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El presente trabajo únicamente pretende invitar a la reflexión sobre la gestión en de la actual crisis sanitaria en nuestro país. Para ello he realizado una sucinta explicación de la principal normativa sanitaria aplicable poniendo de manifiesto tanto los medios existentes en nuestra legislación sanitaria ordinaria para hacer frente a esta crisis como su desplazamiento por un Derecho de excepción, los principales problemas jurídicos que esto ha supuesto y los mecanismos existentes para su control. Finalmente, expongo las conclusiones obtenidas buscando hacer hincapié en aquellos problemas y necesidades detectados. The purpose of this essay is only intended to invite reflection on the management of the health crisis in our country. For this, I have made a brief explanation of the main applicable health regulations, highlighting both the main means we have at our disposal to deal with it, as well as the displacement of ordinary health legislation by an exception legislation, the legal problems that this has entailed and the existing mechanisms for its control. Finally, I present the conclusions obtained, seeking to emphasize those problems and needs detected

The EU plant health legislation enforces the implementation of intensive surveillance programs for quarantine pests. After an outbreak, surveys are implemented to delimit the extent of the infested zone and to manage disease control. Surveillance in agricultural and natural environments can be enhanced by increasing the survey efforts. Budget constraints often limit inspection and sampling intensities, thus making it necessary to adapt and optimize surveillance strategies. A sequential adaptive delimiting survey involving a three-phase and a two-phase design with increasing spatial resolution was developed and implemented for the Xylella fastidiosa demarcated area in Alicante, Spain. Inspection and sampling intensities were optimized using simulation-based methods. Sampling intensity thresholds were evaluated by quantifying their effect on the estimation of X. fastidiosa incidence. This strategy made it possible to sequence inspection and sampling taking into account increasing spatial resolutions, and to adapt the inspection and sampling intensities according to the information obtained in the previous, coarser, spatial resolution. The proposed strategy was able to efficiently delimit the extent of Xylella fastidiosa, while improving on the efficiency and maintaining the efficacy of the official survey campaign. From a methodological perspective, our approach provides new insights into alternative delimiting designs and new reference sampling intensity values

Increasingly, data are collected by companies that provide direct-to-consumer personal genomic tests, yet the existing health legislation covering the use of these data is lagging far behind in the USA.

On 19 June 2019 the Voluntary Assisted Dying Act 2017 (Vic) came into effect, making Victoria the first state in Australia to permit the practice of 'voluntary assisted dying'. As defined in the legislation, voluntary assisted dying refers to "the administration of a voluntary assisted dying substance and includes steps reasonably related to such administration", "for the purpose of causing a person's death". In essence, the model of voluntary assisted dying established in Victoria is designed for patients within the final weeks or months of life, who may receive medical-assistance to 'choose the manner and timing of their death'. The purpose of this paper is to overview the clinical implementation of voluntary assisted dying in Victoria, attending to three broad challenges: balancing tensions in policy goals and ensuring the legislated 'safeguards' function as intended, translating the complex legislation into clinical practice, and managing conscientious objection to voluntary assisted dying. While there is somewhat limited information available regarding the practice of voluntary assisted dying in Victoria, available data and anecdotal reports indicate the implementation of the state's complex model of voluntary assisted dying has not been without challenges, particularly in terms of balancing the legislated 'safeguards' and patient access to voluntary assisted dying, and translating aspects of the complex legislation into clinical practice. The release of more systematic voluntary assisted dying data by the state, alongside independent research into the operation of voluntary assisted dying, is necessary to better evaluate the implementation and impact of voluntary assisted dying as a new component of clinical practice.

The use of falsified and unregistered drugs is a worldwide public health problem. Because these global market products usually do not follow the Good Manufacturing Practices required by health legislation, its composition may be completely different from the original or may contain relevant concentrations of impurities and toxic contaminants. Since anabolic steroids are among the main irregular therapeutic classes seized in Brazil, here we propose a new methodology for analyzing these products, in tablets form, using Attenuated Total Reflection Fourier Transform Infrared Microspectroscopy (µATR-FTIR) mapping. Spectra were acquired from solid tablets by attenuated total reflection, through point mapping methodology. In data processing, a characteristic absorption band for each Active Pharmaceutical Ingredient (API) was integrated and plotted to create its distribution map. This technique was applied in an unprecedented way for the forensic analysis of anabolic steroids and proved to be effective in distinguishing falsified products based on the detection of their APIs. It was possible to detect APIs in 26 out of 30 samples, five of which were classified as falsified only through µATR-FTIR analysis. We were able to create distribution maps of the detected substances associating the microspectroscopic results with characteristic band integration method, which can be used to detect substances and to study samples' homogeneity. We concluded that this methodology is promising for the analysis of anabolic steroid tablets, and can be used in a complementary way with techniques already consolidated in forensic laboratory routine for a better classification of questioned samples between authentic and falsified ones.

Introdução:A gestão da qualidade em serviços de hemoterapia é um elemento crucial para a segurança transfusional. A implementação das atividades de gerenciamento da qualidade é um desafio no contexto brasileiro. Objetivo: Avaliar o efeito de um ciclo de melhoria nos serviços de hemoterapia do interior do Rio Grande do Norte, na conformidade com os critérios de gestão da qualidade, elaborados com base no Método de Avaliação de Risco Potencial em Serviços de Hemoterapia (MARPSH). Método: Estudo quase-experimental, antes e depois, que avaliou 13 critérios de qualidade, elaborados com base no MARPSH da Agência Nacional de Vigilância Sanitária. Participaram do estudo oito serviços de hemoterapia do interior do estado do Rio Grande do Norte, sendo quatro Agências Transfusionais, duas Unidades de Coleta e Transfusão e dois Hemocentros Regionais. Estatísticas descritivas e gráficos de Pareto foram utilizados. Resultados: Observou-se redução de 36,4% dos problemas de qualidade após a realização do ciclo de melhoria. Na análise por serviço, houve um aumento no cumprimento dos critérios variando entre 7,0% e 50,0%. A implementação de protocolos, os procedimentos de auditoria interna e o monitoramento da qualidade foram os critérios que registraram relativamente uma maior adesão após a intervenção, todavia permaneceram como as principais causas de não conformidades, tanto antes quanto após a intervenção. Conclusões: O ciclo de melhoria demonstrou ser uma intervenção válida no aumento da adesão dos serviços às atividades de gestão da qualidade preconizadas pela legislação sanitária, tendo a Vigilância Sanitária um importante papel para alcance dos padrões estabelecidos Introduction: Quality management in hemotherapy services is a crucial element for transfusion safety. However, the implementation of quality management is still a challengein the Brazilian context. Objective:To evaluate the effect of a cycle of improvement in hemotherapy services in the interior of Rio Grande do Norte, in compliance with the quality management criteria, elaborated based on the Potential Risk Assessment Method in Hemotherapy Services. Method:Quasi-experimental study, before and after, that verified the compliance of 13 quality criteria, elaborated based on the Potential Risk Assessment Method in Hemotherapy Services. Eight hemotherapy services from the interior of the state of Rio Grande do Norte participated in the study, being four Transfusion Agencies, two Collection and Transfusion Units and two Regional Blood Centers. Descriptive statistics and Pareto charts wereused to analyze the quality criteria. Results: After the improvement cycle, there was a 36.4% reduction in noncompliance. In the analysis by service, there was an increase in compliance with the criteria, varying between 7% and 50%. The implementation of protocols, internal audit procedures and quality monitoring were the criteria that registered relatively greater adherence after the intervention, however they remained the main causes of non-conformities, both before and after the intervention. Conclusions: The improvement cycle proved to be a valid intervention in increasing the adherence of services to the quality management activities recommended by health legislation, with health surveillance having an important role in reaching the established standards

