the co-occurrences of parents' hospital admissions for mental disorder in the perinatal period.MethodThis is a cohort study using paired parents' population data from the New South Wales (NSW) Perinatal Data Collection (PDC), Registry of Births, Deaths and Marriages (RBDM) and Admitted Patients Data Collection (APDC). The study included all parents (n=196 669 couples) who gave birth to their first child in NSW between 1 January 2003 and 31 December 2009.ResultsThe hospital admission rate for women with a principal mental disorder diagnosis in the period between the year before pregnancy and the first year after birth was significantly higher than that for men. Parents' mental disorders influenced each other. If a man was admitted to hospital with a principal mental disorder diagnosis, his wife or partner was more likely to be admitted to hospital with a principal mental disorder diagnosis compared with women whose partner had not had a hospital admission, andvice versa.ConclusionsMothers' mental disorders after birth increased more significantly than fathers. However, fathers' mental disorders significantly impacted the co-occurrence of mothers' mental disorders.

The objective of this World Bank technical assistance has been to support the Government of Bangladesh’s (GoB) national capacity development framework for improving water and sanitation services (WSS) in Bangladesh, focusing on demand-responsive peer-to-peer or horizontal learning processes and improve horizontal accountability communication and monitoring systems to track progress in the sector. This technical assistance is in line with the World Bank country assistance strategy (CAS) which seeks to support the GoB target of ensuring safe drinking water and sanitation for all. It has contributed to strengthening the long-term capacity of the government, in particular the union Parishad (UP) which is responsible for ensuring water and sanitation services for all in Bangladesh.

Background In the Western world, a significant portion of college students have gambled. College gamblers have one of the highest rates of problem gambling. To date, there have been no studies on gambling participation or the rates of problem gambling in India. Aims This study evaluated the prevalence of gambling participation and problem gambling in college students in India. It also evaluated demographic and psychosocial correlates of gambling in that population. Method We surveyed 5784 college students from 58 colleges in the district of Ernakulam, Kerala, India, using cluster random sampling. Students completed questionnaires that addressed gambling, substance use, psychological distress, suicidality and attention-deficit hyperactivity disorder (ADHD). Results A total of 5580 completed questionnaires were returned, and while only 1090 (19.5%) college students reported having ever gambled, 415 (7.4%) reported problem gambling. Lotteries were the most popular form of gambling. Problem gamblers in comparison with non-gamblers were significantly more likely to be male, have a part-time job, greater academic failures, higher substance use, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. In comparison with non-problem gamblers, problem gamblers were significantly more likely to have greater academic failures, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. Conclusions This study, the first to look at the prevalence of gambling in India, found relatively low rates of gambling participation in college students but high rates of problem gambling among those who did gamble. Correlates of gambling were generally similar to those noted in other countries. Since 38% of college students who had gambled had a gambling problem, there is a need for immediate public health measures to raise awareness about gambling, and to prevent and treat problem gambling in this population. Declaration of interest S.G. was (until October 2014) a member of the UK Responsible Gambling Strategy Board, and authored the Royal College of Psychiatrists’ Faculty report FR/AP/01 Gambling: The Hidden Addiction – Future Trends in Addictions (2014). Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

OBJECTIVES: Cigarette price increases reduce smoking prevalence but as a tobacco control policy are undermined by the availability of lower cost alternatives such as hand-rolling tobacco. The aim of this descriptive study is to explore time trends in the price of manufactured cigarettes and hand-rolling tobacco, and in the numbers of people who smoke these products, over recent years in the UK. SETTINGS AND PARTICIPANTS: UK. OUTCOME MEASURES: Trends in the most popular price category (MPPC) data for cigarettes and hand-rolling tobacco from 1983 to 2012 adjusted for inflation using the Retail Price Index, and trends in smoking prevalence and the proportion of smokers using hand-rolling tobacco from 1974 to 2010. RESULTS: After adjustment for inflation, there was an increase in prices of manufactured cigarettes and hand-rolling tobacco between 1983 and 2012. Between 1974 and 2010, the prevalence of smoking fell from 45% to 20%, and the estimated total number of smokers from 25.3 to 12.4 million. However the number of people smoking hand-rolling tobacco increased from 1.4 to 3.2 million, and MPPC cigarette price was strongly correlated with number of people smoking hand-rolling tobacco. CONCLUSIONS: Although the ecological study design precludes conclusions on causality, the association between increases in manufactured cigarette price and the number of people smoking hand-rolling tobacco suggests that the lower cost of smoking hand-rolling tobacco encourages downtrading when cigarette prices rise. The magnitude of this association indicates that the lower cost of hand-rolling tobacco seriously undermines the use of price as a tobacco control measure.

This synthesis report details the process, outputs and intermediate outcomes of the World Bank’s Water and Sanitation Program (WSP) Technical Assistance (TA) to Support Government of India for implementation of the National Urban Sanitation Policy (P131963). The objective of this TA was to (i) strengthen urban sanitation services and target the urban poor by development of strategies for regulation, funds allocation, improved accountability mechanisms and implementation of inclusive sanitation policies at national level and in at least five states, with two of these low-income states (LIS). This was to be supplemented with (ii) enabling design and use of improved performance monitoring systems by Government of India, 3 states and 300 urban local bodies by 2015, and (iii) strengthen capacity of local urban government institutions to provide improved – inclusive and sustainable – sanitation services for all. This TA provides the building blocks for sustainable sanitation improvements which are being adopted and implemented as part of another TA (P131967) in Madhya Pradesh and Tripura to pilot and operationalize City Sanitation Plans (CSPs) towards outcome oriented sector improvements. The areas addressed in this TA include the following specific goals of the NUSP: open defecation free cities, and integrated city-wide sanitation. The TA provided assistance to central government and the states in putting in place various elements identified as necessary for sector improvement, including planning, provisioning and monitoring processes. The TA also identified the need for the cities to see opportunities for financial recovery of investments through reuse and recycle strategies, to strengthen the incentive for investment in sanitation improvements.