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Background During 2011, a study was undertaken to assess safety conditions in Serbian underground coalmines by analysis of injury data. The study covered all Serbian coalmines, identified week spots from the aspect of safety, and recommended possible courses of action. Since then, Serbia has made changes to safety and health legislation; all coalmines introduced new preventive measures, adopted international standards, and made procedures for risk management. After 10 years a new study has been performed to analyze the impact of these changes. Materials and methods In this study, the injuries that have occurred in the Serbian underground coal mines over the last 20 years were analyzed. Statistical data analysis was performed by IBM SPSS Statistics v23. The injuries that occurred in the last ten years were compared with the results of the previous study (2000–2009). The average values of injury rates for both periods were compared for each of the categories (severity, age, body part, qualification), and the results were presented as absolute difference or percentile difference. Results The results showed reduction in the number of injuries in the category of 20–30 years old workers, where the new training procedures for workers, which were set by mandatory legal regulations, certainly contributed. They also showed an increase in the number of injuries in the category of old workers, which indicates that the law did not have a positive effect on this category. Conclusion The total number of injuries is still high; therefore, it is necessary to introduce mechanization and automation in mines and have a better policy for older workers who retire later nowadays.

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

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.

Ręka Gabriela, Paprzycka Karolina, Piecewicz-Szczęsna Halina. The knowledge and the opinion of patients on the government package called ‘fast oncological therapy’ – a pilot survey study. Journal of Education, Health and Sport. 2020;10(7):98-104. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.07.010 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.07.010 https://zenodo.org/record/3950629 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 15.06.2020. Revised: 26.06.2020. Accepted: 18.07.2020. The knowledge and the opinion of patients on the government package called ‘fast oncological therapy’ – a pilot survey study Gabriela Ręka, Karolina Paprzycka, Halina Piecewicz-Szczęsna 1Gabriela Ręka gabrysia.reka@gmail.com https://orcid.org/0000-0001-9728-5281 1Karolina Paprzycka kpaprzyc007@interia.eu https://orcid.org/0000-0001-7875-429X 2Halina Piecewicz-Szczęsna halpiec@gmail.com https://orcid.org/0000-0002-0573-7226 1 Students’ Scientific Association of Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland 2 Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland Abstract Introduction and purpose: The fast oncological therapy was introduced in 2015 by a set of legal arts called an oncology package. Its main assumption was to reduce malignant neoplasms by improving the availability of diagnostics and complex treatment. The aim of the study is to analyse the level of knowledge and to learn opinions of patients of the Center of Oncology of the Lublin Region on the fast oncological therapy. Material and methods: Material used in the analysis is the results of survey conducted on a group of patients from different hospital departments. An original anonymous questionnaire with 25 open and closed questions was used. Out of 130 distributed questionnaires, 44 items were returned completed. The program used to perform the statistical analysis was Statistica PL 10.0 2011 StatSoft. Results: The survey indicates that 43.2% of respondents have ever heard about fast oncological therapy, 27.3% declare knowledge of the therapy's basic aims. In a detailed knowledge test 1 point was awarded for every right answer. A maximum of 11 points could be obtained, with the average score being 2.3 points. 22.7% of patients surveyed did not answer any question correctly. No relationship has been found between age, place of residence or duration of the disease and the level of knowledge about the fast oncological therapy. 36.4% of respondents admit that they have been treated in accordance with the fast oncological therapy, but most of those who did (75%), evaluate its effect positively. Conclusions: The patients' knowledge about the package is extremely low. Only a minority of respondents are aware of the package's existence. However, the patients judge the changes introduced by fast oncological therapy as positive. Keywords: medical oncology; health legislation; health education

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.

