Health Policy

ncreasingly, the explosion in scien- tific knowledge is overwhelming both researchers and practitioners in the health professions. The man- aged care pharmacist today needs a con - stant and current sense of the basic phar- maceutical sciences, clinical pharmacy, pharmacy management systems, health policy and ethics, new drug introductions, pharmacoeconomics, and pharmacoepi- demiology. Monitoring the ever-changing pharmaceutical industry is now

In this paper, we revisit the revolutionary principles-equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action-raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for accelerated scale-up of primary health-care services necessary to achieve the Millennium Development Goals, the modern iteration of the "health for all" goals. Health has moved from under-investment, to single disease focus, and now to increased funding and multiple new initiatives. For primary health care, the debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combining the strengths of both approaches in health systems. Debates of community versus facility-based health care are starting to shift towards building integrated health systems. Achievement of high and equitable coverage of integrated primary health-care services requires consistent political and fi nancial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and eff ective linkages with communities and non-health sectors. Community participation and intersectoral engagement seem to be the weakest strands in primary health care. Burgeoning task lists for primary health-care workers require long-term human resource planning and better training and supportive supervision. Essential drugs policies have made an important contribution to primary health care, but other appropriate technology lags behind. Revitalisng Alma-Ata and learning from three decades of experience is crucial to reach the ambitious goal of health for all in all countries, both rich and poor.

Over the past decade the approaches adopted towards the mental health care of refugees by a range of national and international healthcare organisations have been the subject of a sustained and growing critique. Much of this critique has focused on the way in which Western psychiatric categories have been ascribed to refugee populations in ways which, critics argue, pay scant attention to the social, political and economic factors that play a pivotal role in refugees' experience. Rather than portraying refugees as ''passive victims'' suffering mental health problems, critics have argued that attention should be given to the resistance of refugees and the ways in which they interpret and respond to experiences, challenging the external forces bearing upon them. In this paper a range of issues concerning the mental health care of refugees will be examined. These include the role of psychiatric diagnosis in relation to refugees' own perceptions of their need and within the context of general health and social care provision. In examining services the emergence of new paradigms in mental health care is identified. These include the growth of holistic approaches that take account of refugees' own experiences and expressed needs and which address the broader social policy contexts in which refugees are placed. A three-dimensional model for the analysis of the interrelationship between ''macro'' level institutional factors in the mental health of refugees and the individual treatment of refugees within mental health services is proposed. #

Background Policy and research related to transition to adult care for adolescents and young adults (AYAs) has focused primarily on patient age, disease skills and knowledge. Objective In an effort to broaden conceptualization of transition and move beyond isolated patient variables, a new social-ecological model of AYA readiness for transition (SMART) was developed. Methods SMART development was informed by related theories, literature, expert opinion and pilot data collection using a questionnaire developed to assess provider report of SMART components with 100 consecutive patients in a childhood cancer survivorship clinic. Results The literature, expert opinion and pilot data collection support the relevance of SMART components and a social-ecological conceptualization of transition. Provider report revealed that many components, representing more than age, disease knowledge and skills, related to provider plans for transferring patients. Conclusions SMART consists of interrelated constructs of patients, parents and providers with emphasis on variables amenable to intervention. Results support SMART's broadened conceptualization of transition readiness and need for assessment of multiple stakeholders' perspectives of patient transition readiness. A companion measure of SMART, which will be able to be completed by patients, parents and providers, will be developed to target areas of intervention to facilitate optimal transition readiness. Similar research programmes to establish evidence-based transition measures and interventions are needed.

El trabajo analiza la creación en la Argentina, entre los años 1930 y 1954, de una
estructura administrativa nacional, orientada a la prevención y el tratamiento de las enfermedades
venéreas. Dicho esfuerzo responde a un proyecto político de un grupo de médicos,
quienes intentaron dar respuesta a los problemas sociales desde el ámbito de la higiene y
colonizar la estructura burocrática del Estado en su calidad de expertos. Por otro lado,
indaga acerca del proceso de especialización de las disciplinas encargadas de estas enfermedades
y su reconocimiento oficial como especialidades médicas.
PALABRAS CLAVE: Enfermedades venéreas, profilaxis, legislación, burocracia, especialidades médicas.

