UNASSIGNED: Organ donation after euthanasia (ODE) has been performed over 100 times in the Netherlands, primarily involving patients suffering from a neurodegenerative or psychiatric disease. In recent years, the number of euthanasia cases related to dementia has increased in the Netherlands, with some patients living with dementia expressing a wish for organ donation after euthanasia.
UNASSIGNED: We describe a unique case of a 67-year-old female diagnosed with primary progressive aphasia as part of frontotemporal dementia who requested and underwent organ donation after euthanasia.
UNASSIGNED: The patient had expressed her explicit wishes for both euthanasia and organ donation, which were discussed with her family physician, the Euthanasia Expertise Center (EE), and an organ donation coordinator. The patient was informed that to proceed with ODE, she should still be capable of voicing a voluntary and well-considered request for organ donation. The legally required euthanasia assessment procedure was carefully completed before ODE. Multiple healthcare professionals assessed the patient\'s competence, voluntariness, and unbearable suffering. Thereafter the patient\'s ODE request was granted, and both lungs and kidneys were successfully donated and transplanted. Post hoc analysis confirmed that all due diligence criteria for euthanasia were met, and the patient\'s relatives received an anonymous letter of gratitude from one of the organ recipients.
UNASSIGNED: This unique case demonstrates that ODE is feasible from medical, ethical, and legal perspectives in patients living with dementia. This case highlights several aspects essential to enable an ODE request by a patient living with dementia to be granted, such as the role of the physician performing euthanasia, the relevance of the decision-making capacity of the patient, the presence of an advance directive, and the involvement of and support by relatives and caregivers. However, several unresolved ethical issues surrounding ODE in patients with dementia, especially in patients with advanced stages of dementia, warrant further exploration, including the timing of discussing organ donation after the initial euthanasia request.

Attention on work-related musculoskeletal disorders (WMSDs) involves statistical surveys showing an increasing trend in the incidence of WMSDs. Technological development has led to new tools and methods for the assessment of physical load at work. These methods are mostly based on the direct sensing of appropriate parameters, which allows more precise quantification. The aim of this paper is to compare several commonly used methods in Slovakia for the assessment of ergonomic risk reflecting current EU and Slovak legislative regulations. A Captiv wireless sensory system was used at a car headlight quality control assembly workplace for sensing, data acquisition and data processing. During the evaluation of postures and movements at work, we discovered differences in the applicable standards: Decree 542/2007 Coll. (Slovak Legislation), the STN EN 1005-4+A1, and the French standards default in the Captiv system. Standards define the thresholds for hazardous postures with significant differences in several evaluated body segments, which affects the final evaluation of the measurements. Our experience from applying improved risk assessment methodology may have an impact on Slovak industrial workplaces. It was confirmed that there is a need to create uniform standards for the ergonomic risk assessment of body posture, including a detailed description of the threshold values for individual body segments.

We reviewed the historical pathway that paved the way for the creation and implementation of public policies for food security in Brazilian schools. We then analyzed the implementation of such policies in Paraíba state (northeastern Brazil) in terms of the investment in purchasing food from familiar agriculture, i.e. agricultural production in small farm units where the labor comes from the owner\'s family that lives on the farm and receives gross income from agriculture. We conducted this study to determine the extent to which public policies for food security in schools promote income to family farmers in Paraíba state. We obtained data from the Management and Accountability System (SIGPC) to quantify the municipalities in Paraíba state that comply with the national school feeding program denominated Programa Nacional de Alimentação Escolar (PNAE). The fiscal years from 2015 to 2017 were used as a reference period because no data is available for the upcoming years. PNAE has been created to underpin programs offering free meals to school-age children, thus allowing for basic learning conditions while tackling hunger among social groups in poverty. PNAE became a public policy subsidiary of familiar agriculture through the Law 11,947 of 2009 which requires the minimal investment of 30% of PNAE funds to purchase food from family farmers. In Paraíba state, 80% of the municipalities buy food through PNAE. However, nearly 40% of the municipalities do not apply the minimum investment to purchase food from family farmers during the evaluated period (2011-2017). We identified that logistics and transportation of food coordinated by the school feeding councils are the main constraints for greater efficiency of the program. Despite such constraints, PNAE offers a unique opportunity to enhance human wellbeing by fostering family farmers to adopt conservation practices and provide healthy, local food to school-aged children.