The presence of insects and other animals in health environments is characterized as a health risk, since it can bring problems to the environment, professionals and users. Thus, the present study was designed with the objective of analyzing the control and prevention measures of pests and vectors in the hemotherapy service of the Regional Blood Center of Arapiraca/AL (HEMOAL); talk about the understanding of management / supervision about the problem, health legislation and preventive coping measures adopted by the service. We conducted a bibliographic and field research. Field research using a questionnaire with the quality management and supervision of the Hemocentro de Arapiraca. With the study it was possible to verify that in the researched institution there is a concern and knowledge about pests and vectors, that the management / supervision of the blood center seeks to follow the health legislation, as well as, that coping and prevention strategies are developed, in the blood center routine, in order to keep the institution free from possible infestations. KEYWORD: Entomology, Health Surveillance, Dedetization. RESUMO: A presença de insetos e outros animais em ambientes de saúde caracteriza-se como um risco para a saúde, uma vez que pode trazer problemas ao ambiente, aos profissionais e aos usuários. Assim, idealizou-se o presente estudo tendo como objetivo analisar o controle e as medidas de prevenção de pragas e vetores no serviço de hemoterapia do hemocentro Regional de Arapiraca/AL (HEMOAL); discorrer sobre o entendimento da gestão/supervisão acerca da problemática, das legislações sanitárias e as medidas de enfrentamento de caráter preventivo adotadas pelo serviço. Realizamos uma pesquisa bibliográfica e de campo. A pesquisa de campo utilizando um questionário junto à gestão de qualidade e supervisão do Hemocentro de Arapiraca. Com o estudo foi possível verificar que na instituição pesquisada existe uma preocupação e conhecimentos sobre pragas e vetores, que a gestão/supervisão do hemocentro procura seguir as legislações sanitárias, bem como, que são desenvolvidas estratégias de enfrentamento e prevenção, na rotina do hemocentro, com o objetivo de manter a instituição livre de possíveis infestações. PALAVRAS-CHAVE: Entomologia, Vigilância Sanitária, Dedetização.

Background: Several studies have reported differential vaccine uptake outcomes that are associated with sociodemographic and socioeconomic characteristics, as well as provider type. However, none has examined a trend over a multiple-year span. In this study, we utilize a longitudinal data-based approach to examine state-level human papillomavirus (HPV) vaccine trends and their influences over time. Methods: We analyzed National Immunization Survey – Teen data (2008–2016) to estimate HPV vaccine initiation rate in young female adolescent ages 13–17 years old among U.S. States. We identified growth patterns using the latent class growth method and explored state-level characteristics, including socioeconomic and sociodemographic attributes, and health legislation and policy-related programs among patterns. Results: We identified three growth patterns, which showed gradually increasing vaccination trends but different baseline HPV uptake rates (high, moderate, low). States within Pattern 1 (highest HPV vaccination rates) included the lowest percentage of families with incomes below federal poverty level, the highest percentage of bachelor's degree or higher, and the lowest number of uninsured, while states within Pattern 3 (lowest HPV vaccination rates) included families with socioeconomic attributes along the opposite end of the spectrum. Conclusions: Latent class growth models are an effective tool to be able to capture health disparities in heterogeneity among states in relation to HPV vaccine uptake trajectories. Impact: These findings might lead to designing and implementing effective interventions and changes in policies and health care coverage to promote HPV vaccination uptake for states represented under the lowest trajectory pattern.

RESUMO O consumo de suplementos alimentares vem aumentando consideravelmente, destacando-se o whey protein. Visto que muitos consumidores fazem suas escolhas através do rótulo do produto, é importante que este esteja adequado e com informações claras e de bom entendimento. Para isso, existem órgãos responsáveis por fiscalizar se as informações presentes estão de acordo com a norma e assim ofertar produtos seguros e de qualidade aos consumidores. Este estudo teve como objetivo avaliar a adequação dos rótulos de suplementos alimentares whey protein comercializados em Fortaleza, Ceará. Aplicou-se um check list baseado na Resolução da Diretoria Colegiada nº 243/2018 em 51 rótulos de suplementos, avaliados em cinco lojas especializadas em produtos nutricionais, sendo excluídos produtos com data de fabricação anterior a julho de 2018 e em idioma estrangeiro sem tradução. Os rótulos analisados foram de 29 marcas diferentes, sendo 25 (92%) de fabricação nacional e quatro (8%) importados. Foram encontradas não conformidades nos parâmetros analisados referentes à formatação da disposição e ao aspecto de caracteres da designação do produto, tais como cor contrastante com o fundo do rótulo, legibilidade da designação, localização da designação do produto, designação em negrito e designação complementada com a fonte do nutriente da qual foi extraído e do modo de uso. Além disso, muitos produtos analisados não apresentaram informações sobre a conservação após a abertura da embalagem. Em relação à designação do produto “suplemento alimentar”, apenas dois (4%) estavam adequados. Os achados deste estudo mostram que a rotulagem de suplementos whey protein não está adequada à legislação vigente e que a indústria demora um tempo para adequar seus rótulos às novas resoluções. ABSTRACT The consumption of food supplements has increased considerably, especially whey protein. Since many users make their choices through the product label, it is important that this information may be transparent for good understanding. For this, there are responsible actors for overseeing whether the information is in accordance with the standard and thus offering safe and quality products to consumers. This study aimed to evaluate the labelling adequacy of whey protein food supplements sold in Fortaleza, in the state of Ceará/BR. A checklist based on Collegiate Board Resolution number 243/2018 was applied to 51 supplement labels, obtained from five stores specializing in nutritional products, thus excluding products with manufacturing data prior to July 2018 and with a foreign language without translation. The identifying labels were obtained from 29 different brands, 25 (92%) of which were domestically manufactured and four (8%) were imported. Non-conformities were found in the layout related parameters and the characters appearance with respect to the product designation, such as background color contrast in the label, designation readability, location of the product designation, boldface designation and designation complemented with the nutrition font from which it was extracted and the method of use. In addition, many filtered products did not contain information about conservation after opening the package. Regarding the product designation “food supplement”, only two (4%) products were suitable. The findings of this study showed that the labelling adequacy of whey protein supplements was not adequate to current legislation and that the industry will take time to adapt its labels to the new resolutions.