This paper explores theoretical and practical distinctions between individual citizens ('citizens') and organized groups ('stakeholder representatives' or 'stakeholders' for short) in public participation processes convened by government as part of policy development. Distinctions between 'citizen' and 'stakeholder' involvement are commonplace in government discourse and practice; public involvement practitioners also sometimes rely on this distinction in designing processes and recruiting for them. Recognizing the complexity of the distinction, we examine both normative and practical reasons why practitioners may lean toward-or away from-recruiting citizens, stakeholders, or both to take part in deliberations, and how citizen and stakeholder roles can be separated or combined within a process. The article draws on a 2012 Canadian-Australian workshop of deliberation researchers and practitioners to identify key challenges and understandings associated with the categories of stakeholder and citizen and their application, and hopes to continue this conversation with the researcher-practitioner community.

Sexual harassment and abuse occur in all sports and at all levels with an increased risk at the elite level. The physical and psychological consequences of sexual harassment and abuse are signifi cant for the athlete, their team and for the health and integrity of sport in general. The sports medicine health professional has an integral role to play in the prevention of sexual harassment and abuse in sport. This paper provides sport healthcare professionals with a practical guide on prevention strategies and advice on the recognition and management of suspected abuse.

Getting research into policy and practice (GRIPP) is a process of going from research evidence to decisions and action. To integrate research findings into the policy making process and to communicate research findings to policymakers is a key challenge world-wide. This paper reports the experiences of a research group in a Nigerian university when seeking to 'do' GRIPP, and the important features and challenges of this process within the African context. In-depth interviews were conducted with nine purposively selected policy makers in various organizations and six researchers from the universities and research institute in a Nigerian who had been involved in 15 selected joint studies/projects with Health Policy Research Group (HPRG). The interviews explored their understanding and experience of the methods and processes used by the HPRG to generate research questions and research results; their involvement in the process and whether the methods were perceived as effective ...

This study investigates why the illegal traffic of kidneys exists and remains resilient in the Philippines. It also evaluates the efficacy of the legal and regulatory framework for kidney (and organ) transplantation, and the corresponding implications for health policy. The experiences of comparable countries are noted.Three surveys were employed in this study: 1) a review of related literature on kidney black markets; 2) questionnaire-based interviews of a multi-stage probability sample of 131 kidney vendors from the two largest supplier regions in the Philippines; and 3) a comparative content analysis of pertinent legal and regulatory measures to address the underground kidney trade.Survey results, based on a 4.0 percent statistical margin of error, indicate that kidney vendors are typically males (98.4 percent) who belong to the lower income classes/groups D and E (88.5 percent). The vast majority of vendors (89.2 percent) were unrelated to kidney recipients, many of whom were of foreign descent (60.3 percent). The study finds that certain key elements underpin the kidney black market in the Philippines: an open, brokered and compensation-based contractual system between unrelated donors and sellers. These elements are sustained and reinforced by a robust supply-and-demand interface anchored on brokerage pricing, government incapacity, policy contradictions and public tolerance or indifference.The study suggests that the relative ambiguity of, and continuity between, the legal and underground kidney transplant systems be carefully addressed prior to enacting more specific reforms. The study also calls attention to the unintended consequences of various reform efforts, which are often neglected in formulating health policy and evaluating its costs and benefits.