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 COVID-19 pandemic has forced a rapid adoption of telemedicine over traditional in-person visits due to social restrictions. While telemedicine improves access and reduces barriers to healthcare access for many, several barriers and challenges remain for persons with disabilities, and novel challenges have been exposed, many of which may persist long-term. The challenges and barriers that need to be systematically addressed include: Infrastructure and access barriers, operational challenges, regulatory barriers, communication barriers and legislative barriers. Persons with disabilities are a vulnerable population and little attention has been placed on their healthcare access during the pandemic. Access and communication during a healthcare encounter are important mediators of outcomes for persons with disabilities. Significant, long-term changes in technological, regulatory, and legislative infrastructure and custom solutions to unique patient and health system needs are required to address these barriers going forward in order to improve healthcare access and outcomes for persons with disabilities.

Background and Purpose: Critically ill patients require a careful approach for prognosis and decision-making. The German health legislation aims to strengthen the role of advance directives (ADs) and health-care proxies (HCPs). Their impact within a dedicated neurocritical care setting is unknown. This study aimed to assess the practice of withdrawal or withholding of life-sustaining therapy (WOLST) in a German neurointensive care unit (NICU) focusing on whether AD or HCP is associated with timing and treatment intensity. Methods: Data on patients who died after WOLST at a dedicated NICU of a German university hospital, from 2010 to 2013, were retrospectively analyzed. Results: Of 400 deceased patients, 310 (77.5%) died after initiation of WOLST. Among them, 68 (21.9%) were identified to have AD or HCP or both (AD + HCP). WOLST patients with AD, HCP, or AD + HCP were older than those without (median age: 77 vs 72 years, P < .001) but did not show any other distinct baseline features. There was no difference in the specific neurocritical care measures between the groups. Poisson regression analysis showed no significant difference in the probability of time-dependent WOLST initiation between those with and without AD/HCP, after adjusting for age and sex (adjusted incidence rate ratio, 1.10; 95% confidence interval, 0.94-1.28; P = .244). Conclusions: In this single-center study of mainly cerebrovascular NICU patients, AD or HCP was neither associated with an earlier WOLST nor associated with a difference in treatment intensity before WOLST. Further prospective studies should assess the emerging concept of advance care planning in neurocritical care.

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.

Introdução: O registro sanitário é um pré-requisito para a comercialização do medicamento no mercado nacional. Objetivo: Este manuscrito faz uma análise da legislação sanitária brasileira para auxiliar na obtenção e na adequação do registro de medicamentos destinados às doenças negligenciadas, verificando se as dúvidas e dificuldades, no momento de se montar o dossiê para esta categoria de medicamentos, são dirimidas. Método: O desenvolvimento deste artigo baseou-se numa análise crítica das legislações disponíveis no sítio eletrônico da Agência Nacional de Vigilância Sanitária, além de compará-las com guias internacionais, somada à prática diária do Setor de Assuntos Regulatórios de um Laboratório Farmacêutico Oficial. Resultados: Os dados obtidos demonstraram que não há uma legislação específica para registro e pós-registro de medicamentos destinados às doenças negligenciadas. Assim, percebe-se que há lacunas na legislação aplicável a estes medicamentos, como por exemplo: a ausência de medicamentos de referência no Brasil e a falta de fornecedores de insumos ativos que atendam à legislação vigente, prejudicando a adequação destes registros e a obtenção de novos registros. Conclusões: Manter um registro desta classe de medicamento na Anvisa nos dias atuais torna-se um grande desafio, tendo que cada registro ser tratado especificamente junto à agência reguladora.

Introdução: As informações em rótulos de suplementos contribuem para a orientação do consumidor sobre a escolha do produto mais adequado às suas necessidades, no entanto, rótulos com informações não conformes à legislação sanitária podem afetar negativamente a saúde dos consumidores. Objetivos: Avaliar a conformidade de rótulos de suplementos de vitaminas e minerais comercializados na cidade de São Paulo no período de 2014 a 2017. Método: Foi elaborado um checklist com os principais itens relacionados à rotulagem, os quais foram verificados em cada embalagem: denominação de venda; lista de ingredientes; composição; conteúdo líquido; identificação de origem; identificação de lote; prazo de validade; frase de advertência e de orientação; cuidados de conservação; uso de expressões; rotulagem nutricional; informação sobre presença de glúten e aditivos permitidos. Resultados: As principais irregularidades observadas foram a presença de frases ou expressões induzindo o consumidor a engano (29%), a denominação de venda de forma incorreta (15%) e a declaração de componentes ativos não autorizados para suplementos vitamínicos (5%). Conclusões: Os resultados evidenciam os problemas relacionados à comercialização de suplementos vitamínicos e minerais no Brasil, em decorrência da complexa legislação, que dificulta sua interpretação gerando pretextos para as empresas produtoras burlarem a lei, prejudicando a saúde da população.

