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Background: Medical interventions are procedures that are conducive to creating danger on people's life and body immunity due to their characteristics. We aimed to raise awareness and make contributions by revealing the fact that serious bodily and mental harms occur due to medical interventions by the ones who do not have the authority to perform., Methods: We evaluated 210 cases appealled to our institution between the years of 2017 and 2022 who suffered damage after medical interventions by people who do not have any authorization or license. The damages that occurred in the cases were evaluated in terms of medical and legal aspects. Analysis of the data were done with SPSS 25.0 for Windows and the statistical alpha significance level were accepted as p < 0.05., Results: 76.7% of the cases were women, 87.1% were young individuals under the age of 40 Of the medical interventions, 91.9% were for aesthetic/cosmetic purposes (laser epilation, tattoo removal, botox, dermapen, cold lipolysis), 8.1% were for therapeutic purposes (bone setter intervention, tooth extraction/prosthesis, intramuscular injection, cupping pull) was found. It was found that 87.1% of the medical interventions were performed in beauty salons, 12.9% in hairdressers, home, medical markets, pharmacies and dental clinics., Conclusions: All over the world and in our country, serious bodily and mental injuries occur in people after medical interventions by unauthorized persons. Therefore, it is necessary to see this situation as an important problem, and raise awareness in the society to make legal arrangements., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Autonomous robotic surgery represents a pioneering field dedicated to the integration of robotic systems with varying degrees of autonomy for the execution of surgical procedures. This paradigm shift is made possible by the progressive integration of artificial intelligence (AI) and machine learning (ML) into the realm of surgical interventions. While the majority of autonomous robotic systems remain in the experimental phase, a notable subset has successfully transitioned into clinical applications. Noteworthy procedures, such as venipuncture, hair implantations, intestinal anastomosis, total knee replacement, cochlear implant, radiosurgery, and knot tying, among others, exemplify the current capabilities of autonomous surgical systems. This review endeavors to comprehensively address facets of autonomous robotic surgery, commencing with a concise elucidation of fundamental concepts and traversing the pivotal milestones in the historical evolution of robotic surgery. This historical trajectory underscores the incremental assimilation of autonomous systems into surgical practices. This review aims to address topics related to autonomous robotic surgery, starting with a description of fundamental concepts and going through the milestones in robotic surgery history that also show the gradual incorporations of autonomous systems. It also includes a discussion of the key benefits and risks of this technology, the degrees of autonomy in surgical robots, their limitations, the current legal regulations governing their usage, and the main ethical concerns inherent to their nature., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Rivero-Moreno et al.)

A number of countries and states prohibit surrogacy except in cases of "medical necessity" or for those with specific medical conditions. Healthcare providers in some countries have similar policies restricting the provision of clinical assistance in surrogacy. This paper argues that surrogacy is never medically necessary in any ordinary understanding of this term. The author aims to show first that surrogacy per se is a socio-legal intervention and not a medical one and, second, that the intervention in question does not treat, prevent, or mitigate any actual or potential harm to health. Legal regulations and healthcare-provider policies of this kind therefore codify a fiction-one which both obscures the socio-legal motivations for surrogacy and inhibits critical examination of those motivations while mobilizing normative connotations of appeals to medical need. The persisting distinction, in law and in moral discourse, between "social" and "medical" surrogacy, is unjustified.

In recent years, imaging studies have become increasingly used at various stages in the management of patients with various conditions and disorders. This process results in a necessity to provide an increasing number of exams, which involves a growing role of radiologists in assessing and reporting those exams. The article discusses tele-radiology as a method that can improve access to radiology services, presenting its potential benefits, as well as the risks involved. It analyses access to radiology healthcare services in Poland in the context of the international and Polish legal provisions concerning the right to healthcare. While funding for imaging studies for patients is widely available and imaging equipment in Poland is improving despite some shortages, the main barrier is identified in the number of specialists capable of assessing the exams. Teleradiology can alleviate this shortage, so the article presents legal provisions and international good practice guidelines in this area, focusing on documents issued by the European Society of Radiology, the American College of Radiology, and the British Royal College of Radiologists. The guidelines concerning such aspects as patients' rights, teleradiologists' qualifications, communication and reporting, responsibility, and technical requirements may help make teleradiology a safe and valuable component of the healthcare system in Poland., Competing Interests: The authors declare no conflict of interest., (© Pol J Radiol 2023.)

