Evaluation of performance-enhancing drugs seized by Israeli enforcement agencies 2012-2017: implications for policy and regulatory change.

BACKGROUND: Illicit performance-enhancing substances are used mostly by athletes to enhance performance in sports, and by bodybuilders to gain muscle and body mass. Among performance-enhancing substances, the most common and known substances are anabolic-androgenic steroids, which are associated with a range of short and long-term adverse medical and psychiatric effects. While the sale and distribution of performance-enhancing substances are considered criminal offenses per the Israeli local pharmacy ordinance, the use and personal possession of these substances are not. Presently, the Division of Enforcement and Inspection of the Israel Ministry of Health cooperates with police and customs agents in performance-enhancing substance-related enforcement activities, which chiefly include seizures carried out at suspicious sites. Moreover, the Division of Enforcement and Inspection provides professional guidance, lab analysis services, and expert opinions on the toxicological and pharmaceutical nature of products seized. This paper presents a contemporary sub-analysis of registered seizures of performance-enhancing substances carried-out by Israel enforcement agencies. The main aim of this analysis is to characterize current patterns of performance-enhancing substances, thus providing the possibility of better assessment of current enforcement and health policy. METHODS: A sub-analysis of 712 seizures of performance-enhancing substances seized by Israeli enforcement authorities during a six-year period ranging from January 2012 to December 2017. RESULTS: This study demonstrates that Israel faces a challenge regarding the importation and distribution of illicit performance-enhancing substances. The most common substances seized were anabolic androgenic steroids (N = 539). Most seizures were carried out in the central mail processing sites, (38.4%), followed by seizures in private premises such as homes and warehouses (29.6%). Significant differences were found between anabolic-androgenic steroids and other substances, relating to place and year of seizure. Among seizures with known sources (N = 355), the most frequent geographic region given as the source of substances was Eastern Europe (47.6%), followed by East Asia (24.8%), West Asia (19.4%), and Western Europe (5.9%). Bulgaria was the country with the highest frequency of seizures (N = 71) followed by Jordan (N = 45), Thailand (N = 37) and Moldova (N = 36). Significant regional differences were found based on the variables of gender, place of seizure, and type of substance. The most frequent month of seizures was August (N = 129), followed by July (N = 119), and June (N = 118). CONCLUSIONS: While data analysis focused on the supply side of the performance-enhancing substances market, the high number of seizures of performance-enhancing substances in Israel represents evidence of the existence of a high demand and a large consumer base for these products. Consequently, there is a need for developing further enforcement, treatment, and prevention policies that do not currently exist in Israel. Policymakers should consider prioritizing law enforcement action and incentivizing intelligence sharing to monitor suspected shipment sources and specific points of entry. Additionally, the results demonstrate that there is a need in reforming the penal law to discourage the use of performance-enhancing substances. Similar measures have already been applied in countries like Spain, Italy, and Belgium. Furthermore, policy-makers should consider enhancing health ministry agencies with a higher enforcement capacity by giving them further investigative and inquiry authority. Due to the troubling magnitude of the phenomenon, policymakers should also prioritize educational and prevention strategies.

Job satisfaction of staff in agencies for disease prevention and control in Hainan Province, China.

This study done in Hainan from March 2017 to June aimed to assess job satisfaction status and influencing factors among the staff of agencies for disease prevention and control in Hainan Province. A questionnaire survey was administered to some staff members at 6 centers for disease control and prevention in Hainan Province, job satisfaction in the questionnaire was rated on a 5-points Likert scale (totally agree, agree, not sure, disagree, totally disagree). The average score of job satisfaction for the six centers was 3.35±0.77, which was relatively low. According to the Wilcoxon rank-sum test, job satisfaction showed significant differences among different job titles (P <0.05). Logistic regression showed that the factors influencing job satisfaction were personal development space, rulesand regulations in CDC, personal safety, public health system, and workload. The factors influencing the staff's satisfaction are personal development space, rules and regulations in CDC, personal safety, public health system and workload.

The Uneven Foci of Work Disability Research Across Cause-based and Comprehensive Social Security Systems.