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PLANNING, ORGANIZATION AND MANAGEMENT OF HOSPITALS & NURSING HOMES

The healthcare industry in the 21st century will continue to be transformed by new innovations and technology. For patients and healthcare staff, these developments will be most evident in new tools, such as robotic surgical tables and intra-hospital delivery drones, that improve healthcare services and outcomes. Healthcare will be omnipresent and exist without walls.Healthcare is going to be evermore ubiquitous and exist in an omnipresent space.
Hospital is a complex organization. There is a wide diversity of objectives and goals among individuals, professional groups and various subsystems. Hospitals deal with problems of life and death. This puts significant psychological and physical stress on personnel. The major product is difficult to determine. Advances in technology, economic, epidemiological and demographic pressure and consumer expectations add complexity to hospital management.
Today the consumer accesses healthcare. In the future, healthcare will access the consumer, technology will change the fundamental ways in which people and health systems interact. Planners must consider health beyond its traditional building type because healthcare is moving to more of a coherent, connected and coordinated framework.
On a one-on-one level, patients will expect doctors to use their data to offer more personalized solutions.Tomorrow’s healthcare design needs to have resilience for changing economics, demographics and regulatory conditions, so these investments can adapt to evolutionary changes over time. Outcome-based care will translate to outcome-based design. Patients and caregivers will demand more of their physical—and virtual—experiences. Healthcare environments will become more engaging over the next decade in response to changing attitudes and technology.
In the near future, advances in artificial intelligence (AI), information technologies, high-speed internet, remote-monitoring technology, and developments in 3D-printing and robotics will change the way healthcare is delivered. A revolution in diagnosis and care provision will take place. The concept of the “Future Hospital” will become a reality. We must prepare for a robotic future; we need to plan for the role of robotics in our hospitals. The future might hold factory-like hospitals, where nearly all healthcare procedures from reception to surgery will be performed by robots or be at least robot- assisted.
Telemedicine, Telecare, E-healthcare and M-healthcare are emerging perspectives. With the aid of different smart devices, nanotechnology is developed in healthcare systems to monitor, diagnose, and treat patients. The development of drugs and precision medicine based on genomics and big data is one of the advancements in healthcare which is continuously under development.
Each human will have a computer chip attached to his/her body containing all his/her medical data, which will be monitored by AI. Computer chips placed in every human body will allow for all diseases to be diagnosed at an early stage; all the health information of each individual will be readily available. Bioprinting has the potential to become the standard in complex tissue fabrication, increasing the need for 3D printing in healthcare in the coming years.
Improvements in hospital performance are important for advancing towards UHC. When health facilities perform well, the overall performance of the health system improves. Improved performance requires clear goals for the hospital sector within the broader health system and clear functions for institutions supporting hospitals to reach these goals. Achieving high-performing hospitals and health systems requires the capacity to formulate policies and implement action to improve planning and management. The health sector needs to expand its skills and strengthen its capabilities to drive change. Hospital management teams must be capable of improving the quality and efficiency of day-to-day operations. Effective leadership is needed to manage finances, to lead and support staff, and to develop partnerships to improve the quality and efficiency of hospital services.
This book addresses the complex concerns and issues to provide a comprehensive and holistic view in planning, designing and management of hospitals and Nursing Homes. It has a unique style, quality content and universal outlook. This will also serve as a reference book. A book that many have been aspiring for: a must read for Hospital & Health Service Administrators, Clinicians, Nursing Officers, Academic, Policy-makers, Planners, Architects, Academic Administrators of medical universities/colleges and Students of Management.

It is sometimes argued that the non-therapeutic, non-consensual alteration of children’s genitals should be discussed in two separate ethical discourses: one for girls (in which such alterations should be termed ‘female genital mutilation’ or FGM), and one for boys (in which such alterations should be termed ‘male circumcision’). In this article, I call into question the moral and empirical basis for such a distinction, and argue that all children—whether female, male, or intersex—should be free from having parts of their genitals removed unless there is a pressing medical indication.