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...

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.

This paper discusses the crucial effects of Turkish health and migration laws on Syrian refugees' access to public health services and social determinants of health. Key aspects of current Turkish laws affect the health of both refugees and Turkish citizens in many ways. The huge influx of refugees is increasing communicable disease risks, overcrowding hospitals, and more generally straining financial and health resources. Turkey's United Nations membership and its candidacy for European Union (EU) have led to increased alignment of Turkey's refugee and migration policies with international law. Major differences remain, however, and Turkey's remaining noncompliance with international refugee laws is a major force driving Syrian refugee's flight to EU countries, as refugees desperately seek the right to better health and social services.

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.

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.

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.

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

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

We describe an exemplary case of inadequate health legislation and defensive medicine, regarding umbilical cord tissue collection for personal “private” use.

The feasibility of eradicating the bacterial ring rot disease of potato, caused by Clavibacter michiganensis subsp. sepedonicus, must be evaluated in terms of current knowledge pertaining to pathogen ecology and disease epidemiology, as well as in consideration of developments in laboratory methods for pathogen detection, seed certification regulations and plant health legislation. For our purposes here, eradication should be understood in a functional sense as describing the apparent elimination of the disease without really knowing whether or not the causal bacterium still lurks somewhere in the crop production system. The potential for such eradication depends on the causal bacterium's capacity (or incapacity) to persist in the environment and the means by which vertical and horizontal transmission among potato production units can be controlled. Strict application of certification regulations and early detection of infected potato lots are essential not only to maintaining control of the ring...

Zusammenfassung In den letzen zehn Jahren wurden die gesetzlichen Rahmenbedingungen des deutschen Gesundheitssystems verandert mit dem Ziel, die Versorgung chronisch kranker Patienten durch eine Forderung innovativer Versorgungsstrukturen zu verbessern. Neue Entwicklungen beinhalteten die bundesweite Einfuhrung von strukturierten Behandlungs- (Disease Management) Programmen (DMP), Vertrage zur integrierten Versorgung, die Forderung der Einbeziehung nicht-arztlicher Berufsgruppen in die hausarztliche Versorgung, die Einfuhrung von Hausarztvertragen sowie die Moglichkeit der interdisziplinaren Zusammenarbeit in Medizinischen Versorgungszentren (MVZ). Ziel dieses Artikels ist es, den Stand der Umsetzung neuer Versorgungsmodelle in der gesetzlichen Krankenversicherung und die Auswirkungen auf die Versorgung chronisch Kranker in Deutschland zu beschreiben. Dazu wurde im Rahmen eines europaischen Projektes zur Entwicklung und Validierung von Methoden zur Evaluation von Disease Management Programmen (DISMEVAL) eine selektive Literaturrecherche durchgefuhrt, um relevante Modelle und Evaluationsstudien zu identifizieren. Anhand vorliegender Evaluations- und Studienergebnisse kann bisher nur unzureichend bewertet werden, inwieweit diese Entwicklungen tatsachlich die Versorgungsqualitat chronisch kranker Patienten in Deutschland verbessert haben. Da eine begleitende Evaluation nur fur DMP gesetzlich vorgeschrieben ist, und diese daruber hinaus methodische Probleme aufweist, gibt es derzeit noch kaum belastbare Ergebnisse zum Erfolg dieser Modelle. Die Ergebnisse zum DMP beziehen sich vorwiegend auf das Programm fur Diabetes mellitus Typ II und zeigen eine konsistente Verbesserung von Prozessparametern, wie z.B. die regelmasige Durchfuhrung von Kontrolluntersuchungen und eine leitliniengerechte Therapie, sowie eine Erhohung der Lebensqualitat von Patienten im DMP. Ob dies langfristig auch zu einer Verminderung von Folgeerkrankungen, Mortalitat und Krankheitskosten fuhrt, bedarf jedoch noch weiterer, methodisch fundierter Untersuchungen.