The health policy of Primo de Rivera elaborated a regulatory legal body to protect the needy classes that attended to their needs; the increase in health activity led to the creation of a large number of care institutions as well as professional health professionals involved in its development. Objectives: the research aims to analyze the practical application of the municipal Health and Welfare Regulations of the city of 1928 and, on the other hand, its impact on the social life of the underprivileged class. Method: a historical research based on the literature review was carried out. Documentary sources: documentary catalogs of libraries and documentary archives, electronic databases, catalogs of magazines specializing in history and other online sources. Descriptors used: midwife, practitioner, doctor, pharmacist, census of the poor. Results: documents from studies based on primary sources were included in the analysis and the results are presented in 4 sections: The Municipal Regulation of 1928, Pharmacists and medicines for poor patients, Doctors and practitioners and Midwives, midwives and childbirth teachers. Conclusion: the Regulation is applied long before its publication and health care is constantly exercised by all the professionals that comprise it; the number of practitioners is equal to that of doctors in this period; the City Council is responsible for paying pharmaceuticals for poor patients to pharmacists and is distributed by quarters; With regard to doctors, and since 1924, sufficient places have been created for the demand of the poor, which will increase, as well as possible substitutes; the creation of the dental clinic for the poor in the Santo Hospital in 1930 is included; in 1928 and 1929 there are 4 matrons for the four districts of the city, following the legislation; In 1930 the municipal midwives received an annual salary increase from 720 to 900 pesetas from the town council. La política sanitaria de Primo de Rivera elaboró un cuerpo legal reglamentario para proteger a las clases menesterosas que atendía sus necesidades; el aumento de la actividad sanitaria supuso la creación de un gran número de instituciones asistenciales así como de sanitarios profesionales implicados en su desarrollo. Objetivos: la investigación tiene por objetivos analizar la aplicación práctica del Reglamento municipal de Sanidad y Beneficencia de la ciudad de 1928 y, por otra parte, su repercusión en la vida social de la clase menesterosa. Método: se llevó a cabo una investigación histórica basada en la revisión bibliográfica. Fuentes documentales: catálogos documentales de bibliotecas y archivos documentales, bases de datos electrónicas, catálogos de revistas especializadas en historia y otras fuentes de red. Descriptores utilizados: matrona, practicante, médico, farmacéutico, padrón de pobres. Resultados: en el análisis se incluyeron documentos procedentes de estudios basados en fuentes primarias y los resultados se presentan en 4 apartados: El Reglamento municipal de 1928, Farmacéuticos y medicamentos para enfermos pobres, Médicos y practicantes y Matronas, comadronas y profesoras de partos. Conclusión: el Reglamento se aplica mucho antes de su publicación y la asistencia sanitaria es ejercida de manera constante por todos los profesionales que la integran; el número de practicantes se equipara al de médicos en este período; el Ayuntamiento se hace cargo del pago de medicamentos para enfermos pobres a los farmacéuticos y se reparte por trimestres; respecto a los médicos, y desde 1924, se van creando plazas suficientes para la demanda del padrón de pobres, que irá en aumento, así como posibles suplentes; se incluye la creación del gabinete odontológico para pobres en el Santo Hospital en 1930; en 1928 y 1929 hay 4 matronas para los cuatro distritos de la ciudad, siguiendo la legislación; en 1930 las matronas municipales reciben un aumento de sueldo anual de 720 a 900 pesetas por parte del ayuntamiento. A política de saúde de Primo de Rivera elaborou um órgão legal regulador para proteger as classes carentes que atendiam às suas necessidades; O aumento da atividade de saúde levou à criação de um grande número de instituições assistenciais, bem como de profissionais de saúde envolvidos no seu desenvolvimento. Objetivos: a pesquisa visa analisar a aplicação prática do Regulamento Municipal de Saúde e Previdência da cidade de 1928 e, por outro lado, seu impacto na vida social da classe menos favorecida. Método: foi realizada uma pesquisa histórica com base na revisão de literatura. Fontes documentais: catálogos documentais de bibliotecas e arquivos documentais, bases de dados eletrônicas, catálogos de revistas especializadas em história e outras fontes online. Descritores utilizados: parteira, praticante, médico, farmacêutico, censo dos pobres. Resultados: foram incluídos na análise documentos de estudos baseados em fontes primárias e os resultados são apresentados em 4 seções: O Regulamento Municipal de 1928, Farmacêuticos e medicamentos para doentes pobres, Médicos e praticantes e Parteiras, parteiras e professoras de parto.Conclusão: o Regulamento é aplicado muito antes de sua publicação e a assistência à saúde é exercida constantemente por todos os profissionais que o compõem; o número de praticantes é igual ao de médicos nesse período; a Câmara Municipal é responsável pelo pagamento dos medicamentos dos doentes pobres aos farmacêuticos e é distribuído por trimestres; No que diz respeito aos médicos, e desde 1924, foram criadas vagas suficientes para a procura dos pobres, que irá aumentar, bem como eventuais substitutos; inclui-se a criação da clínica odontológica para pobres no Hospital Santo em 1930; em 1928 e 1929 há 4 matronas para os quatro bairros da cidade, seguindo a legislação; Em 1930, as parteiras municipais receberam um aumento salarial anual de 720 para 900 pesetas da câmara municipal.

A constitutional expert opinion, which reviews the social and constitutional foundations of tobacco cessation within the framework of statutory health insurance in Germany, comes to the conclusion that the legislator must release the reimbursement of professional tobacco cessation as a curative service by the statutory health insurance – and not only as a subsidy for a psychotherapeutically oriented measure within the framework of prevention.

The frequency of legislation changes and their utility is a subject of interest and always under debate with pro and contra arguments. In the current study, the perception of students regarding medical legislation changes was analyzed. In general, no statistically significant differences were found between the sub-groups of students, thus underlining a unitary perception. The general perception is that changes in legislation are made too often. Moreover, only a small part of the analyzed group agrees on the utility of these changes. Finally, it seems that income is the main driver for students as future employees in the medical system. Also, significant differences between males and females’ perceptions are emphasized, and legislation changes should take into account the primary drivers. Other issues, such as corruption, stability, and performances should be the key points in legislation changes. These results should be a challenge for all stakeholders, in particular for policymakers.

Legal protection is the right to acquire justice, regularity, provision, usefulness and convenience to the rights of individuals or groups in the eyes of the law. This research discusses the protection of the patient's law when receiving health care services in Dr. Slamet Garut Hospital which is studied at the rules of consumer protection and health legislation with the aim to know how the legal protection Patients and their implementation in healthcare services and fulfilling the rights of patients by health and hospital personnel. Techniques used quantitative descriptive, univariate analysis, sample number 97 respondents, data was taken using a question sheet and the results showed that most of the respondents (66.0%) Patient's legal protection is fulfilled and nearly half the respondent (34.0%) Patient legal protection is not met. There should be a strategy or effort from the hospital to further improve the legal protection aspect of the patient in order to obtain appropriate services to the patient, so that the patient's legal protection can be fully fulfilled.

The main objective of this study is to analyse the background and knowledge of Spanish dentists and stomatologists registered in Alicante, Castellón and Valencia, the three provinces that make up the Valencian Community, with regard to forensic dentistry and the current Spanish health legislation and regulations, and to try to quantify the relationship between level of training, specialisation, work experience, position and workplace, and degree of knowledge.An anonymous survey was designed and validated, consisting of thirty-three multiple-choice questions. The survey included questions regarding their professional background and key questions regarding current dental law, forensic science and expertise. Members' level of knowledge of legal and forensic dentistry, health legislation and regulations in the Valencian Community is moderate, with only 63% of the questions answered correctly. Neither their level of education nor work experience correlates significantly with their degree of knowledge. Dentists specialising in General and Aesthetics Dentistry were found to be more knowledgeable about ethical issues. Regarding the workplace, those working as university teachers tended to stand out from the other professionals in terms of legal and ethical knowledge whilst self-employed and employee dentists show a lower level of knowledge than the rest of the sample.The conclusions obtained from this study highlight the need for dentists to complete and update their knowledge of forensic science and current health legislation, as having proper knowledge is a means of avoiding possible legal problems, which not only means better legal protection for the dentist but is also a means of guaranteeing adequate patient care.

Background: The main objective of this study is to analyse the background and knowledge, attitudes and practices of Spanish dentists and stomatologists registered in Alicante, Castellón and Valencia, the three provinces that make up the Valencian Community, with regard to current Spanish health legislation and regulations, and to try to quantify the relationship between level of training, specialisation, work experience, position and workplace, and degree of knowledge. Methods: An anonymous survey was designed, consisting of thirty-three multiple-choice questions, checked beforehand by a statistician and validated by nine dentists and stomatologists from different specialisations, via an online platform called SurveyMonkey®. The validated survey included questions regarding their professional background and key questions regarding current dental law and expertise. The link and QR code (Quick Response) for taking the survey was sent via the official email address of each province's College of Dentists and Stomatologists, so that members could take the survey online for a limited period of time. Results: Members' level of knowledge of health legislation and regulations in the Valencian Community is moderate, with only 63% of the questions answered correctly. Neither their level of education nor work experience correlates significantly with their degree of knowledge. Dentists specialising in General and Aesthetics Dentistry were found to be more knowledgeable about ethical issues. Regarding the workplace, those working as university teachers tended to stand out from the other professionals in terms of legal and ethical knowledge whilst self-employed and employee dentists show a lower level of knowledge than the rest of the sample. Conclusions: The conclusions obtained from this study highlight the need for dentists to complete and update their knowledge of current health legislation, as having proper knowledge is a means of avoiding possible legal problems, which not only means better legal protection for the dentist but is also a means of guaranteeing adequate patient care.

Recientemente hemos conocido una decisión judicial, en relación con un paciente nonagenario COVID-19, que resulta absolutamente clarificadora respecto a la siempre compleja cuestión de los internamientos y tratamientos involuntarios de las personas mayores. El órgano judicial autorizó el internamiento involuntario, pero por el contrario denegó la posibilidad de imponer un tratamiento médico en contra de la voluntad del paciente. Esta situación invita a revisar los diferentes tipos de internamiento involuntario que prevé nuestro ordenamiento jurídico y cómo se regula el tratamiento médico involuntario en función de su finalidad y de la capacidad del paciente para decidir, permitiéndose desde la ausencia de consentimiento a la posibilidad del consentimiento por representación. En el ámbito de la salud pública, el elemento determinante para poder imponer cualquier medida sanitaria en contra de la voluntad del paciente es, única y exclusivamente, el riesgo para la salud de la población. En el caso presentado, el órgano judicial rechaza la posibilidad autorizar el tratamiento médico por no aportar nada desde el punto de vista de la salud pública a los intereses de terceros. Sin embargo, sí autoriza el internamiento involuntario por ser esencial para garantizar el aislamiento.