People abused by angry discipline as children, may tend to abuse or overly punish other people or themselves for perceived wrongs in their adult life. In some individuals, aggressive personality traits may be genetically inherited. The aggressive personality may feel weakened by having guidelines or boundaries for anger. Anger is a normal human emotion, and these guidelines can help express anger in a healthy way.

Health has long been intertwined with the foreign policies of states. In recent years, however, global health issues have risen to the highest levels of international politics and have become accepted as legitimate issues in foreign policy. This elevated political priority is in many ways a welcome development for proponents of global health, and it has resulted in increased funding for and attention to select global health issues. However, there has been less examination of the tensions that characterize the relationship between global health and foreign policy and of the potential effects of linking global health efforts with the foreign-policy interests of states. In this paper, the authors review the relationship between global health and foreign policy by examining the roles of health across 4 major components of foreign policy: aid, trade, diplomacy, and national security. For each of these aspects of foreign policy, the authors review current and historical issues and discuss how foreign-policy interests have aided or impeded global health efforts. The increasing relevance of global health to foreign policy holds both opportunities and dangers for global efforts to improve health.

Empirical research on the effects of school sport policies on children's physical activity is limited. This study examined sport policies (intramural vs. varsity), physical settings within schools, and supervision in relation to physical activity using the System for Observing Play and Leisure in Youth (SOPLAY). Data were collected on physical activity levels of children in four middle schools. Regression analyses assessed the main effects of sport policy, type of physical activity setting, and supervision as well as interactions. Regression models were stratified by gender. Children in intramural schools were more likely to use indoor spaces and be boys. Regression models indicated that varsity sport programs were associated with lower physical activity levels among boys but not girls. Significant associations between type of physical activity settings and physical activity levels were observed only for boys. Adult supervision was not associated with children's physical activity levels. Finally, descriptive results showed athletic facilities were under-utilized in all schools.

The desire to achieve the best outcomes in the provision of healthcare has driven health system reforms in many countries across the globe, including the Emirate of Abu Dhabi, United Arab Emirates. As a young state (the United Arab Emirates was founded as an independent state in 1971) with a diverse (with 78% expatriates) and young population (40.23% of the national Emirati population is under 15 years of age), the government of the Emirate of Abu Dhabi has embarked on a journey to reform their healthcare system. This reform focuses on the redesign, financing, regulation and provision of healthcare with the aim of delivering accessible, affordable and high quality health care. We will describe and review the health system reform in Abu Dhabi to date: its background, history and characteristics. The review looks at whether the main components of the reform (mandatory health insurance; enhanced competition and a centralized regulatory system) have had the desired effects in terms of improving quality, enhancing access and ensuring affordability. Looking towards the future for the health system in Abu Dhabi we conclude that it is too early to tell whether the reform programme is having the desired effects in terms of achieving its goals of quality, access and affordability.

In 2002, California adopted a non-name system for HIV case reporting. This study focused on the acceptability of a non-name reporting system among key stakeholders implementing the system. We conducted qualitative research during the pre-and post-implementation period of the non-name HIV reporting regulations. During both study periods we conducted key informant in-depth interviews (n = 48 and 52, respectively) with health department surveillance staff, laboratory personnel, health care providers and clinic staff; and we conducted four focus group discussions (n = 28 and 30, respectively) with representatives of community-planning group members and advocacy groups. We found that overall, California's non-name HIV reporting regulations were acceptable to most key stakeholders. Acceptability of a non-name system was highest among advocates and healthcare providers. Views of health department staff varied across the four counties, with some expressing a strong preference of a names based system and others accepting the non-name system.

