This is Our Lane: A Pilot Study Examining the Surgeon's Role in Social Justice Advocacy.

BACKGROUND: Despite the importance of social justice advocacy, surgeon attitudes toward individual involvement vary. We hypothesized that the majority of surgeons in this study, regardless of gender or training level, believe that surgeons should be involved in social justice movements. METHODS: A survey was distributed to surgical faculty and trainees at three academic tertiary care centers. Participation was anonymous with 123 respondents. Chi-square and Fisher's exact test were used for analysis with significance accepted when p < 0.05. Thematic analysis was performed on free responses. RESULTS: The response rate was 46%. Compared to men, women were more likely to state that surgeons should be involved (86% vs 64%, p = 0.01) and were personally involved in social justice advocacy (86% vs 51%, p = 0.0002). Social justice issues reported as most important to surgeons differed significantly by gender (p = 0.008). Generated themes for why certain types of advocacy involvement were inappropriate were personal choices, professionalism and relationships. CONCLUSIONS: Social justice advocacy is important to most surgeons in this study, especially women. This emphasizes the need to incorporate advocacy into surgical practice.

Prerequisites for stakeholder framework: Consumer advocacy and health protection in the digital industry. •.

The World Health Organization (WHO) included gaming disorders in International Classification of Disease-11th (ICD-11) on May 25, 2019. Since then, some academics and the gaming industry have continued to argue over the health system's response to online addictive behaviors. Under these circumstances, a framework involving groups representing various interests is needed to derive a reasonable solution to the dispute over the inclusion of gaming disorders in ICD-11. For this framework to work effectively, it is necessary to agree on consistent and advanced research findings that harms related to the excessive use of digital devices or content continue to occur empirically all over the world and that addictive use constitutes a primary addictive disorder. The problematic risk taking involving emerging technologies may include not only health risks from addictive use, but also more general harms associated with digital ethics and norms such as privacy and transparent money transactions. An understanding of a public health model of addiction is required to reduce harms associated with online addictive behavior that exist behind risk taking. Such harms are also mediated by excessive use, excessive money spending, and exposure to addictive content such as violence and pornography. Major stakeholders and their roles can be derived more effectively based on these conceptual models and parameters of harms. In conclusion, the context of the proposed stakeholder framework should be further optimized on the basis of two principles: (1) advocating consumer rights as a general and standard approach to digital products; and (2) protecting consumers' health from harms related to addictive behaviors.

E-Cigarette Advocates on Twitter: Content Analysis of Vaping-Related Tweets.

BACKGROUND: As the majority of Twitter content is publicly available, the platform has become a rich data source for public health surveillance, providing insights into emergent phenomena, such as vaping. Although there is a growing body of literature that has examined the content of vaping-related tweets, less is known about the people who generate and disseminate these messages and the role of e-cigarette advocates in the promotion of these devices. OBJECTIVE: This study aimed to identify key conversation trends and patterns over time, and discern the core voices, message frames, and sentiment surrounding e-cigarette discussions on Twitter. METHODS: A random sample of data were collected from Australian Twitter users who referenced at least one of 15 identified e-cigarette related keywords during 2012, 2014, 2016, or 2018. Data collection was facilitated by TrISMA (Tracking Infrastructure for Social Media Analysis) and analyzed by content analysis. RESULTS: A sample of 4432 vaping-related tweets posted and retweeted by Australian users was analyzed. Positive sentiment (3754/4432, 84.70%) dominated the discourse surrounding e-cigarettes, and vape retailers and manufacturers (1161/4432, 26.20%), the general public (1079/4432, 24.35%), and e-cigarette advocates (1038/4432, 23.42%) were the most prominent posters. Several tactics were used by e-cigarette advocates to communicate their beliefs, including attempts to frame e-cigarettes as safer than traditional cigarettes, imply that federal government agencies lack sufficient competence or evidence for the policies they endorse about vaping, and denounce as propaganda "gateway" claims of youth progressing from e-cigarettes to combustible tobacco. Some of the most common themes presented in tweets were advertising or promoting e-cigarette products (2040/4432, 46.03%), promoting e-cigarette use or intent to use (970/4432, 21.89%), and discussing the potential of e-cigarettes to be used as a smoking cessation aid or tobacco alternative (716/4432, 16.16%), as well as the perceived health and safety benefits and consequences of e-cigarette use (681/4432, 15.37%). CONCLUSIONS: Australian Twitter content does not reflect the country's current regulatory approach to e-cigarettes. Rather, the conversation on Twitter generally encourages e-cigarette use, promotes vaping as a socially acceptable practice, discredits scientific evidence of health risks, and rallies around the idea that e-cigarettes should largely be outside the bounds of health policy. The one-sided nature of the discussion is concerning, as is the lack of disclosure and transparency, especially among vaping enthusiasts who dominate the majority of e-cigarette discussions on Twitter, where it is unclear if comments are endorsed, sanctioned, or even supported by the industry.