Traditionally, the turning point in the fight against tuberculosis is perceived as Robert Koch’s description of the bacterium in 1882. In Norway, the legislation from 1900 has been interpreted as a breakthrough. However, how was tuberculosis understood by doctors in Kristiania in the latter half of the 19th century? As it appears in Norsk Magazin for Lægevidenskaben – the country's most important medical journal – the term was far from unambiguous and precise. During the period 1840-1900, three forms of understanding dominate: tuberculosis as hereditary, something which arose spontaneously from imbalance or as a disease mediated through infection. Throughout the period, tuberculosis was absent in the journal's infectious disease tables. Furthermore, the effective fight against the disease met resistance. Opposition expressed itself through liberal arguments: measures were terrorism and threats to personal freedom. The opposition to fighting tuberculosis was also based on scepticism towards bacteria as pathogens. There are grounds for claiming that “tuberculosis” did not exist in Kristiania – a parallel to Bruno Latour’s pointing out that Pharaoh Ramses could not have had tuberculosis, despite the fact that French doctors recently have detected the disease in his mummy. The Egyptians did not know tuberculosis 3,000 years ago.

The Medicare Secondary Payer Act of 1980 and its subsequent amendments require that insurers and self-insured companies report settlements, awards, and judgments that involve a Medicare beneficiary to the Centers for Medicare and Medicaid Services. The parties then may be required to compensate CMS for its conditional payments. In a simple settlement model, this makes settlement less likely. Also, the reporting delays and uncertainty regarding the size of these conditional payments are likely to further frustrate the settlement process. We provide results, using data from a large insurer, showing that, on average, implementation of the MSP reporting amendments led to a delay in the resolution of disputes involving auto accidents of about six months.

This report examines the experiences of Small Island Developing States in the Caribbean- Barbados, Dominica, Jamaica, and in the Pacific- Fiji, Nauru, and Tonga with specific governmental regulatory measures to reduce the risk of obesity and associated diet-related chronic noncommunicable diseases (NCDs), as well as the obstacles and opportunities encountered. Guided by the diet-related indicators of the World Health Organization (WHO) Noncommunicable Diseases Progress Monitor 2017, the authors reviewed legislation, country reports, articles, and the databases of WHO and the World Trade Organization to identify relevant regulatory measures and to establish the extent of implementation in the selected countries. Obesity prevalence ranged from 25.9% in Dominica to 41.1% in Tonga. The principal diet-related measures implemented by the selected countries were fiscal measures, such as sugar-sweetened beverage taxes and import duties to encourage greater consumption of healthy foods. Governmental action was weakest in the area of restrictions on marketing of unhealthy foods. If they are to reduce their current high rates of obesity and associated NCDs, Caribbean and Pacific states need to intensify implementation of diet-related regulatory measures, particularly in the area of marketing of unhealthy foods and beverages to children. Key implementation challenges include financial and staffing constraints and the need for increased political will to counter industry opposition and to allocate adequate financial resources to keep advancing this agenda.Este es un informe sobre las experiencias de Barbados, Dominica, Jamaica, Fiji, Nauru y Tonga con medidas gubernamentales regulatorias específicas dirigidas a reducir el riesgo de obesidad y enfermedades no transmisibles relacionadas con la dieta y resaltar los obstáculos y oportunidades relacionados con ellas. Guiados por los indicadores relacionados con la dieta establecidos en el Monitoreo de Avances en materia de las Enfermedades no Transmisibles 2017 de la Organización Mundial de la Salud (OMS) se revisó la legislación, los informes de los países, artículos, y las bases de datos de la OMS y la Organización Mundial de Comercio para identificar las medidas regulatorias pertinentes y establecer el alcance de su implementación en los países seleccionados.La prevalencia de obesidad osciló entre el 25,9% en Dominica y el 41,1% en Tonga. Las principales medidas relacionadas con la dieta implementadas por los países seleccionados fueron medidas fiscales, como los impuestos a las bebidas azucaradas y los aranceles de importación, para alentar un mayor consumo de alimentos saludables. La acción gubernamental fue más débil en el área de restricciones en el marketing de alimentos poco saludables. Para reducir las actuales altas tasas de obesidad y enfermedades no transmisibles asociadas, los estados del Caribe y del Pacífico deben intensificar la implementación de medidas regulatorias relacionadas con la dieta, en particular en el área del marketing de alimentos y bebidas poco saludables para los niños. Los desafíos clave de la implementación incluyen limitaciones financieras y de personal y la necesidad de una mayor voluntad política para contrarrestar la oposición de la industria y asignar recursos financieros adecuados para seguir avanzando en esta agenda.Este é um relatório sobre as experiências de Barbados, Dominica, Jamaica, Fiji, Nauru e Tonga com medidas específicas reguladoras do governo destinadas a reduzir o risco de obesidade e doenças não transmissíveis associadas (DNTs) relacionados à dieta e destacar os obstáculos e oportunidades que estimulam um maior uso dessas medidas. Guiados pelos indicadores relacionados à dieta estabelecido no Monitoramento de Progresso das Doenças Não Transmissíveis 2017 da Organização Mundial da Saúde (OMS), revisamos a legislação, os relatórios dos países, artigos, e as bases do dados da OMS e da Organização Mundial do Comércio para identificar as medidas reguladoras relevantes, visando reduzir o risco de obesidade e as DNTs associadas, e estabelecer o escopo de sua implementação nos países selecionados.A prevalência de obesidade variou de 25,9% na Dominica a 41,1% em Tonga. As principais medidas relacionadas à dieta implementadas pelos países selecionados foram medidas fiscais, como impostos sobre bebidas açucaradas e tarifas de importação, para incentivar maior consumo de alimentos saudáveis. A ação do governo foi mais fraca na área de restrições à comercialização de alimentos não saudáveis. Para reduzir as atuais altas taxas de obesidade e doenças não transmissíveis associadas, os países do Caribe e do Pacífico devem intensificar a implementação de medidas reguladoras relacionadas à dieta, particularmente na área da comercialização de alimentos e bebidas não saudáveis para crianças. Os principais desafios da implementação incluem restrições financeiras e de pessoal e a necessidade de maior vontade política para combater a oposição da indústria e alocar recursos financeiros adequados para continuar avançando nesta agenda.

The paper aims to contribute as a reflection on the public production of medicines in Brazil. Public producers present themselves as strategic in Brazil, either as price regulators, in meeting the demands of the Ministry of Health (MoH) on neglected products and those at risk of shortage to SUS. The study used the official bases of the MoH, National Health Surveillance Agency (ANVISA) and Website of Official Pharmaceutical Laboratories (OPL). Thirty-three OPL were identified, 16 with active production of drug registration at ANVISA. For the remaining 17 LFOs, no one identified active portfolio in the bases surveyed. There are 80% of the OPL portfolio concentrated in the first level of the Anatomical Therapeutic Chemical Classification, such as alimentary tract and metabolism, blood and blood forming organs, cardiovascular system, anti-infective for systemic use and nervous system. The OPL participation in the health complex is 48.6% of its portfolio dedicated to the strategic component, 30.6% for primary care and 20.7% for the specialized. It concludes the relevance of the OPL for the Brazilian health policy, with the better realignment of their potential in the face of technological advancement, health legislation, drug dependence and new treatment protocols.

