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Low fruit and vegetable (FV) intake is a public health concern in Malta, where more than one in four adults are living with obesity and only approximately 12% meet the recommended five-a-day intake (1). Socioeconomic disparities can contribute to a poor diet, with international evidence pointing to disadvantaged groups consuming fewer FV (2). The main aims of this local study were to assess FV intakes, perceptions and drivers including barriers, among adults residing in Malta.
This cross-sectional study used an anonymised, convenience sampling design with an online survey (via Google Forms) disseminated on social networks in April-June 2024. The questionnaire (33 items) covered demographics, FV consumption frequency, barriers and suggested improvements. Ethical approval was obtained from the University’s Faculty Research Ethics Committee (FREC ID: FHS-2023-00664). Chi-square tests (or Fisher- Freeman-Halton Exact tests) and Spearman’s correlations were utilised for analysis, and with cross-tabulations used for suggestions for increased consumption.
315 respondents returned the survey (mean age 44.5 years, range 18–65 years; 72% female) and with a mean body mass index (BMI) of 26.4 kg/m2 (SD= 5.66). Mean daily consumption was 1.7 and 1.8 FV portions respectively. Age was positively correlated with fruit intake (p=0.001), with older adults consuming fruit more frequently, but vegetable intake showed no significant correlation with age (p=0.39). Participants in lower income brackets were significantly more likely to report cost as a barrier to FV consumption (p=0.001) than those in higher-incomes. Comparing two districts with contrasting high and low-at-risk-of-poverty (ARP) rates classified according to 2022 statistics (National Statistics Office, NSO, 2023)(3), higher proportions of Northern Harbour respondents had higher incomes despite living in a higher ARP district, and reported earning over €50.1k annually (30.7%) compared to 21.9% in the South Eastern (low-ARP) district, whereas participants earning between €15.1–€20k were more represented in the South Eastern district (21.9%) than in Northern Harbour (1.8%). These income differences were significant (p=0.005). Suggested community improvements for FV access based on income levels revealed that a majority of lower-income participants looked for lower prices (55.6% in <€10k income bracket). In contrast, lower proportions of higher-income participants were concerned with cost (40.7% in >€50.1k bracket) and a quarter reported no community improvements needed. Cost was more frequently reported as a barrier to FV consumption (p<0.001) among non-EU participants (44.4%) and Maltese participants (41.3%) compared to other EU nationals (14.3%).
In conclusion, Maltese adults’ FV intakes fall short of dietary recommendations, and affordability barriers affect those in less affluent groups, reflecting socioeconomic barriers exist for FV consumption. There is a need to focus on targeted approaches such as providing subsidies for low-income pockets and different age groups within communities and different nationalities, regardless of district, in an effort to improve FV consumption in Malta.
Clare Johnson provides a careful discussion of the “other” six sacraments that the Roman Catholic Church and the Orthodox Church celebrate. Relying on the liturgical books themselves, she investigates their biblical roots, the logic behind their coherence, and their theological significance.
Chapter 4 uses assemblage theory, which is an anti-colonialist theory of social and spatial construction that has traction in the Global South, to show how urban inequalities become assembled, disassembled, and reassembled over time and yet how grassroots activism for social and environmental justice and for community resilience can change the form and functions of cities. Buchanan arose at a time when the role of urban planning in the US cities was growing but largely conceived as the top–down imposition of order and dominant values on urban space. However, we are increasingly aware of just how contested and evolving the practice of urban planning and urban development are. Case studies of green gentrification from Los Angeles, California and Accra, Ghana illustrate the competing ideological perspectives on resilience in cities and the potential for and yet tentativeness of progress towards social justice in urban planning. The chapter explores the connections of racism in American land use with colonialism in the Global South, and the commonalities in the experiences of grassroots social-justice movements across cities worldwide.
Antimicrobial resistance is a multidisciplinary issue that has been high in the global agenda since the 2015 WHO Global Action Plan (GAP) and the 2016 UNGA Declaration. The Quadripartite Coalition has set up a consolidated global governance structure to coordinate AMR responses, including a Global Leaders Group, an Independent Panel of Experts and a stakeholders’ platform. At the national level, countries have set up more or less formal mechanisms to coordinate AMR management, develop and implement National Action Plans.
This chapter will draw on these pilot experiences to identify options for broader One Health governance and regulation. The chapter will examine global and regional governance and regulation of AMR – focusing on the EU as a case study – to explore possible applications to other priority areas such as zoonotic diseases.
Chapter 5 traces the history of a number of existing UN mechanisms which represent the interests of particular vulnerable groups in the international system (persons with disabilities, women, and children). The aim of this analysis is to see what types of normative discourses have found traction and led to the development of institutions to represent these vulnerable groups, in order to ascertain the type of normative arguments that would gain support in arguing for international institutions to represent future generations. An important lesson from the case studies is that a normative discourse in which development concerns feature prominently, has been a common thread running through the history of these UN mechanisms. The chapter analyses the differences and similarities between arguments which justify the institutions which have been put in place to represent these vulnerable groups, with arguments used to justify institutions to represent future generations.
