This article focuses on the development of Ireland’s first National Student Mental Health and Suicide Prevention Framework for Higher Education. There is growing concern for student mental health in higher education nationally and globally. The majority of students are aged between 18 and 24, which is identified as a high-risk group for mental health difficulties. Recent surveys of student mental illness, mental distress, and low well-being have been recognized by the World Health Organization, the Union of Students in Ireland National Report on Student Mental Health in Third Level Education, the My World survey and the My World 2 study. The Higher Education Authority in Ireland made a commitment to the Department of Health Connecting for Life (Ireland’s National Strategy to Reduce Suicide 2015–2020) to form national guidelines for suicide prevention in higher education. In order to deliver on this commitment, The National Student Mental Health and Suicide Prevention Framework was developed. The Framework is informed by international evidence and was the product of a collaborative cross sector and cross disciplinary team including health professionals, government representatives, educators, students, policy makers, community organizations, researchers and clinicians.

Background: In April of 2014, the Turkish Ministry of Health held the First Annual Health Technology Assessment (HTA) Meeting in Antalya.

Objectives: The objectives were to understand the perceptions of stakeholders regarding the current status of HTA and document their recommendations and strategies for promoting systematic use of HTA in Turkey.

Methods: The study was conducted using a qualitative written survey assessing current compliance with the fifteen HTA principles suggested by Drummond et al. (Key principles for the improved conduct of health technology assessments for resource allocation decision. Int J Technol Assess Health Care. 2008;24:244–258) and a qualitative method referred to as the Collective Intelligence Platform®.

Results: A total of 216 stakeholders representing academic, public, and the private health sector attended the annual meeting; 178 completed the survey and 183 participated in the Platform. Quantitative Results: Survey participants reported that, although Turkey does not currently fully comply with any of the fifteen HTA principles, there is some compliance with all of them. The overall average score for all fifteen principles was 3.04. Quantitivate Results: Participants recommended a more transparent, independent, and evidence-based policy decision-making system through better coordination of HTA activities, data aggregation, capacity development, and a national HTA core model and framework.

Conclusions: Platform participants described the current HTA environment as disjointed and lacking in resources and support from policy-making leaders. Despite the persisting challenges, awareness of the strengths and weaknesses of the current system combined with increasing interaction among Turkish stakeholders and the international HTA community can meaningfully contribute to the continued development and promotion of HTA in Turkey.

Recent literature has renewed interest in the stratarchical model of intraparty decision-making. In this version of party organization, the functions performed by parties are distributed among their discrete levels. The result is a power-sharing arrangement in which no group has control over all aspects of party life. Thus, the model potentially provides an antidote to the hierarchical version of organization. This article examines the principal parties in Australia, Canada, Ireland and New Zealand to test whether there is empirical evidence of stratarchy. An examination of candidate nomination, leadership selection and policy development finds strong evidence of shared authority between both levels of the party in key areas of intraparty democracy. Both levels accept that they cannot achieve their goals without the support of the other and so a fine balancing act ensues, resulting in constant recalibration of power relations. There is, however, little evidence of the commonly presented model of stratarchy as mutual autonomy for each level within discrete areas of competency. Instead, both the party on the ground and in the centre share authority within all three areas, resulting in a pattern of mutual interdependence rather than mutual autonomy.

Introduction: Any large-scale disaster may place a hospital system in a precarious position. Planning is fundamental to facilitate an equitable process for allocating scarce critical care resources, yet there is a paucity of literature guiding protocol development, and few Canadian hospitals have done this planning. We performed a scoping review of the available literature, and used this data to develop a hospital-wide policy to guide critical care resource allocation as part of the hospital emergency management planning process. Methods: A primary search of MEDLINE (1946-2015), EMBASE (1980-2015), Disaster Lit (2002-2010) and Pubmed focusing on a priori criteria was completed. A secondary search of the grey literature served to increase sensitivity and rigor. Two independent reviewers manually reviewed the citations, and selected eligible abstracts for full-text. Qualitative thematic analysis was undertaken of the selected articles. The results then informed the development of a hospital-wide policy and protocol to guide critical care resource allocation. Results: The search identified 832 citations; 134 papers were reviewed and 11 selected for qualitative analysis. All included papers were expert opinion and reviews. All suggested that an ethical framework be used; eight discussed this in detail. Ten recommended allocating a triage team to implement the protocol. Nine papers recommended specific resource allocation protocols with inclusion/exclusion criteria, physiologic scores, and reassessment at varying time intervals (12-120 hours). Conclusion: Effective planning, prior to a disaster, is critical to saving as many lives as possible. Based on our scoping review, we have developed a hospital-wide protocol that incorporates ethical principles and clear inclusion and exclusion criteria, to help avoid inequity and promote transparent decision-making. Next steps include a public consultation process and review, prior to implementation testing and educational roll-out.