The use of medicinal plants for the treatment of diseases is an old practice and is widely used. However, many products are still marketed without the necessary quality. This study aimed to evaluate the organoleptic characteristics, presence of foreign material, packaging and labeling of plant drugs marketed for the control of diabetes. Comercial samples of cavalinha, jambolão and pata-de-vaca sold in two municipalities in southeastern Brazil were acquired. The analyses of the packaging and labels were performed based on Resolutions of the Collegiate Board of Directors of the Brazilian National Health Surveillance Agency (RDC No. 26/2014 and RDC No. 66/2014). The Brazilian Pharmacopoeia VI was used to guide the preparation of a sensory evaluation questionnaire and analysis of foreign material. None of the samples complied with the packaging requirements. Approximately 69% of the samples failed the sensory analysis. Regarding the analysis for the presence of foreign material, only sample J1 of jambolão was within the 2% w/w limit, as established in the Brazilian Pharmacopoeia. Based on simple and primary quality control analyses, it is concluded that the analyzed plant drugs are not in accordance with Brazilian legislation, putting the health of consumers of these teas at risk. El uso de plantas medicinales para tratar enfermedades es una práctica antigua. Sin embargo, todavía se comercializan muchos productos sin la calidad necesaria. El objetivo fue evaluar las características organolépticas, la presencia de material extraño, el envasado y etiquetado de los medicamentos vegetales comercializados para el control de la diabetes. Se vendieron muestras comerciales de “cavalinha”, “jambolão” y “pata-de-vaca” en dos municipios del sureste de Brasil. Los análisis de los envases y etiquetas se realizaron en base a las Resoluciones del Consejo Colegiado de la Agencia Nacional de Vigilancia Sanitaria (RDC No. 26/2014 y RDC No. 66/2014). Se utilizó la Farmacopea Brasileña VI para orientar la elaboración de un cuestionario de evaluación sensorial y análisis de material extraño. Ninguna de las muestras cumplió con las especificaciones técnicas requeridas para el empaque. Aproximadamente el 69% de las muestras fallaron en el análisis sensorial. En cuanto al análisis de presencia de material extraño, solo la muestra J1 de “jambolão” estuvo dentro del límite de 2% p / p recomendado. A partir de análisis simples y primarios de control de calidad, se concluye que los medicamentos vegetales analizados están en desacuerdo con la legislación brasileña, poniendo en riesgo la salud de los consumidores. O uso de plantas medicinais no tratamento de doenças é uma prática antiga e amplamente utilizada. Porém, muitos produtos ainda são comercializados sem a qualidade necessária. O objetivo deste estudo foi avaliar as características organolépticas, a presença de material estranho, embalagem e rotulagem de drogas vegetais comercializadas para o controle da diabetes. Foram adquiridas amostras comerciais de “cavalinha”, “jambolão” e “pata-de-vaca” comercializadas em dois municípios do sudeste brasileiro. As análises das embalagens e rótulos foram realizadas com base nas Resoluções de Diretoria Colegiada da Agência Nacional de Vigilância Sanitária (RDC n⁰ 26/2014 e RDC n⁰ 66/2014). A Farmacopéia Brasileira VI foi utilizada para orientação da elaboração de questionário de avaliação sensorial e análise de material estranho. Nenhuma das amostras apresentou conformidade com as especificações técnicas exigidas para as embalagens. Cerca de 69% das amostras foram reprovadas na análise sensorial. Com relação à análise de pureza por presença de material estranho, apenas a amostra J1 de “jambolão” ficou dentro do limite de 2% p/p estabelecido na Farmacopéia Brasileira VI. A partir de análises simples e primárias de controle de qualidade, conclui-se que as drogas vegetais analisadas estão em desacordo com a legislação brasileira, o que coloca em risco a saúde dos consumidores destes chás.

The current and growing construction industry in the country has led to increasing of accidents related to construction workers. In an attempt to decrease accidents on site, the design safety concept is the most suitable measures to date. Though the impact is evident and potential benefits of its implementation are apparent, widespread application of this intervention in the Malaysia’s construction industry is currently lacking especially in the academic sector. Therefore, this paper aims to explore the integration of safety and health to the current curricula focusing on the engineering programmes and their perceptions towards design safety concept and its implementation. The types of design disciplines included in the research study were limited to academicians. A total of 72 respondents received via questionnaire and the responses were scored on a 5-point Likert Scale to express their level of agreement. The results show that the graduates are not equipped with adequate knowledge of safety and health legislation and regulations through the current curricula and disagree that the content of the programmes is adequate. Although majority agree on the positive effect of design safety towards accidents on site, there is still minority who believe that the concept has no significant effect towards site safety. However, this paper concludes that there is no major impediment from the academic sector on the implementation and integration of design safety concept to the undergraduate curricula. The implementation of design safety should be in a well organized structure for effective results towards zeroaccident as well as increases the designers’ value in the construction industry.

The countries of the Western Balkans region, which are still outside the European Union (EU) but have expressed their intention to join the Community, need to harmonize their legislation with that of the EU. In this overview, we present some aspects of the process of harmonization of public health and drug policies that need to be improved in order to comply with European health legislation.

Background: The rising prevalence of disability due to noncommunicable diseases and the aging process in tandem with under-prioritization and underdevelopment of rehabilitation services remains a significant concern for European public health. Over recent years, health system responses to population health needs, including rehabilitation needs, have been increasingly acknowledging the power of law and formal written policies as strategic governance tools to improve population health outcomes. However, the contents and scope of enacted legislation and adopted policies concerning rehabilitation services in Europe has not been synthesized. This paper presents a concise overview of laws and policies addressing rehabilitation in five European countries. Methods: Publicly available laws, policies, and national action plans addressing rehabilitation issues of Sweden, Italy, Germany, the Netherlands and the United Kingdom were reviewed and descriptive documents analyzed. Actions found in national health policies were also evaluated for compliance with the key recommendations specified in the World Health Organization’s Rehabilitation 2030: Call for Action. Results: Across countries, legal and policy approaches to rehabilitation planning varied in scope and reach. While all countries entitle citizens to rehabilitation services, comprehensiveness of coverage varied. Health legislation of Germany and Netherlands recognizes access to rehabilitation as a human right for persons with disabilities, while Sweden and the United Kingdom acknowledge its importance in disability laws for achieving substantive equality for persons with disabilities. Regarding policies, in all countries but Italy, targeted universalism remains the predominant strategy governing rehabilitation services, as demonstrated by the lack of comprehensive, national action plans for rehabilitation addressing the general population. Nevertheless, references found in disease specific policies indicate a solid consensus that rehabilitation remains an integral component of the care continuum for those experiencing disability. Conclusion: Although a universal approach to rehabilitation coverage is institutionalized in national legislation of the countries examined, this approach is not expressed in formal policies. Targeted strategies aiming to ensure access to subpopulation groups with higher perceived needs for rehabilitation prevail, indicating a strong political will towards the reduction of health inequalities and the promotion of human rights of people experiencing disability. Results obtained from conducting this descriptive review provide the basis for future appraisals of the situation regarding rehabilitation service and policy development in Europe.

Safety is one of the most important areas of focus in the minerals industry. Queensland’smetalliferous mines and quarries have experienced 1081 fatalities over the last 139 years, manyof which had recurring causes and all of which were preventable. Recurring mistakes andfatalities can result in financial, political, trade union and social consequences for companiesand the only way that the cycle of recurring fatalities can be broken, is by learning fromhistorical failures and preventing their recurrence.This project analysed historical fatality data by examining over 21 different influencingparameters to identify common hazards, causation factors and activities that result in therecurrence of fatalities. The intended purpose of this study is to enable the minerals industry toidentify key areas where safety performance can be improved.The analysis revealed that Safety and Health Legislation seem to have positively impacted uponthe safety performance of the industry by reducing both the quantity and variation of annualfatal accidents to a level where a single fatality per year is now regularly achieved.Multiple data trends and clusters identified a range of fatality causation patterns: Zinc-LeadSilverand Copper-Gold were found to be the most fatal commodities mined with Mount IsaMines accounting for the single most site-specific fatalities, normalised fatality data indicatedthat surface fatalities were 10 % more likely than underground fatalities, mid-week days andFridays dominated fatality trends possibly pointing to mental fatigue and distractions,equipment operators represent the occupation most at risk of fatal accidents with LHD operatorsparticularly susceptible and gravity was determined to be the most hazardous uncontrolledenergy source on mine sites. However, it was the involvement of loaders and the inadequateutilisation of PPE and SWPs that were identified as the fatality causation factors that requireimmediate improvement throughout the industry to yield improved safety performance.Gender, age, level of production, depth of operation and mining method were all found to havehad no discernible impacts on fatality rates.The necessity to communicate this fatality information, learn from it and rapidly evolve Safetyand Health Management Systems on sites is the core conclusion reached. This requires thatcompanies utilise fatality information as an auditing tool to continuously improve their Safetyand Health Management Systems and site procedures every time a fatality occurs within theindustry.