The COVID-19 pandemic has had significant effects on urban and regional food systems. Local administrations worldwide have been challenged to design and implement policies to mitigate immediate food system disruptions while planning for longer-term equity and resilience. The fast pace and high degree of uncertainty of the pandemic have made systematic tracking and assessment of food system change and related policy responses arduous. To address this gap, this paper applies the multilevel perspective on sociotechnical transitions and the multiple streams framework on policy change to 16 months of food policy (March 2020 through June 2021) during the New York State-issued COVID-19 state of emergency, comprising more than 300 food policies advanced by New York City and State legislators and administrators. Content analysis of these policies revealed the most salient policy areas during this period, the status of legislation, and key programs and budget allocations, as well as local food governance and the organizational spaces within which food policy operates. The paper shows that food policy domains that gained prominence focused on support for food businesses and food workers and on ensuring and expanding food access through food security and nutrition policies. Most COVID-19 food policies were incremental and were limited to the duration of the emergency, yet the crisis allowed for enactment of novel policies that deviated from the common policy issues or the typical scale of changes proposed pre-pandemic. Taken together, and viewed through a multilevel and policy streams framework, the findings provide insight into the trajectory of food policymaking in New York during the pandemic and the areas that food justice activists, researchers, and policy makers should focus on as the COVID-19 pandemic is abated.

In this study, the contribution of the ante mortem (AM) inspection and the food chain information (FCI) to ensuring meat safety and public health was investigated, by evaluating the slaughterhouse findings of 223,600 slaughtered dairy cows in the Netherlands. The outcome of this study was that the ante mortem (AM) and post mortem (PM) inspections have a substantial overlap, and that with regard to food safety and public health in over 99% of cases the PM could even be omitted on the basis of the AM. In this study, the data provided by the dairy farmers on the current FCI forms contributed little to nothing with regard to the outcomes of AM and PM inspection. It is concluded that current meat inspection procedures need an update and a more risk-based approach needs to be adopted. Regarding this, the AM inspection of dairy cattle should remain, because it plays an important role in ensuring food safety (e.g., by preventing contamination of the slaughter line by excessively dirty animals, or animals with abscesses), monitoring animal welfare and in detecting some important notifiable diseases. The PM inspection, however, could in many cases be omitted, provided there is a strict AM inspection complemented by a vastly improved (automated) way of obtaining reliable FCI.

BACKGROUND: A striking number of national and subnational governments that previously allowed legal abortion in cases of severe fetal anomaly have passed new legislation to explicitly remove these allowances. However, we know little about the maternal health implications of such restrictions.
OBJECTIVE: This study aimed to examine the health outcomes of pregnant individuals in El Salvador whose fetuses were diagnosed with a fatal congenital malformation and who were legally required to carry these nonviable pregnancies to term under the nation\'s absolute abortion ban.
METHODS: We reviewed the charts of all 239 pregnancies with fetuses classified as having 1 of 18 congenital malformations typically considered to be incompatible with extrauterine life that were evaluated at the National Women\'s Hospital in El Salvador between January 1, 2013 and December 31, 2018. Because regional healthcare providers who identify pregnancy complications in El Salvador are instructed to refer those patients to the National Women\'s Hospital, our analysis captured the total population of lethal fetal malformations treated by the national public health system. We documented pregnant patients\' socioeconomic characteristics, pregnancy-related complications, and the medical procedures used to mitigate complications.
RESULTS: Individuals who were required to carry pregnancies with severe fetal malformations to term (or until preterm labor began naturally) experienced high rates of maternal morbidity. More than half (54.9%) of pregnancies experienced at least 1 serious pregnancy-related health complication, whereas 47.9% underwent a physically-invasive medical procedure to manage complications, including cesarean deliveries, decompression amniocenteses, fetal head decompressions, and, in 1 case, a full hysterectomy. A total of 9% of patients opted to discontinue care after receiving the diagnosis of fatal fetal malformation. We also found striking variation in how physicians managed pregnancies with fatal fetal malformations, suggesting that different interpretations of the law lead to inequities in individual-level patient care.
CONCLUSIONS: Laws prohibiting abortions in cases of severe fetal malformation can increase risks to pregnant patients by requiring clinicians to subject healthy patients to a course of treatment that generates morbidity.