Exertional heat illness can affect athletes during high-intensity or longduration exercise and result in withdrawal from activity or collapse during or soon after activity. These maladies include exercise associated muscle cramping, heat exhaustion, or exertional heatstroke. While certain individuals are more prone to collapse from exhaustion in the heat (i.e., not acclimatized, using certain medications, dehydrated, or recently ill), exertional heatstroke (EHS) can affect seemingly healthy athletes even when the environment is relatively cool. EHS is defined as a rectal temperature greater than 40-C accompanied by symptoms or signs of organ system failure, most frequently central nervous system dysfunction. Early recognition and rapid cooling can reduce both the morbidity and mortality associated with EHS. The clinical changes associated with EHS can be subtle and easy to miss if coaches, medical personnel, and athletes do not maintain a high level of awareness and monitor at-risk athletes closely. Fatigue and exhaustion during exercise occur more rapidly as heat stress increases and are the most common causes of withdrawal from activity in hot conditions. When athletes collapse from exhaustion in hot conditions, the term heat exhaustion is often applied. In some cases, rectal temperature is the only discernable difference between severe heat exhaustion and EHS in on-site evaluations. Heat exhaustion will generally resolve with symptomatic care and oral fluid support. Exercise associated muscle cramping can occur with exhaustive work in any temperature range, but appears to be more prevalent in hot and humid conditions. Muscle cramping usually responds to rest and replacement of fluid and salt (sodium). Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping.

Background: Since the early 1990s former communist countries have been reforming their health care systems, emphasizing the key role of primary care and recognizing family medicine as a specialty and an academic discipline. This study assesses the level of academic development of the discipline characterised by education and research in central and eastern European (CEE) countries.

There is no SDM in clinical practice in Brazil. The first steps have been taken towards research and tool development recently. Likewise, our society is starting to get involved with decision making in health care. This paper aims to offer an overview of the Brazilian health system history, its values, and its influence on SDM. The participative social control concept is introduced as a result of the movement against the dictatorship era. In addition, the influence of social changes on the Medical Ethical Code is delineated. SDM state of the art in Brazil is also discussed and the challenges to implement it on clinical practice are described. Regardless the challenges, it is possible to make a positive assessment of SDM in Brazil.

This paper examines the public policy value of looking at gambling from a public health perspective. The manner in which social issues are framed will either expand or curtail public policy debates. The existing and traditional frames for gambling (e.g. gambling as a matter of individual freedom, gambling as a form of recreation) fail to consider research on the social and economic impacts of gambling. Because a public health frame offers a broad viewpoint of society, it encompasses a number of social and economic impacts not considered in traditional frames. However, the existing gambling frames enjoy varying degrees of cultural, economic, and political support and, as a result, creating a higher profile for a public health framework will encounter a number of barriers. Research can play a decisive role in overcoming these barriers, as it has in a number of related fields (e.g., tobacco use, addiction and product liability, the epidemiology of AIDS). The paper concludes that research that identifies and quantifies the public health factors of gambling will substantially contribute to a public shift toward a public health frame.

The implementation of a pharmacovigilance service compliant with the legal and regulatory responsibilities of clinical trial sponsors presents particular challenges for sponsors in a non-commercial setting.In this paper we examine these challenges in detail. We identify and discuss the key steps in the development of a pharmacovigilance service within a public health service and university setting in the United Kingdom. We describe how we have established a central Pharmacovigilance Office with dedicated staff and resources within our organisation. This office is supported by an electronic pharmacovigilance reporting infrastructure developed to facilitate the receipt and processing of safety information, the onward reporting in compliance with legislation and the provision of sponsor institution oversight of clinical trial participant safety. An education and training programme has also been set up to ensure that all relevant staff in the organisation are fully aware of the pharmaco...