The European Regulation on nutrition and health claims on foods (Nutrition andHealth Claims Regulation: European Commission No. 1924/2006) establishes,for the first time, a common framework for the regulation of such claims acrossthe European Union (EU). The opportunities for product innovation arising fromthis new legislation combined with protection of consumer interest in respect ofcontrolling misleading advertising, while at the same time promoting publichealth, are noteworthy. But such opportunities need to be evaluated against theburden on industry of the need to undertake significant research activity intothese claims and to present a scientific substantiation to satisfy the procedure for approval. Whether this legislation is driving product innovation and thedevelopment of healthy and nutritional food or whether it is a barrier to suchdevelopments is an area in need of investigation. The EU-funded projectREDICLAIM is currently considering these issues and the impact of theNutrition and Health Claims Regulation especially in relation to ‘reduction ofdisease risk’ claims. This article establishes the issues surrounding the commonframework of health legislation and sets out the work programme forREDICLAIM.

Recent scholarship on the Senate indicates that partisanship and polarization have fundamentally changed the dynamics and the nature of policy making in the institution. To understand how senators balance their roles as constituent servants and partisan warriors, we examine senators’ participation in floor amending on major health legislation over a 10-year period (2000–2010). Health care is central to the ideological divide over the nature of the welfare state and has a significant impact on constituents. Unlike previous studies, we develop a fuller picture of the factors that motivate senators to participate by analyzing both amendments filed to a bill and amendments considered on the floor. We find that minority party status and ideology, both the liberal-conservative dimension and ideological extremism, are important indicators of participation. Furthermore, senators elevate ideology in comparison to constituent need when an issue is a presidential priority. Finally, the influence of constituency fact...

Com base nas contribuições de N. Elias e H. Becker, buscamos identificar os processos de patologização e penalização do uso de drogas presentes em proposições legislativas apresentadas ao Congresso Nacional durante a 53ª Legislatura. As 147 proposições reunidas através do descritor "álcool, tabaco e outras drogas" no banco de dados do Observatório da Saúde no Legislativo também dizem respeito a diferentes temas, como "alimentação e nutrição" e "propaganda". No inteiro teor de alguns projetos de lei, há uma recorrente indistinção entre uso, abuso e dependência de substâncias psicoativas ilícitas e lícitas; inclusive na própria ementa dos mesmos é patente uma tendência no sentido do aumento da pena dirigida a usuários e também distribuidores de drogas. A atuação do Poder Legislativo no que tange à questão das drogas contribui para sua penalização e patologização, mais do que para sua politização. Using concepts by N. Elias and H. Becker, we identified processes of pathologization and penalization of drug use in legislative proposals submitted to the National Congress during the 53th Legislature in Brazil. The 147 proposals gathered using "alcohol, tobacco, and other drugs" as descriptor on the database of the Congress Health Watch address other topics as well, such as "food and nutrition" and "advertising". At the core of some legal reform projects lays a recurrent lack of distinction between use, abuse, and dependence with regard to illicit psycho-active substances. A tendency to increase jail time for both distributors and users also evident. The role of the Legislature is key to the issue of drug use, contributing to its criminalizing and pathologization, rather than to its politicization.

This report examines the experiences of Small Island Developing States in the Caribbean- Barbados, Dominica, Jamaica, and in the Pacific- Fiji, Nauru, and Tonga with specific governmental regulatory measures to reduce the risk of obesity and associated diet-related chronic noncommunicable diseases (NCDs), as well as the obstacles and opportunities encountered. Guided by the diet-related indicators of the World Health Organization (WHO) Noncommunicable Diseases Progress Monitor 2017, the authors reviewed legislation, country reports, articles, and the databases of WHO and the World Trade Organization to identify relevant regulatory measures and to establish the extent of implementation in the selected countries. Obesity prevalence ranged from 25.9% in Dominica to 41.1% in Tonga. The principal diet-related measures implemented by the selected countries were fiscal measures, such as sugar-sweetened beverage taxes and import duties to encourage greater consumption of healthy foods. Governmental action was weakest in the area of restrictions on marketing of unhealthy foods. If they are to reduce their current high rates of obesity and associated NCDs, Caribbean and Pacific states need to intensify implementation of diet-related regulatory measures, particularly in the area of marketing of unhealthy foods and beverages to children. Key implementation challenges include financial and staffing constraints and the need for increased political will to counter industry opposition and to allocate adequate financial resources to keep advancing this agenda.

An integrated approach to purchasing health care for U.S. Department of Defense and U.S. Department of Veterans Affairs could have important implications for access, quality, and costs but could face legislative, policy, or contractual challenges.

Planerische Instrumente für gesunde Lebensverhältnisse existieren spätestens seit der dynamischen Periode der Industrialisierung ebenso wie städtebauliche Leitbilder. Sie sind auf örtlicher und überörtlicher Ebene mit unterschiedlichen Zuständigkeiten angesiedelt. Dabei hat räumliche Planung im Kern die Aufgabe, zwischen unterschiedlichen Raumansprüchen und Nutzungskonflikten einen Abwägungsprozess zu gestalten, um die politische Entscheidungsfindung vorzubereiten. Die gesetzlichen Grundlagen und institutionellen Rahmenbedingungen für räumliche Planung und Gesundheitsrecht sind unterschiedlich, weisen aber über das aktuelle Präventionsgesetz Schnittstellen auf. Diese gilt es kooperativ auszugestalten. Planning tools for healthy living conditions have existed at least since the dynamic period of industrialisation, as have urban development visions. They are assigned to local and regional levels with different responsibilities. The crucial element of spatial planning is the task to develop procedures to consider and weigh up different spatial demands and conflicts of use in order to prepare political deliberation and decisionmaking processes. The legal and the institutional frameworks for spatial planning and health differ, but they are interlinked through the current Prevention Act. This presents an opportunity for a co-operative approach.

The objective of this study is to prepare a "Concept Map on Health and Intellectual Property in Central America and the Dominican Republic" in order to help identify the main access barriers to health, especially medicines, and to guide state authorities toward actions to improve the efficiency and effectiveness of policies.The report "Concept Map on Public Health and Intellectual Property, Regional Perspective: Central America and the Dominican Republic" was analyzed. Then the knowledge generation and management methodology was applied and a search strategy was identified to recover the information for preparation of the concept maps.The legal framework and institutional structure, as well as policies, programs, plans, and strategies for health and intellectual property, were identified. A set of barriers that hinder access to medicines was also identified, as well as solutions to overcome them.In Central America and the Dominican Republic, health strategies, policies, programs, and plans are in place, but unfortunately their scope and degree of dissemination is uneven. This, together with social and economic factors, explains why health inequity persists between and within countries. The identified barriers to access to medicines included the expansion and strengthening of the rights of pharmaceutical patent-holders, problems with implementing the flexibilities of the Agreement on Trade-related Aspects of Intellectual Property Rights, pricing policies, and strict regulatory standards.Elaborar um mapa conceitual de saúde pública e propriedade intelectual na América Central e na República Dominicana para facilitar identificar as principais barreiras ao acesso à saúde, em particular ao acesso aos medicamentos, e servir de guia às autoridades públicas para melhorar a eficiência das políticas e a efetividade das ações.Foi analisado o relatório Mapa conceitual de saúde pública e propriedade intelectual (MC SPPI); perspectiva regional: América Central e República Dominicana. Foi usada a metodologia para análise de gestão e geração de conhecimento e identificada a estratégia de busca que permitiu recuperar a informação para a construção dos mapas conceituais.Foram identificados o enquadramento jurídico, a estrutura institucional e as políticas, programas, planos e estratégias de saúde e propriedade intelectual e uma série de barreiras que interferem negativamente no acesso aos medicamentos e as soluções para eliminá-las.Na América Central e na República Dominicana, existem estratégias, políticas, programas e planos de saúde, porém eles têm alcance e disseminação distintos que, ao lado de fatores sociais e econômicos, explicam por que persiste a falta de equidade em saúde entre os países. Entre as barreiras ao acesso aos medicamentos estão o reforço e a ampliação dos direitos dos detentores de patentes farmacêuticas, dificuldades na implementação das flexibilidades dos Aspectos dos Direitos de Propriedade Intelectual Relacionados ao Comércio, políticas de fixação de preços e normas reguladoras estritas.