Glyphosate is a broad-spectrum, non-selective herbicide used to control weeds and protect agricultural crops, and it is classified as potentially carcinogenic by the International Agency for Research on Cancer. In Mexico, the use of pesticides is a common practice, including glyphosate. However, on December 31st, 2020, the Mexican government decreed the prohibition of this herbicide as of January 2024. In this review, we investigate the association between glyphosate and cancer risk and found that most of the studies focused using animals showing negative effects such as genotoxicity, cytotoxicity and neurotoxicity, some studies used cancer cell lines showing proliferative effects due to glyphosate exposure. To our knowledge, in Mexico, there are no scientific reports on the association of glyphosate with any type of cancer. In addition, we reviewed the toxicological effects of the herbicide glyphosate, and the specific case of the current situation of the use and environmental damage of this herbicide in Mexico. We found that few studies have been published on glyphosate, and that the largest number of publications are from the International Agency for Research on Cancer classification to date. Additionally, we provide data on glyphosate stimulation at low doses as a biostimulant in crops and analytical monitoring techniques for the detection of glyphosates in different matrices. Finally, we have tried to summarize the actions of the Mexican government to seek sustainable alternatives and replace the use of glyphosate, to obtain food free of this herbicide and take care of the health of the population and the environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Given low utilization by individuals experiencing gambling problems the potential of self-exclusion (SE) might be not fully exploited in Germany. This paper aims to gain insight into different actors' perceptions and reflections on the problems and difficulties in the process of self-exclusion to delineate which specific attitudes hamper a successful implementation of SE., Methods: 13 individual and four group interviews with individuals experiencing gambling problems and governmental or commercial gambling providers were examined. A Grounded Theory Approach was used to portray the opinions of these different actors on existing regulations of SE and to delineate potentially diverging interests between the distinct groups., Results: The interviewees agreed on the usefulness of SE and consented that it is important to early recognize individuals experiencing gambling problems. They also considered the present practice insufficient but for different reasons. Individuals experiencing gambling problems and providers particularly disagreed on addressing individuals experiencing gambling problems. While individuals experiencing gambling problems stated that they had hardly ever been approached, providers argued that help offers were mostly rejected. Especially commercial providers also regarded insufficient German language skills and rapid fluctuation of guests as strong barriers to approaching individuals experiencing gambling problems. Interviewees from governmental venues furthermore suspected that commercial providers took addressing individuals experiencing gambling problems less seriously., Conclusion: Our results emphasize the dilemma of conflicting interests in both individuals experiencing gambling problems and providers. Rather than acting against the economic interests of employers, venue staff blame individuals experiencing gambling problems for lack of problem recognition. Conversely, individuals experiencing gambling problems blame the providers for not offering help. To address individuals experiencing gambling problems appropriate staff training is required, and SE regulations need to be controlled by an independent body rather than by the providers themselves., (© 2023. The Author(s).)