This is a preprint (submitted manuscript pre peer review) of an article, subsequently published in Public Health Ethics, 7 (1): 1--4. The final version contains typographical as well as substantial changes compared to this first submission, and can be accessed online: http://phe.oxfordjournals.org/content/7/1/1.abstract. The entire special symposium introduced can be accessed online: http://phe.oxfordjournals.org/content/7/1.toc The idea of a special journal symposium on the theme of New Media and Risky Behavior of Children and Young People: Ethics and Policy Implications originally arose out of a workshop at the University of Gothenburg held in 2011 as part of a European project coordinated by the University of Central Lancashire Law School, on possible policy responses to the impact on young people of exposure to audiovisual media portrayals of alcohol consumption. 1 A main outcome of that meeting, where selected experts on the empirical research in this area as well as on relevant aspects of ethics and law participated, was that the problem is just an instance of a much more complex and encompassing one, not least the underlying value and normative issues. While we did have in mind as a thematic topic the possible clash between two powerful set of societal norms and concerns -the well--being of children and the freedom of expression, it turned out to be a less than straightforward matter to connect these to the empirical information available and the same turned out to hold for issues about the proper sharing of responsibilities between businesses, societal institutions, parents and young people themselves.

All rights reserved 1 2 3 4 13 12 11 10 This volume is a product of the staff of the International Bank for Reconstruction and Development/ The World Bank. The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgement on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. v

O avanço verificado no enfrentamento de neoplasias malignas por meio dos sistemas de saúde envolve melhorias nas áreas de vigilância, organização de redes de assistência, programas específicos voltados às prevenções primária e secundária e, obviamente, aos avanços técnico-científicos que caracterizam a abordagem diagnóstica e terapêutica. Embora seja notável o reconhecimento de avanços no manejo de neoplasias malignas em todas as áreas citadas, o câncer da boca permanece com indicadores de morbidade e mortalidade que parecem não acompanhar o acúmulo científico no conhecimento da doença. O presente manuscrito objetiva discutir os motivos desse descompasso, a necessidade de reorientação de prioridades na abordagem do câncer da boca e sua efetivação como política pública de saúde.

Objectives: Nowadays, euthanasia has the meaning of the direct administration of a lethal agent to the patient by another party with a merciful intent after patients' request. Physician assisted suicide refers to the patient intentionally and wilfully ending his or her own life with the assistance of a physician. The objectives of the manuscript were to investigate the opinions of Greek physicians, nurses, lay people and relatives of advanced cancer patients on euthanasia and physician assisted suicide. Methods: The final sample consisted of 215 physicians, 250 nurses, 218 relatives and 246 lay people. A survey questionnaire was used concerning issues such as euthanasia and physician assisted suicide. The survey instrument included 13 questions and described issues such as religious and spiritual beliefs, euthanasia, physician assisted suicide and decision-making situations. Results: 43.3% physicians and 41.3% relatives would agree in advance that in case of heart and/or respiratory arrest there would not be an effort to revive a terminally ill cancer patient. 20.5% physicians had a request for euthanasia. Significant associations were found between physicians (9.3%), relatives (1.8%, p = 0.001) and lay people (3.7%, p = 0.020) on their opinions regarding withdrawing treatment.

Mental health in China is a great concern given the large number of patients and huge social and economic costs. The one-month prevalence rate of adult mental disorder in China is about 17.5%. Over 170 million adults have one or more types of mental disorder. Of this, 16 million people are estimated to have serious mental diseases. Over 90% of patients with serious mental diseases in China have not been given proper medical treatment. Over 60% of suicide cases in China are associated with mental disorders and suicide is the most significant reason for death between 19 and 34 years old in China. This paper reviews the mental health care condition in China and discusses policy implications, given current import issues for mental health care. We review research literature for mental health care in China and collect reports from various published sources. Under-supply of the mental health services is the most pivotal issue for policymakers. The utilization of mental health care services...

This paper describes the development of and lessons learned in implementing the Primary Health Care Access Program (PHCAP) in the Northern Territory. The implementation of the PHCAP is a major Aboriginal health policy reform. PHCAP provides an opportunity for Aboriginal people to gain access to properly resourced comprehensive primary health care (PHC) services. PHCAP is described in its unique funding model that attempts to address tensions within the federal governance system. In this paper we argue that access to PHC services is a key determinant of health and that funding of PHC services has been inadequate and inequitable throughout the Northern Territory. The implementation of PHCAP is reforming the existing health system and leading to the establishment of new PHC services. We analyse the barriers encountered in this process. The PHCAP funding model is analysed for its adequacy and design strength to address federal relations. We consider issues of workforce shortage that wil...