This scoping review identified what kinds of work disability policy issues are critiqued in articles published in countries with cause-based versus comprehensive welfare systems. Drawing on a review of work disability policy research, we identified 74 English-language, peer-reviewed articles that focused on program adequacy and design. Articles on cause-based systems dwelled on system fairness and policies of proof of entitlement, while those on comprehensive systems focused more on system design complexities relating to worker inclusion and scope of medical certificates. Overall, we observed a clear difference in the nature of problems examined in the different systems. Gaps in work disability policy literature are identified, and challenges for comparative policy research are discussed.

Differences in Self-Reported Health and Unmet Health Needs Between Government Assisted and Privately Sponsored Syrian Refugees: A Cross-Sectional Survey.

Between November 2015 and January 2017, the Government of Canada resettled over 40,000 Syrian refugees through different sponsorship programs (GAR and PSR). Timely access to healthcare is essential for good health and successful integration. However, refugee support differs depending on sponsorship program, which may lead to differences in healthcare service access and needs. A cross-sectional study with a sample of Syrian refugees was conducted to assess healthcare access, and perceived physical and mental health status. Results indicate demographic and healthcare access differences between GARs and PSRs. GARs reported significantly lower perceived physical and mental health, as well as, higher unmet healthcare needs than PSRs. GARs are among the most vulnerable refugees; they report higher needs, more complex medical conditions and tend to have more difficulty re-settling. These factors likely combine to help explain lower self-reported health and higher health needs in our sample compared to PSRs.

Federal Funding for Health Security in FY2019.

This article is the latest in an annual series analyzing federal funding for health security programs. We examine proposed funding in the President's Budget Request for FY2019, provide updated amounts for FY2018, and update actual funding amounts for FY2010 through FY2017. Building health security for the nation is the responsibility of multiple agencies in the US federal government, as well as that of state, tribal, territorial, and local governments and the private sector. This series of articles focuses on the federal government's role in health security by identifying health security-related programs in public health, health care, national security, and defense and reporting funding levels for that ongoing work.

A comparison of new drugs approved by the FDA, the EMA, and Swissmedic: an assessment of the international harmonization of drugs.

INTRODUCTION: This study compared the characteristics of new human drugs approved by the Food and Drug Administration (FDA), the European Medicine Agency (EMA), and Swissmedic (SMC) in the period 2007 to 2016. METHODS: The list of new drugs and therapeutic biologics approved by the FDA, the EMA, and SMC in the period 2007 to 2016 was collected from websites of those agencies. The study included regulatory information, approval date, and indication for each drug. Descriptive statistical t tests and x2-tests were performed for the analysis. RESULTS: From 2007 to 2016, 134 new drugs were approved by all three regulatory agencies. Overall, 66.4% of the drugs were first approved by the FDA, 30.6% by the EMA, and 3.0% by SMC. The difference in approval dates between SMC and the EMA, SMC and the FDA, and the FDA and the EMA were statistically significant. The indications approved by the FDA, the EMA, and SMC for the same drugs were similar in content for 23.1% drugs and different in 76.9% of the drugs. Significant differences in indications existed between the FDA and SMC and the FDA and the EMA, but not between the EMA and SMC. CONCLUSION: There were differences in the characteristics of new drugs approved by the EMA, the FDA, and SMC in the period 2007-2016. Overall, two thirds of the new drugs were first approved by the FDA. Differences in indications were found in three out of four new drugs approved by the three regulatory agencies. Despite international drug regulation harmonization efforts, significant differences in the characteristics of new drugs approved by different agencies persist.

Data Resources for Conducting Health Services and Policy Research.

Rich federal data resources provide essential data inputs for monitoring the health and health care of the US population and are essential for conducting health services policy research. The six household surveys we document in this article cover a broad array of health topics, including health insurance coverage (American Community Survey, Current Population Survey), health conditions and behaviors (National Health Interview Survey, Behavioral Risk Factor Surveillance System), health care utilization and spending (Medical Expenditure Panel Survey), and longitudinal data on public program participation (SIPP). New federal activities are linking federal surveys with administrative data to reduce duplication and response burden. In the private sector, vendors are aggregating data from medical records and claims to enhance our understanding of treatment, quality, and outcomes of medical care. Federal agencies must continue to innovate to meet the continuous challenges of scarce resources, pressures for more granular data, and new multimode data collection methodologies.