Food colorants are imperative ingredients for attracting consumers and in deciding their preferences. Here we discuss the current status of natural colorants and synthetic food colorants on the Indian market by appraising the growth of the food colorant market both globally and nationally, based on published case studies on synthetic food colorants (SFCs), rules, and regulations implemented by Food Safety and Standards Authority of India on natural food colorants and SFCs. The substantial lacunae in the research on the impacts of SFCs in the Indian population identified through our literature survey signify the scope and need for appraisal of the issues prevailing in the Indian food colorant market as well as the necessity of renewing the food colorant policies. The illegal use of banned food colorants, the adulteration of natural food colorants, mislabelling of SFCs as natural colorants, and the permitted use of internationally banned food colorants, as well as the unawareness among consumers are serious issues recognized. Appropriate labelling to denote natural food colorants' presence, renewed standards of policy to determine the permitted use of food colorants, comprehensive regulations for the production and use of natural food colorants, stringent rules to constrain the production of toxic SFCs are obligatory to breakdown the dilemma on the Indian food market. Most importantly, awareness and responsiveness should be generated among consumers regarding the illegal use and adulteration of colorants and the need to use natural colorants. We also recommend a logo to designate the presence of natural colorants which will aid the consumers to make the right choice., Competing Interests: Conflict of interestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© Bundesamt für Verbraucherschutz und Lebensmittelsicherheit (BVL) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Public safety (prevention of accidents) is the primary objective in assessing fitness to drive a motor vehicle. However, general access to mobility should not be restricted if there is no particular risk to public safety. For people with diabetes mellitus, the Führerscheingesetz (Driving Licence Legislation) and the Führerscheingesetz-Gesundheitsverordnung (Driving Licence Legislation Health enactment) regulate important aspects of driving safety in connection with acute and chronic complications of the disease. Critical complications that may be relevant to road safety include severe hypoglycemia, pronounced hyperglycemia and hypoglycemia perception disorder as well as severe retinopathy and neuropathy, endstage renal disease and certain cardiovascular manifestations. If there is a suspicion of the presence of one of these complications, a detailed evaluation is required.In addition, the individual antihyperglycemic medication should be checked for existing potential for hypoglycemia. Sulfonylureas, glinides and insulin belong to this group and are therefore associated with the requirement of a 5-year limitation of the driver's license. Other antihyperglycemic drugs without potential for hypoglycemia such as Metformin, SGLT‑2 inhibitors (Sodium-dependent-glucose-transporter‑2 inhibitors, gliflozins), DPP-4-inhibitors (Dipeptidyl-Peptidase inhibitors, gliptins), and GLP‑1 analogues (GLP‑1 rezeptor agonists) are not associated with such a time limitation.The relevant laws which regulate driving safety give room for interpretation, so that specific topics on driving safety for people with diabetes mellitus are elaborated from a medical and traffic-relevant point of view. This position paper is intended to support people involved in this challenging matter., (© 2023. The Author(s).)

Relationships between physicians and pharmaceutical sales representatives (PSRs) often create conflicts of interest, not least because of the various benefits received by physicians. Many countries attempt to control pharmaceutical industry marketing strategies through legal regulation, and this is true in Poland where efforts are underway to eliminate any practices that might be considered corrupt in medicine. The present research considered Polish medical students' opinions about domestic laws restricting doctors' acceptance of expensive gifts from the industry, the idea of compulsory transparency, and the possibility of introducing a Polish Sunshine Law. A qualitative, focus group-based, interview method was used. Data were gathered from nine focus groups involving 92 medical students from three universities located in major Polish cities. The article presents a classification of opposing student views with regard to the consequences of introducing different legal solutions; this should be useful for policy makers deliberating on how to optimally regulate pharmaceutical marketing. The study's results are discussed in the context of the public bioethical debate in Poland., (© 2021. The Author(s).)

While there is evidence for self-exclusion (SE) as an individual-level harm reduction intervention, its effects on reducing harm from gambling at the population level remain unclear. Based on a review of national legal frameworks and SE programs, including their utilization and enforcement in selected high-income societies, the present analysis aims to explore the reach and strengths of SE in the protection of gamblers in these jurisdictions. It places particular emphasis on SE programs' potential to prevent and minimize gambling harm at the population level. The overview examined SE in Finland, Germany, Italy, Massachusetts (USA), Norway, Sweden, and Victoria (Australia). These jurisdictions differ considerably in how gambling is regulated as well as in how SE is implemented and enforced. The reach and extent of enforcement of SE apparently vary with the polity's general policy balance between reducing gambling problems and increasing gambling revenue. But in any case, though SE may benefit individual gamblers and those around them, it does not appear to be capable of significantly reducing gambling harm at the population level. To render SE programs an effective measure that prevents gamblers and those linked to them from financial, social, and psychological harm, utilization needs to be substantially increased by reforming legal regulations and exclusion conditions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kraus, Loy, Bickl, Schwarzkopf, Volberg, Rolando, Kankainen, Hellman, Rossow, Room, Norman and Cisneros Örnberg.)

Dietary supplements may have beneficial value but, by definition, they have no therapeutic effect. However, their labeling and especially the advertisements in the media, often make ungrounded health claims. The aim of the study was to analyze the content of audio-visual advertisements of dietary supplements for health and legal aspects in the context of the European Law and the 1 January 2020 Polish self-regulation between TV broadcasting companies and supplement manufacturers. Supplement advertisements broadcast across six TV and radio stations from 9-15 March 2020 were analyzed. Most of the analyzed advertisements complied with the legal requirements and included terms such as 'supports' or 'facilitates' body function, which are less definite in nature. Almost 30% of the advertised supplements made unproven claims on their effectiveness in various health situations, e.g., effective weight loss, thus assuring the addressee about the beneficial effect of dietary supplements in a given health context. Agreement on the rules and regulations governing supplement advertising resulted in a noticeable improvement in advertisement content, which will hopefully raise consumer awareness about the absence of therapeutic properties of dietary supplements.