In the wake of the COVID-19 pandemic, member states of the World Health Organisation (WHO) agreed to ‘draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response’ (Pandemic Treaty).
Proposals for a Pathogen Access and Benefit-Sharing (PABS) System were included from the earliest drafts of the Pandemic Treaty. Access and Benefit-Sharing (ABS) is a transactional mechanism with its origins in international environmental law, where access to genetic resources for use in research and development is provided in exchange for a share of the benefits associated with their use. The purpose is to generate benefits that can be channelled into environmental conservation and sustainable use activities in countries where the genetic resources originate.
The PABS System could be a mechanism for incorporating One Health considerations into the Pandemic Treaty, but this will depend on its design and implementation. This chapter analyses the proposed PABS System in the Pandemic Treaty negotiating texts to determine whether it constitutes a genuine attempt to apply a One Health approach to pathogen ABS.
Remission of T2DM has been shown to be possible with dietary modifications and significant weight loss in clinical trials as well as real-world studies (1,2). Low-Carbohydrate Diets (LCDs; <130 g carbohydrates/d(3)) have been shown to be effective in inducing T2DM remission(2). However, there is limited evidence of adherence to a LCD and exploration on blood lipid levels in the context of maintaining long-term remission, outside of clinical trials. The aim of this study was to evaluate the change in dietary intake, HbA1c, weight and blood lipids during 6-months of post remission while following a LCD.
Participants who recently induced T2DM remission were recruited from two GP clinics in England after receiving advice to follow an LCD. Four-day food diaries, weight, and blood parameters (i.e., HbA1c and blood lipids) were collected at baseline, 3-months and 6- months. Dietary intake analyses and statistical analyses were conducted using NutriticsTMand SPSS 29.0, respectively. A repeated measures ANOVA test was conducted to see any significant differences between timepoints. Ethical approval was granted from the Health Research Ethics Committee at Edge Hill University and the NHS (ETH2122- 0228 and 22/SC/045, respectively).
Twelve participants (4 female/8 male) completed the study. Mean (± SD) age of participants was 69 ± 8 years. Duration of T2DM prior to remission was 66 ± 54 months. There were no statistically significant changes in HbA1c level across time points (p>0.05). At 6-months, all participants had HbA1c ≤ 48mmol/mol, indicating maintenance of remission. No statistically significant changes were observed in blood lipids except for HDL-C, which improved from baseline to 6 months (+0.17 mmol/L [95% CI, -0.31 to -0.02], p=0.019). A statistically significant weight loss was observed between baseline and 3- months (-3.6 kg [95% CI, 0.5 to 6.6], p=0.02) and baseline and 6-months (-3.7 kg [95% CI, 0.3 to 7.1], p=0.03). There were no significant changes in carbohydrate intake over time.
However, two participants’ carbohydrate intake exceeded 130 g per day at both baseline and 3-months while 3 participants exceed 130 g at 6 months, indicating a trend of increasing carbohydrate intake with time. While energy intake did not change significantly, it was reported to fall below the DRVs according to sex and age group. At all timepoints, fibre intake was found to be below the recommended 30 g per day.
This study showed that people with newly induced T2DM remission can maintain it over 6 months in a real-world setting, with observed metabolic improvements. Adherence to a LCD was also shown to be possible, although a consistent low fibre intake was observed. Therefore, supporting people in achieving and maintaining T2DM remission through a well-planned diet within primary care could bring about significant benefits if scaled to a population level.
In the technological wave of the twenty-first century, artificial intelligence (AI), as a transformative technology, is rapidly reshaping our society, economy, and daily life. Since the concept of AI was first proposed, this field has experienced many technological innovations and application expansions. Artificial intelligence has experienced three booms in the past half century and has developed rapidly. In the 1960s, marked by the Turing test, the application of knowledge reasoning systems and other technologies set off the first boom. Computer scientists at that time began to explore how to let computers simulate human intelligence. Early AI research focused on rule systems and logical reasoning. The rise of expert systems and artificial neural networks brought a second wave of enthusiasm (McDermott, 1982). The third boom is marked by deep learning and big data, especially the widespread application of artificial intelligence-generated content represented by ChatGPT. During this period, AI technology shifted from traditional rule systems to methods that relied on algorithms to learn patterns from data. The rise of deep learning enabled AI to achieve significant breakthroughs in areas such as image recognition and natural language processing.
Companies can innovate their business models to increase nonoperational profits, which helps reduce their sensitivity to supply–demand mismatches. Such companies have different supply chain priorities. Instead of focusing on perfectly matching supply with demand, they aim to improve cash flow management and reduce the cash conversion cycle. They can also benefit from supply chain finance solutions to offset the negative impact of their strategies on supply chain partners. This chapter presents an in-depth analysis of innovative business development with a focus on (1) inventory financing, (2) inventory securitization, (3) vendor-put insurance, (4) reverse factoring, (5) dynamic discounting, and (6) the letter of credit.