The United States appears headed toward another national debate about health system reform. Worry about access and health system deficiencies has reached critical mass, and polls indicate that health care leads the domestic agenda for the 2008 elections. This debate, like previous debates, will succeed or fail in Congress. We highlight key elements of recent sagas in health legislation and offer advice to the next president and Congress for improving the likelihood of a successful outcome in 2009-10: (1) make health reform a top legislative priority; (2) be leaders, not partisans; and (3) develop broad policy consensus but leave the policy details to Congress.

Changing scope of practice regulations in Michigan to allow nurse practitioners to autonomously diagnose, treat, and prescribe medications could increase access to care, improve favorable utilization of care, and improve patient-centeredness.

This report makes recommendations to the Centers for Medicare & Medicaid Services on a set of nonpayment codes that can be used to collect information on the number and level of post-operative visits. The proposed nonpayment codes aim to capture the major differences in the breadth and intensity of post-operative care provided to Medicare beneficiaries.

The framework of the newly revised International Health Regulations is a key driver in the effort to strengthen global public health security. Unanimously agreed upon by the World Health Assembly on May 23, 2005, the regulations are the result of experience gained and lessons learned during the past 30 years. This global legal framework includes a commitment from the World Health Organization (WHO) and from each WHO member state to improve capacity for disease prevention, detection, and response. It provides standards for addressing national public health threats that have the potential to become global emergencies. Its success will rely on the capacity and performance of national public health systems, anchored by strong national public health institutes (NPHIs). The new International Association of National Public Health Institutes aims to strengthen and invigorate existing NPHIs, to create new NPHIs where none exist, and to provide funded grants to support NPHI development priorities.

Objective: Families have an important role in the recognition and treatment of mental illness in their family members. However, the extent to which families are consulted during compulsory assessment processes has received little attention. In 2000, mandatory family/whanau consultation was introduced in New Zealand. This paper reviews the extent of family consultation during compulsory assessment and surveys clinicians’ views and experience. Method: All applications for compulsory assessment in a representative sample of districts were audited over a 2-month period. An email survey of clinicians investigated changes in their practice since the introduction of mandatory family consultation, their views and training experiences. Results: A total of 283 compulsory assessments were audited; 187 (66.1%) family/whanau consultations occurred and were completed by the assessing doctor 82.1% of the time. Of the remaining assessments, 12 did not appear consistent with the legally permitted exceptions to mandatory consultation. Some 88.6% of clinicians were aware of the legislative requirements about consultation. A significant percentage (54.7%) believed their practices had altered following legislative change. Conclusion: Family/whanau consultation occurred in the majority of compulsory assessments. The introduction of mandatory consultation with family/whanau may have improved clinical practice in this regard, although training and guidelines issued at a similar time are also likely to have contributed to the change in practice.

Este trabalho objetiva avaliar as condições higiênico-sanitárias dos comércios de pescado particulares do município de Sobral − CE, através da análise visual e utilização de um checklist, baseado na RDC no 216. As informações foram coletadas através da observação da rotina de trabalho dos estabelecimentos registrados na Vigilância Sanitária Municipal durante inspeções mensais em um período de três meses. Para cada critério contido no checklist, foi realizada uma média das conformidades e não conformidades e quantificação do percentual de acertos de cada. Os estabelecimentos inspecionados encontram-se em condições de funcionamento que oferecem riscos moderados de contaminação dos pescados. Dentre os fatores de risco de contaminação encontram-se a Edificação, devido à presença de insetos, que são potenciais vetores mecânicos de microorganismos, a Higienização de utensílios, devido as não conformidades quanto à disposição dos equipamentos para o adequado fluxo dos trabalhadores, infiltrações, telas, ralos sinfonados, caixas de gorduras, luminárias, instalações elétricas e sanitárias, e Manipuladores, que falavam sobre o alimento, manuseavam dinheiro, não utilizavam cabelos presos e utilizavam adornos. Mesmo observando um despreparo das pessoas envolvidas na atividade, observa-se uma tendência à adequação à legislação sanitária em prol da qualidade do alimento.