Controle do tabagismo e direito do consumidor são temas de webinar

Legislação, estratégias da indústria tabageira e atuação do Estado e da sociedade civil organizada estarão em discussão

California advocates' perspectives on challenges and risks of advancing the tobacco endgame.

In the USA, California's highly-regarded Tobacco Control Program (CTCP) has defined its goal as "ending the tobacco epidemic for all population groups" by 2035. To understand local advocates' perceptions of endgame-oriented policies, we interviewed 28 advocates from California communities that had recently adopted tobacco control policies. There was no consensus among participants on which specific policies would constitute the tobacco endgame in California. There was an agreement, however, that policymakers should promote policies that would impact communities with the highest tobacco use prevalence and that policies should be 'clean', avoiding exemptions. Participants were cognizant of California's history of tobacco control policy innovations beginning locally and eventually being adopted at the state level. Many commented that recent policy innovations in the state had begun a conversation that made more 'radical' ideas seem possible. California tobacco control advocates are engaged in local endgame policy discussions and prepared to advance California's endgame goal.

Análise ético-jurídica da publicidade odontológica no Instagram / Ethical and legal analysis of Odontology-related advertisement on Instagram

A restrição à publicidade odontológica coíbe a mercantilização, resguarda a privacidade do paciente e o protege como consumidor. O objetivo deste estudo foi avaliar a adequação da publicidade na rede Instagram® ao regramento vigente. Numa amostra de 384 perfis profissionais, avaliaram-se postagens públicas à luz da Lei 5.081/1966, Código de Defesa do Consumidor e Código de Ética Odontológica. A identificação adequada não foi feita por 35,4%. Já 3,6% anunciaram especialidades não reconhecidas. A expressão "popular" foi utilizada por 27,1%. Houve publicidade abusiva (16,4%) ou enganosa (8,3%). Serviços gratuitos foram anunciados (9,4%), com divulgação de preços (5,5%). Usando a imagem do paciente (79,4%), constatou-se divulgação de resultados clínicos (72,9%). Houve identificação do paciente em 68,2%, com uso adequado da imagem em apenas 9,1% dos casos. As imagens de antes/depois foram usadas em 76,6% das postagens. As inadequações sem a imagem do paciente orbitam entre infração ética, exercício profissional ilícito e desrespeito ao direito consumerista. Conclui-se que a publicidade odontológica veiculada no Instagram® apresentou condutas ilícitas e antiéticas, com e sem o uso da imagem do paciente o que pode configurar prejuízos ao paciente, ao profissional e à Odontologia como profissão da área de saúde.

Biscoitos integrais: legislação pertinente e percepção do consumidor / Whole grain cookies: relevant legislation and consumer's perception

Inúmeros benefícios são atribuídos aos alimentos integrais, especialmente pela concentração de fibras nesses produtos. Sabe-se que biscoitos integrais compõem a dieta dos consumidores, sendo a rotulagem o principal meio de comunicação entre indústria produtora e consumidores, e que não existe legislação específica para essa categoria de alimentos. Assim, este trabalho objetivou verificar se as informações e/ou discursos nutricionais presentes nos rótulos de biscoitos integrais estão de acordo com a legislação geral de rotulagem, e também averiguar a percepção dos consumidores frente às alegações, bem como sua preferência e consumo desses produtos. O estudo foi realizado em três supermercados da cidade de Videira-SC e contemplou duas etapas: análise de rótulos por meio de check-list e aplicação de questionário com consumidores. Os resultados evidenciaram inadequações, destacando-se a utilização de informações não previstas em lei, que podem induzir o consumidor a erros. Quanto à percepção dos consumidores, estes majoritariamente acreditam que para um alimento ser considerado integral, deve conter no mínimo 50% dessa fonte de ingrediente, e os associam a benefícios à saúde. Verifica-se a necessidade de desenvolver ações que promovam educação nutricional, bem como rigidez, cumprimento das leis vigentes e novos planejamentos de normas técnicas específicas para alimentos integrais, a fim de estabelecer critérios quanto à determinação desse grupo de alimentos. (AU)