Reducing Smoking in the US Federal Workforce: 5-Year Health and Economic Impacts From Improved Cardiovascular Disease Outcomes.

OBJECTIVE: We estimated the reduction in number of hospitalizations for acute myocardial infarction and stroke as well as the associated health care costs resulting from reducing the number of smokers in the US federal workforce during a 5-year period. METHODS: We developed a 5-year spreadsheet-based cohort model with parameter values from past literature and analysis of national survey data. We obtained 2015 data on the federal workforce population from the US Office of Personnel Management and data on smoking prevalence among federal workers from the 2013-2015 National Health Interview Survey. We adjusted medical costs and productivity losses for inflation to 2015 US dollars, and we updated future productivity losses for growth. Because of uncertainty about the achievable reduction in smoking prevalence and input values (eg, relative risk for acute myocardial infarction and stroke, medical costs, and absenteeism), we performed a Monte Carlo simulation and sensitivity analysis. RESULTS: We estimated smoking prevalence in the federal workforce to be 13%. A 5 percentage-point reduction in smoking prevalence could result in 1106 fewer hospitalizations for acute myocardial infarction (range, 925-1293), 799 fewer hospitalizations for stroke (range, 530-1091), and 493 fewer deaths (range, 494-598) during a 5-year period. Similarly, estimated costs averted would be $59 million (range, $49-$63 million) for medical costs, $332 million (range, $173-$490 million) for absenteeism, and $117 million (range, $93-$142 million) for productivity. CONCLUSION: Reductions in the prevalence of smoking in the federal workforce could substantially reduce the number of hospitalizations for acute myocardial infarction and stroke, lower medical costs, and improve productivity.

Predictors and measurement of satisfaction with postpartum care in a government hospital.

In this study, the predictors of satisfaction with postpartum care at a government hospital were evaluated. The descriptive research sample included 300 mothers in their postpartum period. Data were collected using a questionnaire and the Postpartum Nursing Care Evaluation Scale. The regression analysis undertaken showed that mothers who received prenatal care had a significantly higher evaluation score (compared to those who had not received prenatal care), as had mothers who had a caesarean delivery (compared to vaginal birth), as well as those who had received support from friends and relatives during their postpartum period (compared to those who did not receive such support). Our recommendation is that postpartum nursing care be improved for mothers who deliver vaginally, have not received prenatal care, were unintentionally pregnant, and have problems with breastfeeding. The results will help nurses who work with an international population of postpartum women to give professional, systematic, and patient-centered care to postpartum mothers in order to increase patient satisfaction.

Leisure-time physical activity and direct cost of short-term sickness absence among Finnish municipal employees.

We aimed to examine the direct costs of short-term (1-14 days) sickness absence and the effect of employees' physical activity on the costs. The Finnish Helsinki Health Study survey (2007) was used in the analysis (n = 3,935). Physical activity was classified into inactive, moderately active, and vigorously active. Sickness absence (3 years follow-up) and salary data were derived from the employer's registers. On average, an employee was absent 6 days a year due to short-term sickness absence, with a production loss of 2,350 EUR during the 3 years. The vigorously active had less sickness absence than those less active. The direct cost of sickness absence of a vigorously active employee was 404 EUR less than that of an inactive employee. Promoting physical activity among employees may decrease direct cost of short-term sickness absence.

Sharing Overdose Data Across State Agencies to Inform Public Health Strategies: A Case Study.

Data sharing and analysis are important components of coordinated and cost-effective public health strategies. However, legal and policy barriers have made data from different agencies difficult to share and analyze for policy development. To address a rise in overdose deaths, Maryland used an innovative and focused approach to bring together data on overdose decedents across multiple agencies. The effort was focused on developing discrete intervention points based on information yielded on decedents' lives, such as vulnerability upon release from incarceration. Key aspects of this approach included gubernatorial leadership, a unified commitment to data sharing across agencies with memoranda of understanding, and designation of a data management team. Preliminary results have yielded valuable insights and have helped inform policy. This process of navigating legal and privacy concerns in data sharing across multiple agencies may be applied to a variety of public health problems challenging health departments across the country.

Understanding Service Utilization in Cases of Elder Abuse to Inform Best Practices.