Sedation is a commonly used procedure in many medical disciplines including palliative care. It is indicated for a variety of reasons and the type of sedation varies considerably. For example, intentional temporary sedation is sometimes used for procedures (chesttube insertion, endoscopy, etc.) or insomnia whereas at other times sedation is unintentional (sometimes called secondary or consequential sedation) such as when sedation occurs as a side-effect of a drug being used to control a symptom. Thus the topic of sedation in palliative care practice is vast and complex. To develop this framework the authors reviewed the international literature and palliative sedation policies and protocols from within and without Canada. Recommendations from the first draft were presented at two workshops to full-time and part-time palliative care physicians and to family physicians and a subsequent draft based on feedback from the workshops was then sent to selected inter-professional reviewers across Canada. Their feedback was incorporated into the next draft and this was sent to members of the Canadian Society of Palliative Care Physicians (CSPCP) who were then surveyed for their level of agreement with the recommendations. There was a 29.3% response with over 70% agreement with all but three of the recommendations. This final document addresses planned sedation for management of intolerable and refractory symptoms. It does not address emergency sedation e.g. for an acutely agitated and delirious patient. Introduction and Background The role of continuous palliative sedation therapy (CPST) still generates controversy. From the early1990s, when CPST was first described 1,2 , until the present day reports have raised concern about its potential for misuse, or abuse as a form of covert euthanasia 3,4,5,6,7,8. Correctly practiced it is an ethically and medically acceptable form of therapy 9. The expression "terminal sedation" first appeared in the literature in the 1990's in Enck's review of two articles concerning symptom control at the end of life 2. These papers suggested that up to 52% of patients near death had symptoms so resistant to available palliative treatments that only sedation was sufficient to control them. CPST appeared in

Consanguinity or inter-cousin marriage is a phenomenon quite prevalent in certain regions around the globe. Consanguineous parents have a higher risk of having offspring with congenital disorders. It is difficult to model large scale consanguineous parental populations because of disparate cultural issues unique to regions and cultures across the globe. Although consanguinity has previously been studied as a social problem, it has not been modeled from a biological perspective. Discrete Event System Specification (DEVS) is a powerful modeling formalism for the study of intricate details of real-world complex systems. In this paper, we have developed a DEVS model to get an insight into the role of consanguineous marriages in the evolution of congenital disorders in a population. As proof-of-concept, we further developed a consanguinity simulation model in Simio simulation software. Simulation results validated using population growth data show the effectiveness of this approach in the modeling of consanguinity in populations.

A large proportion of non-communicable disease can be attributed to modifiable risk factors such as poor nutrition and physical inactivity. We present data on planning and transport practitioners' perceptions and responses to government public health guidance aimed at ...

Objective: This paper investigates the relationship between the working conditions and illness-and injury-related absenteeism of full-time Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). Method: We used 2005 National Survey of the Work and Health of Nurses, which was designed to be representative of nurses employed in nursing in Canada in the fall of 2005. We estimated Negative Binomial regression models separately for RNs and LPNs with health related absenteeism as the dependent variable. The regressors include working conditions, work settings, and shift type/length along with socio-demographic variables. Results: Depression is a significant determinant of absenteeism for both RNs and LPNs. However, workload and lack of respect are significant determinant of absenteeism for LPNs but not for RNs. Both RNs and LPNs working in other setting (physician offices, private nursing educations, educational institutions, governments and associations) will have less absenteeism than those working in hospitals. For LPNs, those working in long-term facility will also have less absenteeism than those working in hospitals. The length and type of shift also has significant effect on absenteeism. Discussion: Improving working conditions with a resulting reduction in absenteeism might be an economic way to increase the labour supply of nurses without increasing new admissions or new recruits.