Countless benefits are attributed to whole grain foods, especially due to the concentration of dietary fiber in these products. It is widely known that whole grain cookies are part of the consumers' diet, that food labeling is the primary means of communication between producers and consumers, and that a relevant legislation for this class of food is required. Thus, the present study aimed to verify whether nutrition claims and/or terms displayed on the labels of whole grain cookies are in compliance with the applicable labeling legislation, and also to ascertain consumer's perception on these claims as well as their preference for and consumption of these products. The study was carried out in three supermarkets in the city of Videira-SC, split into two stages: label analysis through a checklist and administration of a questionnaire to consumers. Results showed non-compliances, especially the use of terms not foreseen by the law, which could mislead consumers. Regarding the perception of consumers, they mostly believe that a product may contain at least 50% of whole grains to be called a whole grain food, and associate them with health benefits. It is necessary to develop and promote nutrition education actions as well as constitutional rigidity and compliance with the applicable legislation, and new and relevant technical standards for whole grain foods in order to improve requirements for this class of food. (AU)

Ten Years of FDA Tobacco Regulation: Lessons for Public Health Stakeholders.

In the 10 years that the U.S. Food and Drug Administration (FDA) has been regulating tobacco products, the agency has been plagued with setbacks, some of its own making, and some the result of outside forces. What has been consistently true is that the public health community has not had as much of a voice as it should have until public health groups began filing lawsuits against the FDA. This article examines four areas of FDA regulation over the last decade in an attempt to qualitatively describe the work of the Center for Tobacco Products and identify opportunities for public health groups to have greater advocacy success in the future.

Teaching Health Advocacy: A Systematic Review of Educational Interventions for Postgraduate Medical Trainees.

PURPOSE: A systematic review was undertaken to characterize the training approaches that are currently being implemented in postgraduate medical education to teach residents advocacy skills. METHOD: An initial search was conducted in MEDLINE, PubMed, Embase, ERIC, and PsycINFO in November 2016 (updated in December 2017) for articles discussing postgraduate medical education interventions covering advocacy. Articles published between 1995 and 2017 were included. Two authors independently reviewed titles and abstracts (and, if needed, the full text) for inclusion; disagreements were resolved by consensus. Data were extracted from studies to characterize the content and pedagogy of the interventions by mapping them to the CanMEDS health advocate core competencies and key concepts. RESULTS: A total of 3,027 unique abstracts were retrieved; 2,864 were excluded upon title and abstract review, and another 85 were excluded upon full-text review. Seventy-eight total articles were included. More studies involved residents from pediatrics, psychiatry, primary care or preventative medicine, or internal medicine than from emergency medicine, surgery, obstetrics and gynecology, or neurology. Published interventions varied widely by pedagogical approach and assessment method. CONCLUSIONS: Using the CanMEDS framework, this review maps the breadth and nature of postgraduate medical education interventions in health advocacy, with applicability to community organizations, program directors, educators, and administrators working to develop advocacy training interventions. Areas of focus included adapting practice to respond to the needs of or advocacy in partnership with patients, communities, or populations served; determinants of health; health promotion; mobilizing resources as needed; and social accountability.

Derecho al consumo informado: el caso de las bebidas azucaradas en Colombia / Right to informed consumption: the case of sugar-sweetened beverages in Colombia

Introducción: se presenta un análisis sobre el derecho al consumo informado en el caso de las bebidas azucaradas, a través del recorrido administrativo y judicial en Colombia. Metodología: se hace desde una perspectiva jurídica, bioética y médica, señalando cómo la protección judicial de este derecho se da gracias al activísimo social y judicial que se enfrenta con el lobby de la industria, cuyos intereses también inciden, no en el ámbito del acceso a la justicia, pero si en el del diseño de políticas públicas en salud para reducir el consumo de bebidas azucaradas. Conclusiones: de la revisión de la literatura se encontró que ciertas enfermedades no transmisibles se asocian con el consumo de estos productos, por lo cual en diferentes regiones del mundo se han replanteado medidas para mitigar su impacto, mientras en Colombia el escenario desde las políticas públicas no ha sido favorable.