Elder abuse (EA) case resolution is contingent upon victims accepting and pursuing protective service interventions. Refusal/underutilization of services is a major problem. This study explored factors associated with extent of EA victim service utilization (SU). Data were collected from a random sample of EA cases (n = 250) at a protective service program in New York City. In cases involving financial abuse, higher SU was associated with females, poor health, perceived danger, previous help-seeking, and self or family referral. In physical abuse cases, higher SU was associated with family referral and previous help-seeking; lower SU was related to Hispanic race/ethnicity, being married, and child/grandchild perpetrator. In emotional abuse cases, higher SU was associated with self or family referral, victim-perpetrator gender differential, perceived danger, and previous help-seeking; lower SU was related to child/grandchild perpetrator. Findings carry implications for best practices to retain and promote service use among elder victims of abuse.

Protecting victims of elder financial exploitation: the role of an Elder Abuse Forensic Center in referring victims for conservatorship.

OBJECTIVES: The aim of this study was to examine the extent to which an Elder Abuse Forensic Center protects financial exploitation (FE) victims through referral to the Office of the Public Guardian (PG) for investigation and possible conservatorship (called 'guardianship' in many states). METHOD: Los Angeles County Elder Abuse Forensic Center cases involving adults aged 65 and older (April 2007-December 2009) were matched using one-to-one propensity-score matching to 33,650 usual care Adult Protective Services (APS) cases. The final analysis sample consisted of 472 FE cases. RESULTS: Compared to usual care, Forensic Center cases were more likely to be referred to the PG for investigation (30.6%, n = 72 vs. 5.9%, n = 14, p < .001). The strongest predictors of PG referral were suspected cognitive impairment, as identified by APS (odds ratio [OR] = 11.69, confidence intervals [CI]: 3.50-39.03), and Forensic Center review (OR = 7.85, CI: 3.86-15.95). Among referred cases, the court approved conservatorship at higher rates - though not statistically significant - for Forensic Center cases than usual care (52.9%, n = 36/68 vs. 41.7%, n = 5/12). CONCLUSION: Conservatorship may be a necessary last resort to improve safety for some FE victims, and the Forensic Center appears to provide a pathway to this service. These findings suggest modification to the Elder Abuse Forensic Center conceptual model and contribute to an emerging body of evidence on the role of the Forensic Center in addressing elder abuse.

[Quality measurement using administrative data in mandatory quality assurance]. / Qualitätsmessung mit Routinedaten in der gesetzlichen Qualitätssicherung am Beispiel Dekubitusprophylaxe.

For several years, the use of administrative data in mandatory quality measurement has been requested by several stakeholders in Germany. Main advantages of using administrative data include the reduction of documentary expenditures and the possibility to perform longitudinal quality analyses across different healthcare units. After a short introduction, a brief overview of the current use of administrative data for mandatory quality assurance as well as current developments is given, which will then be further exemplified by decubital ulcer prophylaxis. By using administrative data coding expenditures in this clinical area could be reduced by nine million data fields. At the same time the population analysed was expanded resulting in a more than tenfold increase in potentially quality-relevant events. Finally, perspectives, further developments, possibilities as well as limits of quality measurement with administrative data are discussed.

Predicting research use in a public health policy environment: results of a logistic regression analysis.

BACKGROUND: Use of research evidence in public health policy decision-making is affected by a range of contextual factors operating at the individual, organisational and external levels. Context-specific research is needed to target and tailor research translation intervention design and implementation to ensure that factors affecting research in a specific context are addressed. Whilst such research is increasing, there remain relatively few studies that have quantitatively assessed the factors that predict research use in specific public health policy environments. METHOD: A quantitative survey was designed and implemented within two public health policy agencies in the Australian state of Victoria. Binary logistic regression analyses were conducted on survey data provided by 372 participants. Univariate logistic regression analyses of 49 factors revealed 26 factors that significantly predicted research use independently. The 26 factors were then tested in a single model and five factors emerged as significant predictors of research over and above all other factors. RESULTS: The five key factors that significantly predicted research use were the following: relevance of research to day-to-day decision-making, skills for research use, internal prompts for use of research, intention to use research within the next 12 months and the agency for which the individual worked. CONCLUSIONS: These findings suggest that individual- and organisational-level factors are the critical factors to target in the design of interventions aiming to increase research use in this context. In particular, relevance of research and skills for research use would be necessary to target. The likelihood for research use increased 11- and 4-fold for those who rated highly on these factors. This study builds on previous research and contributes to the currently limited number of quantitative studies that examine use of research evidence in a large sample of public health policy and program decision-makers within a specific context. The survey used in this study is likely to be relevant for use in other public health policy contexts.