Background Apps targeted at health and wellbeing sit in a rapidly growing industry associated with widespread optimism about their potential to deliver accessible and cost-effective healthcare. App developers might not be aware of all the regulatory requirements and best practice principles are emergent. Health apps are regulated in order to minimise their potential for harm due to, for example, loss of personal health privacy, financial costs, and health harms from delayed or unnecessary diagnosis, monitoring and treatment. We aimed to produce a comprehensive guide to assist app developers in producing health apps that are legally compliant and in keeping with high professional standards of user protection. Methods We conducted a case study analysis of the Australian and related international policy environment for mental health apps to identify relevant sectors, policy actors, and policy solutions. Results We identified 29 policies produced by governments and non-government organisations that provide oversight of health apps. In consultation with stakeholders, we developed an interactive tool targeted at app developers, summarising key features of the policy environment and highlighting legislative, industry and professional standards around seven relevant domains: privacy, security, content, promotion and advertising, consumer finances, medical device efficacy and safety, and professional ethics. We annotated this developer guidance tool with information about: the relevance of each domain; existing legislative and non-legislative guidance; critiques of existing policy; recommendations for developers; and suggestions for other key stakeholders. Conclusions We anticipate that mental health apps developed in accordance with this tool will be more likely to conform to regulatory requirements, protect consumer privacy, protect consumer finances, and deliver health benefit; and less likely to attract regulatory penalties, offend consumers and communities, mislead consumers, or deliver health harms. We encourage government, industry and consumer organisations to use and publicise the tool. Electronic supplementary material The online version of this article (10.1186/s12911-017-0535-0) contains supplementary material, which is available to authorized users.

State-level marijuana liberalization policies have been evolving for the past five decades, and yet the overall scientific evidence of the impact of these policies is widely believed to be inconclusive. In this review we summarize some of the key limitations of the studies evaluating the effects of decriminalization and medical marijuana laws on marijuana use, highlighting their inconsistencies in terms of the heterogeneity of policies, the timing of the evaluations, and the measures of use being considered. We suggest that the heterogeneity in the responsiveness of different populations to particular laws is important for interpreting the mixed findings from the literature, and we highlight the limitations of the existing literature in providing clear insights into the probable effects of marijuana legalization.

Compare World Health Organization (WHO) guidelines for contraception in a human rights framework with the existing regulatory frameworks of Bolivia, Colombia, and Uruguay and evaluate which aspects of those regulations need to be developed.A systematic analysis was based on the WHO analytical framework "Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations" to determine whether the legislation of Bolivia, Colombia, and Uruguay contain general references to the population, specific references to adolescents, or do not refer to the topic. To this end, 36 documents related to contraception were analyzed: 9 from Bolivia, 15 from Colombia, and 12 from Uruguay.It was confirmed that each country's legislation complies with several WHO recommendations. The three countries have strengths in nondiscrimination and in opportunity for informed decision-making, and have weaknesses in accessibility, quality, and accountability. Acceptability is a strength in Colombia and Bolivia, and confidentiality is a strength in Bolivia and Uruguay. Colombia has weaknesses in availability, confidentiality, and participation.Comparison of national legislation with WHO guidance helps to see the strengths and weaknesses of national regulatory frameworks and to see opportunities to improve regulations.Comparar as diretrizes da Organização Mundial da Saúde (OMS) para contracepção como parte dos princípios dos direitos humanos com os enquadramentos regulamentares existentes na Bolívia, Colômbia e Uruguai e avaliar os elementos destes enquadramentos que precisam ser melhorados.Realizou-se uma análise sistemática segundo a metodologia analítica descrita no documento da OMS ¨Respeito aos direitos humanos ao prestar informações e serviços sobre contracepção: orientação e recomendações com o propósito de verificar se as legislações da Bolívia, Colômbia e Uruguai fazem referências gerais à população, referências específicas aos adolescentes ou não fazem referências. Ao todo, 36 documentos sobre contracepção foram analisados: 9 provenientes da Bolívia, 15 da Colômbia e 12 do Uruguai.Verificou-se que as legislações dos três países cumprem com diversas recomendações da OMS. Não discriminação e oportunidade para decidir de forma esclarecida são os pontos fortes e acessibilidade, qualidade e prestação de contas são os pontos fracos. A aceitabilidade é um ponto forte na Colômbia e Bolívia e a confidencialidade, na Bolívia e Uruguai. Disponibilidade, confidencialidade e participação são os pontos fracos na Colômbia.A comparação das legislações nacionais com o guia da OMS possibilita identificar os pontos fortes e fracos no enquadramento regulamentar nacional e encontrar oportunidades para melhorar.

Long-term care (LTC) residential homes provide a supportive environment for residents requiring nursing care and assistance with daily living activities. The LTC sector is highly regulated. We examine the approaches taken to ensure the delivery of quality and safe care in 10 LTC homes owned and operated by the City of Toronto, Ontario, focusing on mandatory accountability agreements with the Local Health Integration Networks (LHINs). Results are based on document review and seven interviews with LTC managers responsible for the management and operation of the 10 LTC homes. One issue identified was the challenges associated with implementing new legislative and regulatory requirements to multiple bodies with differing requirements, particularly when boundaries do not coincide (e.g., the City of Toronto's Long-Term Care Homes and Services Division must establish 10 different accountability agreements with the five LHINs that span into the City of Toronto's geographic area).

A publicidade é uma ferramenta legítima e não é um problema, se os objetivos comerciais não ultrapassarem os limites éticos. As propagandas de medicamentos no Brasil já eram produzidas desde 1911 e promoviam a venda de medicamentos “mais ou menos” explicitamente. Entretanto, medicamentos são produtos especiais, cujas peças publicitárias requerem cuidados diferenciados no que tange os aspectos éticos e morais. O estudo objetivou investigar quais são e quantificar os ilícitos cometidos em propagandas de medicamentos veiculadas em TV Aberta para o grande público do Distrito Federal e cidades que o circundam, chamadas “Região do Entorno”. No estudo observacional, transversal e descritivo, foram monitoradas 56 propagandas, em 14h de programação, entre março de 2012 a março de 2013. A análise legal da monitoração de 40 peças incluídas na amostragem ocorreu sob a égide da Resolução de Diretoria Colegiada RDC Nº 96/2008 da Anvisa. Os resultados evidenciaram que em 100% das peças publicitárias ocorreram infrações à legislação. Em média foram infringidos quatro artigos da RDC por propaganda e no total foram sete os artigos ignorados da Legislação Sanitária. Em consonância com a literatura, os analgésicos, antigripais, anti-inflamatórios e antiácidos foram os mais divulgados. A ausência de informação sobre os cuidados/advertências, no uso, pode indicar que o medicamento seja totalmente seguro e eficaz, o que induz ao risco sanitário da automedicação irresponsável, que tem se tornado um problema de saúde pública mundial.

Compliance with health legislation is important to ensure food safety in food production. The objective was to evaluate the time and temperature of distribution of hot and cold preparations, as well as to identify the critical control points of the stages of preparation of chicken salpicao, in a self-service restaurant in the city of Guanambi - BA. To evaluate the temperature of distribution, two hot preparations (whole rice and white) and a cold (mayonnaise salad) were selected, served daily in the restaurant. The measurements were taken with the aid of a thermometer, for 120 minutes, with an interval of one hour. Monitoring of the time and temperature were also evaluated in each operation (cooking, cooling and distribution) of chicken salpicao production, with subsequent identification of critical control points. It was found that the mayonnaise salad reached the cooling counter with a temperature above 10 ° C. Although it has been observed a reduction of this during the exposure time, the same was above as recommended by the legislation (up to 10oC / 4 hours exposure). The white and whole rice presented adequate temperatures at the beginning of the distribution, 61oC and 66oC, respectively, with subsequent reduction of these. The cooking, cooling, mixing and distribution stages of chicken salpicao production were identified as critical control points because they present potential health risks to consumers when not properly performed. It is necessary an efficient monitoring and inspection by the responsible organs, in order to obtain the adequacy of the temperature of the foods offered to the consumers. Keywords: Collective Feeding. Monitoring. Food Supply. Resumo O cumprimento as legislacoes sanitarias e importante para garantir a seguranca alimentar na producao de alimentos. Objetivou-se avaliar o tempo e a temperatura de distribuicao de preparacoes quentes e frias, bem como identificar os pontos criticos de controle das etapas de preparo do salpicao de frango, em um restaurante self-service da cidade de Guanambi – BA. Para avaliar a temperatura de distribuicao foram selecionadas duas preparacoes quentes (arroz integral e branco) e uma fria (salada de maionese), servidas diariamente no restaurante. As medicoes foram feitas com o auxilio de um termometro, durante 120 minutos, com intervalo de uma hora. Avaliou-se tambem o monitoramento do tempo e temperatura em cada operacao (coccao, resfriamento e distribuicao) da producao de salpicao de frango, com posterior identificacao dos pontos criticos de controle. Verificou-se que a salada de maionese chegava ao balcao de refrigeracao com temperatura acima de 10°C. Embora tenha sido observada uma reducao desta durante o tempo de exposicao, a mesma encontra-se acima do preconizado pela legislacao (ate 10oC/4 horas de exposicao). O arroz branco e integral apresentaram temperaturas adequadas no inicio da distribuicao, 61 oC e 66 oC, respectivamente, com posterior reducao destas. As etapas de coccao, resfriamento, mistura e distribuicao, da producao de salpicao de frango, foram identificadas como pontos criticos de controle por apresentarem riscos potenciais a saude do consumidor quando nao realizadas adequadamente. Faz-se necessario um acompanhamento e fiscalizacao eficiente por parte dos orgaos responsaveis, a fim de se obter a adequacao da temperatura dos alimentos ofertados aos consumidores. Palavras-chave: Alimentacao Coletiva. Monitoramento. Abastecimento de Alimentos.