Insects are increasingly being considered as an attractive source of protein that can cater to the growing demand for food around the world and promote the development of sustainable food systems. Commercial insect farms have been established in various countries, mainly in Asia, but in Europe, edible insects have not yet emerged as a viable alternative to traditional plant- and animal-based sources of protein. In this paper, we present an interdisciplinary overview of the technological aspects of edible insect farming in the context of the EU regulations and marketing. Based on a review of the literature, we have concluded that edible insect farming can be a viable business sector that significantly contributes to the overall sustainability of food systems if the appropriate regulations are introduced and food safety standards are guaranteed. However, the success of the edible insect industry also requires consumer acceptance of entomophagy, which is rather low in Western societies. Therefore, targeted marketing strategies are indispensable to support the implementation of edible insect programs.

Ethical problems of psychosurgery are debated since 1970s. The issues of informed consent, political and commercial abuses, lacking evidence and needed regulation are overviewed. New surgical techniques provoke new discussions on goals and limits of psychosurgery., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Work on the Act on the Profession of Physiotherapist had been conducted since the 1990s. However, it was not until October 2015 that the legal regulations were eventually introduced, following which physiotherapists gained professional independence and became a profession of public trust. The aim of the study was to assess the factors influencing the knowledge of these legal regulations among physiotherapists., Material and Methods: The study involved 399 physiotherapists and physiotherapy students (28.8±5.9 years old) who completed an anonymous questionnaire, in the form of a knowledge test, consisting of 24 questions on the general aspects of the reference Act., Results: Overall, 30.3% of the respondents proved to have a significant knowledge about the rights and obligations resulting from the Act. The physiotherapists who were entered into the National Register of Physiotherapists (2.6 times) and residents of large cities (1.8 times) had a greater knowledge of the Act. There was a correlation between seniority and gender, and the knowledge of legal regulations., Conclusions: The main factors influencing the state of knowledge about the Act are the entry to the National Register of Physiotherapists, the place of residence and seniority. This proves better access to up-to-date information in cities and a greater interest in the Act among those people who have obtained the right to practice their profession. Med Pr. 2021;72(4):407-14., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Dietary supplements are products containing nutrients sold in various medicinal forms, and their widespread use may stem from the conviction that a preparation that looks like a drug must have therapeutic properties. The aim of this scoping review is to present what is known about the effects of using selected dietary supplements in the context of chronic diseases, as well as the risks associated with their use. The literature shows that the taking of vitamin and mineral supplements by healthy people neither lowers their risk of cardiovascular diseases nor prevents the development of malignancies. Many scientific societies recognize that omega-3 fatty acids lower blood triglycerides, but whether taking them prevents heart disease is less clear-cut. Taking weight loss supplements is not an effective method of fighting obesity. Often, some supplements are increasingly sold illegally, which is then also associated with the higher risk that they may be adulterated with banned substances, thus making them even more dangerous and potentially life-threatening. Supplements are necessary in cases of nutrient deficiency; however, even though prescription is not required, their use should be recommended and monitored by a physician.

Background: Considering the gap between organ donors and receivers, it can be assumed that family physicians may play an important role in organ donation. Thus, we aimed to investigate the family physicians' approaches to organ donation in Turkey., Methods: In this cross-sectional study, an online survey was sent to all family physicians working in Family Health Centers in Turkey Between Jul - Sep 2018. The survey questioned the knowledge, approaches, and opinions about organ donation issues, besides the socio-demographic characteristics., Results: Most physicians stated that they had given information to their patients on this subject at least occasionally (59.19%, n=998). Among participants, the most common reason for refusing consent for organ donation was the fear of commercial abuse (19.66%, n=244). Most participants (52.61%, n=887) stated that they had been positively affected by the media about organ donation. Some physicians were uncertain about the reliability of the brain death diagnosis (18.39%, n=310). A minor group stated that organ donation might be religiously inappropriate (10.50%, n=177)., Conclusion: Although most of the family physicians had a positive manner about organ donation, there was still some wrong knowledge of the participants about legal and medical aspects of organ donation, as well as some other concerns like organ trafficking and reliability of brain death diagnoses, whereas religious concerns were not significant., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2021 Dagcioglu et al. Published by Tehran University of Medical Sciences.)