Affordable Care Act standards for race and ethnicity mask disparities in maternal smoking during pregnancy.

OBJECTIVE: This study compared maternal smoking during pregnancy between the new Patient Protection and Affordable Care Act (ACA) data collection standards and Federal Office of Management and Budget (OMB) standards. METHOD: Data were from the Massachusetts Standard Certificate of Live Births on 1,156,472 babies from 1996 to 2010. A parent reported whether the mother smoked during pregnancy (yes/no), her race (5 options) and, separately, her ethnicity (39 categories). Prenatal smoking rates were compared between the ACA and OMB standards. Detailed ethnicity from the birth certificate was then examined within all broad categories of the ACA standards: White, Black/African American, Other Hispanic, Other Asian/Pacific Islander, and Other categories. RESULTS: For Hispanic/Latina and Asian mothers, the ACA standards captured the variability in smoking across and within racial/ethnic groups more than the OMB standards. However, for White and Black/African American mothers, the broad ACA categories masked striking differences in prenatal smoking. While the overall prevalence among Whites was 10.2%, this ranged from 0.8% for Iranians to 21.0% for Cape Verdeans. Among Black/African Americans (7.6%), this ranged from 0.5% for Nigerians to 12.9% for African Americans. The ACA standards also combined ethnic groups with sizeable populations into Other Hispanics and Other Asian/Pacific Islanders. CONCLUSION: When population health surveys and other reporting tools are being revised, state and federal agencies should consider expanding all race/ethnicity categories to capture detailed ethnicity on everyone.

Management of accidental exposure to HIV: the COREVIH 2011 activity report.

BACKGROUND: Post-exposure prophylaxis (PEP) relies on procedures allowing quick access to treatment in case of accidental exposure to viral risk (AEV). Occupational blood exposure (OBE) affects mainly caregivers; these accidents are monitored and assessed by the inter-regional center for nosocomial infections (C-CLIN), occupational physicians, and infection control units. They are classified apart from sexual exposure for which there is currently no monitoring. METHODS: Data was extracted from the COREVIH (steering committee for the prevention of HIV infection) 2011 activity reports (AR), available online. Data collection was performed using a standardized grid. RESULTS: Twenty-four out of 28 AR were available online. Nine thousand nine hundred and twenty AEV were reported, 44% of OBE, and 56% of sexual and other exposures. PEP was prescribed in 8% of OBE and in 77% of sexual exposures. The type of PEP was documented in 52% of the cases. Follow-up was poorly documented. CONCLUSION: AR provide an incomplete and heterogeneous review of exposure management without any standardized data collection. The difficulties encountered in data collection and monitoring are due to differences in care centers (complex patient circuits, multiple actors) and lack of common dedicated software. Sexual exposures account for 50% of AEV and most are treated; but they are incompletely reported and consequently not analyzed at the regional or national level. A typical AR collection grid is being studied in 2 COREVIH, with the objective to improve collection and obtain useful national data.

Economic evaluation of the vaccination program against seasonal and pandemic A/H1N1 influenza among customs officers in Greece.

INTRODUCTION: Health policies from many countries recommend influenza vaccination of "high-priority" professional groups, including customs officers. Our aim was to estimate the economic impact of the vaccination program against influenza among customs officers in Greece during the 2009/2010 period. MATERIALS AND METHODS: We developed a decision analytical computational simulation model including dynamic transmission elements that estimated the economic impact of various scenarios with different attack rates, symptomatic percentages and vaccination participation among customs officers. We also assessed in real-time the economic impact of the national 2009/2010 campaign against seasonal and pandemic A/H1N1 influenza. RESULTS: Implementing a seasonal and pandemic A/H1N1 influenza vaccination program among customs officers in Greece with a participation rate of 30%, influenza vaccination was not cost-saving in any of the studied influenza scenarios. When the participation rate reached 100%, the program was cost-saving, when the influenza attack rate was 30% and the symptomatic rate 65%. The real-time estimated mean net cost-benefit value in 2009/2010 period was -7.3 euros/custom officer. CONCLUSIONS: With different clinical scenarios, providing a vaccination program against seasonal and pandemic A/H1N1 influenza can incur a substantial net benefit for customs offices. However, the size of the benefit strongly depends upon the attack rate of influenza, the symptomatic rate as well as the participation rate of the customs officers in the program.