O artigo analisa as atuações dos poderes Executivo e Legislativo no Estado do Acre quanto à formulação de propostas políticas para a saúde a partir de 1999, comparando duas legislaturas. Parte-se do princípio de que o Executivo dispõe de amplo poder de agenda, o qual permite definir temas essenciais a serem apreciados pelo Legislativo, bem como determinar os passos e a sequência de procedimentos a serem seguidos ao longo do processo decisório. O estudo foi descritivo e realizado a partir de consulta a documentos da Assembleia Legislativa do Estado do Acre com acesso público. Foram identificados os projetos de lei aprovados pela Assembleia, sendo analisados por autoria, tempo de tramitação e natureza, considerando-se o contexto político-institucional. Das 93 matérias de autoria do Legislativo aprovadas entre 1999 a 2002, 20,4% trataram de temas relacionados à saúde, em especial a medicamentos, vacinas, insumos e produtos para a saúde. No período seguinte (2003-2006), das 294 proposições aprovadas, 6,8% estiveram relacionadas à saúde, envolvendo principalmente políticas, planos, programas e projetos. O estudo sugere que houve, entre os dois períodos analisados, uma mudança na natureza dos projetos de autoria do Legislativo aprovados. Os parlamentares, na segunda legislatura, fizeram uso de uma agenda leve, ao priorizarem questões honoríficas e simbólicas. This article analyzes the actions of the Executive and Legislative Powers of the Brazilian state of Acre in terms of the formulation of health proposals that have been implemented since 1999. Two legislatures are compared. It begins with the principle that the Executive Branch possesses significant agenda-setting power. This power allows this branch to define essential topics to be raised by the Legislative and also to define the steps and the sequence of procedures to be followed in the decision-making process. This descriptive study was performed using publicly available documents from the Acre State Legislative Assembly in Brazil. The bills approved by the Assembly were identified and then organized by author as per their processing time and topic. The political-institutional context was also considered. Out of the 93 topics authored by the Legislative and approved between 1999 and 2002, 20.4% involved health ‒ particularly medications, vaccines, medical supplies, and healthcare products. During the next period (2003–2006), 6.8% of the 294 proposals that were approved involved health ‒ particularly policies, plans, programs, and projects. The study suggests that there was a change in the nature of the projects approved by the Legislative between the periods analyzed. In the second legislature, lawmakers gave preference to a light agenda to prioritize honorific and symbolic issues.

Objetivo. Conocer el proceso de Certificación Hospitalaria en México. Resultados. México contaba con estándares de calidad institucionales, pero no había una evaluación externa que determinará si éstos estaban o no cualificados, de igual manera influía la falta de una legislación estricta en materia de salud la cual se promulgó de una manera eficaz en el 2009, ésta obliga a todos los establecimientos de salud entrar en la era de la certificación. Con lo anterior, el número de hospitales certificados va en aumento y con ello la participación activa del Farmacéutico o Químico Farmacéutico Biólogo (QFB). Conclusión. La certificación Hospitalaria en México va en aumento, con el compromiso de homologar los servicios de salud a nivel internacional. La participación del Farmacéutico o QFB es indispensable, ya que en la mayoría de los establecimientos de salud aún no se cuenta con un profesional farmacéutico en las distintas áreas que se requiere, por lo que la certificación, es una gran oportunidad para la participación directa del Farmacéutico o QFB en el ámbito hospitalario, cumpliendo los estándares de calidad y metas internacionales en materia de salud.

This article gives a few examples of recent developments in Dutch health law, namely equal access to health care, compulsory placement and treatment in a psychiatric hospital, and end of life decisions. They are outstanding examples of trends in health legislation that require to be followed closely.