Worldwide, coastal and floodplain wetlands are rapidly urbanizing, making them highly vulnerable to biodiversity loss, biological invasion and climate change. Yet urban wetlands management is an understudied area of global environmental research. Different policy approaches and institutional arrangements in place for urban wetlands governance have to be studied comparatively to obtain a better understanding of the current issues. This paper investigates four urban wetland policy regimes and the application of ecological reference points across four countries. The regimes are discussed within the context of global policy trends, urbanization patterns and environmental change. The analysis illustrates that the four cases deviate substantially in certain characteristics and converge in others. Global trends such as environmental treaties and restructuring of city spaces are common policy drivers for all cases. Conversely, the localized specific problems have yielded specialized policy responses in each case. Declaration of fixed biological reference points for wetlands were not used at any stage of the policy development process. However, the wetland managers formally or informally set up ecosystem-services oriented benchmarks for urban wetland management. Globally-applicable normative policy directives or universal ecological reference points seem bound to fail in urban wetlands governance. However, in designing effective urban wetland policy and institutions at the regional scale, both context-specific and generalized lessons from empirical policy evaluation of multiple case studies need to be jointly considered. Based on the characteristics of the policy regimes analysed in this study, a hypothetical framework for urban wetland policy evaluation is proposed; this has yet to be validated by empirical application to actual cases.

Objectives: Conducting economic evaluation in the context of clinical studies is common but has been the subject of extensive discussion due to its limitations. Various standard approaches and guidelines how such studies should be conducted have been proposed, but there is very limited information available about how common these studies are, what type of data that is collected, and how the quality of the protocols compares to the suggested standards. This study examines the prevalence and study design of health economic evaluations conducted alongside clinical trials in Sweden between 1995 and 2005.

Methods: A systematic assessment of clinical trial protocols that had arrived as applications to the Medical Products Agency between 1995 and 2005 was performed. Only protocols arriving during the first half of odd years within the time period were included.

Results: A total number of 680 protocols from 1995 to 2005 were examined, and among them, 14.4 percent included a health economic part. With the exception of year 2001, a trend toward an increased prevalence of economic evaluations next to clinical trials can be seen.

Conclusions: This study shows that economic evaluations alongside clinical trials are becoming more common, although most trials still lack a health economic part of the protocol. The information about the economic evaluation provided in the protocols is in many cases scarce, possibly due to the fact that there currently are no generally accepted and applied guidelines for economic evaluations in clinical trial protocols. Introducing requirements for detailed study plans also for the economic evaluation should improve the quality of economic evaluations alongside clinical trials.

With the aim of assessing how exchange practices regarding Animal Genetic Resources for Food and Agriculture (AnGR) affect the various stakeholders in the livestock sector and to identify policies and regulatory options that could guide the global exchange, use and conservation of AnGR, an exploration of future scenarios was used as a complementary approach to reviewing the current situation, as well as to identify stakeholders’ views on AnGR policy development.

Four 2050 future scenarios were developed and included:

1. Globalization and regionalization.

2. Biotechnology development.

3. Climate change and environmental degradation.

4. Diseases and disasters.

Having developed the scenarios, these were then used as an input point for a wide range of stakeholder consultations.

The findings show that such an approach has been a useful analytical tool. The ‘far’ future perspective appeared to make people less defensive, especially in a situation where current exchange problems were not yet particularly visible or well documented. Many interviewees broadly considered that it was not a question of ‘if’ the scenarios would happen, but rather a question of ‘when’. This implies that we might do well to consider the need to respond to future challenges through the proactive development of new policies or regulations. Such a finding is partly in contrast with the general perception of the current regulatory situation being broadly acceptable.

Over the last few decades in Sweden, the proportion of older people living in the community who receive public home-help services has decreased, even amongst the oldest old. At the same time, the abilities of older people in the activities of daily living have on average improved. This paper reports a study of the changes between 1988/89 and 2002/03 in the allocation and utilisation of public home-help services and in the support and care needs of older people (aged 65 or more years). The aims were to analyse whether the reduction in the percentage of home-help recipients could be explained by a reduction in needs among the older population, whether public home-help services had been targeted at people with greater needs, and whether informal care had increased. It was confirmed that over the 15 years, even after taking needs factors into account, the likelihood of an older person being a recipient of public home care had declined. Home help had clearly been targeted at more needy individuals. Among older women (aged 80+ years) with limitations in the activities of daily living and who lived alone, the proportion that received home help declined and the proportion that received informal care increased, which suggests that informal care had substituted for formal care. The findings indicate that the Swedish welfare system had reduced its commitment to the support of older people who require less intensive care and that, in effect, the concept of need for public social care support had been redefined.