Acrylamide is a contaminant as defined in Council Regulation (EEC) No 315/93 and as such, it is considered a chemical hazard in the food chain. The toxicity of acrylamide has been acknowledged since 2002, among its toxicological effects on humans being neurotoxicity, genotoxicity, carcinogenicity, and reproductive toxicity. Acrylamide has been classified as carcinogenic in the 2A group, with human exposure leading to progressive degeneration of the peripheral and central nervous systems characterized by cognitive and motor abnormalities. Bakery products (bread, crispbread, cakes, batter, breakfast cereals, biscuits, pies, etc.) are some of the major sources of dietary acrylamide. The review focuses on the levels of acrylamide in foods products, in particular bakery ones, and the risk that resulting dietary intake of acrylamide has on human health. The evolving legislative situation regarding the acrylamide content from foodstuffs, especially bakery ones, in the European Union is discussed underlining different measures that food producers must take in order to comply with the current regulations regarding the acrylamide levels in their products. Different approaches to reduce the acrylamide level in bakery products such as the use of asparginase, calcium salts, antioxidants, acids and their salts, etc., are described in detail.

Despite the implementation of strict legal standards concerning nutrient loads within wastewater discharges in all European Union (EU) Member States it was not possible to achieve good ecological and chemical water status by 2015 in all EU countries. The main reasons for this situation are the imperfections of the legislation tools regarding the standardization of wastewater quality and the methodology of determining the conditions for wastewater introduction into receivers. The study aims to review and analyze the currently existing in various countries legal regulations setting the standards for wastewater discharged into receivers, which were intended for surface water protection and eutrophication mitigation. Besides the EU effluent standards, the regional and national regulations in chosen EU Member States (e.g., Germany, Sweden, and Denmark) have been reviewed. Moreover, the Helsinki Commission recommendations for signatory countries within the Baltic Sea catchment and the approaches for wastewater quality standardization in non-EU countries (e.g., Russia, Belarus, Switzerland, China, USA, Canada, and Dubai) were assessed. The analysis of the reviewed legal regulations allowed to diversify the methodological approaches for setting effluent quality standards in different regions and countries and to assess the effectiveness of existing legal tools in the field of eutrophication mitigation with the consideration of the environmental and economic reasonability. The results suggest that the receiver-oriented policies used among others in Switzerland and China are the most reasonable in terms of eutrophication mitigation.

The purpose of this work is to analyze the regulatory environment for tobacco use, with particular reference to changes made in the last 10 years. An attempt was made to answer the question of the extent to which the regulatory environment has a real impact on the achievement of the objective set out in the existing legal provisions, which is to protect the health and rights of the persons concerned. An analytical method was used in the work to assess the application of legal principles. A method of analyzing the current line of jurisprudence was also used. In the process of final evaluation of public utilities, certain functional methods were used. The assessment was subjected to Polish law, within the scope of the currently binding Act on Health Protection Against the Consequences of Using Tobacco and Tobacco Products of 1995. The study states that the provisions of this Act are only a formal guarantee of protection. The liability arising from the application of its standard is illusory because the procedure for imposing penalties is ineffective. The pursuit of any property claims related to violation of the rights of related entities, as envisaged in this Act, is complicated. This does not apply to a case which is not affected by the decision. Int J Occup Med Environ Health. 2020;33(5):599-610., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Nowadays acrylamide is known not only as synthetic material used in industry, but also as carcinogenic, cyto- and genotoxic compound which forms during heat-induced process (due to Maillard reaction) mostly in foodstuff such as potato, bakery, plant derivatives products and coffee. The International Agency for Research on Cancer in 1994 declared acrylamide as a probable carcinogenic agent in humans. After metabolic process, acrylamide is distributed to all organs and tissues in human body. Acrylamide is classified as human neurotoxin, because this effect was observed in humans occupationally exposed to this compound. Acrylamide was found to cause apoptosis by mitochondrial dysfunction. Methods of acrylamide inactivation by microorganisms and bioactive diet compounds have also been reviewed. Moreover, there is still deficit of the European Union legal regulation concerning acrylamide mitigation strategies in food. Regulation 2017/2158 from 20 November 2017 is a step in the right direction when it comes to ensuring food safety and maximum levels of acrylamide in foodstuffs, however when exceeding those, it should result in elimination of such food from the market.