Hurdles in tissue engineering/regenerative medicine product commercialization: a pilot survey of governmental funding agencies and the financial industry.

The Tissue Engineering and Regenerative Medicine International Society of the Americas (TERMIS-AM) Industry Committee conducted a semiquantitative opinion survey in 2010 to delineate potential hurdles to commercialization perceived by the TERMIS constituency groups that participate in the stream of technology commercialization (academia, start-up companies, development-stage companies, and established companies). A significant hurdle identified consistently by each group was access to capital for advancing potential technologies into development pathways leading to commercialization. A follow-on survey was developed by the TERMIS-AM Industry Committee to evaluate the financial industry's perspectives on investing in regenerative medical technologies. The survey, composed of 15 questions, was developed and provided to 37 investment organizations in one of three sectors (governmental, private, and public investors). The survey was anonymous and confidential with sector designation the only identifying feature of each respondent's organization. Approximately 80% of the survey was composed of respondents from the public (n=14) and private (n=15) sectors. Each respondent represents one investment organization with the potential of multiple participants participating to form the organization's response. The remaining organizations represented governmental agencies (n=8). Results from this survey indicate that a high percentage (<60%) of respondents (governmental, private, and public) were willing to invest >$2MM into regenerative medical companies at the different stages of a company's life cycle. Investors recognized major hurdles to this emerging industry, including regulatory pathway, clinical translation, and reimbursement of these new products. Investments in regenerative technologies have been cyclical over the past 10-15 years, but investors recognized a 1-5-year investment period before the exit via Merger and Acquisition (M&A). Investors considered musculoskeletal products and their top technology choice with companies in the clinical stage of development being the most preferred investment targets. All sectors indicated a limited interest in early-stage start-up companies potentially explaining why start-up companies have struggled to access to capital and investors based their investment on the stage of a company's life cycle, reflecting each sector's risk tolerance, exit strategy, time of holding an investment, and investment strategy priorities. Investors highlighted the limited number of regenerative medical companies that have achieved commercial status as a basis for why public investors have been approached by so few companies. Based on respondents to this survey, regenerative medical sponsors seeking capital from the financial industry must keep the explanation of their technology simple, since all sectors considered regenerative medical technology as difficult to evaluate. This survey's results indicate that under the current financial environment, many regenerative medical companies must consider codevelopment or even M&A as nondilutive means of raising capital. The overall summary for this survey highlights the highly varied goals and motivations for the various sectors of the government and financial industries.

Evolving trends in maternal fetal medicine referrals in a rural state using telemedicine.

OBJECTIVE: To determine maternal fetal medicine (MFM) referral trends in a Medicaid population over time. STUDY DESIGN: Sixteen clinical guidelines and 23 clinical conditions were identified where co-management/consultation with MFM specialist is recommended. Linked Medicaid claims and birth certificate data for 2001-2006 were used to identify pregnancies with these conditions and whether they received co-management/consultation from a MFM specialist. RESULTS: Between 2001 and 2006, there were 108,703 pregnancies with delivery of 110,890 neonates. Forty-five percent had one or more of the conditions identified for co-management/consultation. Overall pregnancies receiving MFM contact remained unchanged at 22.2% in 2001 and 22.1% in 2006. However, face to face contacts decreased from 14.6% (2001) to 8.7% (2006) while telemedicine consults increased from 7.6% (2001) to 13.3% (2006). Health departments were most likely and family practitioners least likely to refer to MFM (p<0.001). Pregnancy complications leading to MFM referrals include cardiac complications, renal disease, systemic disorders, PPROM, suspected fetal abnormalities, and cervical insufficiency. CONCLUSION: Referral of high-risk pregnancies to MFMs varies with the level of expertise at the primary prenatal site. Increased contact between MFMs and local providers increased MFM referrals.