Introduction: an analysis of the right to informed sugar-sweetened beverages consumption is herein presented from the administrative and legal background in Colombia. Methodology: a study conducted from the legal, bioethical and medical perspective, pointing out how legal protection of this right is possible thanks to social and legal activism which faces industrial lobby whose interests do not influence the access to justice institutions but does influence the design of health public policy for reducing sugar-sweetened beverages intake. Conclusions: our review of the literature found that certain non-communicable diseases are associated with the intake of these products for which measures to mitigate their impact have been reconsidered in different regions of the world, while in Colombia the public policy scenario has been unfavorable.

Advocating for the Health Worker.

BACKGROUND: Health workers in both well-resourced and limited income settings face health threats from exposures encountered in their unique and complex work environment. Even before the 2014 Ebola outbreak, preventable harm was routinely felt by health workers, most visibly through the fatal collusion between the HIV/AIDS epidemic and tuberculosis (TB) infection in high endemic countries. OBJECTIVES: The aim of this paper is to examine the analyses of the health sector workforce by development and public health agencies regarding its sustainability, threats from workers' personal health risks and discussion of protections to address those risks. METHODS: Development and public health agency reports assessing the sustainability of and threats to the health workforce both pre-and post the 2014 Ebola outbreak were examined with a focus on low and middle- income countries (LMICs). FINDINGS: Reviews of the health sector workforce have largely focused on its role as a necessary component of sustainable development. Hence, staff competency, numbers and productivity have been emphasized with little notice of the conditions of work and the highly hazardous environment contributing to worker out-migration, illness and death. CONCLUSIONS: Going forward, the 2016 World Health Assembly campaign to advance human resources for health and other UN efforts on health employment may offer some opportunities to address needed health worker protections. However, to these largely competency-focused workforce development efforts must first be brought resources for and commitment to protecting the safety of these workers' lives and livelihood. Doing less defeats investments in fragile health systems and is plainly unethical.

Insights in Public Health: Formative Factors for a Statewide Tobacco Control Advocacy Infrastructure: Insights from Hawai'i.

Hawai'i has comprehensive statewide tobacco control policies and was the first US state to raise the minimum age of sale, purchase, and possession of tobacco products to age 21 ("Tobacco 21") in a policy including not just cigarettes, but also electronic smoking devices and other tobacco products. This insights article provides strategic thinking about tobacco control advocacy planning. Specifically, we identify formative factors critical to building and sustaining our cross-sector, statewide advocacy infrastructure that has been able to address many ongoing challenges of tobacco-use prevention and control over time. This can provide new insights for other large-scale tobacco-control advocacy efforts.

Advocating for Breast Heath Education for College-Age Students.

Awareness of the risk factors associated with breast cancer can alleviate fear and anxiety, and can lead people to pursue prevention. This article describes a university's annual breast health education event focused on breast health awareness and breast cancer education. Community health organizations and student organizations serve as exhibitors and provide students with opportunities to test their knowledge and dispel myths. Over the past 5 years this event has reached more than 2,000 students. Initiatives such as this event provide health educators with an opportunity to reach this highly vulnerable population.

Pharmaceutical Industry Funding of Health Consumer Groups in Australia: A Cross-sectional Analysis.

Relationships between consumer organizations and pharmaceutical manufacturers are the focus of transparency efforts in some jurisdictions, including Australia. This study describes the frequency and nature of industry sponsorship of Australian health consumer organizations and examines the link between sponsorship of the most highly funded organizations and manufacturers' requests for public reimbursement of products for related health conditions. We downloaded 130 transparency reports covering the period January 2013 to December 2016 from the website of Medicines Australia and carried out a descriptive analysis. For the most heavily funded organizations and their sponsors, we examined Public Summary Documents of the Pharmaceutical Benefits Advisory Committee to identify relevant products under consideration for public reimbursement over the study period. Thirty-four pharmaceutical companies provided 1,482 sponsorships to 230 organizations, spending a total of AU$34,507,810. The top clinical areas in terms of amount of funding received were cancer, eye health, and nervous system disorders. The sponsors of the most highly funded groups were companies that in most cases had drugs under review for public reimbursement for conditions covered by these organizations. Interactions between the pharmaceutical industry and consumer organizations are common and require careful management to prevent biases that may favor sponsors' interests above those of patients and the public.