Hydroelectric power plants managed in response to sub-daily changes of the electricity market undergo rapid variations of turbine discharge, entailing quickly fluctuating water levels downstream. This operation regime, called hydropeaking, causes numerous adverse impacts on river ecosystems. The hydrological alterations which affect hydropeaking rivers can be described by five parameters that change over space and time (magnitude, rate of change, frequency, duration, and timing), where each parameter may be correlated with distinct environmental impacts and therefore may be used to define flow thresholds and set targets for operational mitigation strategies. Thus, this study aims to present an extensive review on the so far established hydropeaking targets and thresholds regarding the outputs from the scientific community as well as from national regulations. We found that only few European countries (Switzerland and Austria) have legal regulations regarding hydropeaking flow thresholds. Other countries, such as Canada and the USA, present environmental legislation that can force hydropeaking mitigation measures. Most mitigation thresholds and management recommendations in literature deal with the effect of downramping on the stranding of salmonids, as well as with minimum flows between peak-flows to avoid spawning ground desiccation. Regarding other fish species and parameters, information on mitigation targets or thresholds is scarcer or non-existent, as well as on hydropeaking mitigation case-studies, resulting in a lack of knowledge and guidelines for its implementation or regulation. Nevertheless, the available literature indicates that multiple aspects must be considered when assessing such values. Thus, to aid in that process, we propose that mitigation targets and thresholds must be based on key species, including particular features regarding season, life-stage and time of day, which must be combined with site-specific morphological characteristics. The presented approach may benefit impacted organism groups in hydropeaking reaches through the establishment of ecologically-based relevant mitigation thresholds and/or targets., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Due to welfare concerns and legal restrictions in certain countries, alternatives to wire net floors must be developed in rabbit husbandries. Also, there is a difference in regulations in Europe for laboratory rabbits vs. rabbits bred and kept for meat production. While there are regulations concerning floor design of enclosures for rabbits bred for meat production in many European countries, the European Directive 2010/63 lacks regulations for rabbits used for scientific purposes. This study compares two floors, which meet the Austrian legal requirements for growing rabbits intended for consumption as well as the requirements for laboratory rabbits. The dual use of rabbits bred for meat production and applicable for scientific purposes would avoid the problem of surplus animals of specialized producers for laboratory rabbits. A noryl floor with 12 mm circular holes was compared to a 10 mm slatted plastic floor. Parameters were soiling of cages and animals, parasitic burden, clinical health, and losses using objective scoring. Soiling of cages and animals and coccidial oocytes were significantly higher on the floors with circular holes. Obvious signs of disease showed a non-significant trend to be more frequent in the group with circular holes. This was linked with significantly higher losses. In conclusion, our study clearly shows that the floor with circular hole design cannot be endorsed, although it meets legal requirements. The slatted floor type can be cautiously recommended; however, to assure animal welfare in laboratory rabbits, legal authorities in Europe should take on the responsibility of regulating floor design in this sector., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Dementia is associated with the gradual impairment of mental ability. The population of people suffering from dementia is as large as 50 million. Most dementia cases result from various neurodegenerative diseases (NDs) linked by a progressive degeneration of neurons. Among NDs, Alzheimer's disease (AD) is the most frequent cause of dementia and accounts for 60- 80% of cases. Certain pathological changes on the cellular and subcellular level occur even 15 years before the manifestation of clinical symptoms of AD. This first asymptomatic phase of AD is considered a preclinical stage, whereas mild cognitive impairment (MCI) is the symptomatic pre-dementia stage. The third, fully symptomatic phase of AD is dementia due to AD. The presence of specific proteins in the cerebrospinal fluid (CSF) may be considered as a characteristic feature of some NDs. The measurement of their CSF concentrations, together with neuropsychological examination and neuroimaging, may be useful for diagnosing AD. The collection of CSF samples is performed by lumbar puncture, which is a medical procedure that requires obtaining informed consent from patients. While asymptomatic AD patients have full legal capacity, those with dementia require a legal guardian who will represent them. Thus, the objective of this study is to compare the legal systems regulating the legal capacity issue in the USA, U.K. (England and Wales), Germany, and Poland. These countries have been chosen as examples of three different types of legal orders, according to the sources of law, i.e., civil law, common law, and case law.