As an elective course for their PhD in nursing program, four doctoral students participated in the June 2004 12th annual George Mason University (GMU) Washington Health Policy Institute. This unique educational offering included presentations and interaction with nursing and health policy leaders and discussion of health policy issues with legislators. Participants were able to incorporate newly acquired health policy skills into their current professional nursing roles and stay connected with other like-minded colleagues who attended the Summer Health Policy Institute. They left believing that they can positively affect current health policy issues by taking an informed, proactive stance and supporting political action committees. Their nursing expertise and knowledge of patients makes them important players in the health policy-making arena. The GMU Washington Health Policy Institute proved to be a premier policy learning experience. It provided these nurses with the opportunity to learn from and network with leading health policy experts.

Increasing the number of physicians who can prescribe buprenorphine for opioid abuse and supporting their ability to treat more patients may be the fastest approach to enhancing capacity for treatment, particularly in less populated counties.

Explores if policies promoting institutional deliveries in developing countries can actually reduce newborn deaths.

What role does the law play in reducing inequalities in health that are unnecessary, avoidable, and unfair? The question is addressed in this paper, whose purpose is to examine how the legal system, as a regulatory agency of the State, contributes to achieving greater equity in access to and use of health-related goods and services. From the legal viewpoint, health is a public commodity that is critical to human well-being and survival. But in prioritizing health as a human right, the legal system is challenged with finding ways to make health equally accessible to all, while bearing in mind the particular needs of different groups. There are currently important gaps in health legislation in the Region that must be addressed if greater equity in health is to be achieved. Such gaps, along with potential ways to correct them, are discussed throughout the paper.

Many changes in health care delivery, health legislation, and the physician workforce that affect the supply and demand for endocrinology services have occurred since the first published workforce study of adult endocrinologists in 2003.The objective of the study was to assess the current adult endocrinology workforce data and provide the first analysis of the pediatric endocrinology workforce and to project the supply of and demand for endocrinologists through 2025.A workforce model was developed from an analysis of proprietary and publicly available databases, consultation with a technical expert panel, and the results of an online survey of board-certified endocrinologists.The Endocrine Society commissioned The Lewin Group to estimate current supply and to project gaps between supply and demand for endocrinologists. A technical expert panel of senior endocrinologists provided context, clinical information, and direction.The following were measured: 1) the current adult and pediatric endocrinology workforce and the supply of and demand for endocrinologists through 2025 and 2) the number of additional entrants into the endocrinology work pool that would be required to close the gap between supply and demand.Currently there is a shortage of approximately 1500 adult and 100 pediatric full-time equivalent endocrinologists. The gap for adult endocrinologists will expand to 2700 without an increase in the number of fellows trained. An increase in the prevalence of diabetes mellitus further expands the demand for adult endocrinologists. The gap can be closed in 5 and 10 years by increasing the number of fellowship positions by 14.4% and 5.5% per year, respectively. The gap between supply and demand for pediatric endocrinologists will close by 2016, and thereafter an excess supply over demand will develop at the current rate of new entrants into the work force.There are insufficient adult endocrinologists to satisfy current and future demand. A number of proactive strategies need to be instituted to mitigate this gap.

The growing expansion of the magistral sector associated with reports of deviations from quality of compounded drugs, with serious cases, has generated a series of efforts by the Health Surveillance in the search for an efficient monitoring of pharmacies and products offered to the population. Thus, the aim of this study was to evaluate the quality of preparations containing simvastatin, manipulated in some pharmacies of Belo Horizonte/MG, after reviewing the health legislation occurred in 2007, through the realization of pharmacopoeic physicochemical analyzes of determination weight, identity and content of active ingredient and uniformity of dosage units. Further, research by neutron activation analysis, the presence and concentration of inorganic impurities in the samples of simvastatin manipulated. The results expressed an index of satisfactoriness of only 30%. This fact confirms the need for fast and efficient acts by public health authorities, and improving processes used in the manipulation within the establishments, to ensure the quality of compounded drugs.