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Background: Research suggests that a whole-school approach to mental health promotion can be more effective than a compartmentalized approach. In particular, student-led initiatives have demonstrated a positive impact on students' mental health, though not without systemic and individual barriers. Factors that lead to successful implementation and sustaining of student-led initiatives are currently not well understood. Methods: A case study is presented to demonstrate how a student-led intervention came about, inspired changes in the school organization and members, and transformed the school's approach to mental health promotion. Analysis of in-depth interviews with student leaders and adult advisors was informed by theories of innovation diffusion and human motivation. Results: Key factors and mechanisms of change were identified for the initiation, transformation, and institutionalization stages of the student-led initiative. Changes in students' identity and adult advisors' mindset were found to be integral to the successful conversion to a whole-school approach in mental health promotion. Conclusions: This study confirms the value of mobilizing the student body as an active resource in promoting mental health in school and the importance of input from school management, advisors, and intervention expert. Recommendations on how to implement a student-led initiative and sustain the positive changes are given.

INTRODUCTION Watershed moments in law are like shooting stars. They are few and far between. Many thought they had witnessed such a moment on 18 May 2018, when the British [...]

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ImportanceEarly intervention for substance use is critical to improving adolescent outcomes. Studies have found promising results for Screening, Brief Intervention, and Referral to Treatment (SBIRT), but little research has examined implementation.ObjectiveTo compare SBIRT implementation in pediatric primary care among trained pediatricians, pediatricians working in coordination with embedded behavioral health care practitioners (BHCPs), and usual care (UC).Design, setting, and participantsThe study is a 2-year (November 1, 2011, through October 31, 2013), nonblinded, cluster randomized, hybrid implementation and effectiveness trial examining SBIRT implementation outcomes across 2 modalities of implementation and UC. Fifty-two pediatricians from a large general pediatrics clinic in an integrated health care system were randomized to 1 of 3 SBIRT implementation arms; patients aged 12 to 18 years were eligible.InterventionsTwo modes of SBIRT implementation, (1) pediatrician only (pediatricians trained to provide SBIRT) and (2) embedded BHCP (BHCP trained to provide SBIRT), and (3) UC.Main outcomes and measuresImplementation of SBIRT (primary outcome), which included assessments, brief interventions, and referrals to specialty substance use and mental health treatment.ResultsThe final sample included 1871 eligible patients among 47 pediatricians; health care professional characteristics did not differ across study arms. Patients in the pediatrician-only (adjusted odds ratio [AOR], 10.37; 95% CI, 5.45-19.74; P < .001) and the embedded BHCP (AOR, 18.09; 95% CI, 9.69-33.77; P < .001) arms had higher odds of receiving brief interventions compared with patients in the UC arm. Patients in the embedded BHCP arm were more likely to receive brief interventions compared with those in the pediatrician-only arm (AOR, 1.74; 95% CI, 1.31-2.31; P < .001). The embedded BHCP arm had lower odds of receiving a referral compared with the pediatrician-only (AOR, 0.58; 95% CI, 0.43-0.78; P < .001) and UC (AOR, 0.65; 95% CI, 0.48-0.89; P = .006) arms; odds of referrals did not differ between the pediatrician-only and UC arms.Conclusions and relevanceThe intervention arms had better screening, assessment, and brief intervention rates than the UC arm. Patients in the pediatrician-only and UC arms had higher odds of being referred to specialty treatment than those in the embedded BHCP arm, suggesting lingering barriers to having pediatricians fully address substance use in primary care. Findings also highlight age and ethnic groups less likely to receive these important services.Trial registrationClinicaltrials.gov Identifier: NCT02408952.

Since the introduction of the diphtheria toxoid vaccine, cases of diphtheria caused by toxigenic strains of Corynebacterium diphtheriae have decreased (1). More recently, however, C. diphtheriae appears to have reemerged, [...]

Pharmaceutical sector corruption undermines patient access to medicines by diverting public funds for private gain and exacerbating health inequities. This paper presents an analysis of UN Convention Against Corruption (UNCAC) compliance in seven countries and examines how full UNCAC adoption may reduce corruption risks within four key pharmaceutical decision-making points: product approval, formulary selection, procurement, and dispensing. Countries were selected based on their participation in the Medicines Transparency Alliance and the WHO Good Governance for Medicines Programme. Each country’s domestic anti-corruption laws and policies were catalogued and analysed to evaluate their implementation of select UNCAC Articles relevant to the pharmaceutical sector. Countries displayed high compliance with UNCAC provisions on procurement and the recognition of most public sector corruption offences. However, several countries do not penalise private sector bribery or provide statutory protection to whistleblowers or witnesses in corruption proceedings, suggesting that private sector pharmaceutical dispensing may be a decision-making point particularly vulnerable to corruption. Fully implementing the UNCAC is a meaningful first step that countries can take reduce pharmaceutical sector corruption. However, without broader commitment to cultures of transparency and institutional integrity, corruption legislation alone is likely insufficient to ensure long-term, sustainable pharmaceutical sector good governance. [ABSTRACT FROM AUTHOR]

The illegal online trade in wildlife has increased significantly over the last 2 decades. Applying a systematic survey approach, we examined the online trade in elephant ivory before and after the implementation of a domestic trade ban in Singapore, to understand the forms of elephant ivory offered for sale, the e-commerce sites used and the effect of the domestic trade ban. Using elephant ivory and lookalikes in form, shape and colour as proxies for elephant ivory, we found that most of the online listings consisted of bird cages and related accessories such as bird feeding cups and ornaments used to adorn them. After the domestic trade ban in elephant ivory was implemented on 1 September 2021, a 76% drop in total listings was observed. Causal impact analysis indicated a strong causal effect of the domestic trade ban, resulting in an 83% drop in the mean number of new listings found weekly relative to the predicted counterfactual market response based on a Bayesian structural time-series model in the absence of the ban. E-commerce sites play an important role in combatting illegal wildlife trade online by removing flagged listings and sending notifications to raise awareness of the ban. We found textual descriptions of products to be more effective for preliminary differentiation of legal and potentially illegal listings compared to the detection of Schreger lines in images, although this remains a significant challenge for law enforcement. Our findings can inform future efforts to develop automated detection methods for elephant ivory in online markets. [ABSTRACT FROM AUTHOR]

Abstract Objective This paper used data from a study of pediatric primary care provider (PCP) screening practices to examine barriers to and facilitators of adolescent alcohol and other drug (AOD) screening in pediatric primary care. Methods A web-based survey (N = 437) was used to examine the influence of PCP factors (attitudes and knowledge, training, self-efficacy, comfort with alcohol and drug issues); patient characteristics (age, gender, ethnicity, comorbidities and risk factors); and organizational factors (screening barriers, staffing resources, confidentiality issues) on AOD screening practices. Self-reported and electronic medical record (EMR)-recorded screening rates were also assessed. Results More PCPs felt unprepared to diagnose alcohol abuse (42%) and other drug abuse (56%) than depression (29%) (p