(1) Background: An analysis of work-related sharp injuries in Healthcare Workers (HCWs) based at a selected hospital in Central Poland by presenting the frequency of accidents, injury rates, and identifying circumstances of Needle Sticks and Sharp Injuries (NSSI) and giving Post-Exposure Procedures (PEP). (2) Methods: A retrospective analysis of medical documentation regarding work-related NSSI at a district hospital located in central Poland; over the period 2010⁻2017. The study group included HCWs who had an accident while on duty. (3) Results: Most injuries were reported by nurses and staff over 40, on the morning shift. The most common injuries were using a needle. The most exposed part of the body were fingers. The average annual injury rates were: 1.22/100 Nurses; 2.02/100 doctors; 1.34/100 hospital beds; and 8.59/100,000 inpatient days. The rates for 3-year periods, after the implementation of legal regulations were higher than before., Conclusion: Injuries rates are more reliable for comparison than frequency. Legislation on the need to register injuries seems to be necessary. In the supervision of work safety of personnel, reliable reporting of all injuries by the respective HCWs plays a key role.

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community's interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS-though a much more precise and refined treatment than its predecessors-is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of psychosurgery can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS.

According to the projections of the statistical office of the European Union, Eurostat, nearly one third of EU citizens will be at least 65 in 2060. The U.S. population age 65 and older continues to increase and is projected to nearly double from 48 million to 88 million by 2050. Elderly people are especially exposed to neurodegenerative diseases (NDs). The most common ND is Alzheimer's disease (AD), a chronic and progressive disorder with a variety of pathological changes within neuronal tissue, which begin even 10-15 years before the onset of cognitive impairment symptoms. AD is perceived as a disease continuum and considered to include three basic phases: preclinical (asymptomatic) stage, mild cognitive impairment (MCI), and dementia due to AD. A very important issue, from medical and legal perspectives, is the NDs patient's consent to medical procedures, including diagnostic procedures, such as lumber puncture. NDs patients are not always able to express their consent and do not always understand the information provided by a physician. This applies to a group of patients in the final stages of NDs. This paper presents legal regulations of selected European countries and signalizes the U.S. legal solutions on the issue of NDs patients' informed consent to medical procedures.

In December 2015 two different laws were adopted. Both are of importance for palliative care. One of the laws criminalizes commercial, "business-like" assisted suicide (§ 217 German Criminal Code), the other one aims to improve hospice and palliative care in Germany. Through the latter far-reaching changes in Social Code Books V and XI, as well as of the Hospital Finance Act have been made. This new Act to Improve Hospice and Palliative Care (HPG) focuses, amongst others, on: (a) Better funding of hospice services, by raising the minimum grant for patients in inpatient hospices paid per day by the health insurance funds by about 28.5%, and for outpatient hospice services by about 18%; (b) further development of general outpatient nursing and medical palliative care, and the networking of different service providers; (c) introduction of an arbitration procedure for service provider agreements to be concluded between the health insurance funds and the teams providing specialized home palliative care (SAPV); (d) the right to individual advice and support by the health insurance funds; (e) care homes may offer their residents advance care planning programs to be funded by the statutory health insurers; (f) palliative care units in hospitals can be remunerated outside the DRG system by per diem rates; (g) separate funding and criteria for multi-professional palliative care services within a hospital.While little concrete impact on hospice and palliative care can be expected following the new § 217 German Criminal Code, the HPG provides a good basis to improve care. For this purpose, however, which complementary and more concrete agreements are made to put the new legal regulations into practice will be crucial.