Background The objective of this study was to evaluate juridical and medical responsibilities of health-care professionals accused of malpractice in Turkey while they care for patients under the age of 18. Methods The cases sent to the Council of Forensic Medicine Institution by the courts, including claims of medical malpractice (n = 1458), in order to get an expert opinion between 2002 and 2006, were examined retrospectively. Cases of negligence by health-care professionals who gave medical care to children between the ages of 0 and 18 were evaluated statistically. Results There was medical malpractice in 28.8% of the cases; and 68.2% of the cases were male. A large proportion of the cases were found to occur in emergency departments; and 57.9% of injuries resulted in death. The specialist doctors seemed to be sued or to be accountable for compensation more frequently than the general practitioners. This can be attributed to the fact that they perform more complicated medical interventions. Conclusions Courts specializing in health legislation may be useful to decrease the time consumed by trials. These specialized courts will also support logical judgment. In addition, postgraduate education is useful in reducing malpractice claims.

OBJETIVO: Identificar y evaluar estudios que analizaron las caracteristicas de los litigios por derecho a la salud en Brasil, Colombia y Costa Rica. METODOS: Se evaluaron estudios que analizaron las caracteristicas de los litigios por derecho a la salud identificados mediante una busqueda en PubMed, LILACS, Biblioteca Cochrane, Scirus (Abril, 2012). Dos revisores evaluaron los estudios. Las variables recabadas fueron, entre otras: causales de litigio, proporcion de demandas por beneficios cubiertos por el sistema de salud y demandas por tecnologias de alto costo. RESULTADOS: Se identificaron 30 estudios (Brasil 19, Colombia 10 y Costa Rica 1). La decision judicial fue frecuentemente favorable para los demandantes: Colombia (75%-87%), Costa Rica (89,7%) y Brasil (70%-100%). En Colombia las demandas se efectuaron por beneficios incluidos en el Plan Obligatorio de Salud (rango 41%-69,9%). En Brasil se presento una variacion importante de demandas entre el Programa de Medicamentos de Dispensacion Excepcional (13%-31%) y los medicamentos basicos del Sistema Unico de Salud (aproximadamente 50%). En relacion al total de demandas, las de medicamentos fueron variables (Colombia 11,9%-35,6%, Costa Rica 30,2% y Brasil 49,6%). Un estudio de Brasil encontro una diferencia estadisticamente significativa al comparar las demandas por medicamentos excepcionales versus los demas, segun el estrato social; y en otro estudio segun las demandas de municipios con mejores indicadores socioeconomicos. Se reporto una concentracion de las demandas en la prescripcion de medicamentos por un grupo acotado de medicos. La prescripcion no fue siempre sustentada por evidencia cientifica. Otro estudio hallo que en la mitad de los casos el costo del proceso judicial resulto ser superior al costo de los servicios demandados. CONCLUSIONES: Existen similitudes en las causales, naturaleza y repercusiones de la judicializacion en el contexto de los paises estudiados. Los estudios incluidos muestran las debilidades de los sistemas de salud para garantizar el acceso a los distintos servicios asi como para la incorporacion de las nuevas tecnologias sanitarias.

Estimates how sensitive physician behavior is to the design of alternative payment models under the Medicare Access and CHIP Reauthorization Act (MACRA).

Razvoj populacijske politike i zdravstvene legislative kao posljedica državne potrebe za većim brojem mladih, zdravih, radno i vojno aktivnih stanovnika, rezultirao je školovanjem svih zdravstvenih radnika pa i primalja, zakonskim reguliranjem njihovog rada, povećanjem njihovog broja, te usavršavanjem primaljske struke. Razvojem ove struke su se postepeno poboljšavali uvjeti rađanja žena , nadzor trudnoća i porođaja, a na taj način se utjecalo na natalitet i mortalitete populacije kao i na prirodni prirast. Na primjeru Broda na Savi vidi se da je to bio dugotrajan i ne kontrolirani razvoj primaljske struke, na ovim prostorima, na koji su utjecale loše socioekonomske prilike ,loše klimatske prilike, te prisutnost granice i posljedično velikih migracija stanovništva. Važno je uočiti da tada udareni temelji populacijskoj politici, a uz nju i promatranoj primaljskoj struci su omogućili razvoj istih u nadolazećim periodu., The development of population policy and health legislation as a result of government, the need for more young, healthy, working and military active population, resulted in the education of all health workers including midwives, legal regulation of their work, increasing their number and training of midwifery profession. With the development of this profession conditions of women giving birth, pregnancy and birth control were gradually improved, and thus influenced the birth rate and mortality of the population and the natural growth. On the example of the town of Brod na Savi one can see that it was time-consuming and controlled development of the midwifery profession in the region, which have affected the poor socio-economic conditions, poor climatic conditions, and the presence of the border and the consequent large-scale migration of the population. It is important to note that the foundations for population policies and the observed midwifery profession enabled the development of the same in the coming period.

Background It has become clear in recent years that a healthy lifestyle, including physical exercise is crucial for health maintenance. Nevertheless, most people do not exercise regularly. Physician intervention is beneficial in increasing patient exercise. In Israel, the 1994 “Sports Law” regarding exercising in a gymnasium requires a physician’s written authorization, but does not direct the physicians what they should ascertain before issuing the certificate. This pre-exercise certificate has been widely discussed in Israel over the last year as the law is to be revised to enable using a modification of the PAR-Q+ (Physical Activity Readiness questionnaire) patient questionnaire as a screening tool. This will leave the requirement for a pre-exercise certificate for a less healthy population, yet without clear instructions to the primary care physician on criteria for ascertaining fitness. Our aim was to evaluate how primary care physicians deal with the ambiguity of defining health criteria for issuing exercise authorization/certificate. Methods We used an anonymous ten-item attitude/knowledge multiple choice questionnaire with an additional 13 personal/education and employment questions. We assessed each potential predictor of physician attitude and knowledge in univariate models. Results 135 useable questionnaires were collected. Of these, 43.7 % of the doctors will provide the pre-exercise certificate to all their patients; 63 % were aware of their HMO/employers guidelines for issuing certificates; 62 % stated they complied with these guidelines, and 16 % stated they did not follow them. In addition, 70 % of the physicians reported regular exercise themselves, an average of 4.12 h/week. These physicians tended to provide the pre-exercise certificate to all patients unconditionally, as compared to physicians that did not exercise regularly. (46 % vs. 14.5 %, p

In 2002, Brazil became the first country in the region to implement pictorial health warning labels on cigarette packages. Since the adoption of the FCTC/WHO in 2005, nine more countries adopted pictorial labels and six passed legislation that is pending of implementation. The message content and the picture style vary across countries. Seventeen countries have banned brand descriptors and nine require a qualitative label with information on constituents and emissions. Since 2005, important progress has been achieved in the region. However, countries that have ratified the FCTC have not yet implemented all the recommendations of Article 11 Guidelines.