An effective health workforce is essential for achieving health-related new Sustainable Development Goals. Odisha, one of the states in India with low health indicators, faces challenges in recruiting and retaining health staff in the public sector, especially doctors. Recruitment, deployment and career progression play an important role in attracting and retaining doctors. We examined the policies on recruitment, deployment and promotion for doctors in the state and how these policies were perceived to be implemented. We undertook document review and four key informant interviews with senior state-level officials to delineate the policies for recruitment, deployment and promotion. We conducted 90 in-depth interviews, 86 with doctors from six districts and four at the state level to explore the perceptions of doctors about these policies. Despite the efforts by the Government of Odisha through regular recruitments, a quarter of the posts of doctors was vacant across all institutiona...

European policymakers have recently become increasingly committed to using Impact Assessment (IA) to inform policy decisions. Welcoming this development, the public health community has not yet paid sufficient attention to conceptual concerns about IA or to corporate efforts to shape the way in which IA is used. This essay is a thematic analysis of literature concerning IA and associated tools and a related assessment of the European Union's (EU) new 'integrated'IA tool. Eight key concerns regarding IA are identified from ...

Previously, our group—the International Working Group for HTA Advancement—proposed a set of fifteen Key Principles that could be applied to health technology assessment (HTA) programs in different jurisdictions and across a range of organizations and perspectives. In this commentary, we investigate the extent to which these principles are supported and used by fourteen selected HTA organizations worldwide. We find that some principles are broadly supported: examples include being explicit about HTA goals and scope; considering a wide range of evidence and outcomes; and being unbiased and transparent. Other principles receive less widespread support: examples are addressing issues of generalizability and transferability; being transparent on the link between HTA findings and decision-making processes; considering a full societal perspective; and monitoring the implementation of HTA findings. The analysis also suggests a lack of consensus in the field about some principles—for example...

Background: Despite indications that infection-related mortality in sub-Saharan Africa may be decreasing and the burden of non-communicable diseases increasing, the overwhelming reality is that health information systems across most of sub-Saharan Africa remain too weak to track epidemiological transition in a meaningful and effective way. Proposals: We propose a minimum dataset as the basis of a functional health information system in countries where health information is lacking. This would involve continuous monitoring of cause-specific mortality through routine civil registration, regular documentation of exposure to leading risk factors, and monitoring effective coverage of key preventive and curative interventions in the health sector. Consideration must be given as to how these minimum data requirements can be effectively integrated within national health information systems, what methods and tools are needed, and ensuring that ethical and political issues are addressed. A more strategic approach to health information systems in sub-Saharan African countries, along these lines, is essential if epidemiological changes are to be tracked effectively for the benefit of local health planners and policy makers. Conclusion: African countries have a unique opportunity to capitalize on modern information and communications technology in order to achieve this. Methodological standards need to be established and political momentum fostered so that the African continent's health status can be reliably tracked. This will greatly strengthen the evidence base for health policies and facilitate the effective delivery of services.

Background: Since the early 1990s, a concerted effort has been made to develop community-and state-based immunization registries. A 1995 survey showed that nine states had laws specifically authorizing immunization registries. This survey was conducted to describe the current status of legislation and policies addressing immunization registries and the sharing of immunization information. Methods: A telephone survey was administered from September 1997 to February 1998 to immunization program managers and/or their designees within the state health department of each of the 50 states and the District of Columbia. Some of the survey items were later updated through follow-up interviews and informal communications. Copies of legislation, administrative rules and regulations, and immunization registry policies were collected for review. Results: As of October 2000, 24 of 51 states (47%) had laws (21) or rules (3) specifically authorizing an immunization registry. Nine additional states (18%) have laws specifically addressing the sharing of immunization information. Conclusions: Over half of the states have enacted legislation or rules addressing registries or the sharing of immunization information. Further research should be conducted to assess the impact of this legislation on immunization registries.