Protecting healthcare staff against the risk of infection caused by injuries when using sharp or pointed instruments has been placed - as a special, common and difficult type of "biological risk" - at the centre of attention in the investigations, studies and research conducted by various countries and subjects that have led to a convergence between the results able to influence European and supranational legislation. This convergence of results is headed towards the recognition of the great potential of the role of technology and, more specifically, of the "protection devices" of paramount and essential importance, as "technical measures", over the other, nevertheless important "organisational" and "personal" measures. The national and international results of the studies and research, as well as their corresponding conclusions, deserve special space in this journal, given the supranational legislative recognition they received in Directive 2010/32/EU. Indeed, this latter Directive, set forth and classified, with a system of absolutely mandatory regulations, the "Framework agreement" concluded between the organisations that are most representative of the hospital and healthcare sector for the "prevention of cut and prick injuries". On the basis of the "European Union" treaty, Directive 2010/32/EU must be assimilated in the legal system of all the member States of this "Union" with appropriately sanctioned legal provisions in the event of breach by "employers" and/or "directors". In this sense, with Legislative Decree no. 19 of 2014, Italy introduced a dedicated "criminal offence of danger" for the breach of "prevention" regulations intended to prevent the specific "biological risk" in question, regulations that have been incorporated into Legislative Decree 81/08 - "The Occupational Safety and Health Consolidation Act" with a special "Section" (X bis) dedicated exclusively to them.

In August 2009 and January 2012, two regulations were passed in Germany to limit UV exposure in the general population. These regulations state that no minors are allowed to use tanning devices. Personnel of tanning salons is mandated to offer counseling regarding individual skin type, to create a dosage plan with the customer and to provide a list describing harmful effects of UV radiation. Furthermore, a poster of warning criteria has to be visible and readable at all times inside the tanning salon. It is unclear whether these regulations are followed by employees of tanning salons in Germany, and we are not aware of any studies examining the implementation of the regulations at individual salons. We performed a simulated client study visiting 20 tanning salons in the city-state of Bremen in the year 2014, using a short checklist of criteria derived from the legal requirements, to evaluate whether legal requirements were followed or not. We found that only 20 % of the tanning salons communicated adverse health effects of UV radiation in visible posters and other materials and that only 60 % of the salons offered the required determination of the skin type to customers. In addition, only 60 % of the salons offered to complete the required dosage plan with their customers. To conclude, our results suggest that the new regulations are insufficiently implemented in Bremen. Additional control mechanisms appear necessary to ensure that consumers are protected from possible carcinogenic effects of excessive UV radiation.

Purpose: To identify research gaps and potential research priorities regarding the impact that legal regulations and administrative policies might have on people with spinal cord injury (SCI) living in Switzerland., Method: We conducted semi-structured interviews with 14 healthcare professionals working for or being associated with the largest SCI clinic in Switzerland. The transcribed interviews were content analyzed, involving qualitative description, and thematic analysis techniques., Results: Four interrelated clusters of issues were corroborated: (1) social insurance, (2) caregiving, (3) work integration, and (4) aging. In addition, two overarching themes were identified: (1) fairness considerations and (2) unavailability of systematic empirical evidence. Work capacity assessment and family caregiving were deemed to be the most pressing research priority areas., Conclusions: Legal frameworks do play both a direct and an indirect role in the lives of people with SCI in Switzerland. This is particularly true with regard to various issues related to the social insurance system, such as family caregiving and work capacity assessment. The salience of these topics is closely related to major sociodemographic and political driving forces, i.e. aging and social insurance reforms. Research directly involving people with SCI is needed to further substantiate and refine the findings of this study., Implications for Rehabilitation: When dealing with issues related to work reintegration, aging, social insurance, and caregiving, rehabilitation professionals should take existing legal frameworks into account. Eligibility criteria for disability benefits may influence the therapy motivation of rehabilitation clients.

With society getting older and affected by many diseases, more and more people suffer from severe cognitive disorders. As practice shows, the legal situations of such people is often problematic. This is due to a number of factors, such as short time since the deterioration of patient's condition, initial symptoms ignored, social prejudice towards the idea of incapacitation or taking decisions for a patient, complicated procedures and, sometimes, insufficient knowledge of legal regulations. Cognitive disorders also occur in patients treated for cancer. To be effective, oncological treatment needs to be started as early as possible. This, however, does not meet the criteria of sudden threat to life. The present article relates to both the psychosocial and legal aspects of care of people suffering from intense disorders of memory, attention, problem solving, executive functions, and other. Surely, physicians know how to handle patients with the above dysfunctions. However, legal procedures aimed to protect patients' rights are often unclear and time consuming. In practice, this often amounts to a dilemma whether to treat or follow the applicable law. Certainly, solutions in this regard should be clearer and better adapted to the needs arising from specific treatment needs of particular groups of patients.