Child sexual abuse (CSA) is a worldwide problem with girls most affected even allowing for the possibility that boys are less likely to report it. In India there is strict anti-CSA legislation like the Protection of Children from Sexual Offences (POCSO) Act, but enforcement falls short due to poor socioeconomic conditions, low education levels, and insensitive actions and responses.

BACKGROUND: Gun violence restraining orders (GVROs), implemented in California in 2016, temporarily prohibit individuals at high risk of violence from purchasing or possessing firearms and ammunition. We sought to describe the circumstances giving rise to GVROs issued 2016-2018, provide details about the GVRO process and quantify mortality outcomes for individuals subject to these orders (\'respondents\').
METHODS: For this cross-sectional description of GVRO respondents, 2016-2018, we abstracted case details from court files and used LexisNexis to link respondents to mortality data through August 2020.
RESULTS: We abstracted information for 201 respondents with accessible court records. Respondents were mostly white (61.2%) and men (93.5%). Fifty-four per cent of cases involved potential harm to others alone, 15.3% involved potential harm to self alone and 25.2% involved both. Mass shooting threats occurred in 28.7% of cases. Ninety-six and one half per cent of petitioners were law enforcement officers and one-in-three cases resulted in arrest on order service. One-year orders after a hearing (following 21-day emergency/temporary orders) were issued in 53.5% of cases. Most (84.2%) respondents owned at least one firearm, and firearms were removed in 55.9% of cases. Of the 379 respondents matched by LexisNexis, 7 (1.8%) died after the GVRO was issued: one from a self-inflicted firearm injury that was itself the reason for the GVRO and the others from causes unrelated to violence.
CONCLUSIONS: GVROs were used most often by law enforcement officers to prevent firearm assault/homicide and post-GVRO firearm fatalities among respondents were rare. Future studies should investigate additional respondent outcomes and potential sources of heterogeneity.

Population level changes in physical activity (PA) may benefit from policy intervention. In response to the United Nations Sustainable Development Goals, Wales introduced legislation to holistically improve health and well-being, including Public Service Boards, to improve the translation of national policy into practice.
An audit of policies published by national and subnational public bodies since 2015 was conducted. Content of the policies were extracted and synthesized to determine: (1) how many policies included a PA action, (2) what the drivers of those policies were, (3) the content of the PA actions, and (4) how the PA actions aligned with the Well-being of Future Generations (Wales) Act 2015.
Sixteen national-level documents with a PA action were published by 4 of 13 public bodies. The policies vary in terms of the clarity and specificity of the actions, the assignment of clear roles/responsibilities, and the setting of targets. Of the 19 subnational Public Service Boards well-being policies, 15 included PA actions.
This audit provides a valuable example of how connections between national and subnational policy can be achieved. The appointment of Public Service Boards has supported the translation of policies into practice in Wales, and similar approaches could be utilized in other countries.

BACKGROUND: The World Health Organization (WHO) had launched the Framework convention on Tobacco Control (FCTC) in 2003 in order to curve the epidemic of tobacco use worldwide. Since most smokers begin to smoke before the age of 18 years, Global Youth Tobacco Survey (GYTS) has been developed in order to monitor tobacco smoking among adolescents. Our aim was to assess smoking among Tunisian youth using GYTS 2017 data.
METHODS: GYTS is cross-sectional, two cluster school-based survey to produce a representative sample of students aged 13-15 years. It was conducted in 2017 in 67 secondary schools in Tunisia. The investigation tool was an anonymously answered questionnaire, which contained core questions about six majors tobacco related topics.
RESULTS: Lifetime cigarettes and waterpipe prevalence were 7.8% (14.4% of boys, 1.6% of girls, p<0.001) and 7.2% (13% of boys, 2.8% of girls, p<0.001), respectively. Among cigarette smokers, 62.5% were able to buy their own cigarettes. Overall, 23.5% of cigarette smokers and 41.5% of waterpipe smokers were not able to buy their products because of their age. Sixty percent of smokers wanted to quit and 56.4% had already tried to stop. Half of the respondents were exposed to SHS in their homes and 62.1% in indoor public places.
CONCLUSIONS: In Tunisia, tobacco prevalence among youth is high. Youth have free access to tobacco products and smoke-free regulations are only partially respected.